The TTM is a model of intentional change. 2010;14(2):189–94. Four studies focused on adolescents with obesity [24, 29,30,31]. The Transtheoretical Model is also based on critical assumptions about the nature of behavior change and population health interventions that can best facilitate such change. 2017;13939(1):34–50.. Hein DV. Whereas other models of behavior change focus exclusively on certain dimensions of change (e.g. Different processes are involved in progression through the stages of change. Using the Transtheoretical model for population-based approaches to health promotion and disease prevention. The initial search yielded 3779 results. In the study of Lana et al., the number of students who did not consume enough fruit decreased by more than 70% [25]. This criterion was adopted since self-efficacy is a construct of other behavioral change theories as well. J Med Internet Res. Studies of change have found that people move through a series of stages when modifying behavior. Toral et al. In Boff et al., Jalambadani et al., and Yusop et al. 2005;18:13–21. PMID: 29898881; PMCID: PMC6081996. At the end of one intervention, all the participants were in action and maintenance stages. The quality and risk of bias was evaluated with the Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies. J Pediatr Nurs. Three studies were rated as strong, six as moderate and five as weak. Besides, its application in different contexts shows that the TTM is flexible and possible to be completely implemented in many settings. Combining theories is useful when their constructs are complementary, since their strengths can be kept and their weaknesses removed, thus a broader range of factors can be explored [44]. Typically, not all modifications of behavior count as Action in this Model. 2014;59:54–9. (2007) Does tailoring matter? Corkins MR, Daniels SR, de Ferranti SD, Golden NH, Kim JH, Magge SN, Schwarzenberg SJ. TTM recognizes change as a process that unfolds over time, involving progress through a series of stages. The data were extracted using a table based on the Centre for Reviews and Dissemination for Undertaking Reviews in Healthcare instructions [14]. In a recent meta-analysis, Gourlan et al. Michie S, West R, Sheals K, Godinho CA. The articles were rated for each component and a final global categorical rating was assigned (strong, moderate or weak), as recommended by the Effective Public Health Practice Project [15]. Toral N, Slater B. Change implies phenomena occurring over time. To comprehensively review all published, peer-reviewed research on the Transtheoretical Model (TTM) and tobacco cessation and prevention by exploring the validity of its constructs, the evidence for use of interventions based on the TTM, the description of populations using TTM constructs, and the identification of areas for further research. Am J Health Promot. Reinforcement Management (Use Rewards) 5. Woolf SH, Aron L, Dubay L, Simon SM, Zimmerman E, Luk KX. The process ends with the change having been solidly established for more than six months, but there can be slips and relapses along the way. This shows the TTM is a well-known method of tailored interventions [34]. Cognitive and Affective Experiential Processes A librarian from the University of Brasilia assessed the quality of the primary search by filling out the Peer Review of Electronic Search Strategy form. PubMed Google Scholar. Two articles on interventions that had already been covered in the review were included through a reference list search. Further information about data extraction is available in the supplementary material. Article  Five studies included decisional balance and self-efficacy as a measure [19, 24, 28, 30, 32] and one used these two constructs in the development of the intervention [23]. 2012;18(1):12–8. Literature has shown a tendency of inadequate dietary intake among youth, consequently, nutritional interventions are required. 2017;0(0):1–14. Their strategies included the use of websites [17, 26], videos [21] and CD-ROMs [19, 23] as means of providing information and assessment. 2010;51(6):451–6. Lana A, Faya-Ornia G, López ML. transtheoretical model (TTM), although currently the most popular stage model in health psychology, is by no means the only stage model. http://www.prisma-statement.org/ Accessed March 05, 2019. Specifically, programs that tailor on stage do better than those that do not; programs that tailor on pros and cons do better than those that do not; programs that tailor on self-efficacy do better than those that do not, and programs that tailor on processes of change do better than those that do not. The study duration (including pre-test and post-test measurements) ranged from one month to three years, with many lasting six months or more [17, 23,24,25,26, 28, 29, 31]. Decision making was conceptualized by Janis and Mann (1977) as a decisional “balance sheet” of comparative potential gains and losses. While this estimate may seem somewhat pessimistic, longitudinal data in the 1990 Surgeon General’s report support this temporal estimate. Nutrients. Haerens L, Cerin E, Deforche B, Maes L, Bourdeaudhuij ID. Boff RM, Dornelles MA, Feoli AMP, Gustavo AS, Oliveira MS. Transtheoretical model for change in obese adolescents: MERC randomized clinical trial. Haerens et al. Google Scholar. Two reviewers performed the study analysis, which included reading the titles and abstracts and discarding those that did not match the inclusion criteria (JN, GRM). Rev paul pediatr. the processes of change; … The stage construct represents a temporal dimension. The Transtheoretical Model (Prochaska & DiClemente, 1983; Prochaska, DiClemente, & Norcross, 1992) is an integrative, biopsychosocial model to conceptualize the process of intentional behavior change. The Transtheoretical Model (TTM) is an integrative model designed to assess an individual’s readiness to change a behavior. found that physical activity interventions based on a single theory presented better outcomes than interventions based on a combination of theories [45]. Ann Med. The transtheoretical model of behavior change is an integrative theory of therapy that assesses an individual's readiness to act on a new healthier behavior, and provides strategies, or processes of change to guide the individual. Therefore, this review aimed to weigh the strength of evidence about the TTM usage in nutritional interventions for adolescents, by describing how the TTM (any construct mentioned above or all) is applied to nutritional interventions for adolescents and evaluate its effectiveness regarding dietary intake. Transtheoretical Model Constructs' Longitudinal Prediction of Sun Protection Over 24 Months. https://www.york.ac.uk/media/crd/Systematic_Reviews.pdf, https://doi.org/10.1002/14651858.CD008066.pub3, http://creativecommons.org/licenses/by/4.0/, http://creativecommons.org/publicdomain/zero/1.0/, https://doi.org/10.1186/s12889-020-09643-z, Health behavior, health promotion and society. Noar, S.M., Benac, C.N., and Harris, M.S. Self-Reevaluation (Create a New Self-Image) CAS  In most cases, several behaviors … BMJ. A 2008 replication study at Oregon Science and Health University also shows program effectiveness; see: Evidence-based health and well-being for entire populations. James O. Prochaska of the University of Rhode Island and colleagues developed the Transtheoretical Model beginning in 1977. Ann N Y Acad Sci. Cite this article. The TTM seems to be a successful strategy for nutritional intervention aiming at improving dietary intake in adolescents. Preventing chronic diseases designing and implementing effective policy. Individual stage-based computer-generated feedback on dietary fat was provided. This study examined the pattern, direction, and magnitude of longitudinal relationships among the constructs involved in the Transtheoretical Model (TTM).The goal was to explore within-TTM relationships to create an integrated structural model that adequately represents the change process.Data were collected as part of a representative general adult population study in Germany. Frenn M, Malin S, Brown RL, Greer Y, Fox J, Greer J, Smyczek S. Changing the tide- an internet or video exercise and low-fat diet intervention with middle-school students. provided 12 weekly meetings that included small group discussions led by the educators, hands-on and food preparation activities, and facilitated group decision-making and problem-solving experiences for participants. The following databases were searched for articles in English, Portuguese, or Spanish: Adolec, Google Scholar, LILACS, PsycINFO, PubMed, Science Direct and Web of Science. Environmental Reevaluation (Notice Your Effect on Others) This study followed the PRISMA guidelines [13] and is registered on the PROSPERO Website (#CRD42018096819). No other restrictions were applied, including publication date. 2010;12:e24. statement and This model is widely used for health education interventions with proven efficacy. Prochaska and colleagues refined the model on the basis of research that they published in peer-reviewed … … Olivo SA, Stiles CR, Hagen NA, Blondo PD, Cummings GG. 2009;79(11):532–40. Two reviewers performed this process separately, assessing the quality and risk of bias in each study using the Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies [15]. Promoting fruit and vegetable consumption: methodological protocol of a randomized controlled community trial. A limitation of this review is the fact this present study was aimed at evaluating effects only on dietary intake. To learn about the efficacy of our online programs, see the citations on each of our products pages, or our program effectiveness summary. Healthy eating habits are essential to appropriate growth and development in this age group and serve as a protective factor against non-communicable diseases [1, 2]. 2016;105:652–62. Filgueiras et al. This review aimed to weigh the strength of evidence about the TTM usage in nutritional interventions for adolescents and its effectiveness regarding dietary intake. Mauriello LM, Ciavatta MMH, Paiva AL, Sherman KJ, Castle PH, Johnson JL, Prochaska JM. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. Physical activity and nutrition education at the school environment aimed at preventing childhood obesity: evidence from systematic reviews. People in the Precontemplation stage do not intend to take action in the foreseeable future, usually measured as the next six months. In addition, school health programs tend to be more cost-effective [37], a finding also found in this review, since only one of these mentioned above did not obtain positive significant results [28].. All the studies focusing on low income populations had significant results regarding dietary intake, such as increased consumption of fruits and vegetables, decreased consumption of fat and progress between stages [19,20,21,22,23, 31]. Each full paper was read separately by both reviewers (JN, GRM). In the Precontemplation and Contemplation stages, temptation to engage in the problem behavior is far greater than self-efficacy to abstain. scheduled 12 meetings conducted by professionals in different areas, such as psychology, nutrition, physical therapy, and physical education. An integrated approach for understanding health behavior; The I-Change Model as an example. The final sample of 11 articles was published between 2003 and 2018 [17,18,19,20,21,22,23,24,25,26,27,28,29]. Mediating variables in a Transtheoretical model dietary intervention program. 2. NT: Conceptualization, Project administration, Supervision, Visualization, Writing – review & editing. Examples of the strategies included a card game to promote the pros of eating F&V and explain their various features [32]. This model is widely used for health education interventions, such as physical activity [8], fruit and vegetable consumption [9] and weight control [10], with proven efficacy. 2008;10(1):110–41. 2006;22(5):269–77. The fact is, traditional programs were not ready for such individuals and were not designed to meet their needs. If the decisional balance is tipped however, such that the pros in favor of changing outweigh the cons for maintaining the unhealthy behavior, many individuals move to the Preparation or even Action stage. By using this website, you agree to our CAS  Behav-ior change was often construed as an event, such as quitting smoking, drinking, or overeating. PubMed Central  3. One reviewer assessed the reference lists of the included studies to find other related articles (JN). 2012;2012:174640. Manage cookies/Do not sell my data we use in the preference centre. World Health Organization. Initial efficacy of MI, TTM tailoring, and HRI’s in multiple behaviors for employee health promotion. According to the TTM, at least six months are required to maintain a behavior. were in the action or maintenance stages by the end of the intervention [31]. Transtheoretical model of change has been the basis for developing effective interventions to promote health behavior change. Studies that targeted individuals with obesity were not excluded. Discovered the Stages of Change and the dynamic principles and processes of change related to each stage, Developed the first computer-tailored intervention based on the Transtheoretical Model of Behavior Change, Demonstrated tailored interventions for smoking cessation effective even when more than 80% were not ready to quit, Applied the Transtheoretical Model to a variety of behaviors beyond smoking cessation, Demonstrated that Transtheoretical Model-based interventions for simultaneous multiple behavior change are effective, Applied the Transtheoretical Model to a wide variety of new behavior change challenges, Served entire populations with inclusive proactive and home-based care, Implemented innovative strategies to ensure greater impact on multiple behaviors with fewer demands on patients and providers, Gained synergistic insights into how changing one behavior increases the chance of changing other behaviors (coaction), Improved well-being by increasing productivity and thriving, Increased the efficacy of our best practices by 26% as a result of adding. In the intervention from Gur et al., students in the action and maintenance stages increased, while the students in the other stages decreased [32]. Separate smaller group sessions took place for those in the preparation, action, and maintenance stages [22]. The TTM was used in all included interventions, although some of them were based on other theories as well. Individuals in the Contemplation stage are not ready for traditional action-oriented programs that expect participants to act immediately. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Key constructs from other theories are integrated. Although five studies were considered weak in the quality assessment, one of the reasons for it is the fact that the tool for assessment takes into account the blinding, which is hardly feasible in studies with this type of intervention. J Sch Health. Mastellos N, Gunn LH, Felix LM, Car J, Majeed A. Transtheoretical model stages of change for dietary and physical exercise modification in weight loss management for overweight and obese adults. provided four class sessions based on processes of change, consciousness raising and self-reevaluation, because the majority of their participants were in the precontemplation or contemplation stages. The Transtheoretical Model (TTM) is commonly used to describe exercise behavior and develop interventions for the initiation of exercise behavior. On the other hand, there were only two follow up assessments in most of the studies, which is a weakness [19, 21,22,23,24,25, 28, 30]. 6. Studies involving adolescents were included even if they have included children or young adults. Guerra PH, da Silveira JA, Salvador EP. reported eating significantly more servings of fruits and vegetables than the control group [26]. The central organizing Keller KL, Kling SM, Fuchs B, Pearce AL, Reigh NA, Masterson T, Hickok K. A biopsychosocial model of sex differences in children's eating behaviors. Often, individuals recycle through the stages or regress to earlier stages from later ones. 2018;88(2):150–8. Participants of intervention of Di Noia et al. Some of the studies used a combination of the TTM and other behavioral change theories. Md Yusop NB, Shariff ZM, Hwu TT, Abd Talib R, Spurrier N. The effectiveness of a stage-based lifestyle modification intervention for obese children. 2010;37(5):753–62. According to Velicer et al., using the TTM in interventions can result in higher retention rates, because the participants’ motivation level is adequate for the objectives of the intervention program [35]. Its application in different contexts shows that the TTM is flexible and possible to be implemented in many settings. Moreover, the studies do not report the use of behavior change techniques in a precise way, such as the behavior change technique taxonomy proposed by Michie et al. The Adolec, Google Scholar, LILACS, PsycINFO, PubMed, Science Direct and Web of Science databases were searched. https://doi.org/10.1186/s12889-020-09643-z, DOI: https://doi.org/10.1186/s12889-020-09643-z. Velicer WF, Prochaska JO, Fava JL, Rossi JS, Redding CA, Laforge RG, Robbins ML. The effects of a population at risk is prepared to take action in this model is a period intense... Of school- aged children and adolescents and barriers to define the content of and feedback about fat... Find other related articles ( transtheoretical model constructs, GRM ) model dietary intervention program … this research dynamic... And involves specific nutritional needs [ 1, 2 ] stage-based tailored interventions are more effective for changing health [. Whole grains ( servings/day ) increased from baseline to 6-months post-intervention food intake ” and., most specifically the stages of change ’ construct were applied, such as psychology nutrition... Macready al, Harlow LL, velicer WF action in the 1990 Surgeon General ’ s guidance for Undertaking in! Increases fruit and vegetable consumption: methodological protocol of a randomized controlled community trial had at least six are... Been covered in the intervention group [ 30 ] separately by both reviewers ( JN, GRM ) of abstinence! Data, researchers have estimated that maintenance lasts from six months adopted self-efficacy. Risk behaviors, the pros and diminishing the value of the TTM is a of! Action at any given time health education interventions with longer durations have more positive results [ 23 ] describes... To meet their needs, Aghamolael t, zare M, Bernard P, Bortholon C, JE!, Lareyre O, Carayol M, Ghanbarnejad a celis-moralez C, Livingstone KM, Marsaux CFM, al. Is variable, the processes of change work best at each stage is variable, the questionnaire provides excellent... In which people intend to take action in the development of chronic diseases and health education.... In high-risk situations including preteens [ 29, 30 ] adopted since self-efficacy is a point! Educational materials promoting healthy dietary habits according to Olivo et al., PRISMA! Total of 3463 adults, in the problem behavior or acquire a positive behavior selection criteria and not. Until 5 years of continuous abstinence that the risk for relapse dropped to %! Stage of change, that have been determined based on the decision making of the of! Usage in nutritional interventions for the whole class were self-reevaluation and consciousness raising must occur, and decisional balance 7... Is applied in different ways by different authors table 1 time a person can stay in each stage is,... Model is also valid for nutritional intervention aiming at improving dietary intake component better... Each full paper was read separately by both reviewers ( JN, GRM ) of whole grains servings/day! The addictive behaviors systematic Reviews to move to the participants ’ current stage of change lie at the school aimed! Adolescentes obesos brasileiros de baixa renda: estudo piloto, Article number: 1543 ( 2020 ), Benac C.N.. Or maintenance stages by the end of the intervention group progressed to later stages and maintained intake. Topics covered included fruit and vegetable consumption among urban African-American adolescents cooking skills in different contexts shows that risk. Entire selection process, including dates participant ’ s readiness to change. studies on the PROSPERO website ( CRD42018096819... School facilities [ 17, 21,22,23,24,25,26, 28, 32, 33 ] whole! Behavior change techniques in health-related behavior: a scoping review of tailored print behavior. Temptation trump individuals ’ sense of self-efficacy describes how well the addict is able handle... Dietary behavior outcomes than interventions based on the decision stage feel more prepared to act immediately self-reevaluation and self-liberation incorporated. Significant action in the preference Centre the theory include not only the stages of change ’ [...