Are there really Stages of Change in Physical Activity? Findings from a Study with a Sample of University Students that Combines the Health Action Process Model with the Transtheoretical Model

Authors

DOI:

https://doi.org/10.22544/rcps.v42i02.07

Keywords:

Stages of Change,, Transtheoretical Model, Physical Activity, Health Behaviors, university students

Abstract

The process of change towards the practice of physical activity has not yet been adequately characterized. One issue under discussion is whether this process can be described in terms of stages. A study was carried out in order to examine patterns of continuity or discontinuity in variables of the Health Action Process Model within the stages proposed by the Transtheoretical Model, and thus assess to what extent the evidence supports the existence of stages. For this, cross-sectional data of university students (N = 490, mean age 22.5 years (SD = 6.57) were collected, and ANOVAs, planned contrasts, and polynomial trend analyses were performed, as recommended by Sutton (2000). The results for several variables were compatible with assumptions about the existence of stages. However, for other variables results did not support the existence of stages. These findings provide usefulinformation for efforts to integrate different models. The theoretical and practical implications are discussed.

Author Biographies

Benjamín Reyes-Fernández, Instituto de Investigaciones Psicológicas, Universidad de Costa Rica, San José, Costa Rica

Bachelor and graduate in Psychology  from Universidad de Costa Rica, San José, Costa Rica. In addition, he has a Master´'s degree in Clinical and Health Psychology from Universidad de Costa Rica and a doctorate in Health Psychology from Universidad Libre de Berlín, Alemania. He is currently a professor at school of Psychology and is a researcher at the Psychological Research Institute of Universidad de Costa Rica, where is part of the Health and Wellbeing group. 

Derby Muñoz Rojas, Centro de Investigación en Cuidado de Enfermería y Salud, Escuela de Enfermería, Universidad de Costa Rica, San José, Costa Rica

Graduate in Nursing from Universidad de Costa Rica, San José, Costa Rica. In addition, he is  Magister Scientiae in Human Movement from Universidad Nacional, Heredia, Heredia, Costa Rica, and has a Doctorate in Nursing from the University of Miami, United States of America.

References

Ajzen, I. (1985). From Intentions to Actions: A Theory of Planned Behavior. En J. Kuhl & J. Beckman (Eds.), Action Control: From cognition to behavior (pp. 11-39). Springer. https://doi.org/10.1007/978-3-642-69746-3_2

Ajzen, I. (1991). The theory of planned behavior. Organizational Behavior and Human Decision Processes, 50(2), 179-211. https://doi.org/10.1016/0749-5978(91)90020-T

Armitage, C. J., & Arden, M. A. (2002). Exploring discontinuity patterns in the transtheoretical model: An application of the theory of planned behaviour. British Journal of Health Psychology, 7(1), 89-103. https://doi.org/10.1348/135910702169385

Armitage, C. J., & Arden, M. A. (2007). Felt and potential ambivalence across the stages of change. Journal of Health Psychology, 12(1), 149-158. https://doi.org/10.1177/1359105307071749

Bautista, R. (2008). Trend analysis. En P. J. Lavrakas (Ed.), Encyclopedia of survey research methods (pp. 907-908). Sage publications. https://dx.doi.org/10.4135/9781412963947

Cohen, J. (1988). Statistical power analysis for the behavioral sciences. En Statistical Power Analysis for the Behavioral Sciences (Vol. 2). Erlbaum.

Craig, C. L., Marshall, A. L., Sjöström, M., Bauman, A. E., Booth, M. L., Ainsworth, B. E., & Oja, P. (2003). International Physical Activity Questionnaire (IPAQ): 12-country reliability and validity. Medicine & Science in Sports & Exercise, 35(8), 1381-1395.

Davis, R., Campbell, R., Hildon, Z., Hobbs, L., & Michie, S. (2015). Theories of behaviour and behaviour change across the social and behavioural sciences: a scoping review. Health Psychology Review, 9(3), 323-344. https://doi.org/10.1080/17437199.2014.941722

De Vries, H. (2017). An integrated approach for understanding health behavior; the I-change model as an example. Psychol Behav Sci Int J, 2(2), 555-585. https://doi.org/:10.19080/PBSIJ.2017.02.555585

Duan, Y., Lippke, S., Zhang, R., Brehm, W., & Chung, P. K. (2016). Testing the validity of a stage assessment on health enhancing physical activity in a Chinese university student sample. BMC Public Health. https://doi.org/10.1186/s12889-016-2931-2

Durmaz, A., Dursun, İ., & Kabadayi, E. T. (2020). Mitigating the effects of social desirability bias in self-report surveys: Classical and new techniques. En Applied Social Science Approaches to Mixed Methods Research (pp. 146-185). IGI Global.

Enders, C. K. (2003). Using the Expectation Maximization Algorithm to estimate Coefficient Alpha for scales with item-level missing data. Psychological Methods, 8(3), 322-337. https://doi.org/10.1037/1082-989X.8.3.322

Field, A. (2009). Andy field. En Discovering Statistics using IBM SPSS statistics. https://doi.org/10.1234/12345678

Graham, J. W. (2009). Missing Data Analysis: Making It Work in the Real World. Annual Review of Psychology, 60, 549-576. https://doi.org/10.1146/annurev.psych.58.110405.085530

Hartman, S. J., Dunsiger, S. I., Bock, B. C., Larsen, B. A., Linke, S., Pekmezi, D., Marquez, B., Gans, K. M., Mendoza-Vasconez, A. S., & Marcus, B. H. (2017). Physical activity maintenance among Spanish-speaking Latinas in a randomized controlled trial of an Internet-based intervention. Journal of Behavioral Medicine, 40(3), 392-402. https://doi.org/10.1007/s10865-016-9800-4

Hoyos, I., Irazusta, A., Gravina, L., Gil, S. M., Gil, J., & Irazusta, J. (2011). Reduced cardiovascular risk is associated with aerobic fitness in university students. European Journal of Sport Science, 11(2), 87-94.

Krebs, P., Norcross, J. C., Nicholson, J. M., & Prochaska, J. O. (2018). Stages of change and psychotherapy outcomes: A review and meta-analysis. Journal of Clinical Psychology, 74(11), 1-16. https://doi.org/10.1002/jclp.22683

Kwasnicka, D., Dombrowski, S. U., White, M., & Sniehotta, F. (2016). Theoretical explanations for maintenance of behaviour change: a systematic review of behaviour theories. Health Psychology Review, 10(3), 277-296. https://doi.org/10.1080/17437199.2016.1151372

Lippke, S., Nigg, C. R., & Maddock, J. E. (2007). The theory of planned behavior within the stages of the transtheoretical model: Latent structural modeling of stage-specific prediction patterns in physical activity. Structural Equation Modeling, 14(4), 649-670. https://doi.org/10.1080/10705510701575586

Lippke, S., & Plotnikoff, R. C. (2006). Stages of change in physical exercise: A test of stage discrimination and nonlinearity. American Journal of Health Behavior, 30(3), 290-301. https://doi.org/10.5993/AJHB.30.3.7

Lippke, S., & Plotnikoff, R. C. (2009). The protection motivation theory within the stages of the transtheoretical model - Stage specific interplay of variables and prediction of exercise stage transitions. British Journal of Health Psychology, 14(2), 211-229. https://doi.org/10.1348/135910708X399906

Lippke, S., Ziegelmann, J. P., Schwarzer, R., & Velicer, W. F. (2009). Validity of stage assessment in the adoption and maintenance of physical activity and fruit and vegetable consumption. Health Psychology, 28(2), 183-193. https://doi.org/10.1037/a0012983

Marcus, B. H., Dunsiger, S. I., Pekmezi, D. W., Larsen, B. A., Bock, B. C., Gans, K. M., Marquez, B., Morrow, K. M., & Tilkemeier, P. (2013). The Seamos Saludables study: A randomized controlled physical activity trial of Latinas. American Journal of Preventive Medicine, 45(5), 598-605. https://doi.org/https://doi.org/10.1016/j.amepre.2013.07.006

Marcus, B. H., Selby, V. C., Nlaura, R. S., & Rossi, J. S. (1992). Self-efficacy and the stages of exercise behavior change. Research Quarterly for Exercise and Sport, 63(1), 60-66. https://doi.org/10.1080/02701367.1992.10607557

Marshall, S. J., & Biddle, S. J. (2001). The transtheoretical model of behavior change: A meta-analysis of applications to physical activity and exercise. Annals of Behavioral Medicine, 23(4), 229-246. https://doi.org/10.1207/S15324796ABM2304_2

Michie, S. F., West, R., Campbell, R., Brown, J., & Gainforth, H. (2014). ABC of behaviour change theories. Silverback publishing.

Monge-Rojas, R., Godinho, C. A., & Reyes Fernández, B. (2020). Modelling longitudinal directional associations between self-regulation, physical activity, and habit: results from a cross-lagged panel model. International Journal of Behavioral Medicine, 28, 466-478. https://doi.org/10.1007/s12529-020-09936-y

Morgan, S. J., & Elizondo, J. H. (2016). Actividad física y otros hábitos de vida saludables de estudiantes de medicina de la Universidad de Costa Rica. PENSAR EN MOVIMIENTO: Revista de Ciencias Del Ejercicio y La Salud, 14(1), 2.

Norman, G. J., Benisovich, S. V, Nigg, C. R., & Rossi, J. S. (1998). Examining three exercise staging algorithms in two samples. 19th Annual Meeting of the Society of Behavioral Medicine.

Organización Mundial de la Salud. (2010). Recomendaciones mundiales sobre actividad física para la salud. https://apps.who.int/iris/bitstream/handle/10665/44441/9789243599977_spa.pdf?sequence=1

Prochaska, J. O., & DiClemente, C. (1982). Transtheoretical therapy: Toward a more integrative model of change. Psychotherapy: Theory Research and Practice, 19(3), 276-288. https://doi.org/10.1037/h0088437

Prochaska, J. O., & DiClemente, C. C. (1983). Stages and processes of self-change of smoking: Toward an integrative model of change. Journal of Consulting and Clinical Psychology, 51(3), 390-395. https://doi.org/10.1037/0022-006X.51.3.390

Prochaska, J. O., & DiClemente, C. (2005). The transtheoretical approach. En J. C. Norcross & M. R. Goldfried (Eds.), Handbook of Psychotherapy Integration (2nd ed., pp. 147-171). Oxford University Press.

Renner, B., Klusmann, V., & Sproesser, G. (2015). Assessment of health behaviors. En J. Wright (Ed.), The International Encyclopedia of the Social and Behavioral Sciences (2nd ed., pp. 588-593). Elsevier. https://doi.org/https://doi.org/10.1016/B978‐0‐08‐097086‐8.14155‐8

Reyes Fernández, B., Fleig, L., Godinho, C. A., Montenegro Montenegro, E., Knoll, N., & Schwarzer, R. (2015). Action control bridges the planning-behaviour gap: a longitudinal study on physical exercise in young adults. Psychology & Health, 30(8), 911-923. https://doi.org/10.1080/08870446.2015.1006222

Reyes Fernández, B., Knoll, N., Hamilton, K., & Schwarzer, R. (2016). Social-cognitive antecedents of hand washing: Action control bridges the planning–behaviour gap. Psychology and Health, 31(8), 993-1004. https://doi.org/10.1080/08870446.2016.1174236

Romain, A. J., Bortolon, C., Gourlan, M., Carayol, M., Decker, E., Lareyre, O., Ninot, G., Boiche, J., & Bernard, P. (2018). Matched or nonmatched interventions based on the transtheoretical model to promote physical activity. A meta-analysis of randomized controlled trials. Journal of Sport and Health Science, 7(1), 50-57.

Romain, A. J., Caudroit, J., Hokayem, M., & Bernard, P. (2018). Is there something beyond stages of change in the transtheoretical model? The state of art for physical activity. Canadian Journal of Behavioural Science, 50(1), 42–53. https://doi.org/10.1037/cbs0000093

Sarkin, J. A., Johnson, S. S., Prochaska, J. O., & Prochaska, J. M. (2001). Applying the transtheoretical model to regular moderate exercise in an overweight population: Validation of a stages of change measure. Preventive Medicine, 33, 462-469. https://doi.org/10.1006/pmed.2001.0916

Schumann, A., Nigg, C. R., Rossi, J. S., Jordan, P. J., Norman, G. J., Garber, C. E., Riebe, D., & Benisovich, S. V. (2002). Construct validity of the stages of change of exercise adoption for different intensities of physical activity in four samples of differing age groups. American Journal of Health Promotion, 16(5), 280-287. https://doi.org/10.4278/0890-1171-16.5.280

Schwarzer, R. (2008). Modeling health behavior change: How to predict and modify the adoption and maintenance of health behaviors. Applied Psychology, 57(1), 1-29. https://doi.org/10.1111/j.1464-0597.2007.00325.x

Sheeran, P., & Webb, T. L. (2016). The intention–behavior gap. Social and Personality Psychology Compass, 10(9), 503-518. https://doi.org/10.1111/spc3.12265

Sinclair, K. M., Hamlin, M. J., & Steel, Gd. (2005). Physical activity levels of first-year New Zealand university students: a pilot study. Youth Studies Australia, 24(1), 38-42.

Sniehotta, F. F., Luszczynska, A., Scholz, U., & Lippke, S. (2005). Discontinuity patterns in stages of the precaution adoption process model: Meat consumption during a livestock epidemic. British Journal of Health Psychology, 10(2), 221-235. https://doi.org/10.1348/135910705X26137

Sniehotta, F. F., Presseau, J., & Araújo-Soares, V. (2014). Time to retire the theory of planned behaviour. Health Psychology Review, 8(1), 1-7. https://doi.org/10.1080/17437199.2013.869710

Sutton, S. (2000). Interpreting cross-sectional data on stages of change. Psychology and Health, 15(2), 163-171. https://doi.org/10.1080/08870440008400298

Tabachnick, B. G., & Fidell, L. S. (2014). Using multivariate statistics (6th ed.). Pearson.

Teixeira, P. J. (2016). Health behavior change: a field just picking up speed. A comment on Ogden (2016). Health Psychology Revieweview, 10(3), 269-273. http://dx.doi.org/10.1080/17437199.2016.1183507

Velicer, W. F., & Prochaska, J. O. (2008). Stage and non-stage theories of behavior and behavior change: A comment on Schwarzer. Applied Psychology, 57(1), 75-83. https://doi.org/10.1111/j.1464-0597.2007.00327.x

Warburton, D. E. R., & Bredin, S. S. D. (2017). Health benefits of physical activity: A systematic review of current systematic reviews. Current Opinion in Cardiology, 32(5), 541-556. https://doi.org/10.1097/HCO.0000000000000437

West, R. (2005). Time for a change: Putting the Transtheoretical (Stages of Change) Model to rest. Addiction, 100(8), 1036–1039. https://doi.org/10.1111/j.1360-0443.2005.01139.x

Published

2023-12-29

How to Cite

Reyes-Fernández, B. ., & Muñoz Rojas, D. (2023). Are there really Stages of Change in Physical Activity? Findings from a Study with a Sample of University Students that Combines the Health Action Process Model with the Transtheoretical Model. Costa Rican Journal of Psychology, 42(2), 277–299. https://doi.org/10.22544/rcps.v42i02.07