• Nutrition Research and Practice
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• v.11 no.3
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• pp.247-256
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• 2017

BACKGROUND/OBJECTIVES: Easy access to intervention and support for certain behaviors is important for obesity prevention and management. The available technology such as smartphone applications can be used for intervention regarding healthy food choices for obesity prevention and management in elementary-school students. The transtheoretical model (TTM) is comprised of stages and processes of change and can be adopted to tailored education for behavioral change. This study aims to develop TTM-based nutrition contents for mobile applications intended to change eating behaviors related to weight gain in young children. SUBJECTS/METHODS: A synthesized algorithm for tailored nutrition messages was developed according to the intake status of six food groups (vegetables, fruits, sugar-sweetened beverages, fast food and instant food, snacks, and late-night snacks), decision to make dietary behavioral changes, and self-confidence in dietary behavioral changes. The messages in this study were developed from December 2014 to April 2015. After the validity evaluation of the contents through expert consultation, tailored nutrition information messages and educational contents were developed based on the TTM. RESULTS: Based on the TTM, stages of subjects are determined by their current intake status, decision to make dietary behavioral changes, and self-confidence in dietary behavioral changes. Three versions of tailored nutrition messages at each TTM stage were developed so as to not send the same messages for three weeks at most, and visual materials such as figures and tables were developed to provide additional nutritional information. Finally, 3,276 tailored nutrition messages and 60 nutrition contents for applications were developed. CONCLUSIONS: Smartphone applications may be an innovative medium to deliver interventions for eating behavior changes directly to individuals with favorable cost-effectiveness. In addition, using the TTM for tailored nutrition education for healthy eating is an effective approach.

• Korean Journal of Health Education and Promotion
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• v.22 no.2
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• pp.97-110
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• 2005

Objectives: Recent studies have shown that tailored messages for cancer screening to the beliefs and stage of cancer screening behavior of individual women increases the take-up probability. Many studies on cancer screening have used the Transtheoretical Model (TTM) to identify variables associated with cancer screening behavior. This study was carried out to identify the cognitive-behavioral factors associated with stomach cancer screening among women aged 40 years and over, and to develop and evaluate a tailored educational program for stomach cancer screening by stages of change. Methods: Building on the TTM constructs, we conducted a quasi-experimental study(N=283) to test the effectiveness of a tailored educational program for endoscopic stomach cancer screening. We carried out pre and post tests in the experimental group(N=162) and the control group(N=121), and the experimental group was subdivided into an on-line group(N=81) and an off-line group(N=81) by educational methodology using e-mail and the postal service. We used the chi-square test, trend test, and paired t-test to test the effectiveness of the program for stomach cancer using a tailored stage-matched messages. Results: To examine the effectiveness of the program for stomach cancer screening by the tailored stage-matched messages, the stage-matched materials were offered to the experimental group(N=162) four times for 4 weeks. The stage-matched materials consisted of the four types for stomach cancer. The tailored message was effective in changing the cognitive-behavioral factors, such as experience process, behavior process, con opinion for stomach cancer, self-efficacy, and the behavioral stages for stomach cancer screening. The stomach cancer screening adherence was higher for the stage-matched materials using postal mail than for those using e-mail. Conclusion: To improve the stomach cancer screening rate, the use of tailored messages for stomach cancer screening will be generated using an expert system. Therefore the implementation of tailored educational program will be supported a partnership between public and private health organizations and increasing awareness of the necessity of community-based interventions.

• Korean Journal of Health Education and Promotion
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• v.22 no.1
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• pp.103-115
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• 2005

The Purpose of this study was to identify the process of change, decisional balance and self-efficacy corresponding to the stages of change in exercise behavior based on the Transtheoretical Model(TTM) in obese adolescents. A random sample of 517 obese adolescents was recruited in Pusan. The data were collected from June 15 to 30, 2004. The research instruments were Stages of Change for Exercise Behavior, Process of Change, Decisional Balance, and Self-Efficacy. The data were analyzed by descriptive statistics and ANOVA using SPSS WIN 10.0 program. The results of this study were as follows 1. The subjects were distributed in each stage of exercise behavior: There were 255 subjects($49.3\%$) in the contemplation stage, 131 subjects($25.3\%$) in the preparation stage, 52 subjects($10.1\%$) in the maintenance stage, 41 subjects($7.9\%$) in the action stage, and 38 subjects($7.4\%$) in the precontemplation stage. 2. Analysis of variance showed that cognitive process (F=13.57, p=.000), behavioral process(F=17.23, p=.000), decisional balance pros(F=11.95, p=.000), and self efficacy(F=12.52, p=.000) were significantly associated with the stages of exercise behavior change, but decisional balance cons(F=2.87, p=.023) was not significantly associated with the stages of exercise behavior change. This study can provide useful information for developing effective exercise behavior program considering obese adolescents' stages of change according t'.t the TTM.

• Journal of Korean Academy of Nursing
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• v.35 no.7
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• pp.1285-1294
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• 2005

Purpose: This study was done to evaluate the predictive value of aspects of the Transtheoretical model (TTM) of behavior change as applied to smoking cessation in a rural population. Method: A convenience sample was recruited from a public health center in a community. A total of 484 participants were recruited, including 319 smokers, 116 ex-smokers and 49 non-smokers. A cross-sectional and descriptive design was used in this study. Data was analyzed using descriptive statistics, frequency statistics, ANOVA and Logistic regression. Result: The major findings were 1) The participants were assessed at baseline for their current Stage of Change resulting in a distribution with $42.1\%$ in Precontemplation, $24.1\%$ in Contemplation, $9.7\%$ in Preparation, $6.2\%$ in Active, and $17.9\%$ in the Maintenance stage. 2) There were statistically significant differences of processes of change, decisional balance and situational temptation across the stages of change. 3) The main factors that affect smoking cessation were age, number of years smoking, age when began smoking, self-liberation and negative/affective situations, which combined explained $33.2\%$ of the smoking cessation. Conclusion: TTM variables measured prior to a smoking cessation program added little predictive value for cessation outcome beyond that explained by demographic and smoking history variables.

• Korean Journal of Health Education and Promotion
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• v.28 no.3
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• pp.67-82
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• 2011

Objectives: The purpose of this study was to identify the factors influencing the stages of exercise behavior change after adjusting for related covariates. Methods: Participants included 362 of fourth to sixth graders in 3 elementary schools in a metropolitan city in Korea. The data were collected using structured questionnaire included Korean Stages of Change Scale for Exercise. Results: Logistic regression results showed that the motivational factors associated with transition from precontemplation to contemplation were cognitive process of change, self-reevaluation, conscious raising; regarding that from contemplation to preparation, cons of the decisional balance; regarding those from preparation to action, behavioral process, counter-conditioning, stimulus control, which were very similar to the results of previous researches subjected other age groups. But, there was no motivational factors associated with from action to maintenance, and self-efficacy had no influence on forwarding stages of change. Conclusions: TTM would be applicable to explain the exercise behavior of some children in Korea, which suggested that it be useful in developing the programs to improve physical activities of Korean school children.

• Research in Community and Public Health Nursing
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• v.15 no.1
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• pp.110-121
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• 2004

Purpose: This study was performed to identify factors associated with drinking behavior using Transtheoretical Model in workers. Method: The study method was a survey of 216 marine shipping metal workers in Koje city from November 11, 2002 to November 30, 2002. Result: The subjects were divided in four stages of drinking behavior: 38.9% in pre contemplation stage, 38.6% in contemplation stage, 17.6% in preparation stage and 7.9% in action & maintenance stage. The amount of drinking was significantly decreased as the workers progressed through each stage. Helping relationships(HR) and Self reevaluation(SR) were identified as the main processes of change in all stages. Self liberation(SEL), Counter conditioning(CC), Helping relationships(HR), Self reevaluation(SR), Dramatic relief (DR) and Social liberation(SL) were used higher than average. The self efficacy score increased as the workers progressed through each stage, but not significantly. The Pros score of decisional balance was the highest in the pre contemplation stage and decreased as the workers progressed through each stage. but not significantly. The Cons score of decisional balance was the highest in the preparation stage, but not significantly in as the workers progressed through each stage. Conclusion: This study can provide the basis of a staged matching alcohol reducing program using TTM for more effective and useful intervention.

• Nutrition Research and Practice
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• v.11 no.4
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• pp.319-326
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• 2017

BACKGROUND/OBJECTIVE: Effective weight reduction remains a challenge throughout the world as the prevalence of obesity and its consequences are increasing. This study aimed to determine the effects of an individualized nutrition counseling program (IC) matched with a transtheoretical model (TTM) for overweight and obese subjects. SUBJECTS/METHODS: Fifty overweight and obese subjects aged 19-60 years with a body mass index ${\geq}23kg/m^2$ were enrolled in the weight reduction study. They were randomized into two groups: Intervention group received an IC matched with a TTM; control group received an educational handbook. Body weight (BW), body fat (BF), waist circumference (WC), waist to height ratio (WHtR), stages of change (SOC), processes of change (POC), food intake, and physical activity (PA) were assessed at baseline and at 4, 8, and 12 weeks after program initiation in both groups. All data were analyzed by intention-to-treat, using SPSS software for hypothesis testing. RESULTS: Forty-five female subjects were included in the 12-week trial at Ramkhamhaeng Hospital, Bangkok, Thailand. The results showed significant weight loss ($1.98{\pm}1.75kg$; 3% loss of initial weight) in the intervention group at 12 weeks, compared to a $0.17{\pm}1.67kg$ loss in the control group. There were significant differences between intervention and control groups in BF mass ($-1.68{\pm}1.78$, $-0.04{\pm}1.62kg$); percentage BF ($-1.54{\pm}2.11$, $0.08{\pm}2.05$); WC ($-5.35{\pm}3.84$, $0.13{\pm}3.23cm$); WHtR ($-0.0336{\pm}0.02$, $-0.0004{\pm}0.02$), and energy consumption ($-405.09{\pm}431.31$, $-74.92{\pm}499.54kcal/day$) in the intervention and control groups, respectively. Intragroup SOC was improved in both groups. The POC for the weight management action (WMA) process was significantly different with POC scores increasing by $16.00{\pm}11.73$ and $7.74{\pm}14.97$ in the intervention and the control groups, respectively. PA level did not change in either group. CONCLUSIONS: The IC matched with a TTM resulted in reductions in BW, BF, and WC, thus reducing likely health risks by decreasing energy intake and inducing positive behavior changes while enhancing the WMA process.

• Information Systems Review
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• v.19 no.4
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• pp.183-209
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• 2017

With changes in information technology (IT), many innovative IT-based services, such as AirBnB, have become popular. Switching behavior toward new and innovative services become a major issue for managers who want to attract many customers. In response, many researchers have investigated why customers switch service providers. However, little research has been conducted on the processes of switching behavior for a hedonic service. To fill this research gap, this study aimed to identify the stages of switching behavior based on transtheoretical model. Furthermore, the factors affecting the service switching behavior in stages were identified on the basis of service provider switching model. This study also hypothesized the customer's switching behavior in accommodation sharing economy service and analyzed it empirically. Results showed that the factors affecting switching behavior differ across five stages. The present results can provide a basis to prevent switching behavior and reduce churn by analyzing the difference in switching behavior among stages. This study also helps managers who want to improve organizational performance by enhancing customer retention capability.

• Korean Journal of Adult Nursing
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• v.21 no.4
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• pp.391-402
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• 2009

Purpose: This study was conducted to identify predictors of the stage of change for smoking cessation of male university students on the basis of the Transtheoretical model (TTM). Methods: The 388 current smokers or exsmokers who agreed to participate were recruited from three areas in Korea from August 2 to September 5, 2006. Data was analyzed using a SPSS program for descriptive statistics, ANOVA, and multiple logistic regression. Results: Most subjects (76.8%) were current smokers. According to stages of change, there were statistically significant differences in self efficacy, smoking temptation, decisional balance (cons, pros), and processes of change. The predictors of transition from contemplation to preparation were behavioral and experiential processes. The predictors of transition from preparation to action were pros of smoking and experiential process. The predictors of transition from action to maintenance were cons of smoking and behavioral process. Conclusion: Specific nursing interventions based on stages of change need to be developed for smoking cessation of male university students.

• Research in Community and Public Health Nursing
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• v.23 no.3
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• pp.316-326
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• 2012

Purpose: This study was to identify the factors associated with stages of exercise behavior change of residents in a community on the basis of the Transtheoretical Model. Methods: Data were collected from 520 residents of a community using a self-report questionnaire. The survey variables comprised the stages of exercise behavior change, the process of change, decisional balance and self efficacy. Results: There were significant differences in the process of change, decisional balance and self efficacy by the stages of exercise behavior change. The factors associated with transition from pre-contemplation to contemplation were consciousness raising and self efficacy; regarding those from contemplation to preparation, cons of the decisional balance and social liberation; regarding those from preparation to action, dramatic relief and counter conditioning; regarding that from action to maintenance, cons of the decisional balance. Conclusion: TTM would be applicable to explain the exercise behavior of some residents in a community, which suggested that the programs for improving exercise behavior of residents in a community need to be developed.