Many studies have shown growing interest in applying the Trans-Theoretical Model (TTM) to both the treatment of obesity and its prevention through promoting healthy lifestyles in both the general population and at-risk groups [1]. The TTM provides a conceptual explanation of the processes that individuals need to undergo when modifying problem behaviors or acquiring positive behaviors. It focuses mainly in relation to changing dietary intake and physical activity, in order to achieve a sustainable weight loss. This model includes two levels: i) the Stages Of Change (SOC), which reflects the temporal dimension of the behavior as it been divided into five consecutive stages; and ii) a set of constructs that explain how people evolved along the SOC. The SOC are: the pre-contemplation (do not intend to lose their weight), contemplation (planning to lose their weight within 6 months), preparation (planning to lose their weight over next 30 days), action (have been making an effort by dieting and exercising to lose their weight for less than 6 months), or maintenance (had successfully maintained their desired weight for more than 6 months) [7]. The other four additional TTM constructs are the Processes Of Change (POC), decisional balance, self-efficacy and temptation [7]. POC is a process or strategy that individual engage in attempt to lose weight that related to behavioral or experiential strategies. TTM generally proposes steps in POC to promote health behavior change which is categorized into i) experiential processes: consciousness raising, counter conditioning, dramatic relief, environmental re-evaluation, reinforcement management and ii) behavioral processes: self-liberation, self-reevaluation, social liberation, helping relationships, and stimulus control [8]. The model predicts that experiential processes increased in the contemplation stage whereas behavioral processes increased more during maintenance [9,10]. Decisional balance, measures the balance between the benefits and the barriers of change. The individuals who were in pre-contemplation stage reported least benefits of changing behavior compared to those in the action and maintenance stages [7,8]. Self-efficacy is measured based on one’s belief in their ability to produce something to achieve their desire needs [11]. In regards with weight loss, self-efficacy promotes weight management through exercise and physical activity [12,13]. When the counseling or the intervention targeted according to stages of readiness to change (compared with usual care), the respondents were more likely to change their diet and their physical activity [14, 15]. By understanding the process of change faced by the targeted group, the intervention initiated will be more effectively accepted. Hence, this study is conducted to assess the readiness to lose weight among overweight and obese adolescents using the TTM targeting among the adolescent group.
Instruments |
Cronbach’s |
Intra-class correlation |
Corrected total item correlation |
Factor loading |
|
Processes of change(39) |
|||||
1. |
Conscious Raising(4) |
0.705 |
0.67(0.63-0.71) |
0.30-0.61 |
0.41-0.64 |
2. |
Counter conditioning(3) |
0.604 |
0.57(0.52-0.62) |
0.32-0.49 |
0.46-0.76 |
3. |
Dramatic control(5) |
0.789 |
0.78(0.75-0.80) |
0.49-0.63 |
0.45-0.71 |
4. |
Environmental re-evaluation(5) |
0.767 |
0.76(0.72-0.79) |
0.49-0.59 |
0.38-0.67 |
5. |
Helping relationship(4) |
0.795 |
0.79(0.77-0.82) |
0.41-0.70 |
0.47-0.78 |
6. |
Reinforce management(4) |
0.733 |
0.69(0.65-0.730 |
0.51-0.54 |
0.44-0.76 |
7. |
Self-liberation(6) |
0.812 |
0.78(0.75-0.81) |
0.49-0.65 |
0.54-0.72 |
8. |
Social liberation(3) |
0.595 |
0.54(0.48-0.600 |
0.32-0.47 |
0.48-0.70 |
9. |
Stimulus control(5) |
0.79 |
0.76(0.73-0.79) |
0.51-0.61 |
0.51-0.74 |
Decisional Balance (20) |
|||||
1 |
Pros (10) |
0.902 |
0.88(0.86-0.90) |
0.58-0.76 |
0.64 -0.80 |
2 |
Cons (10) |
0.739 |
0.72(0.70-0.78) |
0.22-0.59 |
0.38 -0.65 |
Physical Activity and Nutrition Self-efficacy (11) |
0.908 |
0.86(0.85-0.92) |
0.51-0.73 |
0.49-0.86 |
|
Situational Temptations Questionnaire for Adolescents(9) |
0.837 |
0.82(0.78-0.85) |
0.49-0.61 |
0.75-0.88 |
95 % CI – 95 % Confidents Interval
Variable |
Stages of readiness to lose weight (n= 631) |
F |
P value |
Turkey’S HSD (p < 0.05) |
|||||||
PC (f = 40) |
C (f=167) |
PR (f = 98) |
A (f= 254) |
M (f= 72) |
|||||||
mean |
mean |
mean |
mean |
mean |
|||||||
Processes of change to lose weight |
|||||||||||
Consciousness Raising |
8.37 |
10.56 |
11.56 |
12.44 |
11.46 |
16.32 |
< 0.001* |
PC < C, PR, A & M, C < A |
|||
Counter Conditioning |
6.60 |
7.84 |
8.52 |
9.49 |
9.64 |
22.31 |
< 0.001* |
PC < C, PR, A & M, C < A & M, |
|||
Dramatic control |
11.53 |
13.87 |
14.65 |
15.81 |
13.88 |
8.86 |
0.001* |
PC < PR & A, C < A, |
|||
Environmental reevaluation |
8.05 |
9.32 |
10.37 |
10.48 |
10.54 |
5.44 |
< 0.001* |
PC < PR, A & M, |
|||
Helping relationship |
7.68 |
9.23 |
10.63 |
10.43 |
10.79 |
7.39 |
< 0.001* |
PC < PR, A & M, |
|||
Reinforce management |
6.85 |
7.48 |
8.73 |
8.78 |
8.59 |
5.13 |
< 0.001* |
PR < A, C < A |
|||
Self-liberation |
15.55 |
19.20 |
20.49 |
22.71 |
21.31 |
23.50 |
< 0.001* |
PC < C, PR, A & M, C < A & M |
|||
Social liberation |
8.40 |
10. 22 |
10.60 |
11.03 |
10.28 |
8.01 |
< 0.001* |
PC < C, PR, A & M, |
|||
Stimulus control |
7.90 |
9.58 |
11.11 |
11.67 |
11.18 |
10.79 |
< 0.001* |
PC < PR, A & M, C < PR & A |
|||
Decisional Balance to lose weight |
|||||||||||
Pros
|
31.10 |
38.16 |
38.47 |
40.43 |
39.38 |
10.62 |
< 0.001* |
PC < PR, A & M |
|||
Cons |
26.18 |
27.04 |
26.71 |
26.03 |
25.15 |
1.29 |
0.271 |
- |
|||
Physical Activity and Nutrition Self-efficacy |
41.75 |
46.14 |
47.85 |
55.72 |
57.90 |
18.80 |
< 0.001* |
PC < A & M, C < A & M, |
|||
Temptation for high fat and calories diet |
27.23 |
24.93 |
24.48 |
24.05 |
23.44 |
2.88 |
0.022** |
PC < A & M |
sd = Standard deviation
PC = Pre-contemplation, C = Contemplation, PR = Preparation, A = Action, M = Maintanence * Significant if P value < 0.05
Decisional Balance construct is the precedence between the positive or negative reasons for someone to improve the problematic behavior. The mean scores of pros among overweight and obese students were lowest among those at pre-contemplation, and noted to increase across the stages of readiness to lose weight and culminated at maintenance [23,24]. Those at pre-contemplation significantly having lower mean scores of pros than those at preparation, action and maintenance stages which indicated that they had more reasons and having less positive reasons for change [31].
Finding showed that self-efficacy increases significantly as they progress through the stages of change [18]. Physical activity and nutrition self-efficacy positively affect weight loss in different populations [32-34]. Temptation and self-efficacy have an inverse relationship with one another across stages of change. The temptation stage is highest during the earlier stages of change and lowest during the later stages was noted as well in other studies [8,26,35,36].
The limitations of present study are the age of respondents (13-19 years) was covered only for middle adolescent group that do not represent the overall adolescents. Using the selfadministrated questionnaire may influence the adolescent response. Significant differences of the TTM constructs across the stages of readiness to lose weight will give input for effective weight management interventions. A follow-up study in the future should be conducted to strengthen the intervention measure in order to increase the healthy lifestyle practice among overweight and obese adolescents.
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