Physical activity behaviour change theory: The Transtheoretical Model and all that

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Physical activity behaviour change theory The
Transtheoretical Model and all that

• Stuart Biddle
• School of Sport Exercise Sciences

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Today

• The wider context of physical activity - the
  ecological approach
• The role of physical activity correlates or
  determinants in the mediating variable
  framework
• A framework of theories used in physical activity
  research
• How the Transtheoretical Model (TTM) fits in to
  such a framework
• What the TTM is all about the role of
  self-efficacy, pros and cons, and processes of
  change
• What the evidence is for the TTM in physical
  activity settings

3
Today

• The wider context of physical activity - the
  ecological approach
• The role of physical activity correlates or
  determinants in the mediating variable
  framework
• A framework of theories used in physical activity
  research
• How the Transtheoretical Model (TTM) fits in to
  such a framework
• What the TTM is all about the role of
  self-efficacy, pros and cons, and processes of
  change
• What the evidence is for the TTM in physical
  activity settings

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Reconceptualising the environment

• Intrapersonal environment

Interpersonal environment
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Physical environment
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Policy/legislative environment
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Today

• The wider context of physical activity - the
  ecological approach
• The role of physical activity correlates or
  determinants in the mediating variable
  framework
• A framework of theories used in physical activity
  research
• How the Transtheoretical Model (TTM) fits in to
  such a framework
• What the TTM is all about the role of
  self-efficacy, pros and cons, and processes of
  change
• What the evidence is for the TTM in physical
  activity settings

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A behavioural epidemiology framework
Establish Links
Interventions
Determinants
Translation into practice
Measure PA
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MEDIATING VARIABLE FRAMEWORK
Interventions
Longer- term outcomes, e.g., reduced risk of
CHD, diabetes etc, strong social
networks, positive physical self- worth
Short- and medium- term outcomes, e.g.,
enjoyment, body composition, Skill improvement
Physical activity
Modifiable determinants
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Today

• The wider context of physical activity - the
  ecological approach
• The role of physical activity correlates or
  determinants in the mediating variable
  framework
• A framework of theories used in physical activity
  research
• How the Transtheoretical Model (TTM) fits in to
  such a framework
• What the TTM is all about the role of
  self-efficacy, pros and cons, and processes of
  change
• What the evidence is for the TTM in physical
  activity settings

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Psychological theory and physical activity
Biddle et al., Handbook of Sport Psychology, 2007
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Today

• The wider context of physical activity - the
  ecological approach
• The role of physical activity correlates or
  determinants in the mediating variable
  framework
• A framework of theories used in physical activity
  research
• How the Transtheoretical Model (TTM) fits in to
  such a framework
• What the TTM is all about the role of
  self-efficacy, pros and cons, and processes of
  change
• What the evidence is for the TTM in physical
  activity settings

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In search of how people change

• Findings from clinical psychology and
  psychotherapy
• Late 70s identified common principles
• Move towards a more comprehensive model of
  behaviour change
• Prochaska DiClemente (1983)
• Transtheoretical Model of Behaviour Change

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Psychological theory and physical activity
Biddle et al., Handbook of Sport Psychology, 2007
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Today

• The wider context of physical activity - the
  ecological approach
• The role of physical activity correlates or
  determinants in the mediating variable
  framework
• A framework of theories used in physical activity
  research
• How the Transtheoretical Model (TTM) fits in to
  such a framework
• What the TTM is all about the role of
  self-efficacy, pros and cons, and processes of
  change
• What the evidence is for the TTM in physical
  activity settings

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The TTM represents an umbrella theory
Processes of change
Self efficacy
Other theories
Decisional balance (Pros vs Cons)
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Transtheoretical Model of Health Behaviour Change
WHEN
HOW
Precontemplation Contemplation Preparation Action
Maintenance
Self-Efficacy Decisional Balance Processes of
change
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TTM Intentions and behaviour
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Precontemplation

• Do not exercise
• Have no intention of starting

Typical statements So far as I'm concerned I
don't have any problems that need changing" "I
guess I have my faults but there is nothing I
need to change" "I don't go along with all this
heath promotion rubbish - you've got to die from
something
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Contemplation

• Do not exercise but aware that a problem exists!
• Seriously thinking about starting
• Some sort of commitment to change in the near
  future

Typical Statements "yes I know I have a problem
but I'm not ready to do anything yet" "just
wait until I get these assignments done then I'll
start my new regime "I'm just too stressed at
the moment to even think about exercising"
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Preparation

• Started to make small changes but still not
  exercising to criterion level
• May set imminent date on which change is to take
  place (usually within a month)
• Psychologically prepared for change

Typical statements Ok, Ive joined Biddles
gym. Ill start on Monday" Ive signed up for
aerobics, theres no backing out now" "This is
the last weekend before I start my fitness
programme
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Action

• Meeting criterion for physical activity (e.g.,
  exercising 30 min per day, 5 days/wk)
• Started recently (usually within last 6 months)

Typical statements "Anyone can talk about
exercising... but I have!" "It's not easy but
I'm giving it my best shot!" "I dont get out
of breath anymore taking the stairs!
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Maintenance

• Exercising at criterion level for gt 6 months
• Work to prevent relapse

Typical statements Im an exerciser It was
tough at first but now its quite routine
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Processes of Change

• The cognitive, affective and behavioural,
  experiential strategies and techniques people use
  in modifying behaviour
• 10 processes represent the basic change
  principles
• 5 cognitive (thinking)
• 5 behavioural (doing)

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Social Cognitive Theory (SCT) including
self-efficacy

• we learn and modify our behaviours through an
  interaction between personal, behavioural, and
  environmental influences
• reciprocal determinism / causality

Albert Bandura
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SELF-EFFICACY Definition

• peoples judgements of their capabilities to
  organise and execute courses of action
• Bandura (1977, 1986, 1997)

• Efficacy expectations

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Social Cognitive Theory (SCT)

• Efficacy expectancies
• Self reflection of our capabilities
• Banduras most significant contribution
  self-efficacy
• Situation-specific confidence to undertake a
  certain behaviour
• Efficacy beliefs and expectations
• The can I? question
• This will determine many behaviours, especially
  those that challenge us.

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Social Cognitive Theory (SCT)

• Outcome expectancies we reflect on the
  (possible) consequences of our behaviours
• E.g. if I am more active, what are the
  consequences?
• Positive? Better health, fitness, functionality,
  social relations?
• Negative? Injury, perception of inappropriate use
  of time, expense?

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Social Cognitive Theory (SCT) Key practical
elements

• Can I?
• Is it worth it?
• Remember the Loriel principle?
• You can, because youre worth it!

• Efficacy expectations
• Outcome expectations

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Self Efficacy
The confidence that you can be active in
challenging situations
I am confident I can be active when I feel I do
not have the time
I am confident I can be active when the weather
is bad for example its raining or cold
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SOURCES OF SELF-EFFICACY
VERBAL PERSUASION
PERFORMANCE
SELF- EFFICACY
IMITATION MODELING
PHYSIOLOGICAL AROUSAL
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Sources of self-efficacy

• prior success and performance attainment
• what happens in the past will affect how you feel
  about future efforts at the same, or similar,
  behaviours

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Sources of self-efficacy

• imitation and modelling
• We learn from watching others
• evidence suggests that confidence can be obtained
  from observing people similar to ourselves being
  successful (if they can do it, so can I!).
• likely to be stronger if the behaviour in
  question is new to us
• observing how people cope with adversity can
  boost self-efficacy.

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Exercise Confidence

• ... I did manage to influence some of my more
  sedentary colleagues. Exercise was unusual for
  African men of my age and generation. After a
  while even Walter (Sisulu) began to take a few
  turns around the courtyard in the morning. I know
  that some of my younger comrades looked at me and
  said to themselves If that old man can do it,
  why cant I? They, too, began to exercise
• (Nelson Mandela, 1994)

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Sources of self-efficacy

• verbal and social persuasion
• encouragement from others
• if others show confidence in your abilities,
  particularly for difficult tasks, it may boost
  feelings of efficacy
• not a particularly powerful source of
  self-efficacy
• but, it can be influential, and more so if the
  source of encouragement is seen to be
  knowledgeable and credible.

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Sources of self-efficacy

• judgements of physiological states
• For stressful or phobic behaviours, it is
  important to control physiological signs of
  anxiety and arousal
• this may not apply directly to physical activity
• but it does mean that confidence will more likely
  be enhanced through an environment that is
  positive and relaxing, and does not induce
  feelings of anxiety.

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DECISIONAL BALANCE

• Weighing up the pros cons of changing a
  particular behaviour

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TTM PREDICTIONS
Cognitive Processes
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Advantages of Using TTM for Behaviour Change

•  
• Recognises behaviour is not all-or-nothing
• distribution of population by stage
• Work with total populations
• Stage-matched interventions
• Recruitment and retention by stage
• Evaluate success of interventions by stage
  progression

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Today

• The wider context of physical activity - the
  ecological approach
• The role of physical activity correlates or
  determinants in the mediating variable
  framework
• A framework of theories used in physical activity
  research
• How the Transtheoretical Model (TTM) fits in to
  such a framework
• What the TTM is all about the role of
  self-efficacy, pros and cons, and processes of
  change
• What the evidence is for the TTM in physical
  activity settings

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Application of the TTM to physical activity

• Marshall Biddle (2001) Meta Analysis
• 71 published articles and abstracts
• 54 cross-sectional
• 6 longitudinal
• 10 quasi-experimental
• 1 randomised controlled trial
• 91 independent samples
•  

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Physical Activity
Effect Size
2.5
2
1.5
1
0.5
0
Precontemplation Preparation
Maintenance
Contemplation Action
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Self-Efficacy
Effect Size
2.5
k 16 N 4662 Fsk 42
2
k 15 N 3537 Fsk 30
1.5
k 17 N 5719 Fsk 13
1
k 19 N 3462 Failsafe k 37
0.5
0
Precontemplation Preparation
Maintenance
Contemplation Action
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Conclusions Self-Efficacy

• All forward stage movement is characterised by an
  increase in self-efficacy
• Self-efficacy appears especially important when
  moving from action to maintenance
• Relationship appears non-linear

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Decisional Balance
Effect Size
2
1.5
Cons (Narrative)
Cons
1
Pros
0.5
0
Precontemplation Preparation
Maintenance
Contemplation Action
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Conclusions Decisional Balance

• large increase in pros and moderate decrease in
  cons important to begin contemplating change
• Further small increase in pros and moderate
  decrease in cons important to start changing

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Processes of Change
Effect Size
2
2
Behavioural
Cognitive
1.5
1.5
1
1
0.5
0.5
0
Precontemplation Preparation
Maintenance
Contemplation Action
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Individual process use
Effect Size
2.5
2
BEHAV
1.5
1
COG.
0.5
0
Precontemplation
Preparation Maintenance
Contemplation Action
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Conclusions Processes of Change

• Individuals use all processes, especially from
  PRECONT to CONT and from PREP to ACT
• Cognitive and behavioural processes appear
  equally important for contemplating change
• Behavioural processes appear more important than
  cognitive processes from contemplation onwards,
  but confidence intervals are not conclusive
• Stage x process interactions not evident,
  suggesting distinction between higher order
  constructs may not be appropriate in PA settings

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Overall Conclusions

• Tentative support for the model
• Please, NO more studies showing cross-sectional
  differences in core constructs between stages!
• Too few longitudinal and experimental studies to
  examine causal associations
• Evidence for higher-order processes of changes
  (cognitive and behavioural) is weak
• Stage or continuum model?

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Defining properties of a stage theory

• Pseudo-stage model
• A classification system to define the stages ?
• An ordering of stages ?
• Common barriers to change facing people in the
  same stage (?)
• Different barriers to change facing people in
  different stages (?)

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Physical activity behaviour change theory The
Transtheoretical Model and all that

• Stuart Biddle
• s.j.h.biddle_at_lboro.ac.uk