Effectiveness of Trans-Theoretical Model-Based Health Education Intervention in the Promotion of Lifestyle Changes among Adults with Metabolic Syndrome: A Randomized Controlled Trial.

Background: Evidence revealed that, 60% of deaths in the underdeveloped nations are linked to adoption of unhealthy lifestyles. The Trans-theoretical Model (TTM) has been considered a useful interventional approach in smoking cessation, drug addiction and weight control. However, its effectiveness in improving changes in dietary pattern, physical activity and alcohol consumption has not been reported. Purpose: The study aimed at evaluating the effectiveness of the TTM-based health education intervention in the promotion of lifestyle changes among adults with metabolic syndrome. Methods: This was an experimental design where 352 participants with metabolic syndrome were allocated to intervention and control groups. The participants were randomly assigned to receive either standard CVD care or a TTM stage-based lifestyle modification intervention for 12-months. Lifestyle patterns were assessed at baseline and endpoint. The mean difference of the subtotal TTM concept scores between pre and post intervention was evaluated using paired t-test. The chi-square test of independence was used to detect between group differences in the categorical data. Results: Most of the participants were in the pre-action stage of change for their dietary intake patterns and physical activity habits at the baseline assessment with no difference between the groups. The intervention group's total level of change toward adopting a healthy lifestyle was markedly (p < 0.001) improved than the control group at the endpoint. The mean scores for the intervention group's stage of change, self-efficacy, and pros and cons of decisional balance all improved significantly (p < 0.001) from the baseline. The mean scores for the control group's pros and cons of decisional balance and stage of change also considerably (p < 0.05) improved from baseline to the endpoint. Conclusion: The TTM- based health education intervention was effective in improving the participants' lifestyles that includes diet and physical activity. Health care providers, particularly nurses should implement TTM staged-matched educational intervention for individuals who are at risk for cardiovascular diseases.

infl uences of trans-theoretical model based diet nursing intervention on sarcopenia and quality of life in maintenance hemodialysis patients / Efectos de la intervención dietética de enfermería basada en el modelo transteórico sobrela sarcopenia y la calidad de vida en pacientes en hemodiálisis de mantenimiento

Objective: to explore the influences of a trans-theoretical model-based diet nursing intervention on sarcopenia and quality of life in maintenance hemodialysis patients. Methods: the clinical data of 243 patients with maintenance hemodialysis (MHD) admitted to our hospital from January 2019 to August 2020 were retrospectively analyzed. A 1:1 orientation score matching (PSM) method was adopted, and patients with different intervention methods were matched based on gender, age, education time, dialysis age, body mass index, underlying diseases, annual income, and whether they were malnourished. Finally, 82 cases were included in the control group (routine nursing and dietary guidance) and 80 cases in the intrevention group (dietary nursing intervention based on the trans-theoretical model), respectively. Results: After PSM, 82 cases in the control group and 80 cases in the intrevention group were included in the study. After the intervention, the incidence of sarcopenia, the extracellular water rate (ECF/TBF) value, and the malnutrition rate of the intrevention group were lower than those of the control group (p < 0.05); the scores of self-care, facing difficulties, potassium intake management, salt intake management, fluid restriction management, the levels of serum albumin, prealbumin and transferrin were all higher than those of the control group (p < 0.05); the SF-36 Concise Health Scale score of the intrevention group was higher than that of the control group (p < 0.05). The 1-year survival rate in the intrevention group (95.00 %) was higher than that in the control group (85.37 %) (p < 0.05). Conclusion: a TTM-based diet nursing intervention can help improve the dietary management behavior of MHD patients, prevent malnutrition, reduce the incidence of sarcopenia, and improve their quality of life and survival rate.(AU)

Objetivo: explorar el impacto de las intervenciones de enfermería dietética basadas en el modelo transteórico sobre la sarcopenia y la calidadde vida en pacientes en hemodiálisis de mantenimiento.Método: se analizaron retrospectivamente los datos clínicos de 243 pacientes con hemodiálisis de mantenimiento (MHD) ingresados en nuestrohospital de enero de 2019 a agosto de 2020. Se utilizó el método de emparejamiento de la puntuación direccional 1: 1 (PSM) para emparejar alos pacientes con diferentes métodos de intervención en función del sexo, la edad, el tiempo de educación, la edad de diálisis, el índice de masacorporal, la enfermedad subyacente, los ingresos anuales y la desnutrición. Finalmente, 82 casos fueron incluidos en el grupo de control (atenciónrutinaria y orientación dietética) y 80 en el grupo de intervención (intervención dietética basada en el modelo transteórico).Resultados: después del PSM, 82 casos fueron incluidos en el grupo de control y 80 casos en el grupo de observación. Después de la intervención,la incidencia de sarcopenia, los valores de agua extracelular (ecf/tbf) y la tasa de desnutrición del grupo de observación fueron menores que enel grupo de control (p < 0,05); autocuidado, afrontamiento de dificultades, manejo de la ingesta de potasio, manejo de la ingesta de sal, manejode restricción de líquidos, niveles de albúmina sérica, y tanto la prealbúmina como la transferrina fueron mayores que en el grupo de control(p < 0,05). La puntuación de la escala de salud concisa SF-36 en el grupo de observación fue mayor que la del grupo de control (p < 0,05), y latasa de supervivencia a un año en el grupo de observación (95,00 %) fue mayor que en el grupo de control (85,37 %) (p < 0,05).Conclusión: las intervenciones de atención dietética basadas en el TTM ayudan a mejorar el comportamiento de manejo dietético de los pacientescon MHD, a prevenir la desnutrición, a reducir la incidencia de sarcopenia y a mejorar la calidad de vida...(AU)

Educational Nutritional Intervention Program for Adolescents Based on Social Cognitive Theory: Pilot Study of a Cluster Randomized Controlled Trial.

The eating habits of adolescents are often inadequate, with high consumption of unhealthy foods and low consumption of healthy foods. It is necessary to design and implement effective interventions to improve eating habits at this age and evaluate their feasibility, acceptability, and effectiveness. The use of theories for behavior change in health interventions favors the adoption of healthy behaviors. Due to this, the objective was set to determine the feasibility, acceptability, and effect on food consumption of a new educational nutritional intervention program for adolescents based on the Social Cognitive Theory (SCT) and supported by the Trans-theoretical Model (TTM) and identify areas of improvement in study design and intervention for future larger-scale studies. A pilot study of a cluster randomized controlled trial was conducted in adolescents of both sexes, 12 to 15 years of age, students from a public secondary school in Tonala, Jalisco, Mexico. The results show that a nutritional education intervention for adolescents, based on SCT and supported by the TTM, is feasible, acceptable, and with positive results in the modification of the consumption of ultra-processed foods, vegetables/fruits, and water. This pilot study identified some aspects that could be improved to enhance the effectiveness of the interventions in future studies.

The effect of nurse-led motivational interviewing based on the trans-theoretical model on promoting physical activity in healthy older adults: A randomized controlled trial.

AIM: The aim of this study was to evaluate the effect of motivational interviewing based on the trans-theoretical model promoting physical activity in older adults. METHODS: A randomized controlled trial study was conducted with 117 older adults (intervention group: 58, and control group: 59) between April and November 2019. The data were collected via a questionnaire, trans-theoretical model scales, the Physical Activity Scale for the Elderly, the Katz Activities of Daily Living scale and a pedometer. The 24-week intervention consisted of regular motivational interviewing. The control group received usual care at the family health centre. RESULTS: Following the intervention, the Intervention Group showed significant improvements Exercise Processes of Change Scale, Exercise Self-Efficacy Scale and Perceived Benefits of the Decisional Balance Scale for Exercise. There was a significant difference between the groups in terms of stages of change. In the Intervention Group, 81.5% were in the contemplation stage in the pre-test, while in the post-test, 70.4% had transitioned to the action stage. In contrast, in the control group, 62.5% were in the contemplation stage initially, but in the post-test, only 9.3% had reached the action stage. The mean number of step counts increased significantly in favour of the Intervention Group, as did the Physical Activity Scale for the Elderly total score. CONCLUSION: The trial indicated that after the trans-theoretical model-based motivational interviewing, the stages of change among the older adults improved, as did their exercise behaviours. It is recommended that the trans-theoretical model and motivational interviewing be used by nurses to improve healthy lifestyle stage behaviours in older adults.

Protective Attitudes toward Occupational Radiation Exposure among Spine Surgeons in Japan: An Epidemiological Description from the Survey by the Society for Minimally Invasive Spinal Treatment.

Background and Objectives: The global trend toward increased protection of medical personnel from occupational radiation exposure requires efforts to promote protection from radiation on a societal scale. To develop effective educational programs to promote radiation protection, we clarify the actual status and stage of behavioral changes of spine surgeons regarding radiation protection. Materials and Methods: We used a web-based questionnaire to collect information on the actual status of radiation protection and stages of behavioral change according to the transtheoretical model. The survey was administered to all members of the Society for Minimally Invasive Spinal Treatment from 5 October to 5 November 2020. Results: Of 324 members of the Society for Minimally Invasive Spinal Treatment, 229 (70.7%) responded. A total of 217 participants were analyzed, excluding 12 respondents who were not exposed to radiation in daily practice. A trunk lead protector was used by 215 (99%) participants, while 113 (53%) preferred an apron-type protector. Dosimeters, thyroid protector, lead glasses, and lead gloves were used by 108 (50%), 116 (53%), 82 (38%), and 64 (29%) participants, respectively. While 202 (93%) participants avoided continuous irradiation, only 120 (55%) were aware of the source of the radiation when determining their position in the room. Regarding the behavioral change stage of radiation protection, 134 (62%) participants were in the action stage, while 37 (17%) had not even reached the contemplation stage. Conclusions: We found that even among the members of the Society for Minimally Invasive Spinal Treatment, protection of all vulnerable body parts was not fully implemented. Thus, development of educational programs that cover the familiar risks of occupational radiation exposure, basic protection methods in the operating room, and the effects of such protection methods on reducing radiation exposure in actual clinical practice is warranted.

Construction of sports and medical integration intervention program in phase Ⅱ cardiac rehabilitation for patients with acute myocardial infarction / 中国实用护理杂志

Objective:To construct an intervention program of sports and medical integration for patients with acute myocardial infarction (AMI) in phase Ⅱ cardiac rehabilitation, so as to provide reference for the effective implementation of physical activity behavior change in AMI patients during phase Ⅱ cardiac rehabilitation.Methods:Before the research, we browsed relevant literature and guidelines published from July 2016 to June 2021, made a retrospective study on the influencing factors of cardiac rehabilitation behavior for AMI patients, and carried out a qualitative interview on cognitive and compliance motivations for AMI patients. Furthermore based on trans-theoretical model, the first draft of the intervention program was developed and and the expert consultation questionnaire was formed. From February to April 2022, Delphi method was used in 16 experts from 10 hospitals and 1 nursing college in 4 provinces. After 2 rounds of expert consultations on the importance and operability of items, the intervention program was finally determined.Results:The effective recovery rates of the 2 rounds of expert consultations questionnaires were both 16/16. The authority coefficient of expert consultation was 0.90, the judgment basis coefficient was 0.96, and the familiarity degree was 0.84. After the second round of expert consultation, the coefficient of variation of the importance of each item was (0.0-13.4)%, and the coefficient of variation of operability was (0.0-18.1)%. The final intervention program of sports and medical integration for patients with AMI in phase Ⅱ cardiac rehabilitation had 37 items, containing precontemplation stage (8 items), contemplation stage (7 items), preparation stage (5 items), action stage (9 items) and maintenance stage (8 items).Conclusions:The construction process of the intervention program of sports and medical integration for patients with AMI in phase Ⅱ cardiac rehabilitation is scientific and feasible. The content is focused on the patient-centred conception and the whole-process management for the exercise rehabilitation of AMI patients in phase Ⅱ cardiac rehabilitation. This intervention program may improve the safety, feasibility, participation and compliance in phase Ⅱ cardiac rehabilitation in patients with AMI. So it is recommended to be popularized and used in phase Ⅱ cardiac rehabilitation.

Physical Activity and Well-being Status among Employees of University of Medical Sciences.

Background: Workplace physical activity plays an important role in employees' health. As university employees are a population at risk for a sedentary working pattern, this study aimed to investigate the physical activity status of employees of Iran University of Medical Sciences (IUMS) and its subsequent effects on their well-being. Methods: This cross-sectional study included 472 employees from different units of IUMS in Tehran. The participants were selected by a multistage sampling method. Interviews were conducted by using an international physical activity questionnaire, a questionnaire for stages of behavioral change, the World Health Organization Well-being Questionnaire, and a demographic checklist from July to October 2019. Analysis of variance, t test, and logistic regression analysis were used. Data were analyzed using IBM SPSS (Version 21.0). Results: Total physical activity in the study population was 6216.58 ± 5886.09 MET-minutes/week. The mean score of the well-being index was 54.72 ± 22.4; there was an association between sex and location of work with physical activity in domains (p<0.05). The highest prevalence rates for change of stage of physical activity were found in the maintenance stage for men and the contemplation stage for women. There was a significant difference between men and women's well-being index-men reported being more active and energetic than women (p<0.001). Results also revealed that having vigorous physical activity compared with a moderate level could increase the well-being index. Conclusion: Physical activity behavior at the workplace was associated with well-being level. It could, therefore, be postulated that enhancing physical activity may be beneficial to improving well-being in an academic environment.

The Effectiveness of Tailored Interactive Multimedia Software based on the Trans-Theoretical Model for the Promotion of Physical Activity Behaviours.

Background: Although physical activity (PA) is essential, it is difficult to motivate people to take part in PA, especially the ones with high blood pressure (hypertension). One of the most commonly applied theoretical frameworks to change health behaviours is the Trans-Theoretical Model (TTM). The aim of this study was to examine the effectiveness of tailored, interactive multimedia software based on TTM for the promotion of PA behaviours among Iranian adults. Methods: This interventional study selected 120 healthy individuals aged 30 years old-50 years old from health centres in Delijan, Iran using multi-stage sampling. The participants were in the pre-contemplation and contemplation stages of PA behaviour. For the intervention, an active multimedia training (active life) based on TTM, like six training sessions of approximately 30 min (once a week) plus aerobic exercise videos were designed and provided to the intervention group. Data was collected using a valid and reliable questionnaire before and 6 months after the intervention and analysed using statistical tests. Results: The mean age of the participants was 38.20 (SD = 7.11) years old. Six months after the intervention, 61.7% of the individuals in the intervention group and 3.3% in the control group progressed to the action stage, which was significant only in the intervention group (P < 0.001). There was a significant increase in PA in both groups, yet this increase was significantly higher in the intervention group (36.02 [SD = 31.22] to 146.16 [SD = 90.43]; P < 0.001) compared to the control group (33.41 [SD = 28.33] to 54.41 [SD = 44.02; P < 0.001). Conclusion: The results obtained indicated that the implementation of educational intervention using multimedia designed based on TTM could be used as one of the effective strategies to promote PA to prevent hypertension in adults.

Application of Internet nursing based on transtheoretical model in diet management of patients with chronic kidney disease / 中国实用护理杂志

Objective:To explore the effect of Internet nursing based on transtheoretical model (TTM) in dietary management of patients with chronic kidney disease (CKD).Methods:A total of 160 CKD patients in the Nephrology Clinic of Tianjin First Central Hospital were selected and divided into the control group and the observation group by convenience sampling and simple randomization, with 80 cases in each group. Quantitative diet management were given in the control group and Internet nursing intervention with TTM as the framework in the observation group for 6 months. The distribution of behavioral stages, dietary compliance and changes in clinical laboratory parameters before and after intervention were investigated in the two groups.Results:After intervention for 3 and 6 months, the distribution of behavioral phase in the observation group was better than that in the control group, and the difference was statistical significant ( χ2=28.48, 48.49, all P<0.01); the daily sodium intake in the observation group was (2.86 ± 0.64), (2.58 ± 0.56) g, and the daily protein intake was (0.81 ± 0.18), (0.76 ± 0.13) g/kg, respectively; the daily sodium intake and daily protein intake in the control group were (3.76 ± 1.42), (4.11 ± 1.49) g and (1.00 ± 0.19), (1.04 ± 0.21) g/kg, respectively, and the differences between the two groups had statistical significance ( t values were 26.74 -105.11, all P<0.01). After intervention for 3 and 6 months, systolic blood pressure was (126.41 ± 9.12) and (124.96 ± 8.58) mmHg (1 mmHg=0.133 kPa), serum creatinine was (177.01 ± 89.04) and (183.24 ± 101.48) μmol/L in the observation group, while systolic blood pressure was (133.16 ± 14.28) and (133.18 ± 12.34) mmHg, serum creatinine was (213.29 ± 108.02) and (222.61 ± 117.33) μmol/L in the control group, and serum potassium and serum phosphorus were (4.37 ± 0.38) and (1.10 ± 0.16) mmol/L after intervention for 6 months in the observation group, while (4.60 ± 0.43) and (1.21 ± 0.21) mmol/L in control group, and the differences between the two groups had statistical significances ( t values were 5.16-23.89, all P<0.01). Using repeated measures analysis of variance, there were significant differences in daily sodium and protein intake, time effect, effect and interaction effect of systolic blood pressure, serum creatinine, serum potassium and serum phosphorus ( Ftime values were 8.97-61.66, Finterblock values were 3.96-32.28, Finteraction values were 3.15- 36.35, all P<0.05), diastolic blood pressure time effect and interaction effect ( Ftime=8.08, Finteraction=3.64, all P<0.05), and blood uric acid time effect ( Ftime=10.50, P<0.01). Conclusions:The Internet care model framed by TTM is beneficial for improving dietary behavior, improving dietary compliance, and improving clinical laboratory parameters in CKD patients in the long term.

Intimate Partner Violence (IPV) in Bhutan: Understanding Women's Responses to IPV Using the Transtheoretical Model of Behavior Change.

Intimate partner violence is highly prevalent in Asian region. It is largely committed by male against their female intimate partner. This is often associated with the region's unique social and cultural norms which subordinate women throughout their lives. IPV is an ongoing concern in Bhutan. The country's age-old traditions and customs are closely related to culture of silence among women experiencing IPV. This study examined women's responses to intimate partner violence (IPV) in Bhutan. Semi-structured interviews were conducted to explore sensitising concepts such as how and when women recognised IPV and how they responded to it. Fifteen women who had sought supportive services at the institution `RENEW' (Respect, Educate, Nurture, Empower Women) as a result of IPV participated in the interview. The Trans-theoretical model of behaviour change (TTM) was used as a theoretical framework to understand women's cognitive, affective and behavioural change processes. The interviews were audio-recorded and transcribed. Thematic analysis was used to identify the patterns of women's responses. From the analysis, women's experiences of IPV and their responses were located within the four stages of change, including contemplation, preparation, action and maintenance. Women used nine traditional processes of change among which consciousness raising and helping relationships were critical and appeared across all four stages of change. This study provides important insights of Bhutanese women's cognitive and behavioural responses to IPV. The appearance of consciousness raising and helping relationships across all the stages of change represents a potential opportunity for intervention to initiate and promote changes in women's response to IPV in the early stages.

Tailoring Health-promoting Programs for Patients with Chronic Kidney Disease: Randomized Controlled Trial.

Research on dietary and lifestyle modifications to decrease cardiovascular risk and slow disease progression has been limited to patients in the later stages of chronic kidney disease (CKD). Studies on the effectiveness of stage-of-change-tailored interventions on lifestyle modifications for individuals with early stage CKD are limited. Using random assignment, 60 patients with early stage CKD who received up to six tailored intervention visits over 30 months were compared to 60 usual care patients on physical indicators, lifestyle behaviors, and quality of life. Tailored interventions were consistent with the trans-theoretical Model of Change. Waist circumference, nutrition, and stress management improved over time in the intervention group. There was no difference or change in quality of life. To promote a healthier lifestyle, findings suggest that clinicians working with patients with CKD should consider patients' readiness to change their behaviors as well as implementation strategies tailored for different processes of change.

Fruit and vegetable intake among overweight and obese school children: A cluster randomised control trial

@#Introduction: Adequate daily intake of fruits and vegetables is crucial for the prevention of chronic diseases. This study aimed to determine the effects of My Body is Fit and Fabulous at School (MyBFF@school) with nutrition education intervention (NEI) on the stages of change for fruit and vegetable intake among overweight and obese secondary school children based on the trans-theoretical model (TTM). Methods: This was a cluster randomised controlled trial involving 15 out of 415 eligible government secondary schools in central Peninsular Malaysia, which were randomly assigned into intervention (six schools; 579 school children) and control (nine schools; 462 school children). The intervention group was given NEI for 24 weeks, while the control group followed the existing school programme by the Ministry of Education. Results: There was no significant difference between the intervention and control groups for the stages of change, with majority at the maintenance stage after six months (intervention: 34.9%; control: 39.0%). The within group analysis showed a significant reduction after six months for those at the action stage (action and maintenance stage) from 68.0% to 60.4% in the intervention group and from 71.4% to 65.6% in the control group. However, there was a significant increase among those with adequate fruit and vegetable intake in the intervention group and no significant increase in the control group. Conclusion: MyBFF@school with NEI based on TTM provided acceptable changes in fruit and vegetable intake among overweight and obese secondary school children.

Seven in every ten khat chewers in Gondar City had an intention to stop khat chewing: cross-sectional study using Transtheoretical Model.

BACKGROUND: Khat chewing practice is rapidly expanding worldwide and currently, an estimated over 10 million people chew khat daily. The transtheoretical model explains how behavior change occurs across the stages of change. So, this study aimed at assessing the intention to stop khat chewing and associated factors among khat chewers in Gondar City, northwest Ethiopia. METHODS: Community-based cross-sectional study was conducted from March to April 2019 in Gondar City, northwest Ethiopia. Six hundred five khat chewers participated in the study from six randomly selected kebeles. The data were collected using structured and interviewer-administered questionnaire. Bivariate and multiple logistic regression models were fitted. Adjusted Odds ratio (AOR) with 95% confidence interval (CI) and p-values less than 0.05 were used to declare a significant association. RESULTS: Of the study participants, 69.3% (95% CI: 65.8-72.9) had the intention to stop khat chewing within 6 months or before. The majority of the participants (55.4%) were at the contemplation stage. Higher self-reevaluation [AOR = 2.8, (95%CI: 1.6-5.0)], environmental reevaluation [AOR = 1.9, (95%CI: 1.1-3.3)] and social liberation [AOR = 1.8, (95% CI: 1.0-3.1)] were associated with intention to quit khat chewing. In addition, using additional substances daily, khat dependency, and early age initiation of khat chewing were associated with lower intention to quit khat chewing. CONCLUSION: The majority of the khat chewers had the intention to quit khat chewing. Increased self-reevaluation, environmental reevaluation, and social liberation process of changes were associated with enhanced intention of quitting khat chewing. Thus, stage-based interventions should be done to inspire khat chewers to realize their motivation of stopping khat chewing.

Data on the potential of nutrition-information apps from a consumer behaviour perspective.

This paper presents data on the influence of the use of a nutrition-information app (Edo) on healthy eating. The methodology adopted included a baseline (t0) and a follow-up online questionnaire (t1). The first survey was sent to 7000 consumers who had already downloaded the app. This survey collected data on users' perceived healthiness of their own diet, food purchasing habits, sociodemographic information, concern for appearance, perception of the Health Belief Model constructs, and objective and perceived healthy food knowledge. The follow-up survey (t1) was sent to the respondents who had used the app for 12 weeks. It collected data on app satisfaction, recommended additional app features, consumers' perception on the Health Belief Model constructs, and consumers' objective and perceived healthy food knowledge. Data elaboration included two factor analyses elaboration, one for t0 data and one for t1 data. The aim was the identification of constructs as latent factors of the data. The value of each construct was calculated and compared between t0 and t1. The data presented in this article can help the replication of studies about similar apps and enhance the cooperation among app developers, consumer behaviour scientists, nutritionists and marketing experts for apps development. For conclusion and interpretation of data, the original article can be consulted (DOI:10.1016/j.foodres.2019.108766).

Assessment of nutrition-focused mobile apps' influence on consumers' healthy food behaviour and nutrition knowledge.

The research explored if a nutrition-information app influences consumers' healthy food behavior and whether consumers improve their knowledge towards healthy food. Diet and nutrition apps are among the most popular health and fitness apps used by an increasing number of mobile device users. The analyzed app reads the product labels. Then it assesses the quality of ingredients and nutritional values based on user's personal data, such as age and physical activity level, and recommends healthier food alternatives. Scientific evidence of the effectiveness of nutrition-information apps for promoting consumers' healthy food behavior is still limited. The theoretical framework of the study is grounded in constructs from Health Belief Model (HBM) and Trans-theoretical Model (TTM) theories. Data were collected from consumers that spontaneously downloaded an existing nutrition-information app. Out of the 7000 consumers contacted, 143 respondents filled in both the baseline and follow-up questionnaires. The questionnaires included items deriving from the HBM and TTM theoretical constructs adopted, that is self-reported stage of change, susceptibility, severity, benefits, barriers, self-efficacy, cues to action, perceived and objective healthy food knowledge. The average age of respondents is 38 year-old and the sample of respondents is well distributed in terms of level of education, gender, income, working status, and geographical distribution. Findings of the study showed that nutrition-information apps can be effective in overcoming what consumers perceive as personal limitations in approaching healthy food. This is particularly evident among consumers that are building their motivation and concretely planning actions in favor of healthy eating. In particular, using a nutrition-information app decreases the perception of the barriers to healthy food eating. Users have a higher perceived personal strength and self-confidence in approaching healthy food. App users improved their objective and subjective knowledge of healthy food. The results confirmed the effectiveness of the theoretical framework. The results support that family members and friends play a specific role in healthy food behavior inclination. This suggests the inclusion of an additional theoretical construct, the social and family influence construct, when assessing the effectiveness of nutrition-information apps. To improve nutrition-information app effectiveness, the recommendation is that consumer behavior scientists, marketing researchers, nutritionists, and app developers cooperate in the apps design.

Effects of a Trans-Theoretical Model-Based Health Education Program on the Management of Cognitive Dysfunction in Older Adults With Mild Cognitive Impairment: Study Rationale and Protocol Design for a Randomized Controlled Trial.

Introduction: Recent studies have confirmed that the management of cognitive dysfunction produces considerable positive effects in individuals with mild cognitive impairment (MCI), however, compliance with participation in various cognitive dysfunction management strategies remains scant in older adults with MCI. Health education programs can improve the level of knowledge of the disease effectively, though it remains unclear as to whether health education programs are sufficient to promote behavior changes of older adults with MCI in the community. Objective: The study aims to provide insight into the effect of a trans-theoretical Model (TTM)-based health education program on increasing knowledge about mild cognitive impairment (MCI), compliance in cognitive dysfunction management, and other cognition-related health outcomes (general cognitive function, sleep quality, depression symptoms, apathy symptoms) for older adults with MCI. Methods: This study is a single-blinded, randomized, prospective clinical trial. We will recruit 132 participants with MCI who will be randomly assigned to a TTM-based health education group and a standard health education group in a ratio of 1:1. The intervention group will receive a TTM-based health education program (1 session/week, 4-560 min/session for 8 weeks), while the control group will receive standard health education. Assessors blinded to participant allocation will conduct baseline, post-intervention, and 3-month follow-up assessments. Statistical analyses will consist of the Wilcoxon test, the Chi-square test, the T-test, and 2 (group) × 3 (time) ANOVA with a 5% cut-off for significance. Discussion: Supposing the TTM-based health education program will provide validated community-based cognitive dysfunction management strategies for older adults with MCI, this would be a feasible approach to improve the compliance of participation in cognitive dysfunction management and the cognition-related health outcomes. Clinical Trial Registration: ChiCTR1900028351. Registered on December 19, 2019. http://www.chictr.org.cn/edit.aspx?pid=47223&htm=4.

Applying trans-theoretical model for blood donation among Spanish adults: a cross-sectional study.

BACKGROUND: Relying solely on altruistic appeals may fail to fulfil the increasing demand for blood supplies. Current research has largely been attempted to determine and understand motives that serve as blood donation drivers. The Trans-Theoretical Model of behaviour change (TTM) can be used to conceptualise the process of intentional blood donation behaviour. METHODS: A cross sectional survey of Spanish adults was conducted. The final sample consisted of 504 individuals who were administered a self-report questionnaire including the measures of demographic characteristics, Stages of Change, Processes of Change, Self-efficacy and Decisional Balance. Data were analysed by frequency analysis, MANOVA/ANOVA and correlation analysis. RESULTS: Findings indicated that most of the behavioural and cognitive processes of change, self-efficacy and physical cons differentiated participants across the stages of change of blood donation. In contrast, eligibility cons and pros were less influential in stage transitions. Furthermore, significant correlations were observed between TTM constructs except for the physical cons and the processes of change. CONCLUSIONS: The present study extensively supports and replicates the applicability of the TTM to blood donation behaviour change and offers important implications for the development of effective stage-matched interventions to increase blood donation.

Readiness for weight change and its association with diet knowledge and skills, diet decision making and diet and exercise barriers in patients with type 2 diabetes.

AIMS: this study aimed to investigate stages of weight change in type 2 diabetics and its associations with diet knowledge and skills, diet decision making, diet and exercise barriers. MATERIALS AND METHODS: This was a cross-sectional study of 1139 patients with type 2 diabetes aged>18 years in East Azerbaijan, Iran. Data were collected using the Personal Diabetes Questionnaire (PDQ) and were analyzed using SPSS software (version 22) and descriptive statistics, Chi-square and one-way ANOVA tests. RESULTS: 48.1% of the patients were in the pre-contemplation stage. 7.5%, 14.6% and 29.8% of patients were in the stages of contemplation, preparation and action, respectively. Patients with a higher score in diet knowledge and skills and diet decision making were more likely to be involved in the action stage of weight loss process, while those who had more eating problems and exercise barriers were less likely to be involved in the action stage of weight loss. CONCLUSION: The results of this study showed that a substantial percentage of patients are at the pre-contemplation stage, so proper measures are needed to inform patients about the consequences of obesity and overweight. It is also necessary to focus on people with poor incomes and education status and those living in rural areas. Improve diet knowledge and skills and diet decision making and the reduction of barriers to exercise can help patients to take action to lose weight.

Readiness for diet change and its association with diet knowledge and skills, diet decision making and diet barriers in type 2 diabetic patients.

AIMS: to investigate stages of change for dietary in type 2 diabetics and its associations with diet knowledge and skills, diet decision making and diet barriers. MATERIALS AND METHODS: This was a cross-sectional study which was conducted on 1139 diabetics aged>18 years in East Azerbaijan, Iran. Data were collected through a Personal Diabetes Questionnaire (PDQ) and analyzed through SPSS version 22 software using descriptive statistics, Chi-square and one-way ANOVA tests. Tukey's HSD post hoc tests were applied to illustrate ANOVA findings. RESULTS: 59.3% of patients do not follow a diet plan to control their blood glucose. 44.7%, 5.5%, 13%, and 36.8% of patients, respectively, were in the stages of pre-contemplation, contemplation, preparation and action. Patients who had shorter disease duration and those whose current treatment was lifestyle change were more likely within the action stage. Also, patients who had a higher score in diet knowledge and skills and diet decision making and those who had a lower score in diet barriers were more likely in the action stage of change. CONCLUSION: Based on the results of this study, a considerable proportion of diabetic patients were in the pre-contemplation stage. Diet knowledge and skills, diet decision making and diet barriers were factors contributing to diet readiness to change. Therefore, taking necessary measures to increase diet knowledge, skills and diet decision-making and a reduction in diet barriers can help people with type 2 diabetes to change diet.

Ideating Mobile Health Behavioral Support for Compliance to Therapy for Patients with Chronic Disease: A Case Study of Atrial Fibrillation Management.

Poor patient compliance to therapy results in a worsening condition that often increases healthcare costs. In the MobiGuide project, we developed an evidence-based clinical decision-support system that delivered personalized reminders and recommendations to patients, helping to achieve higher therapy compliance. Yet compliance could still be improved and therefore building on the MobiGuide project experience, we designed a new component called the Motivational Patient Assistant (MPA) that is integrated within the MobiGuide architecture to further improve compliance. This component draws from psychological theories to provide behavioral support to improve patient engagement and thereby increasing patients' compliance. Behavior modification interventions are delivered via mobile technology at patients' home environments. Our approach was inspired by the IDEAS (Integrate, Design, Assess, and Share) framework for developing effective digital interventions to change health behavior; it goes beyond this approach by extending the Ideation phase' concepts into concrete backend architectural components and graphical user-interface designs that implement behavioral interventions. We describe in detail our ideation approach and how it was applied to design the user interface of MPA for anticoagulation therapy for the atrial fibrillation patients. We report results of a preliminary evaluation involving patients and care providers that shows the potential usefulness of the MPA for improving compliance to anticoagulation therapy.