physical activity behaviour change theory: the transtheoretical model and all that stuart biddle...
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Physical activity behaviour change theory: The Transtheoretical Model and all that
Stuart Biddle
School of Sport & Exercise Sciences
2
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
4
Intrapersonal environment
Interpersonal environment
Reconceptualising “the environment”
7
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
MeasurePA
InterventionsDeterminantsTranslation
intopractice
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Interventions
Modifiabledeterminants
Physical activity
Longer-term
outcomes,e.g.,
reducedrisk of CHD,
diabetes etc,strong social
networks,positive
physical self-worth
Short- andmedium-
termoutcomes,
e.g., enjoyment,
bodycomposition,
Skill improvement
MEDIATING VARIABLE FRAMEWORK
10
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
11
Psychological theory and physical activity
Theories of Exercise Behaviour
Belief-AttitudeTheories
Competence-BasedTheories
Control-BasedTheories
Stage-BasedTheories
Example:Theory of
Planned Behaviour
Example:Self-Efficacy
Theory
Example:Self-Determination
Theory
Example:Transtheoretical
Model
HybridModels
Example:HAPA
Biddle et al., Handbook of Sport Psychology, 2007
12
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
13
In search of how people changeIn search of how people change
Findings from clinical psychology and Findings from clinical psychology and psychotherapypsychotherapy
Late 70’s identified common principles Late 70’s identified common principles Move towards a more Move towards a more
comprehensive model of comprehensive model of behaviour changebehaviour change
Prochaska & DiClemente (1983)Prochaska & DiClemente (1983)
Transtheoretical Model of Transtheoretical Model of Behaviour ChangeBehaviour Change
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Psychological theory and physical activity
Theories of Exercise Behaviour
Belief-AttitudeTheories
Competence-BasedTheories
Control-BasedTheories
Stage-BasedTheories
Example:Theory of
Planned Behaviour
Example:Self-Efficacy
Theory
Example:Self-Determination
Theory
Example:Transtheoretical
Model
HybridModels
Example:HAPA
Biddle et al., Handbook of Sport Psychology, 2007
15
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
The TTM represents an ‘umbrella’ theory
Self efficacySelf efficacy
Decisional balanceDecisional balance(Pros vs Cons)(Pros vs Cons)
Other Other theoriestheories
Processes of changeProcesses of change
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Transtheoretical Model of Health Behaviour Change
Self-EfficacyDecisional Balance
Processes of change
Precontemplation
Contemplation
Preparation
Action
Maintenance
HOWWHEN
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TTM: Intentions and behaviour
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PrecontemplationPrecontemplation
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
• Do not exercise • Have no
intention of starting
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ContemplationContemplation
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"
• Do not exercise but aware that a problem exists!
• Seriously thinking about starting
• Some sort of commitment to change in the near future
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PreparationPreparation
Typical statements:“Ok, I’ve joined Biddle’s gym. I’ll start on Monday"
“I’ve signed up for aerobics, there’s no backing out now"
"This is the last weekend before I start my fitness programme”
• 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
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ActionAction
Typical statements:
"Anyone can talk about exercising... but I have!"
"It's not easy but I'm giving it my best shot!"
"I don’t get out of breath anymore taking the stairs!”
• Meeting criterion for Meeting criterion for physical activity (e.g., physical activity (e.g., exercising 30 min per exercising 30 min per day, 5 days/wk) day, 5 days/wk)
• Started recently Started recently (usually within last 6 (usually within last 6 months)months)
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MaintenanceMaintenance
Typical statements:
“I’m an exerciser”
“It was tough at first but now it’s quite routine”
• Exercising at criterion level for > 6 months
• Work to prevent relapse
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Processes of ChangeProcesses of Change
The cognitive, affective and behavioural, The cognitive, affective and behavioural, experiential strategies and techniques experiential strategies and techniques
people use in modifying behaviourpeople use in modifying behaviour
10 processes represent the basic change 10 processes represent the basic change principlesprinciples
5 cognitive (thinking) 5 cognitive (thinking) 5 behavioural (doing) 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
“people’s 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 Bandura’s 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
you’re worth it!”
Efficacy expectations Outcome expectations
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Self EfficacySelf Efficacy
““The confidence that you can be active The confidence that you can be active in in
challenging situations”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 it’s raining or cold
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SOURCES OF SELF-EFFICACY
SELF-EFFICACY
VERBALPERSUASION
IMITATION &MODELING
PHYSIOLOGICALAROUSAL
PERFORMANCE
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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 can’t 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 BALANCEDECISIONAL BALANCE
Weighing up the pros Weighing up the pros & cons of changing a & cons of changing a particular behaviourparticular behaviour
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P r e c o n t e m p l a t i o n
C o n t e m p l a t i o n
P r e p a r a t i o n
A c t i o n
M a i n t e n a n c e
B e h a v i o u r a lP r o c e s s e s
E x p e r i e n t i a lP r o c e s s e s
S e l f - e f f i c a c y
Sta
ge
s o
f C
ha
ng
e
P r o s
T r a n s t h e o r e t i c a l M o d e l
C o n s
TTM PREDICTIONTTM PREDICTIONSS
Cognitive Processes
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Advantages of Using TTM for Advantages of Using TTM for Behaviour ChangeBehaviour Change
Recognises behaviour is not “all-or-Recognises behaviour is not “all-or-
nothing”nothing” distribution of population by stagedistribution of population by stage
Work with total populations:Work with total populations: Stage-matched interventionsStage-matched interventions Recruitment and retention by stageRecruitment and retention by stage Evaluate success of interventions by Evaluate success of interventions by
stage progressionstage progression
40
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
41
Application of the TTM to physical activityApplication of the TTM to physical activity
Marshall & Biddle (2001) Meta Analysis:Marshall & Biddle (2001) Meta Analysis:
71 published articles and abstracts:71 published articles and abstracts: 54 cross-sectional54 cross-sectional 6 longitudinal6 longitudinal 10 quasi-experimental10 quasi-experimental 1 randomised controlled trial1 randomised controlled trial
91 independent samples91 independent samples
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Physical Activity
Precontemplation Preparation Maintenance
Contemplation Action
1
2
0
1.5
0.5
Effect Size2.5
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Self-Efficacy
Precontemplation Preparation Maintenance
Contemplation Action
1
2
0
1.5
0.5
Effect Size
2.5
k = 19N = 3462Failsafe k = 37
k = 17N = 5719Fsk = 13
k = 15N = 3537Fsk = 30
k = 16N = 4662Fsk = 42
44
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
45
Decisional Balance
1
0
0.5
Effect Size
Precontemplation Preparation Maintenance
Contemplation Action
Pros
Cons
Cons (Narrative)
2
1.5
46
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
Conclusions: Decisional Balance
47
Processes of Change
Precontemplation Preparation Maintenance
Contemplation Action
Behavioural
Cognitive
1
2
0
1.5
0.5
Effect Size
1
1.5
2
0.5
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Individual process use
CtrCondHelpRelReinManSelfLibStimContConRaisDramRelEnvReSocLibSelfRe
Precontemplation Preparation Maintenance
Contemplation Action
1
2
0
1.5
0.5
Effect Size
2.5
BEHAV
COG.
49
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?
51
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 (?)
Physical activity behaviour change theory: The Transtheoretical Model and all that
Stuart Biddle