Catherine Woods, Nanette Mutrie and Marian Scott 2002

Physical activity intervention: A Transtheoretical Model-based intervention designed to help sedentary young adults become active Catherine Woods, Nanette Mutrie and Marian Scott 2002

Introduction! • The focus of the study was on improving students awareness of sporting facilities available and the positive effects that physical activity has on their health

Background • According to the HEBS (1997) 62% of 16-24 yr olds in Scotland were not achieving the minimum requirements of physical activity • Other studies have supported this (Pinto and Marcus 1995;Douglas et al, 1997)

Transtheoretical Model • Integrative and comprehensive model of behavioural change • Original use was for negative addictive behaviours e.g. smoking • Now one of the most important theoretical health promotion developments of the decade (Samuelson 1997)

Transtheoretical Model (TM) • Involves understanding ‘HOW’ individuals change their behaviour (processes of change) • And ‘WHEN’ this change happens (stages of change)

Experiential Processes: Consciousness raising Dramatic relief Environmental re-evaluation Self re-evaluation Social liberation Behavioural Processes: Counter conditioning Helping relationships Reinforcement management Self-liberation Stimulus control The HOW

The WHEN • Five stages of change (SOC) • Precontemplation (sedentary, no intention) • Contemplation (sedentary, 6 month intention) • Preparation (irregularly active and intention) • Action (regularly active for last 6 months) • Maintenance ( regularly active for longer than 6 months)

The Model • The TM has allowed researchers to identify and work with sedentary populations through use of interventions • A SOC effect for process use has also been identified (Prochaska and DiClemente,1983; Prochaska et al 1991)

This Study • This study builds on current research • Focuses on young adult group in Scotland • Past research covered middle aged adults and the elderly and didn’t take place in Europe

Aim! • To determine the efficacy of a postal intervention, based on the TM processes of change, in helping sedentary young adults become more active • To explain any changes in SOC over 7 month period in terms of processes of change use

Procedure • Sedentary students from large urban university in Scotland • Baseline data was extracted from a survey on physical activity completed during matriculation • 7 months later the target group was asked to complete a follow up questionnaire

Procedure • Pre-post randomised control design • At baseline, sedentary students were randomly assigned to an experimental or control group • Experimental group was targeted with an intervention in first 6 months at uni • Control group received no intervention but had access to all opportunities provided to experimental group

Measures • Baseline questionnaire based on one used in previous study (Carnie and Mutrie 2000) • Action criterion, regular physical activity was defined using both the CDC/ACSM(1995) and ACSM (1990) recommendations • Individuals habitual exercise was assessed using an ordered categorical SOC scale (Marcus et al 1992) • Binary questions made up the rest of the baseline questionnaire

Measures • Follow up questionnaire used same SOC measure. • Used 5 point Likert scale • Questions on the intervention, the university’s facilities and a final section for comments concluded the questionnaire

PAL 1 November Consciousness raising Social liberation PAL 2 January Self re-evaluation Self liberation and counter conditioning Helping relationships Reward management Intervention

Data Analysis • Non-parametric • X2 tests of association • Kruskal-Wallis ANOVAs • Mann-Whitney procedures • Median scores of processes of change

Data collection • Baseline questionnaire completed by 74% of first yr undergrad students • Data was only usable from 88% • 62% were female • 76% of sample were Scottish

Data collection • Follow up questionnaire response 49% • 92% of questionnaires were usable • 68% female • 96% of sample Scottish

Results-Physical Activity Participation • Initial SOC was significantly related with participation in PE but not EC • At follow-up, significantly more of the experimental group were members of the SRS than the control group • Membership was related to improvement in SOC in both groups • 60% of experimental group found intervention useful for adopting a physically active lifestyle

Results - SOC • Experimental gp reported improved SOC • 45% of experimental gp compared to 33% of control group were in regularly active SOC (action and maintenance) • Self re-evaluation and self liberation received highest frequency of use • SOC improvers scored significantly higher on all behavioural processes and 4 cognitive processes • Experimental gp scored significantly higher on social liberation than control gp

Graph • To establish a significant stage effect for process use for SOC improvers

Discuss! • How many of you chose Heriot-Watt on its sporting facilities? • Are sporting facilities advertised well, when applying at HW ? • Do you feel an intervention would work at HW?

Discussion • Significantly more females than males responded which relates to past research (Bull et al, 1999) • 20% of sample pre-uni knew of SRS facilities with 25% saying it influenced their uni choice • Intervention could be used as part of uni marketing, to help recruit students through enhancing their knowledge of facilities

Discussion • SOC improved significantly for experimental gp, not control gp • Suggests intervention design based on TM is useful (DiClemente et al 1991) • Control gp did improve their SOC but thought to have been due to supportive environment of uni

Discussion • Results support the hypothesis of the TM ‘The more advanced an individual is in the SOC, the more frequently they will use the processes of change’ Di Clemente et al, 1991

Discussion • Social liberation (SL) used significantly more by experimental gp • Could be because intervention targeted SL, although targeted others too! • Suggests encouraging PA as natural and socially acceptable could influence intervention design

Results conflicted with past research • Self re-evaluation, self liberation and counter conditioning and reward process had greatest frequency of use. • Past research suggested consciousness raising and dramatic relief were used highly

Discussion • SOC effect found in both groups • Pre-contemplators used processes least with process use peaking in action and maintenance stages • Women used experiential processes more than men

WEAKNESSES Targeted at student population Self report measure – creates bias Time restrictions at baseline data collection Cross-sectional and longitudinal data STRENGTHS Valuable data Target specific Increased students awareness of PA Inexpensive Mail delivered Self instructional Evaluation!

Any questions?

Catherine Woods, Nanette Mutrie and Marian Scott 2002