Search Results (83)

Background/Objectives: There is an invisibility of the diabetes epidemic among Vietnamese Americans. Not only is there limited availability of culturally and linguistically tailored national Diabetes Prevention Program (DPP) and Diabetes Self-Management Education and Support (DSMES) programs, but there are enrollment and retention challenges that hinder these programs’ sustainability and expansion. The purpose of this study was to explore the cultural beliefs, perceived barriers, and motivating factors that influence Vietnamese Americans’ willingness to engage in existing diabetes prevention and self-management programs. Methods: A qualitative descriptive study design was used. A total of 26 participants were recruited through snowball sampling. Bilingual Vietnamese American researchers conducted semi-structured interviews. Content analysis was used to analyze data. Results: Most participants were in the earlier stages of readiness for engagement in a national diabetes program. Major barriers to engagement were related to financial and time constraints, notable among middle-aged participants. Key motivators for engagement included increasing health awareness and family and other social support. Despite their hesitation regarding diabetes program engagement, most participants were further along in the stages of readiness for self-directed lifestyle management. Conclusions: These results will guide the development of a linguistically and culturally adapted diabetes prevention and management program that will support individuals at various stages of their behavior change journey. The program should align with cultural values, address structural barriers, and emphasize the integration of social and familial motivators. Full article

Growing interest in food sustainability education aims to increase awareness of food distribution systems, environmental degradation, and the connectivity of sustainable and ethical food practices. However, recent scholarship has questioned whether such pedagogical efforts are meaningfully internalized by students or lead to sustained behavioral change. Prior studies document persistent gaps in students’ understanding of sustainability impacts and the limited effectiveness of existing instructional approaches in promoting transformative engagement. To address these concerns, the Food Ethics, Sustainability and Alternatives (FESA) course was implemented with 21 undergraduate and graduate students at Montclair State University (Montclair, NJ, USA). Course outcomes were evaluated using a mixed-methods design integrating qualitative analysis with quantitative measures informed by the Theory of Planned Behavior, to identify influences on students’ attitudes, and a Transtheoretical Model (TTM) panel survey to address progression from awareness to action, administered pre- and post-semester. Qualitative findings revealed five central themes: increased self-awareness of food system contexts, heightened attention to animal ethics, the importance of structured classroom dialogue, greater recognition of food waste, and increased openness to alternative food sources. TTM results indicated significant reductions in contemplation and preparation stages, suggesting greater readiness for change, though no significant gains were observed in action or maintenance scores. Overall, the findings suggest that while food sustainability education can positively shape student attitudes, the conversion of attitudinal shifts into sustained behavioral change remains limited by external constraints, including time pressures, economic factors, culturally embedded dietary practices, structural tensions within contemporary food systems, and perceptions of limited individual efficacy. Full article

Individual actions play a pivotal role in climate change, one of the most urgent global challenges, as daily behaviors generate substantial greenhouse gas emissions. Saudi Arabia, in particular, demonstrates its strong commitment to environmental sustainability through the Saudi Green Initiative and Middle East Green Initiative, aiming for net-zero emissions by 2060 and advancing reforestation, land conservation, and renewable energy under Vision 2030. However, many Saudi individuals remain unaware of the environmental consequences of their choices, including transportation, energy consumption, and lifestyle habits. To address this gap, this study developed GreenKSA, the first Arabic-supported gamified mobile application designed to promote pro-environmental behavior within the Saudi culture. The app integrates gamification elements grounded in Self-Determination Theory (SDT) and Trans-Theoretical Model (TTM) in an attempt to bridge the gap between theory and practice. GreenKSA delivers multimedia content—short videos and infographics—demonstrating sustainable routines in households, workplaces, and mobility. The design and user experience of GreenKSA were evaluated in a pilot study of 10 participants. The results indicated high usability (SUS = 91.25) and a positive overall user experience. By combining theory-driven design with culturally relevant gamification elements, this study contributes to digital sustainability interventions and aligns with the global Sustainable Development Goals SDG 12: Responsible Consumption and Production, and SDG 13: Climate Action. Full article

Background: Chinese adolescents face a dual burden of malnutrition, yet the weight-status-specific mechanisms underlying physical activity (PA) participation remain underexplored. Methods: We conducted a cross-sectional study among 1573 adolescents (aged 9–15 years) in Shangrao City, China. Validated scales measured social-ecological factors (family/peer support, physical environment), psychological factors (stage of change, self-efficacy, decisional balance), and PA participation. Data preprocessing utilized full information maximum likelihood to handle missing values. Confirmatory factor analysis was performed to validate the measurement model, followed by multi-group structural equation modeling to analyze pathway configurations across underweight (n = 187), normal-weight (n = 1070), and overweight/obese (n = 316) groups. Mediation effects were tested using bootstrapping with 5000 resamples. Results: Clear weight-specific patterns emerged. Normal-weight adolescents presented a fully functional comprehensive model where PA was predicted by the stage of change (β = 0.211, p < 0.001), friend support (β = 0.120, p < 0.001), self-efficacy (β = 0.092, p < 0.05), and perceived benefits (β = 0.095, p < 0.01). Underweight adolescents primarily relied on internal readiness driven by stage of change (β = 0.270, p < 0.001) and self-efficacy (β = 0.164, p < 0.05), with family support only indirectly influencing participation via psychological mediators. In contrast, overweight/obese adolescents showed a “socially dependent” pattern: friend support directly predicted PA levels (β = 0.136, p < 0.05), significantly enhanced self-efficacy (β = 0.370, p < 0.01), and effectively lowered perceived barriers (β = −0.165, p < 0.05). Additionally, the physical environment strongly impacted perceived benefits (β = 0.471, p < 0.01) but did not translate into action. Conclusions: These findings underscore the significant differences in PA determinants across the spectrum of malnutrition, necessitating targeted public health interventions to support the Healthy China 2030 initiative. Full article

As the hospitality industry adapts to meet customers’ increasing demand for wellness, incorporating innovative wellness services (WSs) has become a crucial strategy to retain customer engagement. This study explored how the psychological trait of grit may serve as a significant determinant of customer engagement with WS in the hospitality context. Grounded in the transtheoretical model (TTM) stages of change, the study examined the relation between grit and customers’ perceptions of wellness hospitality services. By integrating TTM as a theoretical framework, this research attempted to understand the way that individuals interact with and perceive wellness-oriented amenities; also, it offers actionable insights into ways to enhance customers’ engagement. The study employed a quantitative method. By using an online survey (N = 337) and structural equation modeling (SEM), the study explored the relation between grit, WS, and customer engagement in the hospitality industry. Grit was found to be an important antecedent of using and engaging with various WSs. This study also demonstrated that WSs have a significant positive effect on customers’ engagements with WS. These study findings can help hospitality professionals to identify gritty customer segments to retain possible customer retention. Full article

Background/Objectives: Sustainable nutrition is essential for human and planetary health. The Transtheoretical Model-based Sustainable Nutrition Behavior Scale (TTM-SNBS) was developed to assess sustainable nutrition behaviors and the dynamic processes of behavior change in adolescents. Methods: The item pool was generated through literature review and expert consultation using the Delphi technique (10 experts, three rounds). Construct validity was assessed using exploratory and confirmatory factor analyses. Reliability was evaluated through Cronbach’s alpha and test–retest methods. External validity was examined through correlations with the Sustainable and Healthy Eating Behaviors Scale (SHEBS), following COSMIN standards. The study included 512 adolescents aged 14–18 years (54% female) from public high schools in Ankara, Türkiye. Results: Initially, 75 items were developed through expert evaluation. After preliminary testing, two items with low and negative correlations were removed; 73 were retained for validation. Factor analyses and refinement produced a 45-item final validated scale comprising one stage of change item and five subscales: cognitive processes (14 items), behavioral processes (18 items), decisional balance—pros (4 items), decisional balance—cons (4 items), and self-efficacy (4 items). Items showed good discrimination (>0.27). Cronbach’s alpha values ranged from 0.67 to 0.93, and fit indices were acceptable (χ²/df = 2.8–4.2; RMSEA = 0.045–0.065). External validity was supported by significant positive correlations with the SHEBS. Conclusions: The TTM-SNBS is the first psychometrically validated, theory-based instrument to assess sustainable nutrition behaviors in adolescents. It offers a reliable and valid instrument to support future research and interventions promoting sustainable dietary practices. Full article

The Clinical Descriptions and Diagnostic Guidelines (CDDG) for Mental, Behavioral, and Neurodevelopmental Disorders (MBND) in the International Classification of Diseases 11th Revision (ICD-11) are a substantial improvement over their equivalent in the ICD-10. This study evaluates the usefulness of the synchronous and asynchronous modalities of an online training course on the ICD-11-CDDG-MBND to increase readiness to implement it in routine clinical practice among Spanish-speaking clinicians. A convenience sample of psychiatrists, psychologists, and general practitioners completed online evaluations of one of the two course modalities. Acquired knowledge was evaluated through a multiple-choice questionnaire. Readiness to implement the ICD-11-CDDG-MBND was evaluated before and after the course, using an instrument based on the transtheoretical model of stages of change: precontemplation, contemplation, preparation and action. A total of 310 clinicians completed either the asynchronous (n = 176) or synchronous course (n = 134). Prior to the course, most participants were at the precontemplation stage. By the end of the course, participants reported a moderate level of knowledge. The percentage of clinicians at the preparation and action stages was higher than before the courses, with no differences being observed between course modalities. Online training was associated with increased knowledge and motivation to implement the ICD-11-CDDG-MBND. Full article

Water utilities are increasingly turning to digital solutions to promote conservation behaviours among households; however, traditional campaigns often suffer from limited personalisation, low interactivity, and modest long-term impact. Though computer-tailored and recommender systems (RSs) may offer personalisation, these systems lack a generalised framework that integrates behavioural theory with system design. This study addresses this research gap by introducing a novel framework that unites behavioural science, user experience (UX) design, and adaptive digital feedback to foster water-conscious practices at the residential level. The model draws on established behavioural theories, including the Theory of Planned Behaviour, the Transtheoretical Model, and Intervention Mapping, to ensure that tailored recommendations align with users’ psychological drivers, behavioural readiness, and daily routines. An industry-first prototype RS was developed and evaluated through an online survey (N = 300), assessing user perceptions of relevance, motivation, ease of use, and likelihood of action. The results reveal strong support for personalised suggestions, with 82% of respondents agreeing that personalised recommendations would help conserve water, and 76% indicating incentives would motivate adoption. This evidence indicates early acceptance and high potential impact. This study also addresses a critical research gap: no generic model previously existed to guide the integration of RSs with behaviour change interventions in water demand management. Broader implications are also discussed for applying the model to other sustainability domains such as energy use, waste reduction, and climate adaptation. Full article

Backgrounds: To examine the association between stages of exercise behavior change, as defined by the transtheoretical model (TTM), and obesity progression among Chinese children and adolescents, with attention to gender and urban–rural differences. Methods: A total of 5006 Chinese children and adolescents aged 9–18 years were assessed in 2019 and followed up in 2020. Participants were categorized into five TTM stages: precontemplation, contemplation, preparation, action, and maintenance. Logistic regression models evaluated the associations between the TTM stages and obesity outcomes, including incident obesity and transitions from normal or overweight to obesity. Analyses were stratified by gender and urban–rural residence, and interaction effects were tested. Results: Compared to the maintenance stage, precontemplation (OR = 2.08, 95% CI: 1.45–2.99) and contemplation (OR = 1.48, 95% CI: 1.05–2.08) stages had higher obesity risk, with similar trends in follow-up incident obesity (precontemplation: OR = 1.63, 95% CI: 1.17–2.28; contemplation: OR = 1.47, 95% CI: 1.10–1.98). These associations were more pronounced among boys and rural residents. Significant interactions were observed between TTM stages, sex (p = 0.029), and residence (p = 0.005) in obesity transition. Conclusions: Exercise behavior stages are associated with obesity progression, particularly among boys and rural children. These findings underscore the importance of stage-specific interventions tailored to individual readiness for behavior change and contextual factors. Full article

The objective of this study was to propose an analysis pathway that illustrates the psychological mechanism and corresponding environmental motivators affecting the frequency and duration of outdoor activity participation among older adults in China. Firstly, based on the transtheoretical model (TTM) theory and the environmental psychological approach, a literature review was conducted to select the model variables and ensure that they correspond to the requirements of the stage of change construct and the temporal dimension of the TTM theory. Secondly, the variables mentioned above were rearranged according to the perception, action, experience, and emotion stages of the individual psychological mechanism process and the environmental quality improvement outcome to develop the hypothetical model. Subsequently, a confirmatory factor analysis was carried out to test the hypotheses and validate the model based on the survey data collected in Chengdu City, China. Finally, a total of 372 valid questionnaires were received. After analyzing the collected data, the configuration index relationship of the hypothesis model was validated. In conclusion: Through slicing control of environmental factors in diverse human-environmental interaction stages under the guidance of the stage-based behavioral analysis discipline, this study explores an analysis pathway for upgrading outdoor environment facilities to enhance the attraction and attachment characteristics of the environment and, in turn, promote the sustainability of the outdoor activities performed by older people. Full article

Sustainable consumer behavior refers to any behavior that benefits environmental protection and social justice. Previous research has shown that sustainable consumer behavior is positively associated with consumer wellbeing. Recycling behavior is a type of sustainable behavior that has been studied extensively. However, research on behavior change in recycling is limited. The purpose of this study is to identify the change stages for recycling behavior among American consumers. Using national data collected in the U.S. and under the guidance of the transtheoretical model of behavior change (TTM), the results showed that most Americans engage in recycling behavior, but a minority of them do not. Among them, 13% have never considered recycling in the near future. We also identified the differences in behavior change stages in terms of psychological, cognitive, socioeconomic, and environmental factors. The findings have implications for policy makers, business professionals, and consumer educators to develop strategies to encourage consumer recycling behavior. Full article

Combatting climate change requires motivating individuals to adopt climate-friendly behaviors, whether to make individual lifestyle changes, vote for environmental policy, or accept technological innovations. Efforts to promote such behaviors can be more effective when informed by theoretically and empirically driven insights into human behavior change—an endeavor led by persuasion research. This review explores the intersection of persuasion research and climate-friendly behavior, demonstrating how persuasion theory can be applied to encourage climate action. Key theoretical approaches are examined, including the theory of planned behavior, social norms, narrative-based persuasion, framing, and emotional appeals, along with considerations for their practical applications. Additionally, promising future directions for integrating persuasion research into climate change interventions are highlighted; these include tailoring messages based on moral foundations theory and the transtheoretical model, as well as leveraging artificial intelligence to personalize climate-friendly recommendations. By synthesizing insights across persuasion and environmental research, this review provides valuable guidance for environmental researchers, policymakers, intervention designers, communication strategists, and environmental activists in developing robust and effective strategies to increase climate action at a time when accelerating these behaviors is more urgent than ever. Full article

Objectives: Violence in intimate relationships (IPV) is understood as one of the most common forms of violence, being maintained by cultural habits and customs, and legitimized from generation to generation. This study aims at a comprehensive review of the literature on IPV, the relationship between the stages of change, maintenance factors, and the decision to keep or leave the violent partner. Methods: A comprehensive literature search was conducted to identify journal articles focused on IPV, following online databases as well as a manual review from relevant peer-reviewed journals. Results: Seeking help is one of the main steps in the process of change, and the stages of change are directly related to the success of interventions, so identifying stages early provides a more appropriate and effective choice of intervention. Conclusions: Thus, evaluating the stage of preparation for the change in which the victims are found is important for the individual understanding of the experience and supporting the intervention. In this sense, the Domestic Violence Survivor Assessment (DVSA) will also be presented, an instrument for evaluating the process of intentional change in victims of IPV, using the TTM. Full article

Background/Objectives: Current scientific evidence shows both the relationship between good physical condition and a lower incidence of certain chronic diseases (including smoking), as well as the efficacy of cytisinicline. The aim of this protocol is to evaluate the efficacy of the synergistic effect of the combination of targeted physical exercise, together with brief advice and taking the drug cytisinicline, to achieve smoking cessation. Methods: We propose an experimental, multicentre, randomised, controlled study with two parallel arms to be carried out by a multidisciplinary team in the primary care setting of the Andalusian public health system (APHS) in Spain, with a follow-up of 12 months. The population sample will include people who are aged between 18 and 65 years and meet the criteria to be eligible for treatment with cytisinicline financed by the APHS: smokers of 10 or more cigarettes per day who are in the determination/action phase for smoking cessation of the transtheoretical model of Prochaska and Diclemente, willing to start anti-smoking treatment imminently and confirmed, with high dependence to nicotine (Fagerström’s test ≥ 7), with a motivation to quit smoking according to the Richmond test (≥6), and who have made a previous smoking cessation attempt in the last year. The study consists of two treatment arms. EXPERIMENTAL ARM: Smokers who are going to be prescribed targeted physical exercise and brief advice to stop smoking while receiving cytisinicline treatment (1.5 mg tablets) according to the care process. CONTROL ARM: Smokers will receive a standard leaflet explaining physical exercise to the general population and brief advice on smoking cessation when starting cytisinicline treatment, according to the care process. The calculated sample size is 75 participants per arm. Results: The primary results will allow us to estimate the efficacy of prescribing physical exercise as an adjuvant therapy to classic multicomponent treatment, incorporating it as an additional element to be considered when it is accepted by the smoker. Conclusions: This protocol (NCT06579846) evaluates the efficacy of combining physical exercise, brief advice, and cytisinicline to support smoking cessation, improve fitness, and reduce smoking-related comorbidities Full article

Background: Smoking is a detrimental health behavior that can be addressed by designing stage-matched interventions with evidence-based behavioral change models such as the transtheoretical model (TTM). This study applied the TTM to predict smoking cessation stages among adults in Saudi Arabia. Methods: This social media-based cross-sectional study in Saudi Arabia used a convenient sample of 491 adult smokers (men and women). A digital questionnaire containing basic and smoking-related data and smoking scales (stages of change, cessation readiness, decisional balance, and self-efficacy) was used for data collection. The data were collected from 1 July to 30 October 2023 and were investigated using an ordinal regression analysis. The results illustrate that among the studied smokers, cigarette smoking was the prevalent method of smoking, especially among men (71.7%) compared to women (27.8%). Regarding stages of smoking, the pre-contemplation (35.8%) and contemplation (30.1%) stages were the highest, where men were more represented in both stages (37.9% and 40.8%, respectively). In comparison, women represented a higher percentage in the action (23.9%) and maintenance (21.1%) stages. The ordinal regression showed that increasing age (adjusted odds ratio; AOR = 1.045, p = 0.044), high quitting readiness (AOR = 1.134, p < 0.001), self-efficacy (AOR = 1.965, p = 0.028), decisional balance (AOR = 1.870, p < 0.001), and absence of psychological problems (AOR = 2.047, p < 0.001) increased the likelihood of being at higher smoking cessation stages. However, increased smoking duration (AOR = 0.756, p = 0.010), male gender (AOR = 0.340, p < 0.001), not working (AOR = 0.364, p = 0.013), adequate income (AOR = 0.535, p = 0.032), no chronic diseases (AOR = 0.430, p < 0.001), regular smoking (AOR = 0.052, p < 0.001), high smoking dependency (AOR = 0.775, p = 0.038), and hookah smoking (AOR = 0.032, p < 0.001) decreased the likelihood of being at higher smoking cessation stages. Conclusions: Cigarette smoking is a prevalent problem among Saudi adults, especially men, with the highest percentage of these being at lower smoking cessation stages. Thus, this study recommends the development of stage-matched interventions to facilitate the move towards higher smoking cessation stages through efforts by, and collaboration between, community sectors to face this rising issue. Full article