Parent and child readiness to change have been identified as emerging areas informing pediatric obesity interventions. The purpose of this study was to increase understanding of child and parent readiness to change in obese youth by examining how these constructs are related to demographic variables, as well as to psychosocial functioning, in a sample of obese youth presenting for weight- management treatment. A secondary aim was to examine consistency between parent and child readiness to change. Two hundred twenty-eight 7- to 17-year-old children and their parents participated during the child’s initial assessment at a multidisciplinary weight-management clinic. Demographic variables included in analyses were child Body Mass Index, parent Body Mass Index, child age, child gender, child race, and family income. Children completed measures of quality of life, depression, social anxiety, internalizing and externalizing symptoms, and readiness to change. Parents completed assessments of children’s quality of life, children’s internalizing and externalizing symptoms, and parents’ own readiness to change. The child’s Body Mass Index was significantly related to both parent and child readiness to change. There was also a significant positive relation between child readiness to change and the child’s own report of social anxiety symptoms, as well as a curvilinear relation with internalizing symptoms, such as depression. In addition to the child’s Body Mass Index, parent readiness to change was positively related to the child’s age and was higher in African American parents than in European American parents. Race moderated the relation between parent readiness to change and health-related quality of life, internalizing symptoms, and externalizing problems. Parents and children were discordant in their ratings of readiness to change, with parents tending to report higher levels; the child’s Body Mass Index moderated the relation between parent and child report of readiness to change. Clinical implications and future directions are discussed.

The purpose of this study was to investigate to what extent university students are regularly physically active, what motives and barriers they perceive towards exercise and the relationship between motivational profile, self-efficacy and exercise behaviors. A questionnaire including the instruments Physical Activity Stages of Change, BARSE, BREQ-2 and Exercise Adherence Questionnaire was distributed at a university in southern Sweden. The respondents (n = 251) were Men (n = 104) and Women (n = 147). For analysis and processing of the gathered data SPSS was used with One-Way ANOVA, Pearson's r and Regression Analysis. The study showed that 70 percent of the students were regularly physically active. The most common motives for exercise were to improve health and increase physical strength whilst the most frequent barriers were lack of motivation and lack of energy/fatigue. The results also revealed positive correlations between identified regulation, intrinsic regulation, barrier self-efficacy and physical activity.

This study aimed to verify the propositions regarding the application procedures indicated in the cinematherapy literature. Moreover it was also aimed to frame the rationale of cinematherapy on a theoretical basis by integrating the procedures of cinematherapy intervention technique into Transtheoretical Model (Prochaska &amp / Norcross, 2003) and to discover the mechanisms that the applications function through. Finally, it was also aimed to apply cinematherapy intervention technique to the domain of relationship problems. For this study, university students who were in an on-going relationship and were in need of professional help due to their relationship problems were included. Content analyses were conducted for reaching the aims of the study. According to these results, in viewing stage the four-stage process was not attained by all participants, while all stages, except catharsis, were reached in one movie during discussion stage. These results suggest that viewing alone does not induce change, but discussions lead to attaining the stages that would expected to induce change. Moreover, the results revealed that during movie discussions a three-phase process was followed / namely identification, awareness, and solution. Based on the results, it could be assumed that the first phase functions through projection processes / whereas the second phase functions through metaphors and the final stage functions as the projections resolved by using metaphors. Furthermore, according to the outcome monitoring results two participants were grouped in &ldquo / meaningful outcome&rdquo / category, three participants were grouped in &ldquo / ambivalent outcome&rdquo / category, and one participant was grouped in &ldquo / negative outcome&rdquo / category. The results were discussed in accordance with the Transtheoretical Model.

Alors que l'activité physique (AP) est fortement recommandée pour les personnes en surcharge pondérale, beaucoup d'entre elles n'en pratiquent pas ou ne désirent pas en pratiquer (Kearney et al., 1999). Parmi les théories de la motivation, l'approche transthéorique développée par Prochaska et DiClemente (1983) est une approche intégrative qui permet de rendre compte du changement de comportement, notamment à l'égard de l'AP (Farmanbar et al., 2012). Basée sur cette approche, la présente thèse visait à comprendre les mécanismes liés à l'adoption et à l'arrêt d'une AP. Une première étude dont l'objet était de valider un questionnaire de mesure des processus de changement de comportement a révélé une structure factorielle en cinq facteurs invariante d'un sexe à l'autre et prédictrice du niveau d'AP des sujets. Une seconde étude a montré qu'à la suite d'une intervention d'une semaine destinée à améliorer la gestion de la surcharge pondérale, certains processus identifiés par le questionnaire créé étaient impliqués dans le changement de comportement à l'égard de l'AP. Ainsi, un an après l'intervention, trois processus de changement étaient activés chez les participants ayant adopté ou maintenu leur AP: les processus de relations d'aide, de prise de conscience et d'auto-réévaluation/ gestion des renforcements / auto-libération. Une troisième étude visait à examiner les relations entre certaines variables motivationnelles (attentes d'auto-efficacité, satisfaction des besoins psychologiques, régulations motivationnelles), affectives (plaisir perçu), de comportement alimentaire (restriction cognitive) et physiologiques (gluco-dépendance à l'effort, point maximal d'oxydation des lipides) et l'arrêt d'un programme d'AP. Cet arrêt s'est avéré lié aux attentes d'auto-efficacité, à l'amotivation, à la régulation introjectée et à la gluco-dépendance à l'effort. Enfin, une quatrième étude avait pour objet d'examiner la dynamique de ces mêmes variables motivationnelles, affectives et comportementales au cours d'un programme de réentrainement de sept semaines destiné notamment à activer des processus de changement. Des élévations des niveaux d'attente d'auto-efficacité, de régulations identifiée et intrinsèque et de plaisir perçu dans l'AP ont été observées. Ce travail doctoral a donc permis de montrer qu'une approche transthéorique permet de mieux comprendre les comportements liés à l'AP. / While physical activity (PA) is recommended to persons with overweight, many of them do not or do not have the willingness to practice it (Kearney et al., 1999). Through the theories of motivation, the transtheoretical model developed by Prochaska and DiClemente (1983) is an integrative approach which allow to take into account for the change in behavior, particularly with regard to PA (Farmanbar et al., 2012). Based on this approach, the present thesis aimed to understand the mechanisms related to the adoption and cessation of PA. A first study whose purpose was to validate a questionnaire of processes of behavior change revealed a five-factor factorial structure, invariant among sex, and predictive of the PA behavior. A second study showed that, after a one-week intervention designed to improve the management of the overweight, some processes identified by the questionnaire were involved in behavior change regarding PA. Thus, one year after the intervention, three processes were activated among participants that having adopted or maintained their PA: processes of helping relationship, consciousness raising and self-reevaluation/ reinforcement management / self-liberation. A third study sought to examine the relationships between some motivational (self-efficacy, basic psychological need, motivational regulations), affective (perceived pleasure), of eating behavior (cognitive restraint) and physiological (glucodependence, maximal lipid oxidation) variables and the cessation of a program of PA. Then, a fourth study aimed to examine the dynamic of these same motivational, affective and behavioral variables during a training program of seven weeks which aim to active some processes of change. Increases in self-efficacy expectations, identified and intrinsic regulations, perceived pleasure were observed.

Communication concerning the care one wishes to receive at the end of life (EOL) is central to ensuring that wishes are honored. Many studies have examined doctor-patient or doctor-family EOL communication. However, relatively few studies have focused on the occurrence of EOL care discussions among family members. This is an important topic, as research suggests that advance directives (ADs) are ineffective if patients have not involved surrogate decision-makers, most of whom are family members. This study examined EOL care discussions among family members. It used quantitative and qualitative data from a diverse sample of older adults from West Central Florida collected for the purpose of this examination. The quantitative and qualitative data were analyzed separately and together. This study employed the Transtheoretical Model, which proposes that individuals are in varying behavioral “stages of change” and that bringing about a behavioral change requires understanding their particular stage and adapting interventions appropriately. Statistical analysis of the quantitative data (N=364) using multinomial logistic regression showed that participants were in distinct stages that were associated with several factors, including family involvement with health care decision-making and communications with doctors. Racial and ethnic differences were not found in controlled analysis, though Hispanics were less likely to be in more advanced EOL care discussion stages in unadjusted analyses. Several themes were found in qualitative analysis of focus groups (n=36) drawn from the larger sample. Findings suggested that those who engaged in family EOL care discussions were more careful planners overall, more accepting of death, and able to manage complex family dynamics. They also had greater knowledge of EOL matters, largely related to knowledge of loved ones EOL wishes. The quantitative-qualitative (mixed-methods) study reinforced the role of family relationships in general in whether EOL care discussions occurred. It also highlighted the role of being proactive and having EOL care knowledge. All three studies – the quantitative, qualitative, and mixed methods showed the potential for doctors and other health professionals to help families with EOL care discussions and ACP overall.

Because of the expense associated with hospital admissions, the use of observation status has grown. One of the most consistently measured outcomes in observation is the patient length of stay (LOS). Research supports the positive impact that nurse practitioners (NP) have on LOS when added to other service lines that could be applied to observation. Banner Desert Medical Center (BDMC) is currently attempting to decrease their observation LOS. Adding acute care nurse practitioners (ACNP) to the care delivery model is a potential intervention. The purpose of this project was to develop an executive summary to inform staff of current evidence that supports the addition of ACNPs to observation. Then, via a survey, the project aimed to determine the level of staff support by identifying the Transtheoretical Model of Change (TTM) Stage of Change and to recommend appropriate stage-matched interventions for staff based on TTM processes of change. The 10 Likert scale survey questions were adapted from two validated TTM surveys. The final question asked for the pros and cons of the intervention to determine the Decisional Balance (DB). The registered nurse (RN) cohort demonstrated consistently strong support for the proposed intervention with an average mean response of 6.57 on affirmative questions and a correspondingly low average mean of 2.2 on negative questions. When compared to the RN cohort, the physician cohort had lower mean responses with an average of 4.29 on every affirmative, a higher average mean response of 3.85 on the negatively worded questions. The DB for RNs was 19 pros to two cons. The DB for physicians was eight cons to three pros. These finding reflect that nurses are in the Preparation Stage of Change and are ready to move forward with adding ACNPs. An appropriate stage-matched intervention for registered nurses would be the development of change teams. In contrast, the physician cohort is in the Precontemplation stage and is not ready to proceed with adding ACNPs. Appropriate stage-matched interventions for physicians would include facilitating consciousness-raising activities such as an open forum to communicating information about the proposed change and to explore concerns and questions regarding the intervention.

A review of literature indicates limited effort to understand and explain employees' acclimation to, and adoption of, new behaviors required by organization change initiatives. Psychological theories of individual behavior change have, in restricted instances, been applied into organizational environments. The transtheoretical model of change (TTM) offers a comprehensive explanation of behavior change uniting multiple theories of individual change. TTM describes change as a series of stages that individual progress through before arriving at the decision to implement a change in behavior. Movement through the stages is facilitated by processes which increase the probability of a behavior change effort's success. The present research investigated the potential applicability of TTM for explaining individual level change within a new context, specifically, an organizational environment. To examine if individual change in the context of an organization occurs in the fashion described by TTM, measures of core TTM constructs were delivered to employees in a water department of a city in the American southwest. The water department was immersed in an organization change initiative necessitating individual behavior change by its employees. Results of TTM core construct measures and their relationships with each other and the stages of change were examined. Initial findings are indicative of TTM's potential applicability as a description of behavior change within an organizational context. Implications of these findings, potential applications, imitations of the current research, and recommendations for future research are discussed.

The online delivery of higher education courses and programs continues to expand across academic disciplines at colleges and universities. This expansion of online education has been precipitated by, among other things, (a) the rise in personal computer ownership, (b) the ease of access to the Internet, (c) the availability and continuous improvement in technology for the delivery of online courses, and (d) the increase in demand for online courses by both traditional and nontraditional students. However, the proliferation of online education has not been enthusiastically supported by all constituents of higher education. Specifically, some faculty members remain resistant to the shift to online course delivery. This article applies the Transtheoretical Model of Change to the process of gaining faculty support for, and involvement in, online learning. After briefly reviewing current issues in online education and making a case for its adoption, we describe sources of faculty resistance and offer recommendations for interventions that may be applied to transforming faculty resistance to support and eventually to active participation.

The online delivery of higher education courses and programs continues to expand across academic disciplines at colleges and universities. This expansion of online education has been precipitated by, among other things, (a) the rise in personal computer ownership, (b) the ease of access to the Internet, (c) the availability and continuous improvement in technology for the delivery of online courses, and (d) the increase in demand for online courses by both traditional and nontraditional students. However, the proliferation of online education has not been enthusiastically supported by all constituents of higher education. Specifically, some faculty members remain resistant to the shift to online course delivery. This article applies the Transtheoretical Model of Change to the process of gaining faculty support for, and involvement in, online learning. After briefly reviewing current issues in online education and making a case for its adoption, we describe sources of faculty resistance and offer recommendations for interventions that may be applied to transforming faculty resistance to support and eventually to active participation.

Women ages 20–39 years old have seen the most dramatic increase in obesity levels in the United States over the last 2 decades. Researchers have indicated the need for studies to increase motivation in women to promote daily exercise. There is a gap in the literature about what motivational factors are most effective with increasing exercise in daily life. Using the transtheoretical model of change (TM) as the grounding theory, this study measured daily exercise adherence. A selective sampling of women ages 20–39 years old in the United States were recruited to complete an online survey. The online survey included two sections: one to screen participants with informed consent, and the survey itself, including 4 original questions to obtain further information about type of exercise, access to social support, readiness for change, and exercise adherence. A full version of the Exercise Motivations Inventory–2 (EMI-2) was also administered to determine exercise motivation. In total, 105 women were surveyed in the full study and multiple regression was used to assess the findings. Results of the study confirm prior research findings that women engage in exercise due to positive health, ill-health avoidance, and to control weight. In addition, women in the present study indicated positive social support affects daily exercise adherence. The results of this study may contribute to positive social change by furthering our understanding of what contributes to exercise adherence in the United States.