The older adult population and the number of older adults who rely primarily on driving as their means of transportation in later life are increasing. Older adults experience changes due to aging and age-related diseases that may put them at increased risk of crashes and other unsafe driving behaviours. Considerable evidence has demonstrated that some older adults compensate for their declining abilities by voluntarily restricting their own driving to limit exposure to risky driving situations or by stopping driving altogether. Since mobility is critical for maintaining the independence and quality of life of the older adult, it is important to examine factors that influence driving behaviours of older adults and to promote their safe driving for as long as possible. It has been suggested that driving cessation might occur in discrete stages of driving restriction culminating in driving cessation. Yet, the application of TM to older driver behaviour has not been explored in detail. Thus, the purpose of this research was to explore older adults’ perceptions and experiences of the process of older driver behaviour change within the TM framework. Drivers and former drivers (both men and women) aged 71-94 years of age completed a health and demographic questionnaire and participated in either a digitally recorded semi-structured individual interview or a group discussion. Participants were asked a series of pre-determined questions and probes tailored for either current or former drivers to examine this process. The recordings were transcribed and reviewed for themes related to driving behaviour change. The participants exhibited a wide variety of perceptions and experiences related to the process of driving behaviour change in aging. Their driving behaviour in aging could be divided into 2 general classes: those who changed their driving with age and those who did not. The spectrum of experiences ranged from those who gradually imposed restrictions on their driving with age (“the gradual restrictors”) or made plans for stopping (“the preparers”) to those who always employed driving restrictions throughout their driving history (“the consistent”) or those who made no or only minor changes to their driving behaviour with age (“the non-changers”). Some preliminary support for TM within the driving context was found and recommendations for extensions to the TM model were suggested. Further exploration of driving behaviour change within the TM framework is warranted. The findings from this study may be appropriate for use in designing educational strategies and interventions aimed at helping older adults remain on the road safely longer or stop driving, if needed.

Syfte: Pröva en integrerad metod av den transteoretiska modellen och begreppet känsla av sammanhang hos ungdomar gällande munhygienbeteende och upplevelse av intervention och reflektioner kring oral hälsa. Metod: Studien utfördes med en mixad metod. Urvalet bestod av 20 ungdomar där 11 valde att delta. Deltagarna randomiserades till två grupper där experimentgrupp vid base-line fick ta del av den beteendevetenskapliga interventionen och kontrollgrupp av en mer traditionell tandvårdsbehandling. Plack och gingivit mättes vid base-line och efter en månad. Experimentgrupp intervjuades vid uppföljning om upplevelse av att ha fått ta del av intervention och inställningar till oral hälsa. Statistiska analyser av kvantitativa data gjordes för att räkna ut skillnader inom respektive grupper samt mellan dem gällande plack och gingivit. Dataanalysen utfördes med deskriptiv statistik och icke-parametriska test. En kvalitativ innehållsanalys gjordes av intervjuerna och sedan jämfördes kvantitativa och kvalitativa resultat och presenterades i en metaslutsats. Resultat: Mellan base-line och en-månads uppföljning minskade plack och gingivit signifikant hos experimentgruppen. I jämförelse mellan grupperna minskade plack och gingivit mer hos experimentgrupp än kontrollgrupp. Frågeställningen kring deltagarnas upplevelse av interventionen resulterade i huvudkategorierna ”positivt bemötande” och ”begriplig och motiverande kunskap”, med fyra underkategorier. Frågeställningen om reflektioner kring oral hälsa resulterade i ”oral hälsa ur en social kontext” och ”munnens betydelse för att fungera och se bra ut” också med fyra underkategorier. Slutsats: Den integrerade beteendevetenskapliga interventionen gav ett bättre resultat på munhygienbeteende hos deltagarna än den mer traditionella tandvårdsbehandlingen. Upplevelsen av att ha tagit del av interventionen var positiv vilket stärker interventionens användbarhet. Mer forskning behövs för att utreda nyttan och användbarheten av interventionen inom tandvården.

The term ‘epidemic’ is often used to describe the obesity phenomenon and indicate that overweight or obesity is a worldwide phenomenon. While the prevalence of overweight and obesity has been increasing, reviews on overweight and obesity studies indicate a clear need for further effectiveness studies of innovative and cost-effective strategies to improve the long-term outcomes of weight loss and weight maintenance programmes in large populations. Current weight loss interventions, while successful in the short term, are often not cost effective enough to deliver on a large scale because they are labour and time intensive. Most importantly, they do not cover large populations. Despite some individual successful weight loss in these interventions programmes, individuals still need to self- manage their weight following intervention. It is unrealistic to expect health professionals and clinicians to provide timely and long-term ongoing support for 2.1 billions overweight and obesity populations around the world (OECD Health Statics, 2014).Therefore, the solutions for weight control may be more effective if grounded within the online community, that is, design long-term solutions that build and draw on social capital to support weight maintenance and are scaled to cope with large populations. Understanding the individual weight loss experiences through informal online social support and utilising the advantages of computer-mediated communication (CMC) can be a timely and cost-effective way to help people self-manage their weight. A three-month online longitudinal phenomenological interview of 17 informants recruited from an online community forum was applied to explore the weight loss experiences with assistance of informal online social support. Four weight loss threads selected by the informants during their weight loss process were also interpreted to map out the key roles of informal online social support and the interaction process that takes place in an online community forum. This research describes the lived experiences of individuals’ self-help weight loss process and maps out the critical moments and differential experiences involved in the Stages of Change (SoC) to explain the individual differences during different weight loss stages. This research also identifies the interrelationships of Processes of Change (PoC) for facilitating behaviour change. The findings of this research contribute to demonstrate the interaction process between community members and the process of providing and receiving social support at different individual members’ weight loss stages, which helped them to continue to lose weight or maintain their weight. The informal online social support could meet different self-help weight loss individual’s needs during different weight loss stages, which is difficult to be provided by the healthcare providers. The findings also contribute to social marketing as a way of offering a cost-effective and efficient way to assist the self-help individual to self- manage their weight in the long term. It may also be a viable way of addressing the issues of costs and labour intensity found in the current weight loss interventions that want to serve large populations.

Physical activity has been demonstrated in the literature as an effective way to reduce the risk for development of chronic disease. The Transtheoretical Model (TTM) of behavior change has been developed as a means to predict and facilitate movement into healthier lifestyle behaviors. The model is centered on "stages of change", which describe a continuum of readiness to engage in a health behavior change. Stages contain temporal, qualitative, and quantitative characteristics. This was a six-month study that evaluated the effectiveness of stage-matched (theorized to be pertaining only to the maintenance stage of change) vs. generic (theorized to be pertaining to anyone, regardless of stage) newsletters in assisting subjects to attain the Maintenance stage of change. It also sought to identify further qualitative characteristics that can differentiate between the Action and Maintenance stages of change. Results indicated that monthly stage-matched newsletters were no more effective in helping subjects reaching Maintenance than were the generic newsletters. Exerciser self-schema was related to stages of change, but those relationships differed from baseline to six-month follow-up, indicating development of exerciser self-schema during the study period. Implications of this are discussed. Other concepts discussed included "structure" of change process, in that three new scores were developed and correlated with self-efficacy as well as intercorrelated. Motivation was also evaluated and compared across levels of success at adhering to exercise during a three-month period. Limitations of the study and implications are discussed.

Purpose: Assess the effectiveness of an online intervention to encourage self-management in adolescents with cerebral palsy (CP). Specific Aims: (a) assess effectiveness of an online intervention to promote readiness for self-management in adolescents with CP, (b) describe health literacy and associations with readiness to assume self-management, and (c) evaluate adolescents’ exposure to the online intervention. Hypotheses: (a) intervention subjects would demonstrate improvement in self-management, and (b) subjects with higher health literacy would demonstrate higher self-management capabilities. Framework: Transtheoretical Model of Health Behavior Change Design: Randomized control trial, performed in a multidisciplinary CP clinic at a university based children’s hospital. Instruments used: (a) Transition Readiness Assessment Questionnaire (TRAQ) and (b) the Health Literacy Skills Instrument-SF (HLSI). Due to low engagement, the study terminated early. Intervention subjects were interviewed to assess their limited engagement. Results: Seventy-five percent of subjects demonstrated inadequate HL. Mean baseline TRAQ score (n=24) was 2.71 (SE = .24). Positive associations were found between TRAQ and age (.47, p = .00) and TRAQ and HL (.48, p = .00). Conclusion: Failure to engage with the intervention appeared to be related to: (a) low HL, (b) low TRAQ scores (indicating subjects in contemplation stage) (c) inconsistency between subjects’ preference for learning and delivery of information, and (d) low motivation for self directed learning. Online interventions should be easy to use and include learning preferences. Lessons learned will inform future development of interventions for this population.

Anyone who understands MI as a process may spontaneously think that five weeks of MI conversations may be a little short of time to be able to see a clear effect. At least that was my spontaneous thought. This was precisely the starting point of the study, which further led to the purpose of the study, i.e. to evaluate MI as a conversation method and see how effective the method is over a five-week period in a health and lifestyle-related behavior change. The aim is further specified by two questions: How has the health-related behavior changed during five weeks of MI-sessions based on the transtheoretical model? How has motivation changed over five weeks of MI-sessions? In order to answer the purpose and questions, MI- sessions with four female clients have been conducted over five weeks. In order to measure the effect of the MI-sessions, the clients during their first and last call answered scale questions intended to measure the client's motivation. In addition, each conversation has been documented in writing by me as conversation leader, where the most essential parts of the conversation have been noted to make it possible to follow the client's development in the transtheoretical model. The result showed that MI contributed to a strengthened intrinsic motivation as well as progress in the transtheoretical model as a result of a five-week period of MI-sessions. Through the study, it can be concluded that five weeks of MI-sessions are enough to strengthen the inner motivation and develop in the transtheoretical model. / Den som är införstådd i MI som process kanske spontant tänker att fem veckor av MI-samtal kan vara lite kort om tid för att kunna se en klar effekt. Det var åtminstone min spontana tanke. Just detta blev studiens utgångpunkt som vidare ledde fram till syftet med studien d.v.s. att utvärdera MI som samtalsmetod och se hur effektiv metoden är under en femveckorsperiod vid en hälso- och livsstilsrelaterad beteendeförändring. Syftet specificeras vidare av två frågeställningar: Hur har det hälsorelaterade beteendet förändrats under fem veckor av MI- samtal utifrån den transteoretiska modellen? Hur har motivationen förändrats under fem veckor av MI-samtal? För att besvara syftet och frågeställningarna har MI-samtal med fyra kvinnliga klienter genomförts under fem veckor. För att mäta effekten av MI-samtalen har klienterna under sitt första och sista samtal besvarat skalfrågor som avser mäta klientens motivation. Dessutom har varje samtal dokumenterats i skrift av mig som samtalsledare där samtalets mest väsentliga delar noterats för att göra det möjligt att följa klientens utveckling i den transteoretiska modellen. Resultatet visade att MI bidrog till en stärkt inre motivation samt framsteg i den transteoretiska modellen till följd av en femveckorsperiod av MI-samtal. Genom studien kan man dra slutsatsen att fem veckor av MI-samtal räcker gott för att stärka den inre motivationen samt utvecklas i den transteoretiska modellen.

Smokefree environment created by smokefree policies is associated with smoking reduction; however, there is paucity of literature on the relationship between smokefree home rules and smoking intensity in low-and-middle income countries (LMICs), and how smokefree policy affects smoking behavior of smokers at different stages of smoking cessation. This study examined the relationship between smokefree home rules and average number of cigarettes smoked per day (CPD) among daily smokers at different stages of the transtheoretical model (TTM) of change. Data from 18,718 current daily cigarette smokers from the Global Adult Tobacco Survey (GATS) conducted from 2011 to 2017 in 20 LMICs were analyzed. Weighted multivariable linear regression analyses were conducted using the log of CPD as the outcome variable with smokefree home rules as the exposure variable, controlling for selected covariates. Approximately 15% of the participants were in precontemplation, 5% were in preparation, 15% lived in partial smokefree homes, and 30% lived in complete smokefree homes. The average number of CPD was 12.3, 12.0, and 10.6 among participants living in homes where smoking was allowed, partial smokefree homes, and complete smokefree homes, respectively. Compared to living in homes where smoking was allowed, living in complete smokefree homes were associated with 22.5% (95%CI = 18.4%–26.5%), 17.9% (95%CI = 8.4%–27.3%), and 29.3% (95% CI = 17.1%–41.5%) fewer CPD among participants in precontemplation, contemplation, and preparation stages, respectively. These findings suggest that complete smokefree home policy will benefit smokers in LMICs irrespective of their intention to quit smoking in addition to protecting non-smokers from secondhand smoke exposure.

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