This article describes the development of a behavioral staging algorithm for use in the Eat Well, Live Well Nutrition Program, a peer-delivered community-based program for African American women (N = 301). The authors examined whether increased frequency in performing low-fat eating behaviors and lower percentage calories from fat intake resulted as a participant moved through five stages of readiness to change each of five low-fat dietary patterns. Frequency of performing low-fat dietary behaviors was significantly different (p < .05) between four stages for the pattern of avoid fried foods, three stages for modify meats, and two stages for the patterns of substitution, avoid fat as seasoning, replacement. Percentage calories from fat were significantly different (p < .05) between four stages for the pattern of replacement, three stages for avoid fried foods and modify meats, and two stages for substitution and avoid fat as seasoning. Implications of these findings for the tailoring of community-based dietary programs are presented.
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References
1.
1. DiClemente C, Prochaska J: Self-change and therapy change of smoking behavior: A comparison of processes of change in cessation and maintenance. Addict Behav7: 133-142, 1982.
2.
2. DiClemente C, Prochaska J, Fairhurst S, Velicer W, Velasques M, Rossi J: The process of smoking cessation: An analysis of precontemplation, contemplation, and preparation stages of change. J Consult Clin Psychol59: 295-304, 1991.
3.
3. DiClemente C, Prochaska J: Processes and stages of change: Coping and competence in smoking behavior change, in Shiffman S, Wills T (eds.): Coping and Substance Abuse. San Diego, CA, Academic Press, 1985, pp. 319-343.
4.
4. DiClemente C, Prochaska J: Self-efficacy and the stages of self-change of smoking. Cognitive Ther and Res9: 181-200, 1985.
5.
5. Marcus B, Rossi J, Selby V, Niaura R, Abrams D: The stages and processes of exercise adoption and maintenance in a work site sample. Health Psychol11: 386-395, 1992.
6.
6. Prochaska J, Norcross J, Fowler J, Follick M, Abrams D: Attendance and outcome in a work site weight control program: Processes and stages of change as process and predictor variables. Addict Behav17: 35-45, 1992.
7.
7. Grimley D, Prochaska J, Velicer W, Prochaska G: Contraceptive and condom use adoption and maintenance: A stage paradigm approach. Health Educ Q22(1): 20-35, 1995.
8.
8. Prochaska J, Redding C, Harlow L, Rossi J, Velicer W: The transtheoretical model of change and HIV prevention: A review. Health Educ Q21(4): 471-486, 1994.
9.
9. Rakowski W, Dube C, Marcus B, Prochaska J, Velicer W, Abrams D: Assessing elements of women’s decisions about mammography. Health Psychol11: 111-118, 1992.
10.
10. DiClemente C, Hughes S: Stage of change profiles in alcoholism treatment. J Substance Abuse2: 217-235, 1990.
11.
11. Prochaska J, Velicer W, DiClemente C, Fava J: Measuring processes of change: Applications to the cessation of smoking. J Consult Clin Psychol56: 520-528, 1988.
12.
12. Prochaska J: Prescribing to the stages and levels of change. Psychother28: 463-468, 1991.
13.
13. Curry S, Kristal A, Bowen D: An application of the stage model of behavior change to dietary fat reduction. Health Educ Res: Theor Prac7: 97-105, 1992.
14.
14. Glanz K, Patterson R, Kristal A, DiClemente CC, Heinendinger J, Linnan L, McLerran D: Stages of change in adopting healthy diets: Fat, fiber, and correlates of nutrient intake. Health Educ Q21(4): 499-519, 1994.
15.
15. Prochaska J, DiClemente C: Stages of change in the modification of problem behaviors, in Hersen M, Eisler R, Miller P (eds.): Progress in Behavior Modifications. Sycamore, IL, Sycamore, 1992, pp. 184-214.
16.
16. Campbell M, DeVellis B, Strecher V, Ammerman A, DeVellis R, Sandler R: Improving dietary behavior: The effectiveness of tailored messages in primary care settings. Amer J Pub Health84(5): 783-787, 1994.
17.
17. Sporny L, Contento I: Stages of change in dietary fat reduction: Social psychological correlates. J Nutr Educ27: 191-199, 1995.
18.
18. Auslander W, Haire-Joshu D, Houston C, Fisher E, Jr: Community organization to reduce the risk of non-insulin-dependent diabetes among low income African American women. Ethn Dis2(2): 176-184, 1992.
19.
19. Haire-Joshu D, Auslander W, Houston C, Dreitzer D, Williams J: Stages of Change and Dietary Patterns in Poor Black Women at Risk for NIDDM. Paper presented at the annual meeting of the American Diabetes Association, San Francisco, CA, June 1996.
20.
20. Kristal A, White E, Shattuck A: Long-term maintenance of a low-fat diet: Durability of fat related dietary habits in the women’s health trial. J Am Diet Assoc92: 553-559, 1992.
21.
21. Kristal A, Shattuck A, Henry H: Patterns of dietary behavior associated with selected diets low in fat: Reliability and validity of a behavioral approach to dietary assessment. J Am Diet Assoc90: 214-220, 1990.
22.
22. Auslander W, Haire-Joshu D, Houston C, Daily M: Increasing Diet-Related Skills and Knowledge Among Low-Income African American Women at Risk for NIDDM. Paper presented to the Society for Behavioral Medicine, Boston, MA, March 1994.
23.
23. Prochaska J, DiClemente C: Stages and process of self-change of smoking: Toward an integrative model of change. J Consult Clin Psychol51(3): 390-395, 1983.
24.
24. Shannon J, Kristal A, Curry S, Beresford S: Application of a behavioral approach to measuring dietary change: The Fat and Fiber-Related Diet Behavior Questionnaire. Cancer Epidemiol Biomarkers & Prev6: 355-361, 1997.
25.
25. Kristal A, Shattuck A, and Williams A: Food Frequency Questionnaires for Diet Intervention Research. Proceedings of the 17th National Nutrient Databank Conference, Baltimore, MD, Dec. 1994.
26.
26. Block G, Subar A: Estimates of nutrient intake from a food frequency questionnaire: The 1987 National Health Interview Survey. J Am Diet Assoc92: 969-977, 1992.
27.
27. Kristal A, Feng Z, Coates R, Oberman A, George V: Associations of race/ethnicity, education, and dietary intervention with the validity and reliability of a food frequency questionnaire: The women’s health trial feasibility study in minority populations. Am J Epidemiol146(10): 856-869, 1997.
28.
28. Kuczmarski R: Prevalence of overweight and weight gain in the United States. Am J Clin Nutri55(suppl. 2): S495-S502, 1992.
29.
29. SPSS Inc: One-way analysis of variance: Procedure ONEWAY, in Norusis M (ed.): SPSS/PC+ Statistics 4.0: SPSS Statistical Data Analysis. Chicago, SPSS, 1990, pp. B25-B36.
30.
30. Huck S, Cormier W, Bounds J: tests, one-way analysis of variance, and multiple comparison procedures, in Brown M, Hausdorff C (eds.): Reading Statistics and Research. New York, Harper & Row, 1974, pp. 49-73.
31.
31. Rossi P, Freeman H: Evaluation: A Systematic Approach, Vol. 5. Newbury Park, CA, and London, Sage, 1993.
32.
32. Green G, Tossi S, Reed G, Willey C, Prochaska J: Stages of change for reducing dietary fat to 30% of energy or less. J Am Diet Assoc94: 1105-1110, 1994.
33.
33. Potvin L, Gauvin L, Nguyen N: Prevalence of stages of change for physical activity in rural, suburban and inner-city communities. J Comm Health22(1): 1-13, 1997.
34.
Potvin LBowen D , Meischke H, Tomoyasu N: Preliminary evaluation of the processes of changing to a low fat diet. Health Educ Res9: 85-94, 1994.
35.
35. Mhurchu C, Margetts B, Speller V: Applying the stages-of-change model to dietary change. Nutr Rev55(1): 10-16, 1997.
36.
36. Velicer W, Rossi J, Prochaska J: A criterion measurement model for health behavior change. Addict Behav5: 555-584, 1996.
37.
37. Kristal A, Beresford S, Lazovich D: Assessing change in diet intervention research. Am J Clin Nutri1994; 59(suppl. 1): S185-S189, 1994.
38.
38. McConnaughy E, Prochaska J, Velicer W: Stages of change in psychotherapy: Measurement and sample profiles. Psychotherapy: Theory, Res, Practice20: 368-375, 1983.
39.
39. Wynder E, Cohen L, Winters B: The challenges of assessing fat intake in cancer research investigations. J Am Diet Assoc97(suppl. 1): S5-S8, 1997.
40.
40. Birkett N, Boulet J: Validation of a food habits questionnaire: Poor performance in male manual laborers. J Am Diet Assoc95: 564-568, 1995.
41.
41. Carson C, Hassel C: Educating high-risk Minnesotans about dietary fats, blood cholesterol, and heart disease. J Am Diet Assoc94: 659-660, 1994.
42.
42. Glasgow R, Perry J, Toobert D, Hollis J: Brief assessments of dietary behavior in field settings. Addict Behav21: 239-247, 1996.
43.
43. Steptoe A, Wijetunge S, Doherty S, Wardle J: Stages of change for dietary fat reduction: Associations with food intake, decisional balance and motives for food choice. Health Educ J55: 108-122, 1996.
44.
44. Auslander W, Haire-Joshu D, Houston C, Dreitzer D, Williams J: The Eat Well Live Well Nutrition Program: Dietary Changes in African American Women by Activation. Paper presented at the Symposium on Psychosocial Treatments and Services, San Francisco, CA, Sept. 1997.
45.
45. Kumanyika S: Obesity in black women. Epidemiol Rev9: 31-50, 1987.
46.
46. Williamson D, Kahn H, Remington P, Anda R: The 10-year incidence of overweight and major weight gain in US adults. Arch Intern Med150: 665-672, 1990.
