African-Americans have high rates of physical inactivity-related morbidity and mortality, thus effective interventions to increase exercise are necessary. Tailored interventions show promise, but measures need validation in this population. This study validated transtheoretical model measures for exercise in an African-American sample.
Design.
Cross-sectional measure development.
Setting.
Telephone survey of individuals in North Carolina.
Subjects.
521 African-American adults.
Measures.
Stages of change, decisional balance (pros and cons), self-efficacy and processes of change (POC) for regular exercise.
Analysis.
Confirmatory factor analyses tested measurement models. Multivariate analyses examined relationships between each construct and stages of change.
Results.
For decisional balance, the two-factor uncorrelated model was the most parsimonious good-fitting model (χ235 = 158.76; comparative fit index [CFI], .92; average absolute standardized residual [AASR], .04), and alphas were good (pros α = .85 and cons α = .74). The one-factor model for self-efficacy (α = .80) revealed an excellent fit (χ29 = 45.51; CFI, .96; AASR, .03). For the POC subscales with good alphas (α = .62–.91), a 10-factor fully correlated model fit best (χ2[360] = 786.75; CFI, .91; AASR, .04). Multivariate analyses by stage of change replicated expected patterns for the pros, self-efficacy, and POC measures with medium-sized effects (η2 = .05–.13). Results by stage of change did not replicate for the cons scale.
Conclusions.
The structures of these measures replicated with good internal and external validity, except for the cons scale, which requires additional development. Results support the use of these measures in tailored interventions to increase exercise among African-Americans.
PressVFreestoneIGeorgeCF. Physical activity: the evidence of benefit in the prevention of coronary heart disease. Q J Med.2003;96:245–251.
2.
TuomilehtoJLindstromJErikssonJG. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med.2001;344:1343–1350.
3.
US Dept of Health and Human ServicesPhysical Activity and Health: A Report of the Surgeon General.Atlanta, Ga: Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion; 1996.
4.
CrespoCJSmitEAndersonRE. Race/ethnicity, social class and their relation to physical inactivity during leisure time: results from the Third National Health and Nutrition Examination Survey, 1988–1994. Am J Prev Med.2000;18:46–53.
5.
National Center for Health Statistics. Health, United States: 2007 With Chartbook on Trends in the Health of Americans.Hyattsville, Md: National Center for Health Statistics; 2007.
FallonEAHausenblasHA. Transtheoretical model: is termination applicable to exercise?Am J Health Stud.2004; 19:35–42.
8.
ProchaskaJODiClementeCC. Stages and processes of self-change of smoking: toward an integrative model of change. J Consult Clin Psychol.1983;5:390–395.
9.
ProchaskaJODiclementeCCNorcrossJC. In search of how people change. Applications to addictive behaviors. Am Psychol.1992;4:1102–1114.
10.
ProchaskaJOVelicerWF. The transtheoretical model of health behavior change. Am J Health Promot.1997;12:38–48.
11.
ProchaskaJOReddingCAEversK. The transtheoretical model and stages of change. In: GlanzKRimerBKViswanathKV, eds. Health Behavior and Health Education: Theory, Research and Practice.4th ed.San Francisco, Calif: Jossey-Bass Inc; 2008:170–222.
12.
MarshallSJBiddleSJH. The transtheoretical model of behavior change: a meta-analysis of the applications to physical activity and exercise. Ann Behav Med.2001;23:229–246.
13.
MarcusBHRossiJSSelbyVC. The stages and processes of exercise adoption and maintenance in a worksite sample. Health Psychol.1992;11:386–395.
14.
MarcusBHSelbyVCNiauraRSRossiJS. Self-efficacy and the stages of exercise behavior change. Res Q Exerc Sport.1992;63:60–66.
15.
MarcusBHRakowskiJWRossiJS. Assessing motivational readiness and decision making for exercise. Health Psychol.1992;11:257–261.
16.
BlissmerBMcAuleyE. Testing the requirements of stages of physical activity among adults: the comparative effectiveness of stage-matched, mismatched, standard care, and control interventions. Ann Behav Med.2002;24:181–189.
17.
MarcusBHEmmonsKMSimkin-SilvemanL. Evaluation of motivationally tailored vs. standard self-help physical activity interventions at the workplace. Am J Health Promot.1998;12:246–253.
18.
SpencerLAdamsTBMaloneS. Applying the transtheoretical model to exercise: a systematic and comprehensive review of literature. Health Promot Pract.2006;7:428–443.
19.
CardinalBSachsML. Prospective analysis of stage of exercise movement following mail-delivered, self-instructional exercise packets. Am J Health Promot.1995;9:430–432.
20.
EstabrooksPANiggCR. Validation of the stages of change for mild, moderate and strenuous physical activity. Ann Behav Med.1999;21:S232.
21.
HellstenLANiggCNormanG. Accumulation of behavioral validation evidence for physical activity stage of change. Health Psychol.2008;27(1suppl 1):S43–S53.
22.
ReedGRVelicerWFProchaskaJO. What makes a good staging algorithm: examples from regular exercise. Am J Health Promot.1997;12:57–66.
23.
SarkinJAJohnsonSSProchaskaJOProchaskaJM. Applying the transtheoretical model to regular exercise in an overweight population: validation of stages of change measure. Prev Med.2001;33:462–469.
24.
SchumannANiggCRRossiJS. Construct validity of the stages of change of exercise adoption for different intensities of physical activity in four samples of differing age groups. Am J Health Promot.2002;16:280–287.
NiggCRRossiJSNormanGJBenisovichSV. Structure of decisional balance for exercise adoptions. Ann Behav Med.1998;20:S211.
27.
GorleyTGordonS. An examination of the transtheoretical model and exercise behavior in older adults. J Sport Exerc Psychol.1995;17:312–325.
28.
HerrickABStoneWJMettlerMM. Stages of change, decisional balance, and self-efficacy across four health behaviors in a worksite environment. Am J Health Promot.1997;12:49–56.
29.
BenisovichSVRossiJSNormanGJNiggCR. Development of a multidimensional measure of exercise self-efficacy. Ann Behav Med.1998;20(suppl):S190.
30.
MarcusBHEatonCARossiJSHarlowLL. Self-efficacy decisions making and stages of change: an integrative model of physical activity. J Appl Soc Psychol.1994;24:489–508.
31.
NiggCRNormanGJRossiJSBenisovichSV. Processes of exercise behavior change: redeveloping the scale. Ann Behav Med.1999;21(suppl):S079.
32.
PaxtonRJNiggCMotlRW. Are constructs of the transtheoretical model for physical activity measured equivalently between sexes, age groups, and ethnicities?Ann Behav Med.2008;35:308–318.
33.
KumanyikaS. Minority populations. In: BurkeLOckeneI, eds. Compliance in Healthcare Research.Armonk, NY: Futura Publishing Company Inc; 2001:195–218.
34.
MarcusBHWilliamsDMDubbertPM. Physical activity intervention studies: what we know and what we need to know: a scientific statement from the American Heart Association Council on Nutrition, Physical Activity, and Metabolism (Subcommittee on Physical Activity); Council on Cardiovascular Disease in the Young; and the Interdisciplinary Working Group on Quality of Care and Outcomes Research. Circulation.2006;114:2739–2752.
35.
RobbinsMLKnottJEHarrisL. Community and Individual Interventions to Increase Organ and Tissue Donation Intent Among African Americans. Grant #1R3904107 funded by Health Resources and Service Administration, Division of Transplant; 2004.
36.
PateRRPrattMBlairSN. Physical activity and public health: a recommendation from the Centers for Disease Control and Prevention and the American College of Sports Medicine. JAMA.1995;273:402–407.
37.
US Dept of Health and Human Services: Assistant Secretary for Planning and Evaluation. Physical activity fundamental to preventing disease. Available at: http://aspe.hhs.gov/health/reports/physicalactivity/. Accessed June 20, 2009.
38.
NormanGJBenisovichSVNiggCRRossiJS. Examining three exercise staging algorithms in two samples. Ann Behav Med.1998;20(suppl):S211.
39.
NiggCRNormanGJBenisovichSV. Examining the structure of physical self description using an American university sample. Res Q Exerc Sport.2001;72:78–83.
40.
GodinGShepardRJ. A simple method to assess exercise behavior in the community. Can J Appl Sport Sci.1985;10:141–146.
41.
JacobsDRAinsworthBHartmanTJLeonAS. A simultaneous evaluation of 10 commonly used physical activity questionnaires. Med Sci Sports Exerc.1993;25:81–91.
42.
CardinalBJ. Development and evaluation of stage-matched written materials about lifestyle and structured physical activity. Percept Mot Skills.1995;80:543–546.
43.
CardinalBJ. Construct validity of stages of change for exercise behavior. Am J Health Promot.1997;12:68–74.
44.
CardinalBJ. Predicting exercise behavior using components of the transtheoretical model of behavior change. J Sport Behav.1997;20:272–284.
45.
CardinalBJ. Interaction between stage of exercise and history of exercise relapse. J Hum Mov Stud.1998;34:175–185.
NoarSM. The role of structural equation modeling in scale development. Struct Equ Modeling.2003;10:622–647.
48.
HuLBentlerP. Evaluating model fit. In: HoyleR, ed. Structural Equation Modeling.Thousand Oaks, Calif: Sage; 1995:76–99.
49.
KlineRB. In: KennyDA, ed. Principles and Practice of Structural Equation Modeling.New York, NY: Guilford Press; 2005.
50.
ProchaskaJO. Strong and weak principles for progressing from precontemplation to action on the basis of twelve problem behaviors. Health Psychol.1994;13:47–51.
51.
HallKLRossiJS. Meta-analytic examination of the strong and weak principles across 48 health behaviors. Prev Med.2008;46:266–274.
52.
RossiJRReddingCA. Structure and function of self-efficacy across the stages of change for 10 health behaviors [abstract]. Ann Behav Med.2001;23:S094.
53.
VelicerWFDiclementeCCRossiJSProchaskaJO. Relapse situations and self-efficacy: an integrative model. Addict Behav.1990;15:271–283.
54.
KellyGALowingLKelleyK. Gender differences in the aerobic fitness levels of young African-American adults. J Natl Med Assoc.1999;91:384–388.
