Abstract
Zusammenfassung: Das transtheoretische Modell ordnet jeder Stufe der Verhaltensänderung ein spezifisches Muster an Kognitionen zu, wobei insbesondere auf die Selbstwirksamkeitserwartung (SE) und die Entscheidungsbalance mit den wahrgenommenen Vor- (pros) und Nachteilen (cons) der Verhaltensänderung Bezug genommen wird. An einer Stichprobe von 451 Personen mit kardiovaskulären Risikofaktoren aus 63 allgemeinärztlichen Praxen werden diese Modellannahmen in Bezug auf die sportliche Aktivität überprüft. Im Rahmen einer Querschnittsstudie kommen ein Stufenalgorithmus, eine SE-Skala sowie eine Skala zur Erfassung der pros und cons des Zielverhaltens zum Einsatz. Folgende Stufenzuordnung der Motivation zu sportlicher Aktivität wird gefunden: Precontemplation (PC) 51.7 %, Contemplation (C) 25.7 %, Preparation (P) 5.5 %, Action (A) 2.9 % und Maintenance (M) 14.2 %. Die SE steigt von (PC) bis (M) kontinuierlich an, die pros steigen zwischen (PC) und (P) und bleiben dann konstant bis (M), die cons verringern sich ab (C) bis (A) und bleiben dann konstant bis (M). Durch die Ergebnisse werden die Modellannahmen bestätigt.
Abstract: The transtheoretical model postulates that every behavioral stage is characterized by a specific pattern of cognitions with self-efficacy (SE) and decisional balance (pros and cons of a behavioral change) being the best established. We tested the assumptions of the model by addressing a total of 451 persons with increased risk for coronary disease in the offices of 63 general practitioners. In a cross-sectional study, these persons filled in a stages of change algorithm related to vigorous exercise, a SE scale, and a decisional balance scale. Patients were allocated to the following stages: precontemplation (PC) 51.7%, contemplation (C) 25.7%, preparation (P) 5.5%, action (A) 2.9% und maintenance (M) 14.2%. SE scores show a constant increase from (PC) to (M), pros increase from (PC) to (P) and remain constant thereafter, cons decrease between (C) and (A) and remain constant between (A) and (M). The results are in accordance with the assumptions.
Literatur
(1990). Position statement on the recommended quantity and quality of exercise for developing and maintaining cordiorespiratory and muscular fitness in healthy adults. Medicine and Science in Sports and Exercise, 22, 265– 274 .
Armstrong, C. A. , Sallis, J. F. , Hovell, M. F. , Hofstetter, R. (1993). Stages of change, self-efficacy, and the adoption of vigorous exercise: A prospective analysis. Journal of Sport & Exercise Psychology, 15, 390– 402 .Arroll, B. , Beaglehole, R. (1992). Does physical activity lower blood pressure: A critical review of the clinical trials. Journal of Clinical Epidemiology, 45, 439– 47 .Bandura, A. (1977). Self-efficacy: Toward a unifying theory of behavioral change. Psychological Review, 84, 191– 215 .Bandura, A. (1982). Self-efficacy mechanism in human agency. American Psychologist, 37, 122– 147 .Bandura, A. (1986). The explanatory and predictive scope of self-efficacy theory. Journal of Social and Clinical Psychology, 4, 359– 373 .Cowan, R. , Logue, E. , Milo, L. , Britton, P. J. , Smucker, W. (1997). Exercise stage of change and self-efficacy in primary care: Implications for intervention. Journal of Clinical Psychology in Medical Settings, 4, 295– 311 .Dishman, R. K. (1988). Exercise adherence research: Future directions. American Journal of Health Promotion, 3, 52– 56 .Eaton, C. B. (1992). Relation of physical activity and cardiovascular fitness to coronary heart disease, Part I: A meta-analysis of the independent relation of physical activity and coronary heart disease. Journal of the American Board of Family Practitioners, 5, 31– 42 .Fuchs, R. , Schwarzer, R. (1994). Selbstwirksamkeit zur sportlichen Aktivität: Reliabilität und Validität eines neuen Meßinstruments. Zeitschrift für Differentielle und Diagnostische Psychologie, 15, 141– 154 .Gleser, J. , Mendelberg, H. (1990). Exercise and sport in mental health: A review of the literature. Israel Journal of Psychiatry and Related Sciences, 7, 9– 112 .Gutin, B. , Kasper, M. J. (1992). Can vigorous exercise play a role in osteoporosis prevention? A review. Osteoporosis International, 2, 55– 69 .Harris, S. S. , Caspersen, C. J. , DeFriese, G. H. , Estes, H. (1989). Physical activity counseling for healthy adults as a primary preventive intervention in the clinical setting. Journal of the American Medical Association, 261, 3590– 3589 .Herda, C. , Scharfenstein, A. , Basler, H. D. (1998). Fragebogen zum Wohlbefinden (Wissenschaftliche Reihe des Zentrums für Methodenwissenschaften und Gesundheitsforschung, Nr. 2). Marburg: Klinikum der Philipps-Universität .Janis, I. L. , Mann, L. (1977). Decision making: A psychological analysis of conflict, choice and commitment . New York: Free Press .Marcus, B. H. , Banspach, S. W. , Lefebre, R. C. , Rossi, J. S. , Carleton, R. A. , Abrams, D. B. (1992). Using the stages of change model to increase the adoption of physical activity among community participants. American Journal of Health Promotion, 6, 424– 429 .Marcus, B. H. , Eaton, C. A. , Rossi, J. S. , Harlow, L. L. (1994). Self-efficacy, decision making, and stages of change: An integrative model of physical exercise. Journal of Applied Social Psychology, 24, 489– 508 .Marcus, B. H. , Rakowski, W. , Rossi, J. S. (1992). Assessing motivational readiness and decision making for exercise. Health Psychology, 11, 257– 261 .Marcus, B. H. , Rossi, J. S. , Selby, V. C. , Niaura, R. S. , Abrams, D. B. (1992). The stages and processes of exercise adoption and maintenance in a worksite sample. Health Psychology, 11, 386– 395 .Marcus, B. H. , Selby, V. C. , Niaura, R. S. , Rossi, J. S. (1992). Self-efficacy and the stages of exercise behavior change. Research Quarterly for Exercise and Sport, 63, 60– 66 .McAuley, E. (1992). The role of efficacy cognitions in the prediction of exercise behavior in middle-aged adults. Journal of Behavioral Medicine, 15, 65– 88 .Pate, R. R. , Pratt, M. , Blair, S. N. , Haslell, W. L. , Macera, C. A. , Bouchard, C. (1994). Physical activity and public health. A recommendation from the Centers of Disease Control and Prevention and the American College of Sports Medicine. Journal of the American Medical Association, 273, 402– 407 .Pfaffenbarger, R. S. , Kampert, J. B. , Lee, I. M. , Hype, R. T. , Leung, R. W. , Wing, A. L. (1994). Changes in physical activity and other lifeway patterns influencing longevity. Medicine and Science in Sports and Exercise, 5, 857– 865 .Prochaska, J. O. (1991). Assessing how people change. Cancer, 67, 805– 807 .Prochaska, J. O. , DiClemente, C. C. (1983). Stages and processes of self-change in smoking: Towards an integrative model of change. Journal of Consulting and Clinical Psychology, 51, 390– 395 .Prochaska, J. O. , DiClemente, C. C. (1985). Common processes of self-change in smoking, weight control, and psychological distress . In S. Shiffman & T. Wills (Eds.), Coping and substance use (pp. 345-363). New York: Academic .Prochaska, J. O. , DiClemente, C. C. (1992). Stages of change in the modification of problem behaviors. In M. Hersen, R. M. Eisler & P. M. Miller (Eds.), Progress in behavior modification (pp. 184-218). Newbury Park, CA: Sage .Prochaska, J. O. , DiClemente, C. C. , Norcross, J. C. (1992). In search of how people change. American Psychologist, 47, 1102– 1114 .Prochaska, J. O. , Marcus, B. H. (1994). The transtheoretical model. Applications to exercise. In R. K. Dishman (Ed.), Advances in exercise adherence (pp. 161-180). Champain, IL: Human Kinetics Publishers .Prochaska, J. O. , Velicer, W. F. (1997). The transtheoretical model of health behavior change. American Journal of Health Promotion, 12, 49– 56 .Prochaska, J. O. , Velicer, W. F. , Rossi, J. S. , Goldstein, M. G. , Marcus, B. H. , Rakowski, W. , Fiore, C. , Harlow, L. L. , Redding, C. A. , Rosenbloom, D. , Rossi, S. R. (1994). Stages of change and decisional balance for 12 problem behaviors. Health Psychology, 13, 39– 46 .Reed, G. R. , Velicer, W. F. , Prochaska, J. O. , Rossi, J. S. , Marcus, B. H. (1997). What makes a good staging algorithm: Examples from regular exercise. American Journal of Health Promotion, 12, 57– 67 .Robinson, J. I. , Rogers, M. A. (1994). Adherence to exercise programmes: Recommendations. Sports Medicine, 17, 39– 52 .Rodgers, W. M. , Brawley, L. R. (1993). Using both self-efficacy and the theory of planned behavior to discriminate adherers and dropouts from structured programs. Journal of Applied Sport Psychology, 5, 195– 206 .Rossi, S. R. , Rossi, J. S. , Rossi-DelPrete, L. M. , Prochaska, J. O. , Banspach, S. W. , Carleton, R. A. (1994). A process of change model for weight control for participants in community-based weight loss programs. International Journal of Addictions, 29, 161– 177 .Sallis, J. F. , Pinski, R. B. , Grossman, R. M. , Patterson, T. L. (1988). The development of self-efficacy scales for health-related diet and exercise behaviors. Health Education Research, 3, 283– 292 .Schwarzer, R. (1994). Optimistische Kompetenzerwartung: Zur Erfassung einer personellen Bewältigungsressource. Diagnostica, 40, 105– 123 .Shephard, R. J. , Verde, T. J. , Thomas, S. G. , Shek, P. (1991). Physical activity and the immune system. Canadian Journal of Sport Sciences, 16, 169– 185 .(1996). NIH develops consensus statement on the role of physical activity for cardiovascular health. American Family Physician, 54, 763– 767 .
Stephens, T. , Caspersen, L. J. (1993). The demography of physical activity. In: C. Bouchard, R. J. Shepard & T. Stephens (Eds.), Physical activity, fitness and health: Consensus statement (pp. 204-213). Champagne, IL: Human Kinetics .Tabachnick, B. G. , Fidell, L. S. (1989). Using multivariate statistics . New York: Harper & Row .(1990). Healthy People 2000: National health promotion and disease prevention objectives . Washington, DC: US Public Health Service, US Department of Health and Human Services publication 91-50212 .
Will, P. M. , Demko, T. M. , George, D. L. (1996). Prescribing exercise for health: A simple framework for primary care. American Family Physician, 53, 579– 585 .
