This study evaluates the maintenance of a clinically meaningful weight loss (≥ 5 %) after 12 and 36 months of participation in an intervention to promote fruit and vegetable (FV) consumption. A randomised controlled trial was conducted in a primary health care service. For 7 months, participants in the control group (CG) and in the intervention group (IG) performed guided physical exercise three times/week; the IG also participated in collective activities to promote FV consumption. This study selected participants (n 267) who showed clinically meaningful weight loss after nutritional intervention. Sociodemographic, health and body weight data were collected in a face-to-face interview at baseline (T0) and after intervention (T1). Participants were reassessed after 12 (T2) and 36 months (T3) by telephone interview, and the self-reported weight was corrected. The outcome measures weight changes at three time points: M1, comparing T2 with T1; M2, comparing T3 with T2; and M3, comparing T3 with T1. The generalised estimating equation, adjusted for individual characteristics, was used. Participants in the CG showed an increase of 4·2 kg (P < 0·001) at M1 and 4·6 kg (P < 0·001) at M3, while IG individuals showed an increase of 3·6 kg (P < 0·001) at M1 and 3·8 kg (P < 0·001) at M3. The between-group analyses show the effect of nutritional intervention on the maintenance of weight loss at M2 (P = 0·033). Although CG and IG participants increased in weight, the nutritional intervention was associated with maintenance over the long term. This reveals the importance of the promotion of FV consumption for body weight maintenance.

Introduction:Proschaska's transtheoretical model (TTM) of behaviour change suggests that a population of smokers varies along many dimensions, including readiness to quit and the presence of other risk factors. This study examines whether smokers contemplating quitting are more likely to be contemplating another change (e.g., Pap testing and physical activity). Methods:The study used self-reported cross-sectional data (n= 2,873) from the Canadian Community Health Survey (CCHS) Cycle 4.1 2007/2008. The association between the smoking stage of change (SOC) and Pap testing behaviour was assessed. Control variables included sociodemographic and behavioural characteristics (e.g. doctor visits and number of cigarettes smoked). The distribution of health behaviours (e.g., dietary changes and exercise) by smoking SOC among women with recent Pap tests was also examined. Results:Female smokers contemplating or preparing to quit smoking had higher odds of having a recent Pap test, OR = 1.40, 95% CI (1.19, 1.65), and OR = 1.82, 95% CI (1.47, 2.25) respectively, compared to smokers who had no intention of quitting. This association remained statistically significant after adjusting for confounders, AOR = 1.28, 95% CI (1.08, 1.52), and AOR = 1.63, 95% CI (1.31, 2.04) respectively. Fruit and vegetable consumption, physical activity, and recent dental visit were associated with advanced smoking SOC among women with recent Pap tests (P< .05). Conclusions:Advanced smoking SOC was associated with the increased likelihood of having a recent Pap test and engaging in other healthy behaviours. These findings show that targeting several health behaviours simultaneously may be an effective health promotion strategy.

We evaluated the effect of feedback after opportunistic spirometry in general practice on motivation for smoking cessation using stage change in the transtheoretical model. A total of 328 smokers aged over 35 years were given immediate feedback on the presence or absence of lung damage due to smoking, plus brief standard cessation advice. At 3 months, 99 (30.2%) smokers reported making an attempt to quit and 17 (5.2%) smokers reported moving into action stage for cessation. Of 297 (80.5%) successfully followed up, 81 (27.3%) smokers demonstrated forward shift and 35 (11.8%) smokers demonstrated backward shift. Feedback on the presence of lung damage was not significantly associated with reporting a quit attempt (p = .31) or moving into action stage for cessation (p = .30). Odds of forward or backward shift were not independently associated with either feedback on the presence of lung damage or normal lung function. Odds of backward shift with feedback on lung damage depended on participants' assessments of quit benefits, which were correlated with their prior self-assessment of lung damage. Our findings suggest that feedback to smokers after spirometry about the absence of lung damage is not harmful. However, eliciting personal health attitudes is also important so cessation advice can be tailored especially for smokers who believe they already have lung damage from smoking.

This review provides a rigorous investigation of the question of whether the transtheoretical model (TTM) (or stages of change model) is applicable to eating behaviour change. The TTM is currently the most popular of a number of stage theories being used to examine health behaviour change. Stage theories specify an ordered set of ‘stages of readiness to change’ into which people can be classified and identify the factors that can facilitate movement from one stage to the next. If eating behaviour change follows a stage process, then nutritionists could identify the predominant stage or stages in a population and focus resources on those issues most likely to move people to the next stage (e.g. from no intention of changing, to thinking about changing). In addressing this question, the review draws on the defining characteristics of stage theories as clarified by Weinstein et al. (1998), provides an in-depth coverage of methodological considerations, and a detailed summary table of dietary studies applying the TTM. Specific recommendations are made for improving the accuracy of dietary stage classifications. Among the key conclusions are: (1) dietary studies using the TTM have been hampered by a focus on nutritional outcomes such as dietary fat reduction, rather than clearly understood food behaviours (e.g. five servings of fruit and vegetables per day); (2) accurate stage classification systems are possible for food-based goals, but major misclassification problems occur with nutrient-based goals; (3) observation of an association between stage and dietary intake is not sufficient to demonstrate the validity of the model for dietary behaviour; (4) there is a need for valid questionnaires to measure all aspects of the TTM, and more research on the whole model, particularly the ‘processes of change’, rather than on single constructs such as ‘stage’ (5) cross-sectional studies generally support the predicted patterns of between-stage differences in decisional balance, self-efficacy, and processes of change; (6) studies which test the key hypothesis that different factors are important in distinguishing different stages are rare, as are prospective studies and stage-matched interventions. Only such studies can conclusively determine whether the TTM is applicable to eating behaviour. Since the ultimate test of the TTM will be the effectiveness of stage-matched dietary interventions, the review ends by exploring the requirements for such studies.

The transtheoretical model (TTM) is a behavioural theory that describes behaviour change as occurring in five stages, ranging from precontemplation to maintenance. The purpose of the present paper is to review and synthesise the literature published since 1999 on applications of the TTM to dietary behaviour so that the evidence for the use of assessment tools and interventions based on this model might be evaluated. Six databases were identified and searched using combinations of key words. Sixty-five original, peer-reviewed studies were identified and summarised in one of three tables using the following categories: population (n 21), intervention (n 25) and validation (n 19). Internal validity ratings were given to each intervention, and the body of intervention studies as a whole was rated. The evidence for using stage-based interventions is rated as suggestive in the areas of fruit and vegetable consumption and dietary fat reduction. Valid and reliable staging algorithms are available for fruit and vegetable consumption and dietary fat intake, and are being developed for other dietary behaviours. Few assessment tools have been developed for other TTM constructs. Given the popularity of TTM-based assessments and interventions, more research is warranted to identify valid and reliable assessment tools and effective interventions. While the evidence supports the validity of the TTM to describe populations and to form interventions, evidence of the effectiveness of TTM-based interventions is not conclusive.

The psychometric properties of the Stages of Change scales (McConnaughy, Prochaska, & Velicer, 1983) were examined in a clinical sample of clients referred for psychotherapy. Sixty clients completed the Stages of Change scales and the Brief Symptoms Inventory before their first session of psychotherapy. The scales means, standard deviations and high internal consistency (all coefficients exceeding 0.7) compared favourably with previous research conducted by McConnaughy et al. (1983, 1989). The study investigates two methods of interpreting the Stages of Change scales. It discusses the methodological limitations in interpreting the highest scale score, and recommends instead the interpretation of the samples mean scores for the scales. It further assesses the theoretical underpinnings of the scales intercorrelations and argues in support of the “states” of change model proposed by Sutton (1996).