Physical activity behaviour change theory: The Transtheoretical Model and all that Stuart Biddle School of Sport & Exercise Sciences

2 Today  The wider context of physical activity - the ecological approach  The role of physical activity correlates or determinants in the ‘mediating variable framework’  A framework of theories used in physical activity research  How the Transtheoretical Model (TTM) fits in to such a framework  What the TTM is all about: the role of self-efficacy, pros and cons, and processes of change  What the evidence is for the TTM in physical activity settings

3 Today  The wider context of physical activity - the ecological approach  The role of physical activity correlates or determinants in the ‘mediating variable framework’  A framework of theories used in physical activity research  How the Transtheoretical Model (TTM) fits in to such a framework  What the TTM is all about: the role of self-efficacy, pros and cons, and processes of change  What the evidence is for the TTM in physical activity settings

4 Intrapersonal environment Interpersonal environment Reconceptualising “the environment”

5 Physical environment

6 Policy/legislative environment

7 Today  The wider context of physical activity - the ecological approach  The role of physical activity correlates or determinants in the ‘mediating variable framework’  A framework of theories used in physical activity research  How the Transtheoretical Model (TTM) fits in to such a framework  What the TTM is all about: the role of self-efficacy, pros and cons, and processes of change  What the evidence is for the TTM in physical activity settings

8 A behavioural epidemiology framework Establish Links Measure PA InterventionsDeterminants Translation into practice

9 Interventions Modifiable determinants Physical activity Longer- term outcomes, e.g., reduced risk of CHD, diabetes etc, strong social networks, positive physical self- worth Short- and medium- term outcomes, e.g., enjoyment, body composition, Skill improvement MEDIATING VARIABLE FRAMEWORK

10 Today  The wider context of physical activity - the ecological approach  The role of physical activity correlates or determinants in the ‘mediating variable framework’  A framework of theories used in physical activity research  How the Transtheoretical Model (TTM) fits in to such a framework  What the TTM is all about: the role of self-efficacy, pros and cons, and processes of change  What the evidence is for the TTM in physical activity settings

11 Psychological theory and physical activity Theories of Exercise Behaviour Belief-Attitude Theories Example: Theory of Planned Behaviour Competence- Based Theories Example: Self-Efficacy Theory Control-Based Theories Example: Self-Determination Theory Stage-Based Theories Example: Transtheoretical Model Hybrid Models Example: HAPA Biddle et al., Handbook of Sport Psychology, 2007

12 Today  The wider context of physical activity - the ecological approach  The role of physical activity correlates or determinants in the ‘mediating variable framework’  A framework of theories used in physical activity research  How the Transtheoretical Model (TTM) fits in to such a framework  What the TTM is all about: the role of self-efficacy, pros and cons, and processes of change  What the evidence is for the TTM in physical activity settings

13 In search of how people change  Findings from clinical psychology and psychotherapy  Late 70’s identified common principles  Move towards a more comprehensive model of behaviour change Prochaska & DiClemente (1983) Transtheoretical Model of Behaviour Change

14 Psychological theory and physical activity Theories of Exercise Behaviour Belief-Attitude Theories Example: Theory of Planned Behaviour Competence- Based Theories Example: Self-Efficacy Theory Control-Based Theories Example: Self-Determination Theory Stage-Based Theories Example: Transtheoretical Model Hybrid Models Example: HAPA Biddle et al., Handbook of Sport Psychology, 2007

15 Today  The wider context of physical activity - the ecological approach  The role of physical activity correlates or determinants in the ‘mediating variable framework’  A framework of theories used in physical activity research  How the Transtheoretical Model (TTM) fits in to such a framework  What the TTM is all about: the role of self-efficacy, pros and cons, and processes of change  What the evidence is for the TTM in physical activity settings

The TTM represents an ‘umbrella’ theory Self efficacy Decisional balance (Pros vs Cons) Othertheories Processes of change

17 Transtheoretical Model of Health Behaviour Change Self-Efficacy Decisional Balance Processes of change Precontemplation Contemplation Preparation Action Maintenance HOW WHEN

18 TTM: Intentions and behaviour

19 Precontemplation Typical statements: “So far as I'm concerned I don't have any problems that need changing" "I guess I have my faults but there is nothing I need to change" "I don't go along with all this heath promotion rubbish - you've got to die from something Do not exercise Have no intention of starting

20 Contemplation Typical Statements : "yes I know I have a problem but I'm not ready to do anything yet" "just wait until I get these assignments done then I'll start my new regime” "I'm just too stressed at the moment to even think about exercising" Do not exercise but aware that a problem exists! Seriously thinking about starting Some sort of commitment to change in the near future

21 Preparation Typical statements : “Ok, I’ve joined Biddle’s gym. I’ll start on Monday" “I’ve signed up for aerobics, there’s no backing out now" "This is the last weekend before I start my fitness programme” Started to make small changes but still not exercising to criterion level May set imminent date on which change is to take place (usually within a month) Psychologically prepared for change

22 Action Typical statements: "Anyone can talk about exercising... but I have!" "It's not easy but I'm giving it my best shot!" "I don’t get out of breath anymore taking the stairs!” Meeting criterion for physical activity (e.g., exercising 30 min per day, 5 days/wk)Meeting criterion for physical activity (e.g., exercising 30 min per day, 5 days/wk) Started recently (usually within last 6 months)Started recently (usually within last 6 months)

23 Maintenance Typical statements : “I’m an exerciser” “It was tough at first but now it’s quite routine” Exercising at criterion level for > 6 months Work to prevent relapse

24 Processes of Change The cognitive, affective and behavioural, experiential strategies and techniques people use in modifying behaviour 10 processes represent the basic change principles  5 cognitive (thinking)  5 behavioural (doing)

25 Social Cognitive Theory (SCT) … including self-efficacy  we learn and modify our behaviours through an interaction between personal, behavioural, and environmental influences  reciprocal determinism / causality Albert Bandura

26 SELF-EFFICACY: Definition  “people’s judgements of their capabilities to organise and execute courses of action”  Bandura (1977, 1986, 1997)  Efficacy expectations

27 Social Cognitive Theory (SCT)  ‘Efficacy expectancies’:  Self reflection of our capabilities  Bandura’s most significant contribution: ‘self-efficacy’  Situation-specific confidence to undertake a certain behaviour  Efficacy beliefs and expectations  The ‘can I?’ question  This will determine many behaviours, especially those that challenge us.

28 Social Cognitive Theory (SCT)  ‘Outcome expectancies’: we reflect on the (possible) consequences of our behaviours  E.g.: if I am more active, what are the consequences?  Positive? Better health, fitness, functionality, social relations?  Negative? Injury, perception of inappropriate use of time, expense?

29 Social Cognitive Theory (SCT): Key practical elements  Can I?  Is it worth it?  Remember the ‘Loriel principle’?  “You can, because you’re worth it!”  Efficacy expectations  Outcome expectations

30 Self Efficacy “The confidence that you can be active in challenging situations” I am confident I can be active when I feel I do not have the time I am confident I can be active when the weather is bad: for example it’s raining or cold

31 SOURCES OF SELF-EFFICACY SELF- EFFICACY VERBAL PERSUASION IMITATION & MODELING PHYSIOLOGICAL AROUSAL PERFORMANCE

32 Sources of self-efficacy  prior success and performance attainment  what happens in the past will affect how you feel about future efforts at the same, or similar, behaviours

33 Sources of self-efficacy  imitation and modelling:  We learn from watching others  evidence suggests that confidence can be obtained from observing people similar to ourselves being successful (“if they can do it, so can I!”).  likely to be stronger if the behaviour in question is new to us  observing how people cope with adversity can boost self-efficacy.

34 Exercise Confidence “... I did manage to influence some of my more sedentary colleagues. Exercise was unusual for African men of my age and generation. After a while even Walter (Sisulu) began to take a few turns around the courtyard in the morning. I know that some of my younger comrades looked at me and said to themselves ‘If that old man can do it, why can’t I?’ They, too, began to exercise” (Nelson Mandela, 1994)

35 Sources of self-efficacy  verbal and social persuasion:  encouragement from others  if others show confidence in your abilities, particularly for difficult tasks, it may boost feelings of efficacy  not a particularly powerful source of self- efficacy  but, it can be influential, and more so if the source of encouragement is seen to be knowledgeable and credible.

36 Sources of self-efficacy  judgements of physiological states  For stressful or phobic behaviours, it is important to control physiological signs of anxiety and arousal  this may not apply directly to physical activity  but it does mean that confidence will more likely be enhanced through an environment that is positive and relaxing, and does not induce feelings of anxiety.

37 DECISIONAL BALANCE  Weighing up the pros & cons of changing a particular behaviour

38 TTM PREDICTION S Cognitive Processes

39 Advantages of Using TTM for Behaviour Change  Recognises behaviour is not “all-or-nothing”  distribution of population by stage  Work with total populations:  Stage-matched interventions  Recruitment and retention by stage  Evaluate success of interventions by stage progression

40 Today  The wider context of physical activity - the ecological approach  The role of physical activity correlates or determinants in the ‘mediating variable framework’  A framework of theories used in physical activity research  How the Transtheoretical Model (TTM) fits in to such a framework  What the TTM is all about: the role of self-efficacy, pros and cons, and processes of change  What the evidence is for the TTM in physical activity settings

41 Application of the TTM to physical activity Marshall & Biddle (2001) Meta Analysis:  71 published articles and abstracts: 54 cross-sectional  54 cross-sectional  6 longitudinal  10 quasi-experimental  1 randomised controlled trial  91 independent samples

42 Physical Activity Precontemplation Preparation Maintenance Contemplation Action Effect Size 2.5

43 Self-Efficacy Precontemplation Preparation Maintenance Contemplation Action Effect Size 2.5 k = 19 N = 3462 Failsafe k = 37 k = 17 N = 5719 Fsk = 13 k = 15 N = 3537 Fsk = 30 k = 16 N = 4662 Fsk = 42

44 Conclusions: Self-Efficacy  All forward stage movement is characterised by an increase in self-efficacy  Self-efficacy appears especially important when moving from action to maintenance  Relationship appears non-linear

45 Decisional Balance Effect Size Precontemplation Preparation Maintenance Contemplation Action Pros Cons Cons (Narrative) 2 1.5

46  large increase in pros and moderate decrease in cons important to begin contemplating change  Further small increase in pros and moderate decrease in cons important to start changing Conclusions: Decisional Balance

47 Processes of Change Precontemplation Preparation Maintenance Contemplation Action Behavioural Cognitive Effect Size

48 Individual process use Precontemplation Preparation Maintenance Contemplation Action Effect Size 2.5 BEHAV COG.

49 Conclusions: Processes of Change  Individuals use all processes, especially from PRECONT to CONT and from PREP to ACT  Cognitive and behavioural processes appear equally important for contemplating change  Behavioural processes appear more important than cognitive processes from contemplation onwards, but confidence intervals are not conclusive  Stage x process interactions not evident, suggesting distinction between higher order constructs may not be appropriate in PA settings

50 Overall Conclusions  Tentative support for the model  Please, NO more studies showing cross-sectional differences in core constructs between stages!  Too few longitudinal and experimental studies to examine causal associations  Evidence for higher-order processes of changes (cognitive and behavioural) is weak  Stage or continuum model?

51 Defining properties of a stage theory  Pseudo-stage model  A classification system to define the stages   An ordering of stages   Common barriers to change facing people in the same stage (?)  Different barriers to change facing people in different stages (?)

Physical activity behaviour change theory: The Transtheoretical Model and all that Stuart Biddle