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Using the Stages Model for Successful Physical Activity Interventions
This is an excerpt from Motivating People to Be Physically Active-3rd Edition by Bess H. Marcus & Dori Pekmezi.
Jump Start to Health: A Workplace-Based Study
The Jump Start to Health study examined the usefulness of a stage-matched physical activity program in the workplace for healthy, sedentary employees (Marcus, Emmons, et al., 1998). People in the stage-matched group received manuals specifically tailored to their stage of motivational readiness for change. The manual for those in stage 1 (not thinking about change), titled Do I Need This?, focused on increasing awareness of the benefits of activity and the barriers that prevent people from being active. This manual did not provide specific suggestions for starting an exercise routine. The manual for those thinking about change (stage 2), titled Try It, You’ll Like It, included a discussion of the reasons to stay inactive versus the reasons to become more active, learning to reward oneself, and setting realistic goals.
For those in stage 3 (doing some physical activity), I’m on My Way reviewed the benefits of activity, goal setting, and tips on safe and enjoyable activities and addressed obstacles to regular activity (e.g., lack of time, feeling too tired). Keep It Going provided information for those in stage 4 (doing enough physical activity) on the benefits of regular activity, staying motivated, rewarding oneself, enhancing confidence about being active, and overcoming obstacles. For those in stage 5 (making physical activity a habit), I Won’t Stop Now emphasized the benefits of regular activity, avoiding injuries, setting goals, varying activities, rewarding oneself, and planning ahead.
An examination of participants’ responses to questionnaires at the beginning of the program and three months later revealed that more participants who received stage-matched manuals reported becoming more active (37% vs. 27%) than those who received American Heart Association manuals (AHA, 1984a, 1984b, 1984c, 1984d, 1989). The stage-matched approach was particularly effective for those who entered the program in stages 1, 2, or 3, which is noteworthy because these are the people who are most likely to be your clients.
Jump Start: A Community-Based Study
In this community-based study, individually tailored physical activity feedback reports were developed and provided in addition to the previously mentioned stage-matched manuals. (Marcus, Bock, et al., 1998). The goal was to give participants tailored comparisons between their own behaviors and those of other participants who had been successful. Additionally, feedback informed participants about how they had changed since the last time they filled out the questionnaires so that they understood whether they were moving forward, sliding backward, or doing about the same on a variety of strategies and techniques shown to be important for becoming long-term physically active people.
Following are examples of two types of such feedback. The first example gives a comparison between the individual and other successful participants:
Your answers show that you are well aware of the benefits of regular exercise. This is something that you have in common with others in the program who have also made good progress. Because you already do some exercise, it’s now important for you to gradually become more active and make exercise a more frequent and consistent part of your life. Now is the time to think about the things that could stop you from exercising regularly. Being prepared for the problems you may encounter is a big help in adhering to an exercise program. You will be better prepared to overcome obstacles by thinking about the kinds of thoughts and activities that will help you remain active during difficult periods.
This is an example of feedback regarding the individual’s change since the prior assessment:
Your answers show that since we last heard from you, you have been taking more responsibility for your own health and well-being. You are also becoming more aware of the importance of believing in yourself and your ability to remain active. That’s great! However, you are thinking a bit less about these issues than others who have succeeded in becoming and staying active.
To make more progress, try making a commitment to being more active. Think about the things you have done before, achievements you have made, goals you have reached. Try setting small goals for yourself that you know you can meet, such as going for a short walk or adding a few extra minutes of activity into each day. This will help you strengthen your sense of accomplishment.
The individualized feedback concerned the topics of motivation, cognitive and behavioral strategies for becoming more active, barriers to and benefits from exercise, self-efficacy, and minutes of physical activity per week. Participants received printed reports and stage-matched manuals at the beginning of the program when they were first assessed by questionnaire and one, three, and six months later.
Results showed that those who received the individualized program were more likely to achieve recommended levels of physical activity (accumulating at least 30 minutes of physical activity/day at least 5 days/wk) and were more likely to maintain that activity through a 12-month follow-up period than were participants who were given standard materials promoting physical activity (Bock et al., 2001; Marcus, Bock, et al., 1998). Thus, this study shows that using materials matched to each participant’s specific characteristics is helpful in increasing physical activity.
Learning How It Works
Applying the Stages of Change Theory to Physical Activity Promotion in Underserved Populations
Given the success of these stage-matched manuals and individually tailored feedback reports among mostly non-Hispanic White participants in Jump Start, we began to explore how similar approaches could be used to address physical activity-related health disparities in underserved populations. When considering extending a program developed in one community to another, often changes must be made. This is best done in consultation and collaboration with the population of interest. We describe our prior efforts to adapt the individually tailored physical activity print intervention for use among Latinas in this section.
In the Seamos Activas study, the intervention materials and research measures were translated into Spanish through an iterative translation and back-translation process (Pekmezi et al., 2009). Twenty-five cognitive interviews were conducted with Latinas to improve the clarity of the intervention and assessment text and ensure that key messages were not lost in translation. For example, participants noted differences between the terms exercise and physical activity, with exercise more accurately conveying purposeful moderate-intensity activity. “Rewarding yourself for meeting exercise goals” had a materialistic connotation, compared to “doing something good for yourself.” Changes were made to the intervention and assessment materials based on these findings (e.g., consistently referenced exercise in measures and materials). Six focus groups also identified culture-specific attitudes and barriers to physical activity for Latinas. Themes from participant feedback were incorporated into the intervention text and included balancing caregiver and household responsibilities, cultural norms about self-sacrifice, social support, partner negotiation, and dealing with inclement weather and neighborhood safety.
A small pilot randomized control trial (n = 93) found that the resulting culturally and linguistically adapted intervention for Latinas produced larger increases in moderate-intensity (or greater) physical activity from baseline (M = 16.56 min/wk, SD = 25.76) to six months (M = 147.27, SD = 241.55) than a wellness contact control arm (M = 11.88 min/wk, SD = 21.99 at baseline; M = 96.79, SD = 118.49 at 6 months), as well as significantly greater increases in cognitive and behavioral processes of change and available physical activity supplies and equipment at home (see health study manual pictures earlier in this chapter). Promising results were also found when adapting the individually tailored print intervention for use among African American women in the Deep South using similar processes (Pekmezi et al., 2016, 2017, 2020). Thus, while modifications will likely be necessary, successful theory-based programs developed in one community can be extended to another with great effect. Engaging the target population in this adaptation process is critical and will likely improve outcomes.
More Excerpts From Motivating People to Be Physically Active 3rd EditionSHOP
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