Accuracy of the Stages of Change Algorithm: Sexual Risk Reported in the Maintenance Stage of Change
The Transtheoretical Model (TTM), which asserts that health behavior change progresses in stages, is often used to explore health risk behaviors and to target and evaluate health promotion interventions. A four-question staging algorithm is often used to measure an individual’s health behavior stage of change (SOC), but its accuracy or appropriateness for tailoring interventions or evaluating outcomes has not been established. The current study utilized data from three studies on HIV sexual risk behavior to compare SOC to reports of sexual risk on more detailed risk assessments, measured concurrently. Within each data set, detailed behavioral risk assessments were compared with SOC, with specific emphasis on maintenance staging, to evaluate the correspondence between SOC and reported behavior. Those classified in the maintenance SOC for condom use should, by definition, report no sexual risk events over the matched time period. Across all three studies, 18% of those classified in the maintenance SOC for condom use reported one or more sexual risk behaviors during the matched time period. Because the SOC algorithm is frequently used in intervention design, targeting, and evaluation, the potential for mis-categorization in the most advanced stage of maintenance raises concerns. Results suggest that intervention inclusion or evaluation strategies that use the maintenance stage as a primary outcome should be further qualified by behavioral data.
KeywordsStages of change Transtheoretical model HIV-prevention
Data used in this manuscript included research funded by R01-MH56473-03 and 1R01-MH54378 to Jeffrey D. Fisher.
- Cabral, R. J., Galavotti, C., Stark, M. J., Gargiullo, P. M., Semaan, S., Adams, J., et al. (2004). Psychosocial factors associated with stage of change for contraceptive use among women at increased risk for HIV and STDs. Journal of Applied Social Psychology, 34, 959–983. doi: 10.1111/j.1559-1816.2004.tb02579.x.CrossRefGoogle Scholar
- Cates Jr, W., & Berman, S. M. (1999). Prevention of sexually transmitted diseases other then human immunodeficiency virus. In A. J. Goreczny, & M. Hersen (Eds.) Handbook of pediatric and adolescent health psychology (pp. 361–370). Needham Heights, MA: Allyn & Bacon.Google Scholar
- Fisher, J. D., Cornman, D. H., Osborn, C. Y., Amico, K. R., Fisher, W. A., & Friedland, G. (2004). Clinician-initiated HIV-risk reduction intervention for HIV+ persons: Formative research, acceptability, and fidelity of the options project. Journal of Acquired Immune Deficiency Syndrome, 37(suppl 2), S78–S87. doi: 10.1097/01.qai.0000140605.51640.5c.CrossRefGoogle Scholar
- Fisher, J. D., Fisher, W. A., Cornman, D. H., Amico, K. R., Bryan, A., & Friedland, G. H. (2006). Clinician-delivered intervention during routine clinical care reduces unprotected sexual behavior among HIV-infected patients. Journal of Acquired Immune Deficiency Syndrome, 41, 44–52. doi: 10.1097/01.qai.0000192000.15777.5c.CrossRefGoogle Scholar
- Grimley, D. M., Riley, G. E., Bellis, J. M., & Prochaska, J. O. (1993). Assessing the stage of change and decision-making for contraceptive use for the prevention of pregnancy, sexually transmitted disease, and acquired immunodeficiency syndrome. Health Education Quarterly, 20, 455–470.PubMedGoogle Scholar
- Heuts, P. H. T. G., de Bie, R. A., Dijkstra, A., Aretz, K., Vlaeyen, J. W. S., Schouten, H. J. A., et al. (2005). Assessment of readiness to change in patients with osteoarthritis: Development and application of a new questionnaire. Clinical Rehabilitation, 19, 290–299. doi: 10.1191/0269215505cr814oa.PubMedCrossRefGoogle Scholar
- Malotte, C. K., Jarvis, B., Fishbein, M., Kamb, M., Iatesta, M., Hoxworth, T., et al. (2000). Stage of change versus an integrated psychosocial theory as a basis for developing effective behavior change intervention. AIDS Care, 12, 357–364. doi: 10.1080/09540120050043016.PubMedCrossRefGoogle Scholar
- Nahar, A., & Azad, A. K. (1999). Sexually transmitted diseases (STD)/reproductive tract infections (RTI) including acquired immunodeficiency síndrome (AIDS)/ human immunodeficiency virus (HIV) infections among the women of reproductive age group: A review. Journal of Preventive and Social Medicine, 18, 84–88.PubMedGoogle Scholar
- Prochaska, J. O., Velicer, W. F., Redding, C. A., Rossi, J. S., Goldstein, M., DePue, J., et al. (2005). Stage-based expert systems to guide a population of primary care patients to quit smoking, eat healthier, prevent skin cancer, and receive regular mammograms. Preventive Medicine, 41, 406–416. doi: 10.1016/j.ypmed.2004.09.050.PubMedCrossRefGoogle Scholar
- Stark, M. J., Tesselaar, H. M., O’Connell, A. A., Person, B., Galavotti, C., Cohen, A., et al. (1998). Psychosocial factors associated with the stages of change for condom use among women at risk for HIV and STDs: Implications for intervention development. Journal of Consulting and Clinical Psychology, 66, 967–978. doi: 10.1037/0022-006X.66.6.967.PubMedCrossRefGoogle Scholar