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Is the sequencing of change processes by stage consistent across health problems? A meta-analysis.

Clinicians and researchers applying the transtheoretical model (J.O. Prochaska, C.C. DiClemente, & J.C. Norcross, 1992) to health promotion often assume that relationships of processes and stages observed in smoking cessation can be generalized to other problems. A reanalysis of 47 cross-sectional studies determined that use of change processes varies by stage, but the sequencing of processes is not consistent across health problems. In smoking cessation, cognitive processes were used in earlier stages than were behavioral processes. In exercise adoption and diet change, use of behavioral and cognitive processes increased together. Results for substance abuse and psychotherapy were less consistent. Substituting new behaviors, making a commitment, considering consequences, seeking information, controlling cues, and using rewards varied most by stage. Future longitudinal studies should assess these processes as potential mediators of lifestyle change.