APPLYING THE TRANSTHEORETICAL MODEL: ASSESSING EXERCISE IN BLACKS IN A CHURCH SETTING
Rationale/ Background: Sedentary behavior is higher among African-American men and women than other ethnicities, placing them at greater risk for chronic illness. Routine physical activity reduces the risk of chronic health problems such as: (a) overweight and obesity, (b) type 2 diabetes, (c) hypertension, (d) coronary artery disease, (e) stroke, (f) congestive heart failure, and (g) cancers. Assessment of African-Americans’ exercise attitudes in a church-based setting may provide information with which to develop effective interventions to improve physical activity. Participant surveys included: (a) demographics, (b) exercise stage of change, (c) exercise decisional balance, (d) exercise self-efficacy, and (e) current physical activity.
Project/ Approach/ Methods/ Process: Two hundred participants completed surveys, ranging from 18 to 85 years (M = 53.17), with 69% female. The most frequent stage of change was the preparation stage (34%). Hours of total physical activity were 1.45 per week of combined vigorous activity, moderate activity, and walking. ANOVAs showed statistical significance in decisional balance across stages of change, but no statistical significance in self-efficacy by stage of change. ANOVA results conducted to determine any differences in IPAQ total by stage of change showed statistical significance, suggesting a difference in the weekly amount of exercise by stage of change. Correlational analyses and ANOVAs showed correlations between stage of change and age, age and self-efficacy, education and stage of change, income and self-efficacy, IPAQ and employment, and self-efficacy and IPAQ. Chi square tests showed “I don’t have time” and “I am too tired” as statistically significant exercise deterrents associated with exercise stage of change. Chi square tests also determined associations between exercise stage of change and exercise promoters. Both “I am in a better mood if I exercise” and “I sleep better if I exercise” showed statistically significant associations.
Outcomes Achieved/ Documented: Tailoring interventions focused at increasing physical activity in African Americans by including the use of cultural norms and multiple aspects of the TTM (stages of change, self-efficacy, and decisional balance) may help increase weekly physical activity participation. A community-based participatory research design may also be beneficial for intervention development in order to create a supportive environment for behavior change. Sole use of the stages of change without consideration of the other aspects of the model in population assessment and intervention development is cautioned, as the stages of change combined with the other TTM dimensions give more explanatory power.
Conclusions: Health care professionals, especially nurses, are in an optimal position to assess at-risk populations and assist them to initiate and maintain routine physical activity by developing effective interventions. Traditional exercise surveys such as the decisional balance and self-efficacy surveys in the TTM may need to be revised to include psychobehavioral and environmental factors to provide a more comprehensive assessment of attitudes of African Americans toward physical activity.