What makes patients with diabetes adopt physical activity behaviors?-a transtheoretical model approach

Background Physical activity is an essential health behavior in patients with diabetes and is the one which is least adapted in the Indian context. There is a need to understand the motivators and demotivators of this behavior. This study was conducted to evaluate the stages of physical activity behavior change, process of change, decisional balance that influences the change and situational self-efficacy in patients with diabetes attending a tertiary care health facility in Chennai, India. Methods Among 150 patients with diabetes attending the tertiary care hospital, selected in a non-random consecutive manner, a questionnaire-based survey was administered covering the domains of stage of change, process of change, decisional balance and situational self-efficacy. Results About 50% of the sample were not physically active belonging to the precontemplation or the reversal phase. About 23% were in the maintenance phase of physical activity and remaining 27% were in various intermediate stages of contemplation, preparation and action. The dominant dimensions of process of change were dramatic relief, self-re-evaluation and positive reinforcement. There was a high level of perceived pros of physical activity as well as cons and so there was a decisional balance not favouring either end of the behavior change spectrum. Situational self-efficacy levels were low. The perceived pros (OR 1.042; 95% CI 1.005-1.080) and cons (OR 0.929; 95% CI 0.877-0.985) influenced the behavior change in a statistically significant manner in a multivariate adjusted model. Conclusion A very low proportion of patients with diabetes are in maintenance phase of physical activity with a majority in various stages of change. The patients show various processes of change which all help in moving them through the early stages of change. Perceived pros and cons influence the physical activity behavior change and measures taken to address them are likely to positively influence physical activity behavior.