Congruence of readiness to change, self-efficacy, and decisional balance for physical activity and dietary fat reduction

Purpose. The current study examines the relations between decisional balance and self-efficacy variables on stage of change between the behaviors of avoiding dietary fat and increasing exercise. Design. A cross-sectional design was used. Setting. The current study took place in public primary care clinics from four sites across Louisiana. Clinics were associated with leaching hospitals and located in urban and rural areas. Subjects. Subjects included 515 adult outpatients, 60% African-American, 81% women, and 43% married. The age ranged from 18 to 87 years old, and the mean age was 45 (SD = 14). Patients were predominantly low-income (mean household income of $490 per month) and uninsured (71%). Measures. Standard questionnaires were given to assess stage of change, decisional balance, and seIf-efficacy for exercise and dietary fat reduction. Results. Although the chi(2) analysis revealed that dietary fat and exercise stage of change were significantly related, Pearson chi(2) (df = 16) = 74.30, p < .001, 35% of the sample was stage incongruent between behaviors (e.g., a significant percentage of exercise maintainers were precontemplators for reducing dietary fat). Only 27% of the sample was in the same stage for both behaviors. Correlations and multivariate analyses of variance (MANOVAs) indicated that relationships between behaviors were similar to those found previously within behaviors; however the effect sizes were markedly attenuated. Conclusions. These results have implications for healthcare providers working with weight management. Accurate assessment of readiness for change for both exercise and dietary fat consumption is critical. For many patients, readiness for change differs dramatically between the two behaviors, and interventions may need to be tailored more precisely. Providers may need to use more active, behaviorally focused interventions for the more advanced behavior while simultaneously implementing more cognitively focused interventions for the less advanced one.