Search

There is a large disparity in Pre-exposure Prophylaxis (PrEP) utilization among communities of color compared to White Americans. There is also a lack of theory-based survey instruments to measure the underlying reasons for the disparity among communities of color. The purpose of this study was to create an instrument based on a qualitative approach involving community interviews. Semi-structured interviews guided by the Multi-theory Model (MTM) of health behavior change were performed in a sample of 12 members from communities of color. The analysis entailed a directed content analysis along the themes of MTM constructs to develop a survey instrument. The barriers to PrEP that emerged included the cost of PrEP, lack of protection from other sexually transmitted diseases, reduced trust between partners, and the stigma associated with PrEP. The perceived disadvantages included the potential cost of PrEP, partner mistrust when taking PrEP, discussion of sexual behaviors with a provider, and unclear process of acquiring the PrEP prescription. The results guided the development of a survey tool to further investigate aspects of cost, partner relations, stigma, reassurance of safety, and other factors. The tool can be used for future studies as part of guided interventions to increase PrEP uptake. [ABSTRACT FROM AUTHOR]

IntroductionSmoking causes lung cancer and a wide range of acute and chronic diseases annually throughout the world. A fourth-generation behavioral framework, namely the Multi-Theory Model (MTM) of health behavior change was used to predict the initiation and maintenance of smoking cessation among health worker smokers.MethodsA cross-sectional study of 170 smoking healthcare workers was conducted in Kabul. A non-probability convenience sampling method was used to recruit respondents. A valid and reliable 37-item MTM-based questionnaire was administered to male smokers. Stepwise multiple regression was used to explain smoking cessation. The overall Cronbach’s alpha coefficient (α) for the initial and retention scales of the MTM variables was 0.80 and 0.79, respectively.ResultsThe average age of the participants was 29.33 ± 6.21 years. The reported average year of smoking was 5.6 ± 4.7 with the average number of 5.64 ± 5.21cigarette smoking per day. Behavioral confidence and changes in physical environment were significant predictors of smoking cessation initiation. The sustenance of smoking cessation behavior was significantly influenced by emotional transformation, practicing for change and changes in social environment.ConclusionMTM has the usefulness to assess both the initiation and sustenance behavior of smoking cessation. Potential arrangements utilizing MTM develops ought to be created in future interventions to alter behavior of smoking cessation.

The total fertility rate has declined in certain countries, dropping below the replacement level. The attitudes and desires of some families regarding having children have also shifted. To cultivate positive societal views on childbearing, there is a need for updated educational initiatives, such as a multi-theory model. Although the multi-theory model has been used in various contexts to facilitate health behavior change, with its effectiveness validated in predicting and influencing behaviors, there has been no documented use of this model in the context of fertility, either in Iran or globally. Developing fertility encouragement programs requires cultural sensitivity and attention to accepted social norms and customs, which can enhance program efficacy. We believe the Multi-Theory Model can be effective and useful in encouraging couples to increase fertility.

Many behavior change theories have evolved over time. Originally, the first conceptions prioritized interventions based on information, such as raising awareness and transferring knowledge. Second-generation theories prioritize the development of skills and the promotion of awareness. The emergence of evidence-based techniques in the 1990s gave rise to third-generation theories such as the Theory of Planned Behavior and Social Cognitive Theory. Presently, fourth-generation trends amalgamate various components from multiple theories to implement accurate treatments, employing technology and emphasizing targeted behavior change. This paper aims to do a concise evaluation of the multi-theory model (MTM) of health behavior change interventions in the context of planning substance use prevention and treatment. The current area of intervention programs aimed at preventing and treating substance use may benefit from MTM, an innovative fourth-generation behavior change model. Tobacco, alcohol, and other drugs have all been the subjects of experimental, cross-sectional, and qualitative research. We have presented that additional research is required to compare MTM with knowledge-based therapies or interventions grounded in other theories. A gold standard would be the randomized controlled trials and behavioral change interventions particularly useful for this purpose. In addition, research evaluating the interventions’ efficacy must be carefully planned and executed.

Abstract Background Considering the prevalence of overweight and abdominal obesity in middle-aged women, this study was conducted to determine the effect of empowerment program to reduce sugar consumption based on the Multi-Theory Model (MTM) on Body Mass Index (BMI) and abdominal obesity in women aged 30–60 in Joven. Methods This quasi-experimental study (include descriptive and interventional sections) was conducted on the Joven city, Khorasan Razavi province, Iran country from October 2020 to August 2021. Sampling was performed as a multi-stage cluster. First, a descriptive study was performed among 400 women, and then 128 people who were eligible to enter the interventional phase of the study were selected. In the control group, 63 people and in the intervention group, 65 people were eligible to enter the study. The educational intervention was performed in five 60-minute sessions for groups of 12 people. The instruments included the demographic questionnaire, sugar consumption checklist and researcher-made questionnaire based on MTM constructs. Before the intervention, one, three and six months after the intervention, the questionnaire was completed by both intervention and control groups also measurement of waist circumference and BMI were performed using standard instruments. The obtained data were analyzed by SPSS 17. Results After the educational intervention, there was a significant difference between the intervention and control groups in all the MTM constructs. Also, six months after the educational intervention, BMI, waist circumference and amount of consumption of sugary substances decreased significantly in the intervention group (p

Background: Considering the prevalence of overweight and abdominal obesity in middle-aged women, this study was conducted to determine the effect of empowerment program to reduce sugar consumption based on the Multi-Theory Model (MTM) on Body Mass Index (BMI) and abdominal obesity in women aged 30–60 in Joven. Methods: This quasi-experimental study (include descriptive and interventional sections) was conducted on the Joven city, Khorasan Razavi province, Iran country from October 2020 to August 2021. Sampling was performed as a multi-stage cluster. First, a descriptive study was performed among 400 women, and then 128 people who were eligible to enter the interventional phase of the study were selected. In the control group, 63 people and in the intervention group, 65 people were eligible to enter the study. The educational intervention was performed in five 60-minute sessions for groups of 12 people. The instruments included the demographic questionnaire, sugar consumption checklist and researcher-made questionnaire based on MTM constructs. Before the intervention, one, three and six months after the intervention, the questionnaire was completed by both intervention and control groups also measurement of waist circumference and BMI were performed using standard instruments. The obtained data were analyzed by SPSS 17. Results: After the educational intervention, there was a significant difference between the intervention and control groups in all the MTM constructs. Also, six months after the educational intervention, BMI, waist circumference and amount of consumption of sugary substances decreased significantly in the intervention group (p < 0.05). Conclusion: Educational intervention based on the MTM can be effective in reducing the consumption of sugary substances and shaping behaviors related to healthy lifestyle in women. [ABSTRACT FROM AUTHOR]

Skin cancer, including melanoma, is the most common cancer worldwide and a significant public health concern. A significant risk factor for melanoma is through increased exposure to ultraviolet (UV) radiation through the use of indoor tanning beds. Although rates of indoor tanning bed use have decreased in recent years, young adults, particularly White, college-age women, comprise the majority of indoor tanning bed users in the United States. The purpose of this cross-sectional study was to explore and explain the initiation and sustenance of indoor tanning cessation among college students using the multi-theory model (MTM) of health behavior change. Data were collected from 254 college students who reported current indoor tanning use using a validated 46-item survey to assess demographics and the MTM constructs. Data were analyzed using multiple linear regression to determine the ability of the MTM constructs to predict the initiation and sustenance of indoor tanning cessation. For initiation of indoor tanning cessation, participatory dialogue: advantages (B = 0.038, p = 0.001), behavioral confidence (B = 0.129, p < 0.001) and changes in the physical environment (B = 0.088, p < 0.001) were significantly associated with indoor tanning cessation following covariate adjustment. For sustenance, only emotional transformation (B = 0.140, p < 0.001) demonstrated a significant relationship with indoor tanning cessation, following adjustment. Findings from this study demonstrate the utility of the MTM in explaining indoor tanning cessation and designing intervention strategies and clinical recommendations to encourage indoor tanning cessation among college students. [ABSTRACT FROM AUTHOR]

Background: Screen-time (ST) is the time spent on digital media. The American Academy of Pediatrics recommends the daily ST of less than an hour for preschoolers. However, increased ST among preschoolers is becoming a public health concern. Objective: This study assessed the multi-theory model (MTM)'s applicability in explaining the ST behavior change among preschoolers through parents. Methods: A quota sample of 72 parents was drawn from Northern India. Data were analyzed using multiple regression. Results: Behavioral confidence (p < 0.001) and changes in the physical environment (p < 0.001) significantly predicted the initiation of reducing ST. The sustenance of limiting ST was significantly predicted by the emotional transformation (p < 0.001), practice for change (p < 0.001), and changes in the social environment (p = 0.001). Conclusions: The study highlights the usability of the MTM model in designing and testing interventions for parents to limit ST among their children. [ABSTRACT FROM AUTHOR]

Manoj Sharma,1 Anuj Chandra,2 Ryan Toth,2 Vinayak K Nahar3,4 1Department of Environmental & Occupational Health, School of Public Health, University of Nevada, Las Vegas, NV, USA; 2Advanced Center for Sleep Disorders, Chattanooga, TN, USA; 3Department of Dermatology, School of Medicine, University of Mississippi Medical Center, Jackson, MS, USA; 4Department of Preventive Medicine, School of Medicine, University of Mississippi Medical Center, Jackson, MS, USACorrespondence: Vinayak K NaharDepartment of Dermatology, School of Medicine, University of Mississippi Medical Center, 2500 North State Street – L216, Jackson, MS, 39216, USATel +1 601 495 5876Fax +1 601 984 1150Email naharvinayak@gmail.comPurpose: The objective of this study was to assess the utility of a fourth-generation multi-theory model (MTM) in explaining the intention for initiation and sustenance of PAP adherence among newly diagnosed sleep apnea patients.Patients and Methods: For this cross-sectional study, data were collected at a private sleep center located in the Southeastern United States. A total of 138 newly diagnosed patients with sleep apnea who had been prescribed PAP therapy completed a valid and reliable 41-item MTM instrument. Stepwise multiple regression modeling was conducted to assess MTM based explanatory variables of PAP adherence in this study sample.Results: MTM constructs namely participatory dialogue (β = 0.17, p = 0.014), behavioral confidence (β = 0.48, p < 0.001), and changes in the physical environment (β = 0.26, p = 0.001) were statistically significant predictors of the intention for initiation of PAP therapy and accounted for 53.5% of the variance. Emotional transformation (β = 0.57, p < 0.001), changes in the social environment (β = 0.16, p = 0.016), and practice for change (β = 0.16, p = 0.047) were statistically significant predictors of the intention for sustenance of PAP therapy and accounted for 60.6% of the variance.Conclusion: The MTM was found to be a promising theoretical model in explaining the intention for initiation and sustenance of PAP therapy.Keywords: sleep apnea, positive airway pressure, compliance, predictors, multi-theory model

Background: Effective tobacco cessation programs using advice and counselling, have helped a substantial proportion of people quit smoking. Effectiveness of this tobacco cessation counselling needs to be evaluated. Aim: The aim of the present study was to evaluate the effectiveness of tobacco cessation counselling and behavioural changes using Multi Theory Model (MTM). Setting and Design: A non-randomised uncontrolled trial was conducted on 100 tobacco users visiting dental college in Bangalore. Methods and Materials: A 28 item questionnaire multi-theory model (MTM) for health behaviour was administered at baseline, 2 weeks, 6 weeks and 12 weeks after providing standardized tobacco cessation counselling (TCC) intervention at baseline. Statistical Analysis: Data were analysed and comparison were made using repeated measure ANOVA and Bonferroni adjustment (p < 0.05). Results: A total of 64 participants completed the 12 week follow-up. The mean age was 44.3 ± 10.1 years and 75.8% were males. There was significantly increase in mean MTM behaviour change score from baseline (32.78 ± 4.8) to 2 weeks (52.37 ± 5.27), 6 weeks (49.81 ± 4.34) and 12 weeks (48.7 ± 3.50) (p < 0.001). Conclusion: There was increase in MTM model scores in subsequent follow up suggesting behavioural changes and overall effectiveness of the Tobacco cessation counselling (TCC) among tobacco users.

This cross-sectional study was conducted in 2019 on 204 postmenopausal women aged 45–55 years who referred to Yazd health centers to determine the predictors in initiating and sustaining nutritional behaviors to deal with menopausal symptoms based on the multi-theory model (MTM). The participants were required to complete the demographic information questionnaire and a researcher-made questionnaire over the effective nutritional behaviors in menopause based on the MTM. The data were summarized and analyzed using SPSS 18 and AMOS23 by running descriptive indicators and path analysis. Behavioral confidence (β = 0.61, P < 0.001) had a higher predictive power in initiating a nutritional behavior compared to the changes in the physical environment (β = 0.13, P < 0.05) and participatory dialogue (β = 0. 10, p < 0.05). Among the behavior-related constructs, only emotional transformation (β = 0.78, P < 0.001) could predict the behavioral sustaining. A positive and significant association was observed between nutritional behavior sustaining and quality of life (β = −0.41, P < 0.001). The MTM is an appropriate model for predicting the initiation and sustaining of the nutritional behaviors in dealing with menopause. The behavioral confidence, changes in physical environment, and participatory dialogue constructs played a significant role in predicting the initiation of behavior. The emotional transformation construct was also an important predictor in maintaining nutritional behaviors to deal with menopausal symptoms. So, future researchers are recommended to conduct MTM-based investigations according to the predictive constructs among menopausal women. [ABSTRACT FROM AUTHOR]

This research aims to identify the predictive factors related to the initiation and sustaining of regular physical activity behaviors and their influence in adapting to menopausal symptoms. The study uses the multi-theory model (MTM) as the conceptual framework. The descriptive cross-sectional research was conducted on 200 post-menopausal women aged 45-55 years. All participants were referred to health centers, where they completed a three-part questionnaire involving: demographic information, a questionnaire on the influence of regular physical activity on the onset and sustaining of menopause using the MTM, and a standard questionnaire of menopausal quality of life. Data were collected, managed, and analyzed using SPSS 20 and AMOS 23 software. This study reveals that behavioral confidence and changes in the physical environment with coefficients of 0.55 and 0.14 respectively had a direct and significant impact on the initiation of regular physical activity-related behaviors during menopause. The construct of participatory dialogue had no significant impact on the initiation of regular physical activity-related behaviors and menopause. Regarding the sustainability of regular physical activity, the emotional transformation construct with a coefficient of 0.73 and change in social environment construct with a coefficient of 0.11 directly and significantly impact keeping regular physical activity behaviors due to menopause. Therefore, interventions based on the MTM can prove very useful for this specific population. In addition, the use of constructs validated by this study will especially be useful in producing evidence-based intervention for the target population. [ABSTRACT FROM AUTHOR]

Drowsy driving among college students is a critical public health issue due to its significant impact on road safety. This cross-sectional study aimed to investigate the determinants of stopping drowsy driving behavior among college students using the multi-theory model (MTM) of health behavior change. Data for this study were collected from September to October 2023 via a 42-item psychometric valid, web-based survey disseminated via Qualtrics, involving 725 students from a large southwestern university. Nearly half of the participants (49.38%) reported drowsy driving in the past month. Hierarchical multiple regression analysis revealed that participatory dialogue ( p = 0.0008) and behavioral confidence ( p < 0.0001) significantly predicted the initiation of refraining from drowsy driving, with the final model explaining 36.4% of the variance. Similarly, emotional transformation ( p < 0.0001) and practice for change ( p = 0.0202) significantly predicted the sustenance of behavior change, with the final model accounting for 40.6% of the variance. These findings underscore the importance of targeted MTM-based interventions focusing on enhancing students' awareness and confidence in managing drowsiness to mitigate drowsy driving, ultimately improving road safety and student well-being.

Objectives: Menopause is a natural part of women's lives and is associated with a series of complications that can impair their quality of life. This study was conducted to determine the effect of specific educational interventions on the quality of life among postmenopausal women.Methods: This randomized controlled trial was conducted on 80 menopausal women who met the inclusion and exclusion criteria and were selected through the multi-stage stratified random sampling method. The participants were randomly allocated to either the control or intervention group (40 per group). The intervention comprised 5 × 45-min educational sessions based on the Multi-Theory Model on the predetermined days of the week. The scores of the quality of life level were collected at baseline, immediately, and 3 months after the intervention using the Menopause-Specific Quality of Life questionnaire (MENQOL). The control group received a health advice.Results: Analysis of variance of repeated measures showed a significant interaction between time and intervention. The comparison between the mean score of quality of life of the "before," "immediately after intervention," and "3 months after the intervention" showed a significant difference between the two groups. The intervention group quality of life improved significantly as the intervention went on compared to the control group.Conclusion: Structured simple educational programs based on the Multi-Theory Model could be used as a simple and noninvasive intervention that help menopausal women improve their quality of life through menopausal symptoms relief. Further interventions with larger trials may be required to confirm these findings. [ABSTRACT FROM AUTHOR]

Purpose: Toothbrushing holds key importance in practical, competent, and efficacious design to limit the formation of dental plaque on the dental tissues, in turn, leading to a decrease in dental diseases. The recent addition to this growing knowledge in health behavior research is the multi-theory model (MTM) which addresses two crucial modules of health behavior: initiation and sustenance. In spite of reinforcing the habit of brushing twice daily, a lack of sustenance is found among young adults; hence, the objectives were to explore the substratal structure of MTM and to test the fit of MTM questionnaire in dental and medical students in India. Methodology: A questionnaire aimed at addressing sociodemographic information and MTM was designed. Reliability analysis was performed and explorative analysis was done using principal component analysis as the factor extraction method. Construct validity was investigated using exploratory factor analysis (EFA) to add a level of statistical. Results: Reliability analysis revealed a Cronbach's alpha value of 0.892 and split-half reliability value of 0.779. Test–retest reliability was found to be 0.77 (P < 0.01). Guttman split-half reliability was found to be 0.677. EFA suggested seven domains. Indices for model fit showed good fit with P < 0.01. Conclusion: The present study concludes that the Indian version of MTM is a reliable and valid instrument for measuring the initiation and sustenance of toothbrushing behavior in dental and medical students in India. [ABSTRACT FROM AUTHOR]

Globally, cervical cancer is the fourth leading cause of death among women. While overall cervical cancer rates have decreased over the last few decades, minority women continue to be disproportionately affected compared to White women. Given the paucity of theory-based interventions to promote Pap smear tests among minority women, this cross-sectional study attempts to examine the correlates of cervical cancer screening by Pap test using the Multi-theory Model (MTM) as a theoretical paradigm among minority women in the United States (U.S.). Structural Equation Modelling (SEM) was done for testing the construct validity of the survey instrument. Data were analyzed through bivariate and multivariate tests. In a sample of 364 minority women, nearly 31% (n = 112) of women reported not having received a Pap test within the past three years compared to the national rate (20.8%) for all women. The MTM constructs of participatory dialogue, behavioral confidence, and changes in the physical environment explained a substantial proportion of variance (49.5%) in starting the behavior of getting Pap tests, while the constructs of emotional transformation, practice for change, and changes in the social environment, along with lack of health insurance and annual household income of less than $25,000, significantly explained the variance (73.6%) of the likelihood to sustain the Pap test behavior of getting it every three years. Among those who have had a Pap smear (n = 252), healthcare insurance, emotional transformation, practice for change, and changes in the social environment predicted nearly 83.3% of the variance in sustaining Pap smear test uptake behavior (adjusted R2 = 0.833, F = 45.254, p < 0.001). This study validates the need for health promotion interventions based on MTM to be implemented to address the disparities of lower cervical cancer screenings among minority women.

Background: Effective tobacco cessation programs using advice and counselling, have helped a substantial proportion of people quit smoking. Effectiveness of this tobacco cessation counselling needs to be evaluated.Aim: The aim of the present study was to evaluate the effectiveness of tobacco cessation counselling and behavioural changes using Multi Theory Model (MTM).Setting and Design: A non-randomised uncontrolled trial was conducted on 100 tobacco users visiting dental college in Bangalore.Methods and Materials: A 28 item questionnaire multi-theory model (MTM) for health behaviour was administered at baseline, 2 weeks, 6 weeks and 12 weeks after providing standardized tobacco cessation counselling (TCC) intervention at baseline.Statistical Analysis: Data were analysed and comparison were made using repeated measure ANOVA and Bonferroni adjustment (p < 0.05).Results: A total of 64 participants completed the 12 week follow-up. The mean age was 44.3 ± 10.1 years and 75.8% were males. There was significantly increase in mean MTM behaviour change score from baseline (32.78 ± 4.8) to 2 weeks (52.37 ± 5.27), 6 weeks (49.81 ± 4.34) and 12 weeks (48.7 ± 3.50) (p < 0.001).Conclusion: There was increase in MTM model scores in subsequent follow up suggesting behavioural changes and overall effectiveness of the Tobacco cessation counselling (TCC) among tobacco users. [ABSTRACT FROM AUTHOR]

Background: Substance use is a chronic disorder that requires lifelong multimodal management. This study utilized the Multi-Theory Model (MTM) of Health Behavior Change to identify correlates of change in substance use behavior. Methods: Data were collected, using a cross-sectional design, from 93 participants who completed treatment at a substance use treatment facility. Participants completed a 40-item, newly developed, self-administered questionnaire, grounded on relevant substance use, treatment, and health-related behavior. Cronbach's alpha of all subscales were over 0.70 and deemed acceptable. Results: The majority of the participants were Caucasian (72.7%). Males comprised 60% of the sample. A stepwise multiple regression predicting initiation and sustenance of intentional substance use cessation showed a total of 34.2% of the variance. The initiation for the intentional substance use cessation was accounted for by participatory dialogue, advantages minus disadvantages (p =.001) and behavioral confidence (p = < 0.001). The sustenance for intentional substance use cessation was accounted for a total of 33% of the variance by practice for change (p =.004) and changes in the social environment (p = < 0.003). Conclusions: The MTM could be a useful model for predicting substance use behavior change. Clinicians and patients can gain insight and discuss behavioral changes necessary for recovery. [ABSTRACT FROM AUTHOR]

Background: Water pipe (WP) smoking has increased and become a major leisure pastime among young people in Iran. The aim of this study was to test MTM in its ability to predict reducing WP smoking in male adolescents. Methods: This cross-sectional study was performed with730 high school male students (grades 10–12), who were recruited through multi-stage random sampling in Hamadan city in Western Iran in 2017. We included 200 students who had smoked WP in the 30 past days (current smoker) determined by a screening question. The self-administered questionnaire included information on demographic variables and MTM constructs related to WP smoking. The questionnaire had acceptable validity and reliability. Results: The regression analysis revealed that 35.7% of the variance in initiating reducing WP smoking behavior was predicted by participatory dialog (p <.001) and behavioral confidence (p <.001). Sustenance of reducing WP smoking behavior was predicted up to 13.5% by emotional transformation (p <.001), practice for change (p <.05) and changes in the social environment (p <.05). Conclusions: MTM appears to be a robust theory in its application for reducing WP smoking. This theory must be reified and empirically tested with intervention development for WP smoking behavior in male students. Abbreviations: MTM: Multi-Theory Model; WP: Water pipe [ABSTRACT FROM AUTHOR]

Background: Smoking continues to be a public health problem worldwide. Smoking and tobacco use are associated with cardiovascular diseases that include coronary heart disease, atherosclerosis, cerebrovascular disease, and abdominal aortic aneurysm. Programs for quitting smoking have played a significant role in reduction of smoking in the United States. The smoking cessation interventions include counseling, nicotine replacement therapy, buproprion therapy, and varenicline therapy. The success rates with each of these approaches vary with clear need for improvement. Moreover, there is a need for a robust theory that can guide smoking cessation counseling interventions and increase the success rates. A fourth generation approach using multi-theory model (MTM) of health behavior change is introduced in this article for smoking cessation. An approach for developing and evaluating an intervention for smoking cessation is presented along with a measurement tool. Methods: A literature review reifying the MTM of health behavior change for smoking cessation has been presented. An instrument designed to measure constructs of MTM and associated smoking cessation behavior has been developed. Results: The instrument developed is available for validation, reliability and prediction study pertaining to smoking cessation. The intervention is available for testing in a randomized control trial involving smokers. Conclusion: MTM is a robust theory that holds promise for testing and application to smoking cessation.

Many behavior change theories have evolved over time. Originally, the first conceptions prioritized interventions based on information, such as raising awareness and transferring knowledge. Second-generation theories prioritize the development of skills and the promotion of awareness. The emergence of evidence-based techniques in the 1990s gave rise to third-generation theories such as the Theory of Planned Behavior and Social Cognitive Theory. Presently, fourth-generation trends amalgamate various components from multiple theories to implement accurate treatments, employing technology and emphasizing targeted behavior change. This paper aims to do a concise evaluation of the multi-theory model (MTM) of health behavior change interventions in the context of planning substance use prevention and treatment. The current area of intervention programs aimed at preventing and treating substance use may benefit from MTM, an innovative fourth-generation behavior change model. Tobacco, alcohol, and other drugs have all been the subjects of experimental, cross-sectional, and qualitative research. We have presented that additional research is required to compare MTM with knowledge-based therapies or interventions grounded in other theories. A gold standard would be the randomized controlled trials and behavioral change interventions particularly useful for this purpose. In addition, research evaluating the interventions' efficacy must be carefully planned and executed., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Sharma, Awan and Kapukotuwa.)

Introduction: Menopause is associated with symptoms and complications that can affect women's quality of life. Therefore, acceptance of the symptoms and complications can improve quality of life during this period. In this regard, the purpose of this study was to design an educational program based on the multi-theory model (MTM) to deal with complications of the menopausal period and improve the women's quality of life. Material and methods: In designing this study, four phases are considered. In the first phase, the questionnaire of menopausal symptom acceptance behaviors will be designed based on the MTM using literature review and a panel of experts' viewpoints. The validity and reliability of the questionnaire will be confirmed at this stage. In the second phase, a descriptive study will be conducted by administering the questionnaire designed in the first phase along with the Menopause-Specific Quality of Life questionnaire. The third phase includes the curriculum design based on the findings of the descriptive study, investigations of various studies, and viewpoints of the experts' panel. Therefore, the main components of the intervention will be identified. These components will determine the influential constructs of the MTM according to the descriptive research. Later, the related interventions and messages will be produced and designed from different sources. Intervention strategies will include group discussion, lectures, confidence-building skills, movie screenings, role play, preparation of daily activities booklets for postmenopausal women, and training classes for husbands and children to improve social support for women. The interventions, contents, and messages designed with the presence of health professionals and members of the target community will be pre-tested by examining factors such as audience perception of the message, appropriateness of the education to the audience's literacy and culture, as well as attractiveness, credibility, and acceptance of the materials. Finally, the fourth phase will be the implementation of the pre-test/post-test educational intervention using the intervention and control groups. Results and conclusions: The present study provides good information about the needs and strategies to enhance the quality of life in postmenopausal women by utilizing a menopausal acceptance training program. Therefore, designing a program to increase the menopausal acceptance in postmenopausal women can be effective in improving the quality of life and reducing the treatment and medical care costs. [ABSTRACT FROM AUTHOR]

Background: Most college students do not adequately participate in enough physical activity(PA) to attain health benefits. A theory-based approach is critical in developing effective interventions to promote PA. The purpose of this study was to examine the utility of the newly proposed multi-theory model (MTM) of health behavior change in predicting initiation and sustenance of PA among college students. Methods: Using a cross-sectional design, a valid and reliable survey was administered in October 2015 electronically to students enrolled at a large Southern US University. The internal consistency Cronbach alphas of the sub-scales were acceptable (0.65-0.92). Only those who did not engage in more than 150 minutes of moderate to vigorous intensity aerobic PA during the past week were included in this study. Results: Of the 495 respondents, 190 met the inclusion criteria of which 141 completed the survey. The majority of participants were females (72.3%) and Caucasians (70.9%). Findings of the confirmatory factor analysis (CFA) confirmed construct validity of sub-scales (initiation model: χ2 = 253.92 [df = 143], P < 0.001, CFI = 0.91, RMSEA = 0.07, SRMR = 0.07; sustenance model: χ2= 19.40 [df = 22], P < 0.001, CFI = 1.00, RMSEA = 0.00, SRMR = 0.03). Multivariate regression analysis showed that 26% of the variance in the PA initiation was explained by advantages outweighing disadvantages, behavioral confidence, work status, and changes in physical environment. Additionally, 29.7% of the variance in PA sustenance was explained by emotional transformation, practice for change, and changes in social environment. Conclusion: Based on this study’s findings, MTM appears to be a robust theoretical framework for predicting PA behavior change. Future research directions and development of suitable intervention strategies are discussed.

Eating outside-of-home (EOH) is one of the main changes in lifestyle that occurred worldwide in the past few decades. Given that EOH behavior is influenced by individual and contextual factors, the utilization of a theory seems to be suitable in analyzing this health behavior. The fourth-generation theory multi-theory model (MTM) is designed exclusively for health behavior change at the individual and community levels. Therefore, the purpose of this analytical cross-sectional study was to investigate EOH behavior by using the MTM among a nationally representative sample in the United States (US). Data for this study were collected from April-May 2023 via a 61-item psychometric valid, web-based, structured survey disseminated via Qualtrics. Chi-square/Fisher's exact tests were used to compare categorical data, whereas the independent-samples t -test was used to compare the mean scores of MTM constructs across groups. Pearson correlation analysis was performed for the intercorrelation matrix between the MTM constructs and hierarchical regression models were built to predict the variance in the initiation and sustenance by certain predictor variables beyond demographic characteristics. The p values in the multiple comparisons were calculated by using adjusted residuals. Among a total of 532 survey respondents, 397 (74.6%) indicated being engaged in EOH at least twice a week, whereas 135 (25.4%) reported not being engaged in EOH. People who were engaged in EOH were younger (mean age = 42.25 ± 17.78 years vs. 55.89 ± 19.43 years) African American, (15.9% vs. 6.7%, p = 0.01), single or never married, (34.0% vs. 23.0%, p = 0.02), had a graduate degree (9.6% vs. 3.7%, p = 0.03), and were employed (72.0% vs. 34.8%, p < 0.001) as opposed to those who reported not being engaged in eating outside the home. Among the MTM constructs of initiation, "behavioral confidence" and "changes in the physical environment" were the significant predictors of initiating a reduction in EOH behavior and explained 48% of the variance in initiation. Among the MTM constructs of sustenance, "emotional transformation" and "changes in the social environment" were the significant predictors of sustaining a reduction in EOH behavior and explained 50% of the variance in sustenance. This study highlights a need to design MTM-based educational interventions that promote in-home eating instead of frequent EOH for health, family bonding, economic, and other reasons.

Background: Smoking continues to be a public health problem worldwide. Smoking and tobacco use are associated with cardiovascular diseases that include coronary heart disease, atherosclerosis, cerebrovascular disease, and abdominal aortic aneurysm. Programs for quitting smoking have played a significant role in reduction of smoking in the United States. The smoking cessation interventions include counseling, nicotine replacement therapy, buproprion therapy, and varenicline therapy. The success rates with each of these approaches vary with clear need for improvement. Moreover, there is a need for a robust theory that can guide smoking cessation counseling interventions and increase the success rates. A fourth generation approach using multi-theory model (MTM) of health behavior change is introduced in this article for smoking cessation. An approach for developing and evaluating an intervention for smoking cessation is presented along with a measurement tool. Methods: A literature review reifying the MTM of health behavior change for smoking cessation has been presented. An instrument designed to measure constructs of MTM and associated smoking cessation behavior has been developed. Results: The instrument developed is available for validation, reliability and prediction study pertaining to smoking cessation. The intervention is available for testing in a randomized control trial involving smokers. Conclusion: MTM is a robust theory that holds promise for testing and application to smoking cessation. [ABSTRACT FROM AUTHOR]

Colorectal cancer is the third most common cancer worldwide and is the second leading cause of cancer-associated deaths. While colorectal cancer is on the decline in the United States (US), disparities still exist, despite the non-invasive screening modalities, such as stool-based tests have shown themselves to be effective in the detection of colorectal cancer. Many of the existing stool-based test interventions lack the use of a contemporary theory-based approach. Given the paucity of theory-based interventions intended to promote stool-based tests, this cross-sectional study utilizes the multi-theory model (MTM) of health behavior change to explain the seeking of stool-based tests for colorectal cancer (CRC) screening. An online 57-item questionnaire with an established psychometric validity was used to collect responses from the US-based sample ( n = 640) of adults aged 45-75 years old. The data were analyzed using bivariate and multivariate statistical methods. Structural equation modeling (SEM) was conducted to test the construct validity of the survey instrument. In this nationwide sample, 39.2% ( n = 251) of participants reported having received some form of a stool-based test. Among the participants who did not undergo stool-based CRC screening, the MTM subscales, including "participatory dialogue", "behavioral confidence", and "changes in the social environment", were significant predictors of initiating screening behavior and explained 48% of the variance in the initiation among this group (R 2 = 0.579, F = 5.916, p < 0.001; adjusted R 2 = 0.481). The MTM may be a useful framework with which to design educational, mass media, social media, and clinical interventions for the promotion of stool-based CRC screening among adults aged 45-75 years old.

Background: Most college students do not adequately participate in enough physical activity (PA) to attain health benefits. A theory-based approach is critical in developing effective interventions to promote PA. The purpose of this study was to examine the utility of the newly proposed multi-theory model (MTM) of health behavior change in predicting initiation and sustenance of PA among college students. Methods: Using a cross-sectional design, a valid and reliable survey was administered in October 201 5 electronically to students enrolled at a large Southern US University. The internal consistency Cronbach alphas of the subscales were acceptable (0.65-0.92). Only those who did not engage in more than 1 50 minutes of moderate to vigorous intensity aerobic PA during the past week were included in this study. Results: Of the 495 respondents, 190 met the inclusion criteria of which 141 completed the survey. The majority of participants were females (72.3%) and Caucasians (70.9%). Findings of the confirmatory factor analysis (CFA) confirmed construct validity of subscales (initiation model: χ² = 253.92 [df=143], P<0.001, CFI = 0.91, RMSEA = 0.07, SRMR = 0.07; sustenance model: χ² = 19.40 [df=22], P<0.001, CFI = 1.00, RMSEA = 0.00, SRMR = 0.03). Multivariate regression analysis showed that 26% of the variance in the PA initiation was explained by advantages outweighing disadvantages, behavioral confidence, work status, and changes in physical environment. Additionally, 29.7% of the variance in PA sustenance was explained by emotional transformation, practice for change, and changes in social environment. Conclusion: Based on this study's findings, MTM appears to be a robust theoretical framework for predicting PA behavior change. Future research directions and development of suitable intervention strategies are discussed. [ABSTRACT FROM AUTHOR]

Background: Physical activity (PA) brings many benefits to pregnant women and fetuses; however, the majority of pregnant women do not participate actively in PA during pregnancy., Objectives: This study aimed to: (1) assess the utility of Multi-Theory Model (MTM) to explain the intentions of PA behavior in Chinese pregnant women; (2) analyze the predictors in initiating and maintaining PA behavior based on MTM., Methods: A cross-sectional study including pregnant women was conducted from March to June 2022 at a university hospital in Hangzhou, Zhejiang Province, China. Participants completed measures that included a self-developed demographic questionnaire and a 29-item MTM questionnaire. Descriptive statistics and stepwise multiple regression were used to analyze the data. The reliability was assessed by Cronbach's alpha and test-retest stability. The construct validity was evaluated by using exploratory factor (EFA) analysis and confirmatory factor analysis (CFA)., Results: A total of 450 pregnant women participated in this study. The score of the magnitude of intention to initiate and maintain PA behavior during pregnancy was 2.30 (1.08) and 2.24 (1.09). The overall Cronbach's alpha value was 0.857. A four-factor structure for initiation model and a three-factor structure for maintenance model were determined. Results of the CFA confirmed construct validity of subscales (initiation model: χ 2 = 206.123, df = 140, p < 0.001, χ 2 /df = 1.472, RMSEA = 0.046, SRMR = 0.0432, GFI = 0.913, CFI = 0.982; maintenance model: χ 2 = 49.742, df = 29, p < 0.001, χ 2 /df = 1.715, RMSEA = 0.057, SRMR = 0.0432, GFI = 0.958, CFI 0.985). The result of regression indicated that participatory dialogue (β = 0.030; p = 0.002), behavioral confidence (β = 0.128; p < 0.001), changes in physical environment (β = 0.041; p = 0.005), trimester (β = -0.192; p = 0.001), and Gestational Diabetes Mellitus (GDM) (β = 0.408; p < 0.001) explained 52.1% variance in initiating PA behavior. Emotional transformation (β = 0.197; p < 0.001), practice for change (β = 0.083; p = 0.001), changes in social environment (β = 0.063; p < 0.001), pre-pregnancy exercise habit (β = -0.251; p = 0.001), and GDM (β = 0.298; p = 0.003) were significantly associated with pregnant women's intentions to maintain PA behavior and explained 49.1% variance., Conclusions: The constructs of MTM were effective in explaining the intention to initiate and maintain PA behavior among Chinese pregnant women.

Globally, cervical cancer is the fourth leading cause of death among women. While overall cervical cancer rates have decreased over the last few decades, minority women continue to be disproportionately affected compared to White women. Given the paucity of theory-based interventions to promote Pap smear tests among minority women, this cross-sectional study attempts to examine the correlates of cervical cancer screening by Pap test using the Multi-theory Model (MTM) as a theoretical paradigm among minority women in the United States (U.S.). Structural Equation Modelling (SEM) was done for testing the construct validity of the survey instrument. Data were analyzed through bivariate and multivariate tests. In a sample of 364 minority women, nearly 31% (n = 112) of women reported not having received a Pap test within the past three years compared to the national rate (20.8%) for all women. The MTM constructs of participatory dialogue, behavioral confidence, and changes in the physical environment explained a substantial proportion of variance (49.5%) in starting the behavior of getting Pap tests, while the constructs of emotional transformation, practice for change, and changes in the social environment, along with lack of health insurance and annual household income of less than $25,000, significantly explained the variance (73.6%) of the likelihood to sustain the Pap test behavior of getting it every three years. Among those who have had a Pap smear (n = 252), healthcare insurance, emotional transformation, practice for change, and changes in the social environment predicted nearly 83.3% of the variance in sustaining Pap smear test uptake behavior (adjusted R2 = 0.833, F = 45.254, p < 0.001). This study validates the need for health promotion interventions based on MTM to be implemented to address the disparities of lower cervical cancer screenings among minority women. [ABSTRACT FROM AUTHOR]

Objective: The purpose of the study was to assess the attitudes and beliefs towards HPV vaccination among Ghanaian parents with unvaccinated adolescents using the Multi-Theory Model (MTM) of behavior change. Additionally, we used MTM constructs to predict the likelihood of parents allowing their adolescents to initiate and complete the recommended HPV vaccine series., Methods: A 44-item validated survey was administered among parents with unvaccinated adolescents living in the Ashanti Region of Ghana. HPV vaccine initiation predictors were perceived beliefs and MTM constructs: participatory dialogue, behavioral confidence, and change in the physical environment. HPV vaccine completion predictors were emotional transformation, social environment, and practice for change., Results: Multiple linear regression analyses showed that perceived beliefs (95% CI: 0.03 - 0.14), change in the physical environment (95% CI: 0.06 - 0.15), and behavioral confidence (95% CI: 0.00 - 0.07),  were strongly associated with parents' likelihood of allowing their adolescents to initiate the HPV vaccine series (p<0.001). Together, perceived beliefs, behavioral confidence, and change in the physical environment accounted for 13.6% of the variance (R2 = 0.136). The emotional transformation (95% CI: 0.04 - 0.10),  and social environment (95% CI: 0.25 - 0.35),  predictors were both strongly associated with parents' likelihood of allowing their adolescent to complete the vaccine series (p<0.001). Together, emotional transformation and social environment accounted for 45.8% of the variance (R2 = .458). A sample of 380 parents with unvaccinated adolescents, between the ages of 35 - 60 years, participated in this study. Many of the participants were unaware of HPV (98.7%) and its related vaccinations (96.8%)., Conclusion: Our findings underscore the need for comprehensive multi-level interventions to create HPV vaccination awareness among Ghanaian parents with unvaccinated adolescents.

Florida residents have the second highest incidence of skin cancer in the nation. Sunscreen usage was found to be the one of the most effective integrative health approaches for reducing risk of skin cancer. Given the limited information on the likelihood of adopting and continuing sunscreen usage behavior, this cross-sectional study aimed to examine the correlates of initiating and sustaining sunscreen usage behavior among Florida dwellers, using the fourth-generation, multi-theory model (MTM) of behavior change. A web-based survey containing 51 questions was emailed to Florida residents aged 18 years or above, who were randomly selected from the state voter file. Psychometric validity of the survey instrument was established using structural equation modeling, and Cronbach's alpha values were calculated for assessing the internal consistency. An independent-samples-t-test and hierarchical multiple regression tests were used to analyze the data. The results indicated that participants who engaged in sunscreen usage behavior, participatory dialogue (β = 0.062, p < 0.05), behavioral confidence (β = 0.636, p < 0.001), and changes in the physical environment (β = 0.210, p < 0.001) were statistically significant and accounted for 73.6% of the variance in initiating sunscreen usage behavior. In addition, the constructs of emotional transformation (β = 0.486, p < 0.001) and practice for change (β = 0.211, p < 0.001), as well as changes in the social environment (β = 0.148, p < 0.001) were significant predictors of maintaining sunscreen usage behavior and contributed to 59% of variance in sustenance. These findings offer a valuable insight regarding the applicability of MTM models to guiding public health interventions promoting sunscreen usage and preventing UV radiation risk and related skin cancer. [ABSTRACT FROM AUTHOR]

African Americans have been disproportionately vaccinated at lower rates, which warrants the development of theory-based interventions to reduce vaccine hesitancy in this group. The fourth-generation theories, e.g., multi-theory model (MTM) of health behavior change, are vital in developing behavioral interventions. Therefore, the current study aims to determine recent trends in COVID-19 vaccination rates and to test the MTM model in predicting the initiation of COVID-19 vaccines among vaccine-hesitant Blacks. A sample of 428 unvaccinated African Americans were recruited through a web-based survey using a 28-item psychometric valid questionnaire. Chi-square, independent-samples-t-test or Welch's t test, and Pearson's correlation tests were utilized for the analyses. Hierarchical regression modelling was performed to determine the increment in variation accounted for through addition of predictors over a set of models. Nearly 48% of unvaccinated Blacks reported being vaccine-hesitant. The vaccine-hesitant group was relatively younger (40.5 years ± 15.8 vs. 46.2 years ± 17.4, p < 0.001), were Republicans (22.1% vs. 10.0%, p < 0.001), lived in the North-East region (26.0% vs. 11.4%, p < 0.001) and had religious affiliations other than Christianity (21.2% vs. 13.6%, p = 0.04). The mean scores of perceived advantages ((9.01 ± 3.10 vs. 7.07 ± 3.60, p < 0.001) and behavioral confidence (8.84 ± 3.76 vs. 5.67 ± 4.09, p < 0.001) were higher among vaccine non-hesitant group as opposed to the hesitant ones. In a final regression model, all MTM constructs) predicted nearly 65% of variance in initiating COVID-19 vaccination behavior among the vaccine-hesitant group (adjusted R2 = 0.649, F = 32.944, p < 0.001). With each unit increment in MTM constructs (e.g., participatory dialogue and behavior confidence), the initiation of COVID-19 vaccination among vaccine-hesitant Blacks increased by 0.106 and 0.166 units, respectively. Based on the findings of this study a m-health educational intervention to promote COVID-19 vaccine uptake behavior among Blacks is proposed. [ABSTRACT FROM AUTHOR]