An examination of sequential and simultaneous behavior change within two multiple health behavior change conditions
Research on the treatment of multiple health risk behaviors has grown in recent years, especially in the field of health behavior change. Yet, there is little research on how people change behaviors that are treated simultaneously. To help predict behavior change, and, thus, to prevent chronic illness on a population level, it is necessary to understand patterns of behavior change. In the present study, changes in pairs of multiple health risk behaviors that changed over time were examined. Data from four randomized controlled trials using Transtheoretical Model (TTM) tailored interventions and comparison groups (N = 1,277 weight management study; N = 9,461 cancer prevention study) were analyzed. Patterns of sequential behavior change were compared to patterns of simultaneous behavior change. Sequential change is when one behavior in a pair changed in a particular period, followed by changes in the other behavior. Simultaneous behavior change is when both behaviors in a pair changed in the same time period and sustained that change. Simultaneous and sequential patterns of behavior change were analyzed over four time points (baseline, 6, 12, and 24 months) for each behavior pair. Ten different patterns of change were found and cohered into three distinct groupings of change: (1) overall simultaneous vs. sequential patterns (24 months), (2) simultaneous versus sequential patterns during the first phase of the study (first 12 months) and the second phase (12-24 months) of the study, and (3) simultaneous versus sequential patterns for those who recycled behaviors during the course of the study (over a 24 month period). A series of chi-square analyses revealed specific patterns of behavior change over time. The analyses revealed that even when behaviors are treated simultaneously they are more likely to change sequentially. The results are discussed in terms of the proportions of individuals who changed both behaviors in a pair sequentially or simultaneously. Furthermore, the questions of whether the treatment and control groups followed different patterns of change, whether dissimilar behavior pairs (i.e., smoking, sun, diet) follow different patterns of change than similar behaviors (i.e., physical activity, diet, and emotional eating), and whether baseline Stage of Change impacts behavior change patterns were addressed. The findings provide a new window into the process of behavior change, illuminating a new way in which to understand the underlying mechanisms of behavior change. The discovery that the majority of behavior change is sequential rather than simultaneous advances the field of multiple health behavior change in a novel way; even when behaviors are treated simultaneously they are more likely to change sequentially.^
Eva-Molly Petitto Dunbar,
"An examination of sequential and simultaneous behavior change within two multiple health behavior change conditions"
Dissertations and Master's Theses (Campus Access).