The relationship of glucose testing attitudes and behavior to the stages of change: Application of the transtheoretical model to diabetes

Janet Marie Dryfoos, University of Rhode Island


Diabetes is the third leading cause of death by disease in the United States. A landmark study revealed that the onset and progression of diabetes complications are related to control of glucose levels. Unfortunately, there is very little literature on model-based strategies of behavioral change in the diabetes population. Thus, the development and application of theoretical models and measures of health behavior change in people with diabetes are needed.^ Surveys were mailed to 1300 nationally representative individuals, and 1500 individuals who used insulin. The sample was older (M = 57.3, SD = 13.1), with many retired people (41.1%). Participants were primarily female (60.8%), married (64.9%), and Caucasian (74.0%). The survey measured core Transtheoretical Model (TTM) constructs (including Stages of Change, Decisional Balance, Temptations, and Processes of Change) for glucose testing, among other behaviors. It also measured demographic, psychosocial, quality of life, medical utilization, medical care satisfaction, and medical history variables.^ The sample was split randomly (into two halves for exploratory and confirmatory analyses), and by insulin use. Cluster solutions examined for the insulin using and non-insulin using exploratory samples ranged from two to ten. Six cluster solutions were chosen for both samples, based on interpretability and parsimony. MANOVAs were done on Processes of Change for glucose testing by cluster membership and the patterns found were similar to those typically seen across the States of Change. Crosstab analyses of Stage of Change by cluster membership showed greater overlap than would be expected by chance alone. These results were replicated on the two confirmatory samples.^ The present study attempted to validate the stages of change construct by searching for intrinsic homogeneous subtypes of people, and was a unique test of the TTM. The results reflect a continuum of different types of people, similar to the groups that have been defined by more traditional staging approaches and overlaping greatly with them. Furthermore, groups found show patterns on related variables similar to the patterns found with more traditional stage definitions. These results lend relatively strong support to the concept of stages of change, as well as to some of the specific stages that have traditionally been used. ^

Subject Area

Psychology, Behavioral|Health Sciences, Medicine and Surgery

Recommended Citation

Janet Marie Dryfoos, "The relationship of glucose testing attitudes and behavior to the stages of change: Application of the transtheoretical model to diabetes" (1998). Dissertations and Master's Theses (Campus Access). Paper AAI9902558.