Evidence-based health and well-being for entire populations.

Research Publications by Topic


Johnson, J.L., Prochaska, J.O., Paiva, A.L., Fernandez, A.C., DeWees, S.L.,& Prochaska J.M. (2013). Advancing Bodies of Evidence for Population-Based Health Promotion Programs: Randomized Controlled Trials and Case Studies. Population Health Management, 16(6), 373-380. doi:10.1089/pop.2012.0094
Evers, K.E., Castle, P.H., Prochaska, J.O., & Prochaska, J.M. (In press). Examining relationships between multiple health risk behaviors, well-being, and productivity. Psychological Reports.
Prochaska, J.J., Prochaska, J.M. & Prochaska, J.O. (2013). Building a science for multiple-risk behavior change. In S. Shumaker, J. Ockene, K. Riekert (Eds.), The Handbook of Health Behavior Change Fourth Edition (pp. 245-267). New York, NY: Springer Publishing Company, LLC.
Prochaska, J.M. & Prochaska, J.O. (2014). A stage approach to enhancing adherence to treatment. In D.L. Mostofsky (Ed.), The Handbook of Behavioral Medicine First Edtion (pp. 58-76). Malden, Ma: John Wiley & Sons, Inc.
Evers, K. E., Prochaska, J.O., Castle, P.H., Johnson, J. L., Prochaska, J.M., Harrison, P.L., Rula, E.Y., Coberley, C., & Pope, J.E. (2012) Development of an individual well-being scores assessment. Psychology of Well-Being: Theory, Research and Practice, 2(2) doi:10.1186/2211-1522-2-2.
Prochaska, J.O., Evers, K.E., Johnson, J.L., Castle, P.H., Prochaska, J.M., Sears, L.E., Rula, E.Y., & Pope, J.E. (2011). The Well-being Assessment for Productivity: A well-being approach to presenteeism. Journal of Occupational and Environmental Medicine, 53, 735-742.
Levesque, D.A., Johnson, J.L., Welch, C.A., Prochaska, J.M., & Fernandez, A.C. (2012). Computer-tailored intervention for juvenile offenders. Journal of Social Work Practice in the Addictions, 12, 391-411.


Johnson, S.S., Paiva, A.L. Mauriello, L.M., Prochaska, J.O., Redding, C.A., & Velicer, W.F. (2013).
Coaction of Behavior Change in Multiple Behavior Change Interventions: Consistency across Multiple Studies on Weight Management & Obesity Prevention. Health Psychology, 33, 475-480.
Keywords: Weight Management

Objective: Coaction refers to the extent to which taking action on one behavior increases the odds of taking action on a second behavior. This integrative study examines the generalization of coaction in three studies on weight-related behaviors.
Methods: Data from three randomized trials of tailored interventions (n=1277, n=1800, and n=6000) were examined to determine if coaction of behavior change occurred differentially in treatment and control groups. In each analysis, the likelihood of progressing to the Action or Maintenance stages for the target behaviors was evaluated using logistic regression.
Results: Despite differences in populations, targeted behaviors, levels of tailoring in interventions, and timing of follow-up assessments, 17 out of 24 (70.8%) logistic regressions revealed significant coaction in the treatment group as opposed to only 3 out of 24 (12.5%) in the control condition. In 23/24 analyses, coaction of behavior change was larger on an absolute basis in the treatment group. Individuals in the treatment group progressing to Action/Maintenance for one behavior were 1.4 – 5 times more likely to make progress on another behavior compared to those in the treatment group who did not make progress on the first behavior.
Conclusions: This study demonstrates that despite considerable variability in study design, coaction reliably occurs more in the presence of Transtheoretical-Model based multiple behavior change interventions. Additional studies are needed to replicate these results in other behavioral areas and to examine the predictors of differential coaction. The ability to consistently create coaction within multiple behavior interventions will increase the efficacy and cost-effectiveness of multiple behavior change interventions.


Johnson, S.S. & Cook, B. (2013). Using the Transtheoretical Model to Promote the Adoption & Maintenance of Regular Exercise.
In C. Nigg (Ed.) ACSM’s Behavioral Aspects of Exercise. Philadelphia, PA: Lippincott Williams & Wilkins.
Keywords: Exercise


Levesque, D.A., Ciavatta, M.M., Castle, P.H., Prochaska, J.M., & Prochaska, J.O. (2012). Evaluation of a stage-based, computer-tailored adjunct to usual care for domestic violence offenders. Psychology of Violence, 2(4), 368–684.
Keywords: Domestic Violence and Dating Violence


Levesque, D.A., Driskell, M.M., Prochaska, J. M. (2009). Acceptability of a stage-matched expert system intervention for domestic violence offenders. In R.D. Maiuro & C.M. Murphy (Eds.), Motivational interviewing and stages of change in intimate partner violence (pp. 43-60). New York: Springer Publishing.
Keywords: Domestic Violence and Dating Violence



Levesque, D. A., Van Marter, D. F., Schneider, R. J., Bauer, M. R., Goldberg, D. N., Prochaska, J. O., & Prochaska, J. M. (2011). Randomized Trial of a Transtheoretical Model Computer-TailoredIntervention for Patients With Depression. American Journal of Health Promotion, 26(2), 77-89.
Keywords: Depression Prevention
Objectives: We examined whether a low-cost Transtheoretical Model (TTM) intervention tailored to stage of change and other TTM variables for using effective methods (e.g., physical exercise) to prevent or reduce depression could improve depression outcomes in primary care.

Methods: The intervention consisted of three individualized computer-generated reports and a print workbook mailed to the home. A randomized controlled trial assessed the intervention’s effectiveness in two samples recruited from health care organizations in Eastern Massachusetts and Chicago: 1) primary care patients experiencing subclinical or major depression but not involved in treatment (Untreated Sample, n=481); and 2) patients newly prescribed antidepressant medication (Antidepressant Sample, n=328). Participants received the intervention (n=402) or usual care (n=407). The primary outcomes, assessed at 9 months follow-up, were reliable and clinically significant reduction in depression, and onset of major depression among patients experiencing only subclinical symptoms at baseline. Planned analyses further examined the intervention’s effectiveness in various subgroups of clinical and practical interest (e.g., Untreated vs. Antidepressant samples).

Results: The intervention group was significantly more likely than control to experience a reliable and clinically significant reduction in depression (OR=1.65, CI=1.23-2.21), and was less likely to develop major depression during follow-up (OR=0.63, CI=0.40-0.98). The intervention was equally effective in the Untreated and Antidepressant samples, but did show differential effectiveness based on other participant characteristics.

Conclusion: The TTM program has the potential to fill an important gap in services and improve depression outcomes in primary care.


Prochaska, J.O., Evers, K.E., Castle, P.H., Johnson, J.L., Prochaska, J.M., Rula, E.Y., Coberley, C., & Pope, J.E. (2012). Enhancing Multiple Domains of Well-being by Decreasing Multiple Health Risk Behaviors: A Randomized Clinical Trial. Population Health Management.15(0), 1-11 DOI: 10.1089/pop.2011.0060.

Keywords: Well-Being
Tailored behavior change programs have proven effective at decreasing health risk factors, but the impact of such programs on participant well-being has not been tested. This randomized trial evaluated the impact of tailored telephone coaching and Internet interventions on health risk behaviors and individual well-being. Exercise and stress management were the primary health risks of
interest; improvements in other health risk behaviors were secondary outcomes. A sample of 3391 individuals who reported health risk in the areas of exercise and stress management were randomly assigned to 3 groups: telephonic coaching that applied Transtheoretical Model (TTM) tailoring for exercise and minimal tailoring (stage of change) for stress management; an Internet program that applied TTM tailoring for stress management and minimal tailoring for exercise; or a control group that received an assessment only. Participants were administered the Well-Being Assessment and, at baseline, had relatively low well-being scores (mean, 60.9 out of 100 across all groups). At 6 months a significantly higher percentage of both treatment groups progressed to the action stage for exercise, stress management, healthy diet, and total number of health risks, compared to the control group. Both treatment groups also demonstrated significantly greater improvements on overall well-being and the domains of emotional health, physical health, life evaluation, and healthy behaviors. There were no differences between the groups for 2 well-being domains: basic access to needs and work environment. These results indicate that scalable, tailored behavior change programs can effectively reduce health risk and accrue to improved well-being for participants.


Prochaska, J. M., Prochaska, J. O., Evers, K. E., & Tsuda, A. (in press). Transtheoretical-based expert systems guiding youth to have healthier, less stressful lives. In A. Tsuda, Y. Ohya, & Y. Tanno (Eds.), Clinical Stress Psychology. Tokyo: University of Tokyo Press.
Keywords: Stress Management


Dempsey-Fanning, A., Johnson, S.S., Westhoff, C.W. (2011).
Prediction of oral contraception continuation using the Transtheoretical Model of Health Behavior Change. Perspectives on Sexual and Reproductive Health, 43(1), 23-29. DOI: 10.1363/4302311
Keywords: Sexual Activity and Condom Use
Context: Improved continuation of oral contraceptive use may decrease the incidence of unintended pregnancy. Therefore, identifying predictors of continuation is important to informing targeted interventions. Methods: A survey conducted in 2003–2005 collected data from young women who sought oral contraceptives at three family planning clinics in New York, Dallas and Atlanta. Cluster analysis of data from 1,245 women was used to identify three distinct groups on the basis of baseline responses to items measuring constructs from the transtheoretical model of health behavior change: perceived advantages of pill use, perceived disadvantages and self-confidence in ability to sustain use. Logistic regression was used to assess the likelihood of continuation among the clusters.
Results: Participants who were confident in their ability to use the pill and who considered both its advantages and its disadvantages important were more likely to continue use for six months than were those who gave low scores to the method’s advantages and their ability to use it (odds ratio, 1.4). The same appeared to be true for those who gave high scores to the pill’s advantages and their ability to use it, but a low score to the method’s disadvantages (1.3);however, this finding was only marginally significant. Demographic variables were not significant after adjustment for cluster membership.
Conclusions: Cluster membership based on transtheoretical model constructs helps predict oral contraceptive continuation. Women who undervalue the advantages of pill use and have low confidence in their ability to use the method represent a target for interventions and future research.


Mauriello, L.M., Gökbayrak, N.S., Van Marter, D.F., Paiva, A.L., & Prochaska, J.M. (2011). An internet-based computer tailored intervention to promote responsible drinking: Findings from a pilot test with employed adults. Alcoholism Treatment Quarterly, 30, 81-108.
Keywords: Responsible Drinking
This article describes pilot test findings of an Internet-based, Transtheoretical Model-based, computer-tailored intervention for adults who exceed national guidelines for low-risk drinking. In a pilot test, 166 adults recruited from worksites completed one session and evaluated the program. Pre- and post- assessments indicate intention to make behavioral changes. Importantly, 94.3% of participants indicated that they would recommend the program. Ratings were positive with the majority of participants agreeing or strongly agreeing with all 14 evaluation items. Feasibility was demonstrated by recruiting and engaging employed adults. This program is a cost-effective prevention program promoting responsible drinking to adults.


Mauriello, L., Dyment, S., Prochaska, J.M., Gagliardi, A. & Weingrad-Smith, J. (2011). Acceptability and feasibility of a multiple behavior computer tailored intervention for underserved pregnant women. Journal of Midwifery and Women’s Health, 56, 75-80.
Keywords: Multiple Behavior Change/Pregnancy
Abstract: A pilot test of a computer- tailored intervention designed to promote health behaviors during pregnancy among a low-income, multi-ethnic population was conducted. Intervention content, based on the Transtheoretical-Model, offered pregnant women assistance with smoking cessation, stress management, and fruit and vegetable consumption. Pregnant women (N=87) were recruited from federally qualified health centers. After completing the intervention women answered a 16-item evaluation. Participants rated the program very positively with 89.7% to 95.5% of participants agreeing or strongly agreeing with all evaluation items. For example, 95.4% of respondents reported that: the program could help them be healthier; they learned new information; and the program was designed for pregnant women like them. Additionally, the majority of participants (92%) reported they would recommend the program to a friend. There were no significant differences in the ratings based on demographic characteristics of the participants. Qualitative responses support acceptability for the program. Further, pre and post assessments indicated an increase in intention to make behavioral changes. With acceptability and feasibility confirmed, the next steps are to test efficacy and consequently to distribute the program to populations of underserved pregnant women.


Levesque, D.A., Van Marter, D.F., Greene, R.N., Prochaska, J.M., Castle, P.H., & Prochaska, J. O. (2011). Assessing adolescents’ readiness to use healthy relationship skills for dating violence prevention: Measure development and validation. Family and Intimate Partner Violence Quarterly, 3, 319-343.
Keywords: Anger and Violence Prevention in Youth


Prochaska, J.M., Mauriello, L., Dyment, S., & Gökbayrak, S. (2011). Designing a health behavior change program for dissemination to underserved pregnant women. Public Health Nursing, 28, 548-555.
Keywords: Multiple Behavior Change/Pregnancy
Abstract: Making evidence-based health interventions more available to underserved populations has been identified as a major healthcare priority. A case study provides an example to guide researchers, academics, and practitioners on how to incorporate dissemination in all aspects of project planning and implementation. Formative research toward developing a healthy pregnancy program for undeserved pregnant women was conducted with an advisory council, expert interviews, focus groups and usability interviews with the target population, key informant interviews, expert reviews of the pilot program, and a pilot test. The extensive formative research served to lay the foundation for the development of this comprehensive healthy pregnancy program. Successful adoption of interventions depends upon strong formative research, participatory research methods, interdisciplinary collaboration, and a commitment to dissemination from project inception. The development of the intervention discussed serves as a useful and practical example for others working in health care and behavioral medicine to improve the overall health and well-being of the underserved.


Prochaska, J.O., Evers, K.E., Johnson, J.L., Castle, P.H., Prochaska, J.M., Sears, L.E., Rula, E.Y., & Pope, J.E. (2011). The Well-Being Assessment for Productivity: A Well-Being Approach to Presenteeism. Journal of Occupational & Environmental Medicine, 53 (7), 735–742.
Keywords: Well-Being
Objective: To develop a presenteeism assessment, the Well-Being Assessment for Productivity (WBA-P), that provides an informative evaluation of job performance loss due to well-being related barriers. Method: The WBA-P was developed using exploratory and confirmatory factor analysis using survey data from 1827 employed individuals. Evidence of criterion-related validity was established using multivariate analysis of variance across measures of health and well-being. Results: A hierarchical, two-factor model demonstrated good fit and included factors capturing productivity loss from personal reasons (WBA-PP) and work environment (WBA-PW). Significant interactions existed between these and previously validated presenteeism measures with respect to physical and emotional health, risk factors, and life evaluation. Conclusions: This initial psychometric evidence suggests that the WBA-P and its subscales are valid measures of presenteeism that capture actionable well-being–related performance barriers.


Prochaska, J.O. & Prochaska, J.M. (2011). Recent findings related to the Transtheoretical Model. In J. Trafton & W.P. Gordon (Eds.) Best Practices in the Behavioral Management of Disease, (Volume 1, pp S1-1-S1-5).
Keywords: Transtheoretical Model


Prochaska, J.O. & Prochaska, J.M. (2011). High-impact paradigms for changing behavior to enhance health, productivity and well-being. In J. Brown & D.B. Nash (Eds.) Disease Management and Wellness in the Post-Reform Era, (pp. 61-710. Washington, D.C.: Atlantic Information Services, Inc.
Keywords: Transtheoretical Model


Mauriello, L.M., Ciavatta, M.H., Paiva, A.L., Sherman, K.J., Castle, P.H., Johnson, J.L., Prochaska, J.M. (2010) Results of a multi-media multiple behavior obesity prevention program for adolescents, Preventive Medicine, 51, 451-456.
Keywords: Obesity Prevention (Youth)/Multiple Behavior Change
Background: This study reports on effectiveness trial outcomes of Health in Motion, a computer tailored multiple behavior intervention for adolescents. Methods: Using school as level of assignment, students (n = 1800) from eight high schools in four states (RI, TN, MA, and NY) were stratified and randomly assigned to no treatment or a multi-media intervention for physical activity, fruit and vegetable consumption, and limited TV viewing between 2006 and 2007. Results: Intervention effects on continuous outcomes, on movement to action and maintenance stages, and on stability within action and maintenance stages were evaluated using random effects modeling. Effects were most pronounced for fruit and vegetable consumption and for total risks across all time points and for each behavior immediately post intervention. Co-variation of behavior change occurred within the treatment group, where individuals progressing to action or maintenance for one behavior were 1.4–4.2 times more likely to make similar progress on another behavior. Conclusion: Health in Motion is an innovative, multiple behavior obesity prevention intervention relevant for all adolescents that relies solely on interactive technology to deliver tailored feedback. The outcomes of the effectiveness trial demonstrate both an ability to initiate behavior change across multiple energy balance behaviors simultaneously and feasibility for ease of dissemination.


Horiuchi, S., Kim, E., Tsuda, A., & Prochaska, J.M. (2010). Relationship between stage of change and self-efficacy for stress management behavior in Korean university students. Japanese Journal of Behavioral Medicine, 16, 12-19.
Keywords: Stress Management


Johnson, S. S., Cummins, C. O., Evers, K. E., Prochaska, J. M., & Prochaska, J. O. (2009). Proactive health consumerism: An important new tool for worksite health promotion. Journal of Health Promotion, 23(6): suppl 1-8.
Keywords: Organizational Change
Abstract: Consumerism in health care has taken on the form of a major innovation among employers and health plans. Yet many of our efforts to enhance the skills and attitudes that enable consumerism have met with limited success. Proactive Health Consumerism is proposed as an approach that utilizes many of the hard-won lessons from health promotion research. Along with prerequisites that create the motivation and framework for increased health consumerism, this article provides a theory-driven example of a new tool for health promotion professionals to employ when enhancing the health consumer skills of working populations. Strategies for maximization of effectiveness and integration with supporting resources are also described.

Velicer, WF, Bickmore, T, Bryan Blissmer, B, Redding, C, Johnson, J, Meier, & Jenna Zaffini, J. (2009). Relational Agent Interventions for Multiple Risk Factors: Demonstration and Initial Results. Psychology & Health, 24, 403.
Keywords: Multiple Behavior Change


Driskell, M. M., Dyment, S. J., Mauriello, L. M., Castle, P. H., & Sherman, J. M. (2008). Relationships among multiple behaviors for childhood and adolescent obesity prevention. Preventive Medicine, 46, 209-215.
Keywords: Obesity Prevention (Youth)
Abstract: BACKGROUND: Curbing the epidemic of childhood and adolescent obesity requires impacting multiple behaviors. This article examines the interrelationships of physical activity, fruit and vegetable consumption, and limiting television time among elementary, middle, and high school students. METHODS: Nationwide samples of students in grades 4 through 12 (n=4091) completed self-administered questionnaires assessing Transtheoretical Model constructs and behavioral indicators for physical activity, fruit and vegetable consumption, and limiting television time. Analyses were conducted to compare the prevalence of students at-risk for the target behaviors across the age groups and to examine the interrelationships of the target behavior risks. RESULTS: Across the three age groups, physical activity and fruit and vegetable consumption declined, while limiting TV time increased. In addition, high school students had the greater number of behavioral risks. Across all three samples, being at-risk for one behavior almost always significantly increased the odds of being at-risk for another behavior. CONCLUSION: The findings of this study provide further evidence for the need for early promotion of healthy lifestyle behaviors. The relationships among the target behaviors in three samples strongly support a multiple behavior approach for obesity prevention. Transtheoretical Model-based tailored interventions are currently being used to change multiple behaviors without overwhelming students.


Johnson, S. S., Cummins, C. O., & Evers, K. E. (2008). The impact of transtheoretical model-based multiple behavior interventions on nutrition. In N. E. Bernhardt & A. M. Kasko (Eds.), Nutrition for Middle-Aged and Elderly. (pp. 195-212). Hauppauge, NY: Nova Science Publishers.
Keywords: Multiple Behavior Change


Johnson, S. S., Paiva, A. L., Cummins, C. O., Johnson, J. L., Dyment, S. J., Wright, J. A., Prochaska, J. M., Prochaska, J.O., & Sherman, K. (2008). Transtheoretical model-based multiple behavior intervention for weight management: Effectiveness on a population basis. Preventive Medicine, 46, 238-246.
Keywords: Exercise/Healthy Eating/Impact of Programs/Multiple Behavior Change/Weight Management
Abstract: BACKGROUND: The increasing prevalence of overweight and obesity underscores the need for evidence-based, easily disseminable interventions for weight management that can be delivered on a population basis. The Transtheoretical Model (TTM) offers a promising theoretical framework for multiple behavior weight management interventions. METHODS: Overweight or obese adults (BMI 25-39.9; n = 1277) were randomized to no-treatment control or home-based, stage-matched multiple behavior interventions for up to three behaviors related to weight management at 0, 3, 6, and 9 months. All participants were re-assessed at 6, 12, and 24 months.
RESULTS: Significant treatment effects were found for healthy eating (47.5% versus 34.3%), exercise (44.9% versus 38.1%), managing emotional distress (49.7% versus 30.3%), and untreated fruit and vegetable intake (48.5% versus 39.0%) progressing to Action/Maintenance at 24 months. The groups differed on weight loss at 24 months. Co-variation of behavior change occurred and was much more pronounced in the treatment group, where individuals progressing to Action/Maintenance for a single behavior were 2.5-5 times more likely to make progress on another behavior. The impact of the multiple behavior intervention was more than three times that of single behavior interventions. CONCLUSIONS: This study demonstrates the ability of TTM-based tailored feedback to improve healthy eating, exercise, managing emotional distress, and weight on a population basis. The treatment produced a high level of population impact that future multiple behavior interventions can seek to surpass.


Levesque, D. A., Driskell, M. M., Prochaska, J. M., & Prochaska, J. O. (2008). Acceptability of a stage-matched expert system intervention for domestic violence offenders. Violence and Victims, 23, 432-445.
Keywords: Domestic Violence and Dating Violence
Abstract: Most interventions for men who batter are standardized and “one-size-fits-all,” neglecting individual differences in readiness to change. A multimedia expert system intervention based on the Transtheoretical Model (the “stage model”) was developed as an adjunct to traditional court-mandated programs. The expert system assesses stage of change, decisional balance, self-efficacy and processes of change, and provides immediate individualized matched feedback designed to increase readiness to end the violence. Fifty-eight male batterer intervention program clients were invited by agency staff to complete an expert system session and an evaluation of the program; 33 men were recruited at program intake and the remainder from ongoing groups. Responses to the intervention were very positive. For example, 87% of participants reported that they found the program to be easy to use and 98% said it could probably or definitely help them change their attitudes or behaviors. Findings provide encouraging evidence of the acceptability of this stage-matched approach to intervention for domestic violence offenders.


Levesque, D. A., Velicer, W. F., Castle, P. H., & Greene, R. N. (2008). Resistance Among Domestic Violence Offenders: Measurement Development and Initial Validation. Violence Against Women, 14, 158-184.
Keywords: Domestic Violence and Dating Violence


Prochaska, J. J. & Prochaska, J. M. (2008). Multiple risk behavior change: What most individuals need. In S. A. Shumaker, J. K. Ockene, & K. A. Riekert (Eds.), Handbook of Health Behavior Change (3rd ed.) (pp. 287-305). New York: Springer Publishing.
Keywords: Multiple Behavior Change


Prochaska, J. M. & Prochaska, J. O. (2008). Transtheoretical model guidelines for families with child abuse and neglect. In A. R. Roberts & G. J. Greene (Eds.), Social Workers’ Desk Reference (2nd ed., pp. 379-384). Oxford: Oxford University Press.
Keywords: Domestic Violence and Dating Violence


Prochaska, J. O., Butterworth, S., Redding, C. A., Burden, V., Perrin, N., Leo, M., Flaherty-Robb, M., & Prochaska, J. M. (2008). Initial efficacy of MI, TTM tailoring and HRI’s with multiple behaviors for employee health promotion. Preventive Medicine, 46,226-231.
Keywords: Multiple Behavior Change
Abstract: OBJECTIVE: This study was designed to compare the initial efficacy of Motivational Interviewing (MI), online Transtheoretical Model (TTM)-tailored communications and a brief Health Risk Intervention (HRI) on four health risk factors (inactivity, BMI, stress, and smoking) in a worksite sample. METHOD: A randomized clinical trial assigned employees to one of three recruitment strategies and one of the three treatments. The treatment protocol included an HRI session for everyone and in addition either a recommended three TTM online sessions or three MI in person or telephone sessions over 6 months. At the initial post-treatment assessment at 6 months, groups were compared on the percentage who had progressed from at risk to taking effective action on each of the four risks. RESULTS: Compared to the HRI only group, the MI and TTM groups had significantly more participants in the Action stage for exercise and effective stress management and significantly fewer risk behaviors at 6 months. MI and TTM group outcomes were not different. CONCLUSION: This was the first study to demonstrate that MI and online TTM could produce significant multiple behavior changes. Future research will examine the long-term impacts of each treatment, their cost effectiveness, effects on productivity and quality of life and process variables mediating outcomes.


Prochaska, J. O., Johnson, S. S., & Lee, P. (2008). The transtheoretical model of behavior change. In E. Schron, J. Ockene, S. Schumaker, & E. W.M. (Eds.), The Handbook of Behavior Change (3rd ed.) (pp. 59-83). New York: Springer.
Keywords: Patient Practice


Prochaska, J. O., Redding, C. A., & Evers, K. E. (2008). The transtheoretical model and stages of change. In K. Glanz, B. K. Rimer, & F. M. Lewis (Eds.), Health Behavior and Health Education: Theory, Research and Practice (4th ed.) (pp. 97-121). San Francisco, CA: Jossey-Bass, Inc.
Keywords: Patient Practice


Prochaska, J. O. & Prochaska, J. M. (2008). Termination at each stage of change. In A Clinician’s Guide to the Termination of Psychotherapy (pp. 147-162). New York: Brunner-Routlidge, Taylor & Francis.
Keywords: Patient Practice


Evers, K. E., Prochaska, J. O., Van Marter, D. F., Johnson, J. L., & Prochaska, J. M. (2007). Transtheoretical-based bullying prevention effectiveness trial in middle schools and high schools. Educational Research, 49, 397-414.
Keywords: Bullying Prevention/Impact of Programs
Abstract: BACKGROUND: Bullying threatens the physical and mental well-being of students across a broad range of schools. Tailored interventions based on the Transtheoretical Model and delivered over the internet were designed to reduce participation in each of three roles related to bullying (bully, victim, and passive bystander). METHODS: Effectiveness trials were completed in 12 middle schools and 13 high schools in the USA. A diverse sample of 1237 middle (6th-8th grade, with 45.1% in the 7th grade; ages 11-14) and 1215 high school (9th-11th grade, with 41.6% in the 9th grade; ages 14-17) students were available for analyses. RESULTS: Analyses showed significant treatment effects for both intervention groups when compared to control for both the middle and high school programs. CONCLUSIONS: Given the relative ease of dissemination, these programs could be applied as stand-alone practices or as part of more intensive interventions.


Mauriello, L. M., Rossi, J. S., Fava, J. L., Redding, C. A., Robbins, M., Prochaska, J. O., & Meier, K.S. (2007). Assessment of the pros and cons of stress management among adolescents: Development and validation of a decisional balance measure. American Journal Health Promotion, 22, 140-143.
Keywords: Stress Management
Abstract: PURPOSE: This article reports on the development of a decisional balance measure based on the Transtheoretical Model (TTM) for stress management among adolescents. DESIGN: Measurement development was conducted with participants of a pilot survey. SETTING: Surveys were completed in health and physical education classes. SUBJECTS: Ninth and tenth graders (N=317) completed an assessment of TTM constructs. MEASURES: The focus of this paper is the development of a decisional balance measure. ANALYSIS: A split-half cross-validation procedure was implemented. RESULTS: A brief reliable eight-item instrument was developed measuring the pros and cons of practicing stress management. A theoretically consistent pattern of pros and cons across the stages of change was obtained and indicated construct validity. Girls were more likely to practice and acknowledge benefits of stress management. CONCLUSION: This instrument will aid future work on promoting stress management practices among adolescents, particularly when using the TTM to develop interventions.


Mauriello, L. M., Sherman, K. J., Driskell, M. M., & Prochaska, J. M. (2007). Using interactive behavior change technology to intervene on physical activity and nutrition with adolescents. Adolescent Medicine: State of the Art Reviews, 18, 383-399.
Keywords: Obesity Prevention (Youth)
Abstract: The use of interactive technologies to promote health behaviors is a rapidly expanding field. Yet, the integration of these technologies in the development of physical activity and nutrition interventions for adolescents is in its infancy. Health in Motion, a multimedia obesity prevention program for adolescents, is described as a case example of a web-based interactive program for promoting physical activity and fruit and vegetable consumption among high school students. Lessons gathered from existing programs are summarized and used to offer future directions for advancing the development of adolescent interventions in this field.


Prochaska, J. M. (2007). The transtheoretical model applied to the community and the workplace. Journal of Health Psychology, 12, 198-200.
Keywords: Organizational Change


Prochaska, J. O., Evers, K. E., Prochaska, J. M., Van Marter, D., & Johnson, J. L. (2007). Efficacy and effectiveness trials: Examples from smoking cessation and bullying prevention. Journal of Health Psychology, 12, 170-178.
Keywords: Bullying Prevention
Abstract: If health psychology is to maximize impacts on health, there will need to be a shift from relying primarily on efficacy trials to increasing reliance on effectiveness trials. Efficacy trials use homogeneous, highly motivated samples with minimal complications from a single setting receiving intensive treatments delivered under highly controlled conditions. Two effectiveness trials on bullying prevention illustrate the use of a heterogeneous population from multiple sites receiving a low intensity tailored treatment delivered under highly variable conditions. In spite of considerable noise the effectiveness trials produced robust results (odds ratios of about four) that bode well for population impacts under real-world dissemination.


Silver, B., Prochaska, J. M., Mederer, H., Harlow, L., & Sherman, K. (2007). Advancing women scientists: Exploring a theoretically-grounded climate change workshop model. Journal of Women and Minorities in Science and Engineering, 13, 207-230.
Keywords: Organizational Change
Abstract: Universities in the United States have an increasing need to recruit the best and the brightest faculty to remain globally competitive, but the majority of schools share a profile that includes a low percentage of women in most of the science, technology, engineering, and math (STEM) disciplines. Changes in university culture are needed to enable departmental diversity growth, to expand offerings and perspectives, and to strengthen the view that STEM is an attractive choice for female students and prospective faculty. This paper describes the theoretical models used to develop a prototype workshop series to be implemented in departments to help faculty progress in their readiness to advance women scientists, defined as collaborating, mentoring, sharing resources, and generating support through community. The three theoretical underpinnings are the gender-as-structure theory of organizational change, Appreciative Inquiry, and the Transtheoretical Model. These workshops are one aspect of the climate change efforts implemented by the ADVANCE program of the University of Rhode Island.


Wallace, L. M., Evers, K. E., Wareing, H., Dunn, O. M., Newby, K., Paiva, A., & Johnson, J. L. (2007). Informing school sex education using the stages of change construct: Sexual behaviour and attitudes towards sexual activity and condom use of children aged 13-16 in England. Journal of Health Psychology, 12, 179-183.
Keywords: Sexual Activity and Condom Use
Abstract: A survey of 3820 school children in England aged 13-16 years examined sexual activity using the Transtheoretical Model (TTM) Stages of Change. A quarter (26%) of teens were sexually experienced, 44.8 per cent did not use contraception and 48.9 per cent did not use condoms, every time. Past history of condom and contraceptive use, and partner willingness to use condoms were the best predictors of being in Action or Maintenance stage for condom use. Of virgins, 19.82 per cent were in Contemplation or Preparation stages for intercourse, and 85.4 per cent would use condoms every time. Sex education should be tailored to Stage, and signposting to sexual health and contraception services.


Evers, K. E., Prochaska, J. O., Johnson, J. L., Mauriello, L. M., Padula, J. A., & Prochaska, J. M. (2006). A randomized clinical trial of a population- and transtheoretical model-based stress-management intervention. Health Psychology, 25, 521-529.
Keywords: Impact of Programs/Stress Management
Abstract: Stress has been associated with a variety of chronic and acute conditions and with higher use of health care services. This research reports on 18-month outcomes of a randomized clinical trial of a stress-management program based on the Transtheoretical Model (TTM; J. O. Prochaska & C. C. DiClemente, 1986). A national sample of 1,085 individuals participated (age range = 18-91 years, M = 55.33; 68.9% female, 31.1% male; 84.8% Caucasian; 15.2% non-Caucasian). Both the treatment and control groups received assessments at 0, 6, 12, and 18 months. In addition to the assessments, the treatment group received 3 individualized reports (0, 3, 6 months) and a manual. The 18-month assessment was completed by 778 individuals (72%). A random effects model indicated that participants completing the study in the treatment group had significantly more individuals reporting effective stress management at follow-up time points than did completers in the control group. Results also indicate that the intervention had significant effects on stress, depression, and specific stress-management behaviors. Results provide evidence for the effectiveness of this TTM population-based stress-management intervention.


Evers, K. E. (2006). eHealth promotion: the use of the internet for health promotion. American Journal of Health Promotion, 20, suppl 1-7, iii.
Keywords: Internet and Health Behavior Change
Abstract: The use of the Internet for health promotion is explored in this edition including growth trends, general applicability, and evaluation strategies for online interventions. This article examines the range of preliminary studies of eHealth Promotion interventions and their summary results, and reviews potential evaluation tools and their use in online programming. Also assessed is their utility in population-based programming and review-selected implications for the field.


Johnson, J. L., Evers, K. E., Paiva, A. L., Van Marter, D. F., Prochaska, J. O., Prochaska, J. M., Mauriello, L. M., Cummins, C. O., & Padula, J. A. (2006). Prevention profiles: Understanding youth who do not use substances. Addictive Behaviors, 31,1593-1606.
Keywords: Substance Abuse
Abstract: This study replicates innovative profiles of prevention among students not using substances but who may be at different risks for acquisition. Using the Transtheoretical Model constructs of Decisional Balance and Temptations, cluster analyses were performed on four independent samples of students (n=1240) in the USA, England, and Israel. For each sample, the same four distinct profiles emerged. ANOVAs indicated that the processes of prevention varied significantly across these profiles. The prevention profiles were extended to youth in elementary, middle, and high schools and from a focus on single substances to multiple substances, including alcohol, tobacco, and illicit drugs. Implications for developing prevention programs are also discussed.


Johnson, S. S., Driskell, M. M., Johnson, J. L., Dyment, S. J., Prochaska, J. O., Prochaska, J. M., & Bourne, L. (2006). Transtheoretical model intervention for adherence to lipid-lowering drugs. Disease Management, 9, 102-114.
Keywords: Impact of Programs/Medication Adherence
Abstract: An estimated 60% of individuals prescribed lipid-lowering medications are nonadherent. Failure to adhere increases morbidity, mortality, health care utilization, and health care costs. This study examined the effectiveness of a population-based, individualized Transtheoretical Model (TTM) expert system intervention to improve adherence and increase exercise and diet in a randomized 18-month trial involving 404 adults. Compared to usual care, treatment participants who started in a pre-action stage were significantly more likely to be in the Action and Maintenance (A/M) stages for adherence at end of treatment (55.3% versus 40%, z = 2.11, p < 0.05, h = 0.31) and at 18-months (56% versus 37.8%, z = 2.38, p < 0.01, h = 0.36). The treatment group scored significantly better on two measures of adherence at six and 12 months post-treatment (all p < 0.05, odds ratios [OR] 1.49-3.67). Among those who began in A/M, treatment participants were significantly more likely to remain in A/M at 18 months (85.2% versus 55.6%, z = 2.63, p < 0.01, h = 0.67). Those receiving treatment were significantly more likely to progress to A/M for exercise and dietary fat reduction (43.3% versus 24.7% for exercise, and 24.7% versus 12.5% for diet). TTM expert system interventions can have a significant impact on entire populations for adherence. Results for dietary fat and exercise suggest covariation of treatment effects.


Johnson, S. S., Driskell, M. M., Johnson, J. L., Prochaska, J. M., Zwick, W., & Prochaska, J. O. (2006). Efficacy of a transtheoretical model-based expert system for antihypertensive adherence. Disease Management, 9, 291-301.
Keywords: Impact of Programs/Medication Adherence
Abstract: Blood pressure is not controlled in as many as 50%-75% of hypertensive patients, primarily because of inadequate adherence to treatment. This paper examines the efficacy of a Transtheoretical Model (TTM)-based expert system intervention designed to improve adherence with antihypertensives in a sample of 1,227 adults. Participants were proactively recruited and randomly assigned to receive usual care or three individualized expert system reports and a stage-matched manual over 6 months. Participants were surveyed at baseline, and 6, 12, and 18 months. Significantly more of the intervention group participants reported being in Action and Maintenance at follow-up time points (i.e., 73.1% of the treatment group versus 57.6% of the control group at 12 months and 69.1% of the treatment group versus 59.2% of the control group at 18 months). Scores on a behavioral measure of nonadherence differed significantly at follow-up time points. TTM-based expert system interventions have the potential for a significant impact on entire populations of individuals who fail to adhere, regardless of their readiness to change.


Levesque, D. A., Cummins, C. O., Prochaska, J. M., & Prochaska, J. O. (2006). Randomized trial of stage-based interventions for informed Medicare choices. Health Care Financing Review, 27, 25-40.
Keywords: Informed Decision Making
Abstract: A randomized trial involving 1,351 new Medicare enrollees was conducted to assess the efficacy of a Transtheoretical Model (TTM) based manual and multimedia expert system program that delivered guidance and feedback matched to individual stage of readiness to compare Medicare health plans. At 6 months post-intervention, compared to enrollees in the control group, those receiving the manual plus expert system intervention or the manual alone exhibited greater increases in Medicare knowledge. The TTM-based interventions also increased use of and satisfaction with traditional Medicare education materials among most enrollees. The interventions’ impact on stage of change for comparing plans was observed only among treatment group participants who had examined and evaluated the materials. The challenges to increasing informed choice and possible dissemination channels for stage-based materials are discussed.


Levesque, D. A., Cummins, C. O., Prochaska, J. M., & Prochaska, J. O. (2006). Stage of change for making an informed decision about Medicare health plans. Health Services Research, 41, 1372-1391.
Keywords: Informed Decision Making
Abstract: OBJECTIVE: To assess the applicability of the Transtheoretical Model of change (TTM) to informed choice in the Medicare population. DATA SOURCES/STUDY SETTING: Two hundred and thirty-nine new Medicare enrollees randomly selected from the Center for Medicare and Medicaid Services’ October 2001 Initial Enrollee File, a repository of data for persons who are going to turn 65 and become entitled to enroll in Medicare in the next 3 months. STUDY DESIGN: Study participants completed TTM measures of stage of change, decisional balance, and self-efficacy for informed choice, as well as measures of Medicare knowledge, perceived knowledge, and information seeking. Model testing was conducted to determine whether well-established relationships between stage of change, decisional balance, and self-efficacy replicate for informed choice in the Medicare population, and whether Medicare knowledge and information-seeking increase across the stages. DATA COLLECTION/EXTRACTION METHODS: Survey data were collected using mail surveys with telephone follow-up for nonresponders. PRINCIPAL FINDINGS: Predicted relationships were established between stage of change for informed choice and decisional balance, self-efficacy, Medicare knowledge, and information seeking. The amount of variance accounted for by stage of change for informed choice was larger than that found for smoking cessation, where the TTM has had its greatest successes. CONCLUSIONS: The methods and findings lay the groundwork for development of TTM-based interventions for Medicare beneficiaries, and provide a prototype for the application of the TTM to informed decision making among other types of consumers who are being asked to take more responsibility for their health care.


Mauriello, L. M., Driskell, M. M., Sherman, K. J., Johnson, S. S., Prochaska, J. M., & Prochaska, J. O. (2006). Acceptability of a school-based Intervention for the prevention of adolescent obesity. The Journal of School Nursing, 22, 269-277.
Keywords: Obesity Prevention (Youth)
Abstract: This article describes the development and pilot testing of a computer-based, multiple- behavior obesity prevention program for adolescents. Using the Transtheoretical Model as a framework, this intervention offers individualized feedback based on readiness to engage in physical activity, to consume fruits and vegetables, and to limit television viewing. Focus groups and interviews with students, teachers, school administrators, and experts guided the development. Forty-five students participated in a baseline intervention session and completed a 16-item acceptability measure. Ratings were positive, with item means ranging from 3.60-4.75 on a 5-point scale. Student responses to open-ended questions aided in the enhancement of the intervention, for which an effectiveness trial begins in September 2006. This formative work demonstrated the acceptability of this school-based intervention approach, which can be promoted and prescribed by school nurses. Further, if found effective, it can be disseminated as an efficient, low-cost, population-based approach designed to address the epidemic of obesity.


Prochaska, J. M., Mauriello, L. M., Sherman, K. J., Harlow, L., Silver, B., & Trubatch, J. (2006). Assessing readiness for advancing women scientists using the transtheoretical model. Sex Roles, 54, 869-880.
Keywords: Organizational Change
Abstract: The under-representation of women in science, technology, engineering, and math disciplines is of wide interest. In this article we report on the development of new Transtheoretical Model-based measures to assess readiness to take action to advance women scientists. Reliable measures of Stage of Change, Decisional balance, and Self-efficacy were developed with a sample of science faculty from a northeastern university. Theoretical relationships among the constructs were validated and offer support for extending the Transtheoretical Model to this area. These measures are being used as part of a campus-wide initiative to examine the advancement of women scientists before and after a series of interventions.


Prochaska, J. M., Prochaska, J. O., Evers, K. E., & Tsuda, A. (2006). A new stress management program based on the transtheoretical model using the internet. In A. Tsuda & J. O. Prochaska (Eds.), New Practice for Stress Management (pp. 58-71). Tokyo: Shibundo.
Keywords: Stress Management


Evers, K. E., Cummins, C. O., Prochaska, J. O., & Prochaska, J. M. (2005). Online health behavior and disease management programs: Are we ready for them? Are they ready for us? Journal of Medical Internet Research, 7, e27.
Keywords: Internet and Health Behavior Change
Abstract: Advancing the science and practice of health promotion and disease management on the Internet requires a systematic program of research examining the population impact of such programs. With impact described as the combination of effectiveness and participation, such research needs to include the examination of the quality and effectiveness of programs that are available to the general public, as well as descriptive and predictive knowledge about population readiness to participate in such programs. There have been few studies examining the quality of interactive health behavior change (HBC) programs on the Internet, and even fewer investigations of the effectiveness of such programs. Based on the review of over 300 HBC programs on the Internet using the “5 A’s” of Health Behavior Change on the Internet (HBC-I Screener), which represent standard minimum guidelines for evaluation, it appears HBC on the Internet is in the early stages of development. As health behavior change on the Internet matures from the provision of health information to meeting the requirements necessary to produce health behavior change, and as program developers take advantage of the interactive nature of the Internet, the basic screening and expanded evaluation criteria developed in this project will provide templates for both consumers and developers of programs. The second component necessary for evaluating the impact of HBC on the Internet is the extent to which the population is ready to participate in such programs. We need to move beyond a narrow focus on early adopters and produce a population perspective that includes those not ready, those getting ready, and those ready to use such programs, as well as those already participating. By understanding participation levels of such programs, and what drives this participation, the development and dissemination of practical tailored and targeted interventions can help maximize population participation in Internet programs for health behavior change.


Hageman, L., Montgomery, J. E., & Prochaska, J. M. (2005). Are you emotionally ready for adoption? Family Building, 16-17.
Keywords: Adoption Readiness


Prochaska, J. M., Levesque, D. A., & Prochaska, J. O. (2005). Skills for mastering change in the workplace. In K. Prashant (Ed.), Change Management. Hyderabad, India: ICFAI Books.
Keywords: Organizational Change


Prochaska, J. M., Paiva, A. L., Padula, J. A., Prochaska, J. O., Montgomery, J. E., Hageman, L., & Bergart, A. M. (2005). Assessing emotional readiness for adoption using the transtheoretical model. Children and Youth Services Review, 27, 135-152.
Keywords: Adoption Readiness
Abstract: This research applied the Transtheoretical Model (TTM) to conceptualizing and assessing emotional readiness to be an adoptive parent. Readiness to adopt was defined as taking the three steps of: accepting that it is more important to be a parent than to have this child biologically; researching and finding that adoption is right for this individual; and sharing adoption plans with others. The three criteria for emotional readiness were based on adoption literature, clinical experience and “practice wisdom” of adoption professionals, and focus groups. The development and validation of measures for the 14 variables of the TTM is described. With an adoption agency, 217 prospective adoptive parents completed an assessment. Findings provide evidence of the validity of the TTM measures and the application of TTM to the field of adoption. Results showed that individuals in the earlier stages of change weighed the cons of being emotionally ready as higher than the pros, while the opposite was true for individuals in the Maintenance stage. Individuals in the Action and Maintenance stages reported higher self-efficacy than those in the Contemplation and Preparation stages. Individuals in the latter stages applied processes of change at higher levels than those in the Contemplation stage. These findings support the applicability of the TTM to emotional readiness to be an adoptive parent and provide impetus for future efforts to develop stage-matched interventions that can guide adoption professionals in their work.


Prochaska, J. M. (2005). The transtheoretical model. Taking stock: A survey on the practice and future of change management. In H. Nauheimer (Ed.), The Change Management Toolbook. Berlin, Germany.
Keywords: Organizational Change


Prochaska, J. M. & Prochaska, J. O. (2005). Helping patients change unhealthy behaviors. In D. S. Jones & S. Quinn (Eds.), Textbook of Functional Medicine (pp. 722-728).
Keywords: Patient Practice


Prochaska, J. M. (2005). Stress management using the transtheoretical model. In K. Takenaka (Ed.), Stress Management. Japan: Yumani.
Keywords: Stress Management


Prochaska, J. O. & Prochaska, J. M. (2005). An update on maximum impact practices from a transtheoretical approach. In Best Practices in the Behavioral Management of Chronic Disease (pp. 1-16). Los Altos, CA: Institute for Disease Management.
Keywords: Patient Practice


Cummins, C. O., Evers, K. E., Johnson, J. L., Paiva, A., Prochaska, J. O., & Prochaska, J. M. (2004). Assessing stage of change and informed decision making for Internet participation in health promotion and disease management. Managed Care Interface, 17, 27-32.
Keywords: Informed Decision Making/Internet and Health Behavior Change
Abstract: The Internet is a potentially powerful source of low- or no-cost programs through which individuals can be guided in changing their behavior to improve health. Using the Transtheoretical Model and survey methodology, the authors sought to produce reliable and valid instruments for assessing “stage of change” and “informed decision making,” and to generate cross-sectional and longitudinal stage-of-change data for a sample of Internet users, as they apply to Internet use for health promotion and disease management. They found that only 24.7% of their sample used the Internet for these purposes and concluded that considerably more research will be needed to determine how to help significant percentages of populations to progress toward enhancing their health through the internet.


Evers, K. E. (2004). The use of the transtheoretical model with adolescents: Issues, interventions, and outcomes. In S. Keller & W. F. Velicer (Eds.), Research on the Transtheoretical Model: Where Are We Now, Where Are We Going? (pp. 44-47). Lengerich, Germany: Pabst.
Keywords: Patient Practice


Prochaska, J. M., Prochaska, J. O., & Johnson, S. S. (2004). Assessing readiness for treatment adherence. In W. O. Donohue & E. Levensky (Eds.), Promoting Treatment Adherence (pp. 35-46). Oaks, CA: Sage Publications.
Keywords: Patient Practice


Prochaska, J. M., Prochaska, J. O., Cohen, F. C., Gomes, S. O., Laforge, R. G., & Eastwood, A. (2004). The transtheoretical model of change for multi-level interventions for alcohol abuse on campus. Journal of Alcohol and Drug Education, 47, 34-50.
Keywords: Substance Abuse
Abstract: This paper brings together the pressing problem of alcohol abuse on college campuses on one of the most promising solution—stage-based interventions applied at multiple levels. The interventions fit the Transtheoretical Model, which construes behavior change as a process that unfolds over time and involves progress through a series of stages. Unique to the paper is how the stage paradigm can be applied at four levels of the university (leadership, facility and staff, students, and alumni) and into the community. This approach to change can produce impressive impacts on alcohol abuse and its serious consequences.


Prochaska, J. O. & Prochaska, J. M. (2004). Assessment as intervention within the transtheoretical model. In M. E. Maruish (Ed.), The Use of Psychological Testing for Treatment Planning and Outcomes Assessment (3rd ed.). Lawrence Erlbaum Associates.
Keywords: Patient Practice


Prochaska, J. O., Velicer, W. F., Prochaska, J. M., & Johnson, J. L. (2004). Size, consistency, and stability of stage effects for smoking cessation. Addictive Behaviors, 29, 207-213.
Keywords: Smoking Cessation
Abstract: In the Transtheoretical Model (TTM), the stage effect is one of the most important determinants of health behavior change. Randomly assigned to 1 of 11 treatment conditions were 4653 smokers. A total of 66 stage effects were possible with 6 for each of the 11 treatment groups. The results suggest that brief stage-matched interventions that help populations progress one stage could produce 75% more abstinence. Interventions that help populations progress two stages could produce 300% more abstinence. The results also support the importance of replicating the stage effects across treatment conditions and over time.


Xiao, J. J., Newman, B., Prochaska, J. M., Leon, R., & Bassett, R. (2004). Voices of debt troubled consumers: A theory-based qualitative inquiry. Journal of Personal Finance, 3, 56-74.
Keywords: Financial Well-Being
Abstract: The Transtheoretical Model of change (TTM) provided the framework for the study of behavioral changes of consumers with troubling debt. This paper reports findings from interviews with five experts who are professionals in personal financial services and education and 15 consumers who are having troubling consumer debts. The findings demonstrate how key concepts of the TTM are linked to authentic concerns and experiences described by consumers who have tried to reduce their credit card debts, which are informative for professionals, educators, and researchers in personal finances.


Xiao, J. J., Newman, B. M., Prochaska, J. M., Leon, B., Bassett, R. L., & Johnson, J. L. (2004). Applying the transtheoretical model of change to consumer debt behavior. Financial Counseling and Planning Education, 15, 77-88.
Keywords: Financial Well-Being
Abstract: The Transtheoretical Model of change (TTM) provided the framework for developing a measure to assess readiness to get out of credit card debt with consumers who are having credit card debt troubles. Key constructs of the TTM include stages of change, decisional balance, self-efficacy, and processes of change. The items for the measure were developed by qualitative interviews with experts in credit counseling and consumers with debt troubles. A survey was then completed with a sample of debt-troubled consumers. Multiple quantitative analyses were conducted to determine the reliability and validity of the measure. The results have potential for use by counseling practitioners, educators, and researchers.


Xiao, J. J., O’Neill, B., Prochaska, J. M., Kerbel, C. M., Brennan, P., & Bristow, B. J. (2004). A consumer education programme based on the transtheoretical model of change. International Journal of Consumer Studies, 28, 55-65.
Keywords: Financial Well-Being
Abstract: Abstract MONEY 2000tm is a successful consumer education programme that was implemented by Cooperative Extension personnel in over two dozen states of the USA between 1996 and 2002. One of the unique features of this programme is that it was based on the Transtheoretical Model of change (TTM), a framework that has been widely used to study health-related behaviour changes such as smoking cessation. This paper first describes how the MONEY 2000tm programme was developed around major constructs contained within the TTM. Findings are reported from a survey conducted with participants in the first two states that delivered the programme. The findings suggest that several change processes used by MONEY 2000tmparticipants are associated with specific stages of change. In addition, there may be differences in behavioural changes between participants who increased their savings and those who reduced their debts.


Cummins, C. O., Prochaska, J. O., Driskell, M. M., Evers, K. E., Wright, J. A., Prochaska, J. M., & Velicer, W.F. (2003). Development of review criteria to evaluate health behavior change websites. Journal of Health Psychology, 8, 55-62.
Keywords: Internet and Health Behavior Change
Abstract: Notes that a growing number of major health care organizations, such as the American Heart Association and the Mayo Clinic, are investing considerable resources in developing and marketing Internet-based programs for health promotion and disease management. These programs have the potential to provide some of the best-tailored interventions in behavior change science at relatively low costs. This report discusses review criteria developed in order to conduct a systematic evaluation of Internet programs for preventive behaviors (alcohol, diet, exercise, and smoking) and disease management (pediatric asthma, depression, and diabetes.) These criteria can be used to develop and evaluate the quality of health promotion programs on the Internet.


Evers, K. E., Prochaska, J. M., Prochaska, J. O., Driskell, M. M., Cummins, C. O., & Velicer, W. F. (2003). Strengths and weaknesses of health behavior change programs on the internet. Journal of Health Psychology, 8, 63-70.
Keywords: Internet and Health Behavior Change
Abstract: Full reviews were conducted on 37 public websites on health behavior change for disease prevention and management. All had at least four of five of the ë5Aís for effective health behavior change treatment on the Internet— (advise, assess, assist, anticipatory guidance, and arrange follow-up) that are assumed to be minimum criteria for a program to have the potential for producing behavior change. The strength of these 37 programs included: rationales provided for assessments; privacy and confidentiality protections; some form of feedback provided; and some form of interactivity. The weaknesses included: few were theory driven; few had individualized tailoring; few had empirically based tailoring; and few were evidence based or reported subsequent plans for evaluation.


Johnson, J. L., Fava, J. L., Velicer, W. F., Monroe, A. D., & Emmons, K. (2002). Testing stage effects in an ethnically diverse sample. Addictive Behaviors, 27, 605-617.
Keywords: Patient Practice
Abstract: The Transtheoretical Model (TTM) has been extensively validated in representative samples of adult smokers. Stage effects, i.e., the patterned relationships between Stage of Change (SOC) and other TTM variables, have been reported in a variety of samples. This study describes reliability data for the TTM variables and tests the stage effects with an ethnically diverse sample of 296 parents with young children. On the basis of theory and previous empirical evidence from a general population, it is possible to make quantitative predications about the magnitude of the expected effect sizes for the Decisional Balance, Situational Temptations, and Processes of Change subscales. For each variable, both a test of significance and a comparison with the expected effect sizes is reported. Results indicated significant stage differences for 8 of the 11 TTM subscales, and all quantitative predictions were confirmed. This study supports the use of TTM measures in an ethnically diverse sample.


Mannock, T. J., Levesque, D. A., & Prochaska, J. M. (2002). Assessing readiness of clients with disabilities to engage in job seeking behaviors. Journal of Rehabilitation, 68, 16.
Keywords: Vocational Rehabilitation
Abstract: The Transtheoretical Model (TTM, also known as the “stage model”) offers an empirically based approach to conceptualizing and assessing readiness to return to work following a disabling injury. The development and validation of the University of Rhode Island Change Assessment-Vocational Counseling (URICA-VC), a three-dimensional stage measure, is described. At a state rehabilitation center, 155 clients completed a 48-item assessment at intake. Cluster analysis found three stage clusters: Reluctant, Reflective, and Participative. Findings provide preliminary evidence of the validity of the URICA-VC. For example, individuals in the Participative cluster were three times as likely as individuals in the earlier clusters to return to work. These findings support the applicability of the TTM to vocational counseling and provide an impetus for future efforts to develop stage-matched interventions that can guide rehabilitation professionals in their work.


Prochaska, J. O. & Levesque, D. A. (2002). Enhancing motivation of offenders at each stage of change and phase of therapy. In M. McMurran (Ed.), Motivating Offenders to Change: A Guide to Enhancing Engagement in Therapy (pp. 55-73). New York: John Wiley & Sons.
Keywords: Domestic Violence and Dating Violence


Burkholder, G. J. & Evers, K. E. (2001). Application of the transtheoretical model to several problem behaviors. In P. M. Burbank (Ed.), Promoting Exercise and Behavior Change in Older Adults: Interventions with the Transtheoretical Model (pp. 85-146). New York: Springer Publisher Company, Inc.
Keywords: Patient Practice


Levesque, D. A., Prochaska, J. M., Prochaska, J. O., Dewart, S. R., Hamby, L. S., & Weeks, W. B. (2001). Organizational stages and processes of change for continuous quality improvement in health care. Consulting Psychology Journal: Practice and Research, 53, 139-153.
Keywords: Organizational Change
Abstract: This article provides an overview of the Transtheoretical Model of change (TTM, or stage model) and how it can guide the development of stage-matched interventions to increase physicians’ readiness for continuous quality improvement (CQI) in health care. In addition, this article describes the development and initial validation of two TTM measures—stages and processes of change—designed to assess the extent to which hospitals are engaging in activities that can facilitate individual providers’ movement through the stages of change for CQI. 299 Ss[SV2] participated in the study. A majority (57%) of informants reported that their organizations were in the maintenance stage for CQI. Organizational-level processes of change differed significantly across the stages: Hospitals in the precontemplation stage tended to use the processes least, and hospitals in the maintenance stage tended to use them most.


Prochaska, J. M., Levesque, D. A., Prochaska, J. O., Dewart, S. R., & Wing, G. R. (2001). Mastering change: A core competency for employees. Brief Treatment and Crisis Intervention, 1, 7-15.
Keywords: Organizational Change
Abstract: Organizations are changing at an unprecedented rate and requiring individuals to change with them. Change can be exciting and create opportunities for learning and personal growth. It can also arouse anger, frustration, anxiety, and a sense of helplessness especially in those who are not ready for change. Staff clinicians who learn to master the change process through gaining skills in proactive learning, collaborative teamwork, and stress management can increase their sense of well-being and security, and effectiveness in an ever changing workplace. They can also help their agencies cope more productively with changes, whatever they may be. To master change behavior involves traveling through a series of five stages: precontemplation, contemplation, preparation, action, and maintenance. To master change employees need to know where they are currently in the stages of change for proactive learning, teamwork, and stress management, where they need to go next, and the strategies for how best to get there.


Prochaska, J. M., Prochaska, J. O., & Levesque, D. A. (2001). A transtheoretical approach to changing organizations. Administration and Policy in Mental Health, 28,247-261.
Keywords: Organizational Change
Abstract: Discusses the applicability of the Transtheoretical Model of change of J. O. Prochaska and C. C. DiClemente (1983) to implementing change in organizations. The model has the potential to do for organizational change what it has done for individual behavior change. Stage-matched interventions can reduce employee resistance, reduce stress, and reduce the time to implement the organizational change. Stage-matched interventions allow all staff the opportunity to participate in the change process, even if they are not prepared to take action.


Prochaska, J. O., Velicer, W. F., Fava, J. L., Ruggiero, L., Laforge, R. G., Rossi, J. S., Johnson, S.S., & Lee, P.A. (2001). Counselor and stimulus control enhancements of a stage-matched expert system intervention for smokers in a managed care setting. Preventive Medicine, 32, 23-32.
Keywords: Smoking Cessation
Abstract: BACKGROUND: Previous research has demonstrated the efficacy of an interactive expert system intervention for smoking cessation for a general population. The intervention provides individualized feedback that guides participants through the stages of change for cessation. Enhancing the expert system by adding proactive telephone counseling or a stimulus control computer designed to produce nicotine fading could produce preventive programs with greater population impacts. METHODS: Four interventions were compared: (a) the interactive expert system intervention; (b) the expert system intervention plus counselor calls; (c) the expert system intervention plus the stimulus control computer; and (d) an assessment only condition. A 4 (intervention) x 4 (occasions) (0, 6, 12, and 18 months) design was used. Smokers were contacted at home via telephone or mail. The initial subject pool was the 24,178 members of a managed care company. Screening was completed for 19,236 members (79.6%), of whom 4,653 were smokers; 85.3% of the smokers were enrolled. RESULTS: Thirty-eight percent were in the precontemplation stage, 45% in the contemplation stage, and only 17% in the preparation stage. At 18 months, the expert system resulted in 23.2% point prevalence abstinence, which was 33% greater than that of assessment only. The counselor enhancement produced increased cessation at 12 months but not at 18 months. The stimulus control computer produced no improvement, resulting in 20% worse cessation rates than the assessment only condition. CONCLUSIONS: The enhanced conditions failed to outperform the expert system alone. The study also demonstrated the ability of the interactive expert system to produce significantly greater cessation in a population of smokers than assessment alone.


Sarkin, J. A., Johnson, S. S., Prochaska, J. O., & Prochaska, J. M. (2001). Applying the transtheoretical model to regular moderate exercise in an overweight population: validation of a stages of change measure. Preventive Medicine, 33, 462-469.
Keywords: Exercise/Weight Management
Abstract: BACKGROUND: The overweight population may benefit from Transtheoretical Model-based interventions focusing on regular moderate exercise. Current stages of change measures assessing regular moderate exercise specific to an overweight population (BMI > or =25) are lacking. This study examined the validity of a staging algorithm for moderate exercise for the purposes of healthy weight management. METHODS: A sample of 670 healthy adults (mean age 50.9 +/- 15.0; mean BMI 30.6 +/- 5.5; 53% female; 93% Caucasian) completed a questionnaire that included demographics, self-reported levels of exercise, and constructs from the Transtheoretical Model (TTM). Analyses of variance and follow-up tests were used to assess the concurrent and construct validity of the staging algorithm. RESULTS: The staging algorithm discriminated those in the action stages from those in the preaction stages for the moderate- and strenuous-intensity categories (P < 0.001). The constructs of pros and cons (P < 0.001) and confidence (P < 0.001) differed across the stages. CONCLUSIONS: In addition to demonstrating good concurrent and construct validity for the stages of change measure, the patterns found across the stages of change were consistent with the theoretical predictions of the TTM and replicated the patterns observed in previous studies.


Levesque, D. A., Gelles, R. J., & Velicer, W. F. (2000). Development and validation of a stages of change measure for men in batterer treatment. Cognitive Therapy and Research, 24, 175-199.
Keywords: Domestic Violence and Dating Violence
Abstract: The Transtheoretical Model of change offers a promising stage-based approach to client-treatment matching to increase the efficacy of batterer treatment. This paper describes the development and validation of the URICA-Domestic Violence (URICA-DV), a 4-dimensional stage measure assessing batterers’ readiness to end their violence. Two hundred fifty-eight batterers in treatment at 2 Rhode Island agencies completed a questionnaire that included the URICA-DV, demographics, and measures expected to vary systematically with stage in a manner predicted by the Transtheoretical Model. A cross-validated cluster analysis yielded 7 stage clusters based on URICA-DV scores: Reluctant, Immotive, Nonreflective Action, Unprepared Action, Preparticipation, Decision-making, and Participation. Findings provide preliminary evidence of validity of the URICA-DV. For example, participants in the most advanced stage clusters were most likely to have used strategies to end the violence in the last year. They engaged in less partner blame and valued the Pros and minimized the Cons of changing more than counterparts in the earlier stage clusters.


Prochaska, J. M. (2000). A transtheoretical model for assessing organizational change: A study of family service agencies’ movement to time-limited therapy. Families in Society, 81, 76-84.
Keywords: Organizational Change
Abstract: This research examined how well a leading model of intentional change, the Transtheoretical Model, captures the dynamics of organizational change. Within a total population of family service agencies in the United States providing counseling, the stages, pros and cons, and processes of planned change to time-limited therapy (TLT) were assessed. Measurement development occurred in the design of staging, decisional balance, and processes measures for changing to TLT. A series of MANOVAs were run comparing groups representing five stages of change. Follow-up Tukey tests determined which specific stages differed from each other. Each of the study’s dimensions was found to have systematic relationships predicted by the Transtheoretical Model of change.


Brogan, M. M., Prochaska, J. O., & Prochaska, J. M. (1999). Predicting termination and continuation status in psychotherapy using the transtheoretical model. Psychotherapy: Theory, Research, Practice, Training, 36, 105-113.
Keywords: Patient Practice
Abstract: Measures from the Transtheoretical Model of change (TMC) were compared to traditional client characteristic variables as predictors of psychotherapy client termination and continuation. According to the TMC, stages of change, processes of change, decisional balance, and levels of attribution are core dimensions of behavior change in psychotherapy. Sixty pairs of therapists (mean age 35 years) and 18-71 year old clients were given questionnaires assessing demographics, distress symptoms, and dimensions of the TMC. Therapists also completed an Assessment of Client’s Termination Status questionnaire. Client characteristics were not significant predictors but the transtheoretical variables of stages of change, processes of change, and decisional balance for therapy were excellent predictors. A discriminative function analysis correctly classified 92% of the clients into two groups: (1) premature terminators and (2) appropriate terminators and therapy continuers. Discussion focused on the importance of matching therapy to client’s stage of change in order to reduce the average rate of 40% of clients terminating therapy prematurely.


Levesque, D. A., Prochaska, J. M., & Prochaska, J. O. (1999). Stages of change and integrated service delivery. Consulting Psychology Journal: Practice and Research, 51,226-241.
Keywords: Organizational Change
Abstract: In the past 20 years, the Transtheoretical Model of change (i.e., the stage model) has arisen as one of the leading integrative approaches to individual behavior change. The case study presented here describes the application of the Transtheoretical Model to organizational change. Measures of core constructs of the model—stages of change and decisional balance—were developed to assess a university’s readiness for integrated service delivery and to guide the development of a stage matched change management program that could minimize resistance and maximize the likelihood of successful change. Thirty-one university staff and administrators completed an assessment containing the stage and decisional balance measures as well as measures of behaviors representing the goals of integrated service delivery. Data provide preliminary evidence of the applicability of the model to integrated service delivery. For example, stage of change displayed characteristic relationships to behavior and the pros and cons of integrated service delivery. On the basis of the pattern of findings, a stage-matched change management program was developed, tailored to the organization’s readiness to change.


Prochaska, J. O. & Prochaska, J. M. (1999). Why don’t continents move? Why don’t people change? Journal of Psychotherapy Integration, 9, 83-102.
Keywords: Patient Practice
Abstract: People don’t change because they can’t, don’t want to, don’t know how, or don’t know what to change. The Transtheoretical Model provides an integrative model for understanding reasons for not changing, as well as readiness to change. Stages and levels of change guide therapists in their work in helping clients change. Clients in the precontemplative stage typically cannot change without special help. Those in the contemplation stage are not sure they want to change. Those in the preparation stage are afraid they do not know how to successfully change. The levels of change help guide therapists and clients on what to change.


Prochaska, J. O. & Prochaska, J. M. (1999). Helping cure health care systems: Changing minds and behaviour. Disease Management and Health Outcomes, 6, 335-341.
Keywords: Patient Practice
Abstract: Proactive approaches to chronic disease management need to complement passive-reactive treatment of acute diseases. Such programmes need to be applied across the continuum of care from wellness to prevention to early detection to secondary prevention and to chronic care. Proactive recruitment to action oriented programmes results in few patients showing up, finishing up or ending up better off and can demoralise patients and professionals. However, programmes matched to each stage of change can produce unprecedented participation and impact rates. Interactive technologies for health behavioural change have the potential to be to behavioural medicine what pharmaceuticals are to traditional medicine. They are the most cost-effective method for delivering the ëmaximum scienceí about major health problems to entire populations in user friendly ways and with no known adverse effects.


Evers, K. E., Harlow, L. L., Redding, C. A., & LaForge, R. G. (1998). Longitudinal changes in stages of change for condom use in women. American Journal of Health Promotion, 13, 19-25.
Keywords: Sexual Activity and Condom Use
Abstract: Identified how women naturally progressed through the Transtheoretical Model stages of condom use (CU) over a 1-year period, using the longitudinal dynamic methodology of latent transition analysis. Four hundred-ninety-one women (aged 18-77 years) were assessed for their stage of CU 2 times, one year apart, based on answers to two questions. Latent transition analysis identified the best-fitting model of naturalistic stage progression, which included both forward and backward movement. Precontemplation and maintenance were the most stable stages, with more than 50% of the Ss remaining in this stage one yr later, and the action stage was the least stable (15% of Ss remaining in this stage). Transition probabilities for all stages showed a high rate of relapse.


Johnson, S. S., Grimley, D. M., & Prochaska, J. O. (1998). Prediction of adherence using the transtheoretical model: Implications for pharmacy care practice. Journal of Social and Administrative Pharmacy, 15, 135-148.
Keywords: Medication Adherence
Abstract: Practical and theoretically derived intervention techniques are needed to improve adherence with prescription medications. Recently, there has been increased attention on the potential applicability of the Transtheoretical Model of Change (TTM) to intervening on medication adherence. This paper compares the predictive ability of the constructs of the TTM to static predictors (i.e., demographics and sexual history characteristics) in the area of adherence with oral contraceptives, a daily medication. Three hundred and six pill users from two community samples responded to an anonymous questionnaire regarding pill use and the TTM constructs. Hierarchical multiple regressions indicated that demographic and sexual history variables did not add significantly to the prediction of adherence based on the TTM constructs. Moreover, stage of adherence emerged as a strong and significant predictor and the model constructs accounted for a large proportion of the variance in nonadherence. The ability of the TTMís constructs to predict nonadherence is of particular importance given that this research addressed a difficult question by restricting the range of prediction to current pill users and not including individuals who had discontinued pill use. Discontinuation is presumably easier to predict because it is the most extreme form of nonadherence. Implications for individualizing interventions within pharmacy practice to improve adherence with OC and other prescription medications are discussed.


Evers, K. E., Bishop, C. H., Gerhan, L. S., & Weisse, C. S. (1997). AIDS educator effectiveness as a function of sexual orientation and HIV status. Journal of Applied Social Psychology, 27, 902-914.
Keywords: Sexual Activity and Condom Use
Abstract: Investigated the effectiveness of an AIDS educator as a function of his HIV status and sexual orientation. A 2 x 2 factorial design was employed with 61 male and 75 female heterosexual 18-23 year old undergraduates. Ss viewed 1 of 4 videotapes of an AIDS educator who introduced himself as either HIV positive or negative and either heterosexual or homosexual. The videos were identical except for the introduction. Results show that all videos increased knowledge about AIDS. However, students’ perceptions of risk increased only when they believed the educator was HIV positive and heterosexual. Intentions to get tested for HIV increased when they perceived the educator as HIV positive but declined when they thought he was HIV negative. Results suggest the sexual orientation and HIV status of educators can impact their effectiveness.


Prochaska, J. O. & Prochaska, J. M. (1993). A transtheoretical model of change for addictive behaviors. In M. Gessop & M. Casas (Eds.), Psychological Treatments of Addictive Behaviors. Barcelona, Spain: Cevron.
Keywords: Substance Abuse


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