Pollak K I, Carbonari J P, DiClemente C C, Niemann Y F, Mullen P D
Center for Health Promotion Research and Development, University of Texas, Houston 77225, USA.
Addict Behav. 1998 Jul-Aug;23(4):437-48. doi: 10.1016/s0306-4603(97)00079-8.
This study, a secondary analysis of prospective data of smokers, tested whether the causal relationships between the processes of change and decisional balance of the transtheoretical model of change (TTM) are stage-specific. It was expected that for smokers in the contemplation stage, higher levels of experiential processing cause the cons of smoking to become more important and the pros of smoking to become less important. In other words, the level of experiential process use was expected to causally influence decisional balance (pros minus cons) for people in the contemplation stage. For ex-smokers in the action stage, when the cons outweigh the pros (cons become more important while pros become less important), they should increase their behavioral process use: decisional balance was expected to causally influence use of behavioral processes. Cross-lagged panels were analyzed using structural equation modeling. Results indicate that experiential process use has causal predominance over decisional balance for smokers in the contemplation stage. For those in the action stage, however, neither decisional balance nor behavioral process had apparent causal predominance. Mean-level invariance indicates that the contemplation and action stages are different. Further analysis investigated smokers who progressed from contemplation to either preparation or action or from preparation to action. For these smokers who had progressed toward action, decisional balance did causally influence use of behavioral processes. This evidence provides support for the use of the TTM as the basis for planning interventions that target specific stage-dependent causal mechanisms.
本研究是对吸烟者前瞻性数据的二次分析，旨在检验转变理论模型（TTM）中改变过程与决策平衡之间的因果关系是否具有阶段特异性。研究预期，对于处于 contemplation 阶段的吸烟者，更高水平的体验性加工会使吸烟的弊端变得更加重要，而吸烟的益处变得不那么重要。换句话说，预期体验性过程使用水平会对处于 contemplation 阶段的人的决策平衡（益处减去弊端）产生因果影响。对于处于 action 阶段的戒烟者，当弊端超过益处（弊端变得更重要而益处变得不那么重要）时，他们应该增加行为过程的使用：预期决策平衡会对行为过程的使用产生因果影响。使用结构方程模型分析交叉滞后面板。结果表明，对于处于 contemplation 阶段的吸烟者，体验性过程使用对决策平衡具有因果优势。然而，对于处于 action 阶段的人，决策平衡和行为过程都没有明显的因果优势。均值水平不变性表明 contemplation 阶段和 action 阶段是不同的。进一步分析调查了从 contemplation 阶段进展到准备阶段或 action 阶段，或从准备阶段进展到 action 阶段的吸烟者。对于这些向 action 阶段进展的吸烟者，决策平衡确实对行为过程的使用产生了因果影响。这一证据支持将 TTM 用作规划针对特定阶段依赖性因果机制的干预措施的基础。
