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- Motivating People to Be Physically Active
Motivating People to Be Physically Active
by Bess H. Marcus and LeighAnn H. Forsyth
Series: Physical Activity Intervention
216 Pages
Motivating People to Be Physically Active, Second Edition, translates research, theories, and concepts of behavioral science into a useful handbook for health professionals involved in the planning, development, implementation, or evaluation of physical activity promotion programs. The book describes proven methods for helping people overcome sedentary behavior and make physical activity a regular part of their lives.
Based on the five-stage model of motivational readiness for change, this comprehensive reference will help you design intervention programs for individuals and groups in both worksite and community settings. This behavior change method can be used with healthy adults as well as those with chronic physical or psychological conditions. You'll also learn to measure and improve clients' motivation and assess their physical activity patterns and barriers.
The second edition has been fully updated and expanded to include these features:
-An updated chapter that discusses and compares the recent physical activity recommendations of the Centers for Disease Control and Prevention, the American College of Sports Medicine, and the Institute of Medicine and presents the pros and cons of the recommendations for key populations
-An expanded description of the benefits of a physically active lifestyle
-Information on how technology, including accelerometers, and Web-based intervention strategies can be used in changing physical activity behavior
Motivating People to Be Physically Active, Second Edition, contains many practical tools and ideas to assist you in program implementation. You'll find reproducible questionnaires, worksheets, logs, and more to assist clients in their transition to active living. The book includes case studies of successful community and worksite programs that can serve as a starting point for your own interventions and stage-specific strategies and recommendations for including and motivating all participants. The authors also provide a list of suggested readings that you can use to enhance your programs. Web addresses and phone numbers of physical activity organizations are included, which can provide you with additional information and resources.
With its focus on psychological and behavioral research and accessible reading style, Motivating People to Be Physically Active, Second Edition, is the essential resource for physical activity behavior modification. In addition to allowing you to design effective intervention programs, its many program ideas, tips, and tools spark your motivation to educate and encourage others to lead a more active and healthier lifestyle.
Motivating People to Be Physically Active, Second Edition, is part of the Physical Activity Intervention Series (PAIS). This timely series provides useful educational resources for professionals interested in promoting and implementing physical activity programs to a diverse and often resistant population.
Contents
Physical Activity Intervention Series Preface
Preface
Acknowledgments
Part I Theoretical Background and Tools for Measuring Motivational Readiness
Chapter 1 Describing Physical Activity Interventions
Physical Activity Recommendations
Definitions of Physical Activity, Exercise, and Physical Fitness
Physical Activity Interventions
Theoretical Models
Motivational Readiness for Behavior Change
Conclusion
Chapter 2 The Stages of Motivational Readiness for Change Model
Motivational Readiness and the Stages of Change
Match Treatment Strategies to Stages of Change
Processes of Behavior Change
Conclusion
Chapter 3 Integrating Other Psychological Theories and Models
Learning Theory
Decision-Making Theory
Behavioral Choice Theory
Social Cognitive Theory
Ecological Model
Relapse Prevention Model
Conclusion
Chapter 4 Putting Theories to Work By Looking at Mediators of Change
Consider Mediators of Physical Activity Behavior Change
Factors That Enhance Physical Activity
Unlock the “Black Box”
Conclusion
Chapter 5 Using the Stages Model for Successful Physical Activity Interventions
Imagine Action: A Community-Based Program
Jump Start to Health: A Workplace-Based Study
Jump Start: A Community-Based Study
Project Active: A Community-Based Study
Project STRIDE: A Community-Based Study
Step Into Motion: A Community-Based Study
Conclusion
Part II Applications
Chapter 6 Assessing Physical Activity Patterns and Physical Fitness
Discovering Patterns of Physical Activity Behavior
Determining Intensity Level
Tracking Physical Activity Behavior
Assessing Fitness
Assessing Physical Activity and Fitness in Group Settings
Conclusion
Chapter 7 Using the Stages Model in Individual Counseling
Physical Readiness
Physical Activity History
Psychological Readiness
Confidence
Set Short- and Long-Term Goals
Measure Success
Conclusion
Chapter 8 Using the Stages Model in Group Counseling Programs
Leading a Stage-Based Group
Learning From a Sample Stage-Based Curriculum
Assessing Your Effectiveness as a Leader
Conclusion
Chapter 9 Using the Stages Model in Work Site Programs
Building Support for Your Program
Assessing Motivational Readiness
Choosing Your Target Audience
Reaching Your Target Audience
Developing Stage-Matched Materials
Focusing on Moderate-Intensity Activity
Planning Events
Adding Incentives for Participation
Conclusion
Chapter 10 Using the Stages Model in Community Programs
Assessing the Community's Readiness for Change
Reaching Individuals Within a Community
Developing Stage-Matched Messages
Using a Media-Based Approach to Reach Your Target Audience
Working With Community Leaders to Reach Your Target Audience
Conclusion
Appendix A: Questionnaires
Appendix B: Additional Resources
References
Index
About the Authors
Bess H. Marcus, PhD, is a professor in the departments of community health and psychiatry and human behavior at the Alpert Medical School of Brown University and director of the Centers for Behavioral and Preventive Medicine at the Miriam Hospital. Dr. Marcus is a clinical health psychologist who has spent the past 20 years conducting research on physical activity behavior and has published more than 150 papers and book chapters as well as three books on this topic.
Dr. Marcus has developed a series of assessment instruments to measure psychosocial mediators of physical activity behavior and has also developed low-cost interventions to promote physical activity behavior in community, workplace, and primary care settings. Dr. Marcus has participated in panels for the American Heart Association, American College of Sports Medicine, Centers for Disease Control and Prevention, and National Institutes of Health; these panels have created recommendations regarding the quantity and intensity of physical activity necessary for health benefits. Marcus was also a contributing author to the Surgeon General's Report on Physical Activity and Health. She served as an advisor on the curriculum development for Project Active and is a coauthor of Active Living Every Day (Human Kinetics). Marcus is recognized internationally for her outstanding research in helping people to become more physically active and has spoken on this topic worldwide.
Marcus makes time to be physically active on most days of the week. She enjoys walking, swimming, and cycling with her husband, Dan, her three children, and friends.
LeighAnn Forsyth, PhD, is a clinical health psychologist. She has a private practice specializing in weight management, body image, and women's health. She also is an adjunct professor of psychology at Cleveland State University, where she conducts research on physical activity adoption and lectures on behavior modification.
During a clinical internship and two-year postdoctoral fellowship at the Brown University Center for Behavioral and Preventive Medicine at the Miriam Hospital, Forsyth participated in several research programs applying the stages of motivational readiness to promote physical activity adoption.
She has published several professional articles and book chapters on physical activity promotion and the stages of motivational readiness and serves as a consultant on physical activity research grants. Forsyth is a member of the Society of Behavioral Medicine and the Association for the Advancement of Behavior Society.
With three young children, Forsyth receives a daily dose of physically active parenting. She also enjoys jogging, hiking, playing tennis, and biking. She and her husband, Paul, and their children reside in Shaker Heights, Ohio.
“In my opinion Motivating People to Be Physically Active, Second Edition is the best book of 2009 on how to apply theory to practice. It is the only one I have liked well enough to write a recommendation.
The book starts with four chapters that provide a thorough review of physical activity and behavior change theory, with special emphasis on motivational readiness to change. This review was one of the best I have read in terms of being well grounded scientifically but also very practical. The next chapter describes how to apply these concepts to assess physical activity patterns. The final four chapters describe how to develop programs for individual counseling, group counseling, work settings and community settings. The book includes forms that can be used to track physical activity and counsel clients, and the appendix is full of questionnaires that can be used to measure many of the concepts described in the book.
The book is well organized, clearly written, thoroughly documented and easy to read. I recommend it highly to anyone who is involved in designing or managing fitness programs, coaching or personal fitness training, or is teaching or studying these issues.”Michael P. O'Donnell, MBA, MPH, PhD
Editor in Chief, American Journal of Health Promotion
Readiness to change important when designing community physical activity interventions
Implement stage-specific strategies for your community physical activity programs.
Stage-Specific Strategies for Community Physical Activity Programs
We created the following list of intervention strategies to help you design your own community program. As we have tried to stress in this and other chapters, no one program works for everyone, so we do not provide a step-by-step program development guide. Rather, we hope you pick some of the following strategies plus generate some of your own ideas so that you create a program that addresses the needs of your target audience, your community's stage of change, any time constraints you may be working under, and your financial resources.
Stage 1
Not Thinking About Change
For this segment of the population, your goal is to help increase awareness about the (a) benefits of physical activity, (b) support for it in the local community, and (c) acceptance of physical activity by other community members. Here are some strategies for increasing awareness and encouraging people to begin to think about the role physical activity could play in their lives.
What communication channels might you use to reach people not considering becoming active?
- Distribute print materials targeted toward people who are presently not thinking about becoming more physically active.
- Work with the media to gain visibility for your messages. You might achieve this by doing the following (USDHHS et al., 1999):
- Invite newspaper reporters to visible or newsworthy events.
- Work with reporters in writing feature stories.
- Provide timely news releases or newspaper articles.
- Participate as a guest on radio or television talk shows.
- Purchase radio, television, or cable advertising time.
- Display key messages and your program logo in storefront windows, on community bulletin boards, on billboard signs, and on banners strung across the main street or at major community locations (USDHHS et al., 1999).
- Design bumper stickers with physical activity and health promotion messages (USDHHS et al., 1999).
- Ask utility companies, banks, physicians, and others to place promotional and educational information in their monthly billings. Ask to place promotional and educational materials in waiting rooms of hospitals and health maintenance organizations, private physicians' offices, clinics, mental health centers, and senior citizen centers (USDHHS et al., 1999).
What types of information are most relevant to people in this earliest stage?
- Host health fairs that include exercise testing, blood pressure screenings, or body fat composition assessments. Relate how these are affected by physical activity.
- Emphasize the short-term benefits of being active (e.g., feeling invigorated, sleeping better, reducing stress, feeling better about oneself) rather than the long-term benefits that these people might believe are unobtainable.
- Dispel misconceptions about physical activity (e.g., "No pain, no gain," overestimated risk of injuries such as heart attack).
- Increase awareness of what they might miss by choosing not to be active (e.g., enjoyment from being active, better self-esteem).
What are some other strategies that might move these people closer to considering change?
- Help people to visualize success-to visualize a happy, healthy, and active lifestyle.
- Encourage these people to read or think about how physical activity might benefit them. For this group, it is better to focus on the benefits of physical activity and not to dwell on the risks of a sedentary lifestyle.
- Link the benefits of a physically active lifestyle to people's highest priorities and values in life (e.g., relationship with family, personal faith, health, or happiness).
- Encourage these people to see how their sedentary behavior affects them personally and others in their lives (e.g., a sedentary parent models an unhealthy lifestyle to her children).
How might you show community support for physical activity?
- Encourage health care providers to advise their patients on how they might benefit from physical activity.
- Choose a spokesperson that the target audience trusts, respects, believes, or can identify with to help increase awareness. Identify role models within the community. Recruit local people to endorse your program (USDHHS et al., 1999).
- Conduct targeted informational campaigns and sessions (USDHHS et al., 1999) such as the following:
- Lunch-'n'-learn or community lectures
- Workshops, seminars, or adult education classes
- Youth group programs
- One-on-one counseling or instruction
- Guest talk-show appearances on television and radio
- Columns or featured articles in the newspaper
- Give informative presentations at work sites, in schools, and to community organizations such as Rotary Clubs, Business and Professional Women, or the American Association of Retired Persons (USDHHS et al., 1999).
Stage 2
Thinking About Change
For this segment of the community, one of your goals is to increase awareness of the benefits of physical activity, community support, and the social norms for this behavior. Another goal is to move these people closer to actually trying out the behavior. Here are some ideas for achieving these goals.
What communication channels might you use?
- Distribute print materials targeted toward people who are thinking about becoming more physically active or include health and physical activity tips in general publications (USDHHS et al., 1999).
- Increase awareness by working with the media to gain visibility for your messages (USDHHS et al., 1999):
- Invite newspaper reporters to visible or newsworthy events.
- Work with reporters in writing feature stories.
- Provide timely news releases or newspaper articles.
- Participate as a guest on radio or television talk shows.
- Purchase radio, television, or cable advertising time.
- Display key messages and your program logo in storefront windows, on community bulletin boards, on billboard signs, and on banners strung across the main street or at major community locations (USDHHS et al., 1999).
- Design bumper stickers with physical activity and health promotion messages.
- Ask utility companies, banks, physicians, and others to place promotional and educational information in their monthly billings. Ask to place promotional and educational materials in waiting rooms of hospitals and health maintenance organizations, private physicians' offices, clinics, mental health centers, and senior citizen centers (USDHHS et al., 1999).
- Make health videos available at video stores and libraries.
- Set up a Web site with links to relevant stage-appropriate physical activity and health sites.
What types of information are most relevant to people who are considering becoming more active?
- Provide basic information about what is needed to achieve a physically active lifestyle such as selecting the appropriate shoes or clothing (USDHHS et al., 1999).
- Describe a variety of activities available to most people that can be done alone or with family and friends.
- Suggest ways to build in some activity into one's daily routine (e.g., taking the stairs at work).
- Dispel misconceptions about physical activity (e.g., "No pain, no gain," overestimated risk of injury such as heart attack).
What are some other strategies that might move these people closer to trying some physical activity?
- Provide messages that link physical activity to values or issues relevant to your target audience.
- Help them weigh the pros and cons of a physically active lifestyle. Focus on the costs of changing (effort, energy, and the things they must give up to overcome a sedentary lifestyle) and how they might deal with them.
- Encourage them to start off slowly (e.g., a 5- or 10-minute walk) and build gradually (add 5 minutes per day per week) and explain how to reward themselves when they achieve their goals.
- Give out self-assessment questionnaires such as the Physical Activity Readiness Questionnaire (PAR-Q, found in chapter 7) and the decisional balance questionnaire (questionnaire 4.4 in appendix A).
- Help people to visualize success-to visualize a happy, healthy, and active lifestyle.
How might you show community support for trying some physical activity?
- Host health fairs that include exercise testing, blood pressure screenings, or body fat composition assessments. Relate how these are affected by physical activity.
- Choose a spokesperson that the target audience trusts, respects, believes, or can identify with. Identify role models within the community. Recruit local people to endorse your program (USDHHS et al., 1999).
- Encourage health care providers to advise these patients on how they might benefit from physical activity and some steps they could take to begin a physically active lifestyle.
- Conduct targeted informational campaigns and sessions (USDHHS et al., 1999) such as the following:
- Lunch-'n'-learn or community lectures
- Workshops, seminars, or adult education classes
- Youth group programs
- One-on-one counseling or instruction
- Guest talk-show appearances on television and radio
- Columns or featured articles in the newspaper
- Give informative presentations at work sites, in schools, and to community organizations such as Rotary Clubs, Business and Professional Women, or the American Association of Retired Persons (USDHHS et al., 1999).
- Set up physical activity hotlines that people can call with questions about physical activity (USDHHS et al., 1999).
Questionnaire measures readiness to change physical activity behavior
The processes of change are the strategies and techniques people use to change their thinking and their behavior; your clients are therefore likely to increase their use of many of the processes of change long before they are meeting national guidelines for a physically active lifestyle.
Measuring Processes of Change
A client's use of the processes of change for physical activity behavior can be measured with questionnaire 4.1 in appendix A, which we and our colleagues developed (Marcus, Rossi, Selby, Niaura, & Abrams, 1992). This questionnaire has been used in many exercise studies. When people's scores on these items increase, it is usually a good indicator that they are becoming more active (Dunn et al., 1997). The processes of change are the strategies and techniques people use to change their thinking and their behavior; your clients are therefore likely to increase their use of many of the processes of change long before they are meeting national guidelines for a physically active lifestyle.
You may want to have clients complete this questionnaire every 3 months so that you can learn whether they are making progress toward behavior change even if they are not meeting their specific physical activity goals. Recall that a person's stage of motivation for change when she first comes to see you has a great impact on how quickly she increases her use of the processes of change. The setting in which you work might also affect which processes of change increase first and how quickly the client puts them to use. For example, if you are a personal trainer at a health club, you are more likely to start working with clients on behavior change, and thus you are more likely to see increases in the behavioral processes of change. However, if you work at a community center, YMCA, or YWCA implementing a program such as the Active Living Program (Blair, Dunn, Marcus, Carpenter, & Jaret, 2001), you may see changes in your clients' cognitive processes before changes in their behavioral processes. Most published studies indicate that it is important for people to first increase their use of the cognitive processes and then of the behavioral processes. However, some studies indicate that the order is not important; people need to increase their use of all (or most) of the processes of change to become and stay regularly active (Marcus et al., 1992).
For each process of change, the average score can range from 1 to 5. Table 4.2 shows typical scores for the four items in each process group for people in each stage of motivational readiness for change. Use this as a guide for understanding where your client is in the change process and on which areas to focus to help her start and stick with a program of regular physical activity. If the survey results are similar on a number of processes, you can choose either a single process or, in collaboration with your client, several processes to work on.
Scoring Processes of Change
For each process, average the individual items by adding each group together and dividing by 4. Do not score an individual process if fewer than three items were answered.
Readiness to change important when designing community physical activity interventions
Implement stage-specific strategies for your community physical activity programs.
Stage-Specific Strategies for Community Physical Activity Programs
We created the following list of intervention strategies to help you design your own community program. As we have tried to stress in this and other chapters, no one program works for everyone, so we do not provide a step-by-step program development guide. Rather, we hope you pick some of the following strategies plus generate some of your own ideas so that you create a program that addresses the needs of your target audience, your community's stage of change, any time constraints you may be working under, and your financial resources.
Stage 1
Not Thinking About Change
For this segment of the population, your goal is to help increase awareness about the (a) benefits of physical activity, (b) support for it in the local community, and (c) acceptance of physical activity by other community members. Here are some strategies for increasing awareness and encouraging people to begin to think about the role physical activity could play in their lives.
What communication channels might you use to reach people not considering becoming active?
- Distribute print materials targeted toward people who are presently not thinking about becoming more physically active.
- Work with the media to gain visibility for your messages. You might achieve this by doing the following (USDHHS et al., 1999):
- Invite newspaper reporters to visible or newsworthy events.
- Work with reporters in writing feature stories.
- Provide timely news releases or newspaper articles.
- Participate as a guest on radio or television talk shows.
- Purchase radio, television, or cable advertising time.
- Display key messages and your program logo in storefront windows, on community bulletin boards, on billboard signs, and on banners strung across the main street or at major community locations (USDHHS et al., 1999).
- Design bumper stickers with physical activity and health promotion messages (USDHHS et al., 1999).
- Ask utility companies, banks, physicians, and others to place promotional and educational information in their monthly billings. Ask to place promotional and educational materials in waiting rooms of hospitals and health maintenance organizations, private physicians' offices, clinics, mental health centers, and senior citizen centers (USDHHS et al., 1999).
What types of information are most relevant to people in this earliest stage?
- Host health fairs that include exercise testing, blood pressure screenings, or body fat composition assessments. Relate how these are affected by physical activity.
- Emphasize the short-term benefits of being active (e.g., feeling invigorated, sleeping better, reducing stress, feeling better about oneself) rather than the long-term benefits that these people might believe are unobtainable.
- Dispel misconceptions about physical activity (e.g., "No pain, no gain," overestimated risk of injuries such as heart attack).
- Increase awareness of what they might miss by choosing not to be active (e.g., enjoyment from being active, better self-esteem).
What are some other strategies that might move these people closer to considering change?
- Help people to visualize success-to visualize a happy, healthy, and active lifestyle.
- Encourage these people to read or think about how physical activity might benefit them. For this group, it is better to focus on the benefits of physical activity and not to dwell on the risks of a sedentary lifestyle.
- Link the benefits of a physically active lifestyle to people's highest priorities and values in life (e.g., relationship with family, personal faith, health, or happiness).
- Encourage these people to see how their sedentary behavior affects them personally and others in their lives (e.g., a sedentary parent models an unhealthy lifestyle to her children).
How might you show community support for physical activity?
- Encourage health care providers to advise their patients on how they might benefit from physical activity.
- Choose a spokesperson that the target audience trusts, respects, believes, or can identify with to help increase awareness. Identify role models within the community. Recruit local people to endorse your program (USDHHS et al., 1999).
- Conduct targeted informational campaigns and sessions (USDHHS et al., 1999) such as the following:
- Lunch-'n'-learn or community lectures
- Workshops, seminars, or adult education classes
- Youth group programs
- One-on-one counseling or instruction
- Guest talk-show appearances on television and radio
- Columns or featured articles in the newspaper
- Give informative presentations at work sites, in schools, and to community organizations such as Rotary Clubs, Business and Professional Women, or the American Association of Retired Persons (USDHHS et al., 1999).
Stage 2
Thinking About Change
For this segment of the community, one of your goals is to increase awareness of the benefits of physical activity, community support, and the social norms for this behavior. Another goal is to move these people closer to actually trying out the behavior. Here are some ideas for achieving these goals.
What communication channels might you use?
- Distribute print materials targeted toward people who are thinking about becoming more physically active or include health and physical activity tips in general publications (USDHHS et al., 1999).
- Increase awareness by working with the media to gain visibility for your messages (USDHHS et al., 1999):
- Invite newspaper reporters to visible or newsworthy events.
- Work with reporters in writing feature stories.
- Provide timely news releases or newspaper articles.
- Participate as a guest on radio or television talk shows.
- Purchase radio, television, or cable advertising time.
- Display key messages and your program logo in storefront windows, on community bulletin boards, on billboard signs, and on banners strung across the main street or at major community locations (USDHHS et al., 1999).
- Design bumper stickers with physical activity and health promotion messages.
- Ask utility companies, banks, physicians, and others to place promotional and educational information in their monthly billings. Ask to place promotional and educational materials in waiting rooms of hospitals and health maintenance organizations, private physicians' offices, clinics, mental health centers, and senior citizen centers (USDHHS et al., 1999).
- Make health videos available at video stores and libraries.
- Set up a Web site with links to relevant stage-appropriate physical activity and health sites.
What types of information are most relevant to people who are considering becoming more active?
- Provide basic information about what is needed to achieve a physically active lifestyle such as selecting the appropriate shoes or clothing (USDHHS et al., 1999).
- Describe a variety of activities available to most people that can be done alone or with family and friends.
- Suggest ways to build in some activity into one's daily routine (e.g., taking the stairs at work).
- Dispel misconceptions about physical activity (e.g., "No pain, no gain," overestimated risk of injury such as heart attack).
What are some other strategies that might move these people closer to trying some physical activity?
- Provide messages that link physical activity to values or issues relevant to your target audience.
- Help them weigh the pros and cons of a physically active lifestyle. Focus on the costs of changing (effort, energy, and the things they must give up to overcome a sedentary lifestyle) and how they might deal with them.
- Encourage them to start off slowly (e.g., a 5- or 10-minute walk) and build gradually (add 5 minutes per day per week) and explain how to reward themselves when they achieve their goals.
- Give out self-assessment questionnaires such as the Physical Activity Readiness Questionnaire (PAR-Q, found in chapter 7) and the decisional balance questionnaire (questionnaire 4.4 in appendix A).
- Help people to visualize success-to visualize a happy, healthy, and active lifestyle.
How might you show community support for trying some physical activity?
- Host health fairs that include exercise testing, blood pressure screenings, or body fat composition assessments. Relate how these are affected by physical activity.
- Choose a spokesperson that the target audience trusts, respects, believes, or can identify with. Identify role models within the community. Recruit local people to endorse your program (USDHHS et al., 1999).
- Encourage health care providers to advise these patients on how they might benefit from physical activity and some steps they could take to begin a physically active lifestyle.
- Conduct targeted informational campaigns and sessions (USDHHS et al., 1999) such as the following:
- Lunch-'n'-learn or community lectures
- Workshops, seminars, or adult education classes
- Youth group programs
- One-on-one counseling or instruction
- Guest talk-show appearances on television and radio
- Columns or featured articles in the newspaper
- Give informative presentations at work sites, in schools, and to community organizations such as Rotary Clubs, Business and Professional Women, or the American Association of Retired Persons (USDHHS et al., 1999).
- Set up physical activity hotlines that people can call with questions about physical activity (USDHHS et al., 1999).
Questionnaire measures readiness to change physical activity behavior
The processes of change are the strategies and techniques people use to change their thinking and their behavior; your clients are therefore likely to increase their use of many of the processes of change long before they are meeting national guidelines for a physically active lifestyle.
Measuring Processes of Change
A client's use of the processes of change for physical activity behavior can be measured with questionnaire 4.1 in appendix A, which we and our colleagues developed (Marcus, Rossi, Selby, Niaura, & Abrams, 1992). This questionnaire has been used in many exercise studies. When people's scores on these items increase, it is usually a good indicator that they are becoming more active (Dunn et al., 1997). The processes of change are the strategies and techniques people use to change their thinking and their behavior; your clients are therefore likely to increase their use of many of the processes of change long before they are meeting national guidelines for a physically active lifestyle.
You may want to have clients complete this questionnaire every 3 months so that you can learn whether they are making progress toward behavior change even if they are not meeting their specific physical activity goals. Recall that a person's stage of motivation for change when she first comes to see you has a great impact on how quickly she increases her use of the processes of change. The setting in which you work might also affect which processes of change increase first and how quickly the client puts them to use. For example, if you are a personal trainer at a health club, you are more likely to start working with clients on behavior change, and thus you are more likely to see increases in the behavioral processes of change. However, if you work at a community center, YMCA, or YWCA implementing a program such as the Active Living Program (Blair, Dunn, Marcus, Carpenter, & Jaret, 2001), you may see changes in your clients' cognitive processes before changes in their behavioral processes. Most published studies indicate that it is important for people to first increase their use of the cognitive processes and then of the behavioral processes. However, some studies indicate that the order is not important; people need to increase their use of all (or most) of the processes of change to become and stay regularly active (Marcus et al., 1992).
For each process of change, the average score can range from 1 to 5. Table 4.2 shows typical scores for the four items in each process group for people in each stage of motivational readiness for change. Use this as a guide for understanding where your client is in the change process and on which areas to focus to help her start and stick with a program of regular physical activity. If the survey results are similar on a number of processes, you can choose either a single process or, in collaboration with your client, several processes to work on.
Scoring Processes of Change
For each process, average the individual items by adding each group together and dividing by 4. Do not score an individual process if fewer than three items were answered.
Readiness to change important when designing community physical activity interventions
Implement stage-specific strategies for your community physical activity programs.
Stage-Specific Strategies for Community Physical Activity Programs
We created the following list of intervention strategies to help you design your own community program. As we have tried to stress in this and other chapters, no one program works for everyone, so we do not provide a step-by-step program development guide. Rather, we hope you pick some of the following strategies plus generate some of your own ideas so that you create a program that addresses the needs of your target audience, your community's stage of change, any time constraints you may be working under, and your financial resources.
Stage 1
Not Thinking About Change
For this segment of the population, your goal is to help increase awareness about the (a) benefits of physical activity, (b) support for it in the local community, and (c) acceptance of physical activity by other community members. Here are some strategies for increasing awareness and encouraging people to begin to think about the role physical activity could play in their lives.
What communication channels might you use to reach people not considering becoming active?
- Distribute print materials targeted toward people who are presently not thinking about becoming more physically active.
- Work with the media to gain visibility for your messages. You might achieve this by doing the following (USDHHS et al., 1999):
- Invite newspaper reporters to visible or newsworthy events.
- Work with reporters in writing feature stories.
- Provide timely news releases or newspaper articles.
- Participate as a guest on radio or television talk shows.
- Purchase radio, television, or cable advertising time.
- Display key messages and your program logo in storefront windows, on community bulletin boards, on billboard signs, and on banners strung across the main street or at major community locations (USDHHS et al., 1999).
- Design bumper stickers with physical activity and health promotion messages (USDHHS et al., 1999).
- Ask utility companies, banks, physicians, and others to place promotional and educational information in their monthly billings. Ask to place promotional and educational materials in waiting rooms of hospitals and health maintenance organizations, private physicians' offices, clinics, mental health centers, and senior citizen centers (USDHHS et al., 1999).
What types of information are most relevant to people in this earliest stage?
- Host health fairs that include exercise testing, blood pressure screenings, or body fat composition assessments. Relate how these are affected by physical activity.
- Emphasize the short-term benefits of being active (e.g., feeling invigorated, sleeping better, reducing stress, feeling better about oneself) rather than the long-term benefits that these people might believe are unobtainable.
- Dispel misconceptions about physical activity (e.g., "No pain, no gain," overestimated risk of injuries such as heart attack).
- Increase awareness of what they might miss by choosing not to be active (e.g., enjoyment from being active, better self-esteem).
What are some other strategies that might move these people closer to considering change?
- Help people to visualize success-to visualize a happy, healthy, and active lifestyle.
- Encourage these people to read or think about how physical activity might benefit them. For this group, it is better to focus on the benefits of physical activity and not to dwell on the risks of a sedentary lifestyle.
- Link the benefits of a physically active lifestyle to people's highest priorities and values in life (e.g., relationship with family, personal faith, health, or happiness).
- Encourage these people to see how their sedentary behavior affects them personally and others in their lives (e.g., a sedentary parent models an unhealthy lifestyle to her children).
How might you show community support for physical activity?
- Encourage health care providers to advise their patients on how they might benefit from physical activity.
- Choose a spokesperson that the target audience trusts, respects, believes, or can identify with to help increase awareness. Identify role models within the community. Recruit local people to endorse your program (USDHHS et al., 1999).
- Conduct targeted informational campaigns and sessions (USDHHS et al., 1999) such as the following:
- Lunch-'n'-learn or community lectures
- Workshops, seminars, or adult education classes
- Youth group programs
- One-on-one counseling or instruction
- Guest talk-show appearances on television and radio
- Columns or featured articles in the newspaper
- Give informative presentations at work sites, in schools, and to community organizations such as Rotary Clubs, Business and Professional Women, or the American Association of Retired Persons (USDHHS et al., 1999).
Stage 2
Thinking About Change
For this segment of the community, one of your goals is to increase awareness of the benefits of physical activity, community support, and the social norms for this behavior. Another goal is to move these people closer to actually trying out the behavior. Here are some ideas for achieving these goals.
What communication channels might you use?
- Distribute print materials targeted toward people who are thinking about becoming more physically active or include health and physical activity tips in general publications (USDHHS et al., 1999).
- Increase awareness by working with the media to gain visibility for your messages (USDHHS et al., 1999):
- Invite newspaper reporters to visible or newsworthy events.
- Work with reporters in writing feature stories.
- Provide timely news releases or newspaper articles.
- Participate as a guest on radio or television talk shows.
- Purchase radio, television, or cable advertising time.
- Display key messages and your program logo in storefront windows, on community bulletin boards, on billboard signs, and on banners strung across the main street or at major community locations (USDHHS et al., 1999).
- Design bumper stickers with physical activity and health promotion messages.
- Ask utility companies, banks, physicians, and others to place promotional and educational information in their monthly billings. Ask to place promotional and educational materials in waiting rooms of hospitals and health maintenance organizations, private physicians' offices, clinics, mental health centers, and senior citizen centers (USDHHS et al., 1999).
- Make health videos available at video stores and libraries.
- Set up a Web site with links to relevant stage-appropriate physical activity and health sites.
What types of information are most relevant to people who are considering becoming more active?
- Provide basic information about what is needed to achieve a physically active lifestyle such as selecting the appropriate shoes or clothing (USDHHS et al., 1999).
- Describe a variety of activities available to most people that can be done alone or with family and friends.
- Suggest ways to build in some activity into one's daily routine (e.g., taking the stairs at work).
- Dispel misconceptions about physical activity (e.g., "No pain, no gain," overestimated risk of injury such as heart attack).
What are some other strategies that might move these people closer to trying some physical activity?
- Provide messages that link physical activity to values or issues relevant to your target audience.
- Help them weigh the pros and cons of a physically active lifestyle. Focus on the costs of changing (effort, energy, and the things they must give up to overcome a sedentary lifestyle) and how they might deal with them.
- Encourage them to start off slowly (e.g., a 5- or 10-minute walk) and build gradually (add 5 minutes per day per week) and explain how to reward themselves when they achieve their goals.
- Give out self-assessment questionnaires such as the Physical Activity Readiness Questionnaire (PAR-Q, found in chapter 7) and the decisional balance questionnaire (questionnaire 4.4 in appendix A).
- Help people to visualize success-to visualize a happy, healthy, and active lifestyle.
How might you show community support for trying some physical activity?
- Host health fairs that include exercise testing, blood pressure screenings, or body fat composition assessments. Relate how these are affected by physical activity.
- Choose a spokesperson that the target audience trusts, respects, believes, or can identify with. Identify role models within the community. Recruit local people to endorse your program (USDHHS et al., 1999).
- Encourage health care providers to advise these patients on how they might benefit from physical activity and some steps they could take to begin a physically active lifestyle.
- Conduct targeted informational campaigns and sessions (USDHHS et al., 1999) such as the following:
- Lunch-'n'-learn or community lectures
- Workshops, seminars, or adult education classes
- Youth group programs
- One-on-one counseling or instruction
- Guest talk-show appearances on television and radio
- Columns or featured articles in the newspaper
- Give informative presentations at work sites, in schools, and to community organizations such as Rotary Clubs, Business and Professional Women, or the American Association of Retired Persons (USDHHS et al., 1999).
- Set up physical activity hotlines that people can call with questions about physical activity (USDHHS et al., 1999).
Questionnaire measures readiness to change physical activity behavior
The processes of change are the strategies and techniques people use to change their thinking and their behavior; your clients are therefore likely to increase their use of many of the processes of change long before they are meeting national guidelines for a physically active lifestyle.
Measuring Processes of Change
A client's use of the processes of change for physical activity behavior can be measured with questionnaire 4.1 in appendix A, which we and our colleagues developed (Marcus, Rossi, Selby, Niaura, & Abrams, 1992). This questionnaire has been used in many exercise studies. When people's scores on these items increase, it is usually a good indicator that they are becoming more active (Dunn et al., 1997). The processes of change are the strategies and techniques people use to change their thinking and their behavior; your clients are therefore likely to increase their use of many of the processes of change long before they are meeting national guidelines for a physically active lifestyle.
You may want to have clients complete this questionnaire every 3 months so that you can learn whether they are making progress toward behavior change even if they are not meeting their specific physical activity goals. Recall that a person's stage of motivation for change when she first comes to see you has a great impact on how quickly she increases her use of the processes of change. The setting in which you work might also affect which processes of change increase first and how quickly the client puts them to use. For example, if you are a personal trainer at a health club, you are more likely to start working with clients on behavior change, and thus you are more likely to see increases in the behavioral processes of change. However, if you work at a community center, YMCA, or YWCA implementing a program such as the Active Living Program (Blair, Dunn, Marcus, Carpenter, & Jaret, 2001), you may see changes in your clients' cognitive processes before changes in their behavioral processes. Most published studies indicate that it is important for people to first increase their use of the cognitive processes and then of the behavioral processes. However, some studies indicate that the order is not important; people need to increase their use of all (or most) of the processes of change to become and stay regularly active (Marcus et al., 1992).
For each process of change, the average score can range from 1 to 5. Table 4.2 shows typical scores for the four items in each process group for people in each stage of motivational readiness for change. Use this as a guide for understanding where your client is in the change process and on which areas to focus to help her start and stick with a program of regular physical activity. If the survey results are similar on a number of processes, you can choose either a single process or, in collaboration with your client, several processes to work on.
Scoring Processes of Change
For each process, average the individual items by adding each group together and dividing by 4. Do not score an individual process if fewer than three items were answered.
Readiness to change important when designing community physical activity interventions
Implement stage-specific strategies for your community physical activity programs.
Stage-Specific Strategies for Community Physical Activity Programs
We created the following list of intervention strategies to help you design your own community program. As we have tried to stress in this and other chapters, no one program works for everyone, so we do not provide a step-by-step program development guide. Rather, we hope you pick some of the following strategies plus generate some of your own ideas so that you create a program that addresses the needs of your target audience, your community's stage of change, any time constraints you may be working under, and your financial resources.
Stage 1
Not Thinking About Change
For this segment of the population, your goal is to help increase awareness about the (a) benefits of physical activity, (b) support for it in the local community, and (c) acceptance of physical activity by other community members. Here are some strategies for increasing awareness and encouraging people to begin to think about the role physical activity could play in their lives.
What communication channels might you use to reach people not considering becoming active?
- Distribute print materials targeted toward people who are presently not thinking about becoming more physically active.
- Work with the media to gain visibility for your messages. You might achieve this by doing the following (USDHHS et al., 1999):
- Invite newspaper reporters to visible or newsworthy events.
- Work with reporters in writing feature stories.
- Provide timely news releases or newspaper articles.
- Participate as a guest on radio or television talk shows.
- Purchase radio, television, or cable advertising time.
- Display key messages and your program logo in storefront windows, on community bulletin boards, on billboard signs, and on banners strung across the main street or at major community locations (USDHHS et al., 1999).
- Design bumper stickers with physical activity and health promotion messages (USDHHS et al., 1999).
- Ask utility companies, banks, physicians, and others to place promotional and educational information in their monthly billings. Ask to place promotional and educational materials in waiting rooms of hospitals and health maintenance organizations, private physicians' offices, clinics, mental health centers, and senior citizen centers (USDHHS et al., 1999).
What types of information are most relevant to people in this earliest stage?
- Host health fairs that include exercise testing, blood pressure screenings, or body fat composition assessments. Relate how these are affected by physical activity.
- Emphasize the short-term benefits of being active (e.g., feeling invigorated, sleeping better, reducing stress, feeling better about oneself) rather than the long-term benefits that these people might believe are unobtainable.
- Dispel misconceptions about physical activity (e.g., "No pain, no gain," overestimated risk of injuries such as heart attack).
- Increase awareness of what they might miss by choosing not to be active (e.g., enjoyment from being active, better self-esteem).
What are some other strategies that might move these people closer to considering change?
- Help people to visualize success-to visualize a happy, healthy, and active lifestyle.
- Encourage these people to read or think about how physical activity might benefit them. For this group, it is better to focus on the benefits of physical activity and not to dwell on the risks of a sedentary lifestyle.
- Link the benefits of a physically active lifestyle to people's highest priorities and values in life (e.g., relationship with family, personal faith, health, or happiness).
- Encourage these people to see how their sedentary behavior affects them personally and others in their lives (e.g., a sedentary parent models an unhealthy lifestyle to her children).
How might you show community support for physical activity?
- Encourage health care providers to advise their patients on how they might benefit from physical activity.
- Choose a spokesperson that the target audience trusts, respects, believes, or can identify with to help increase awareness. Identify role models within the community. Recruit local people to endorse your program (USDHHS et al., 1999).
- Conduct targeted informational campaigns and sessions (USDHHS et al., 1999) such as the following:
- Lunch-'n'-learn or community lectures
- Workshops, seminars, or adult education classes
- Youth group programs
- One-on-one counseling or instruction
- Guest talk-show appearances on television and radio
- Columns or featured articles in the newspaper
- Give informative presentations at work sites, in schools, and to community organizations such as Rotary Clubs, Business and Professional Women, or the American Association of Retired Persons (USDHHS et al., 1999).
Stage 2
Thinking About Change
For this segment of the community, one of your goals is to increase awareness of the benefits of physical activity, community support, and the social norms for this behavior. Another goal is to move these people closer to actually trying out the behavior. Here are some ideas for achieving these goals.
What communication channels might you use?
- Distribute print materials targeted toward people who are thinking about becoming more physically active or include health and physical activity tips in general publications (USDHHS et al., 1999).
- Increase awareness by working with the media to gain visibility for your messages (USDHHS et al., 1999):
- Invite newspaper reporters to visible or newsworthy events.
- Work with reporters in writing feature stories.
- Provide timely news releases or newspaper articles.
- Participate as a guest on radio or television talk shows.
- Purchase radio, television, or cable advertising time.
- Display key messages and your program logo in storefront windows, on community bulletin boards, on billboard signs, and on banners strung across the main street or at major community locations (USDHHS et al., 1999).
- Design bumper stickers with physical activity and health promotion messages.
- Ask utility companies, banks, physicians, and others to place promotional and educational information in their monthly billings. Ask to place promotional and educational materials in waiting rooms of hospitals and health maintenance organizations, private physicians' offices, clinics, mental health centers, and senior citizen centers (USDHHS et al., 1999).
- Make health videos available at video stores and libraries.
- Set up a Web site with links to relevant stage-appropriate physical activity and health sites.
What types of information are most relevant to people who are considering becoming more active?
- Provide basic information about what is needed to achieve a physically active lifestyle such as selecting the appropriate shoes or clothing (USDHHS et al., 1999).
- Describe a variety of activities available to most people that can be done alone or with family and friends.
- Suggest ways to build in some activity into one's daily routine (e.g., taking the stairs at work).
- Dispel misconceptions about physical activity (e.g., "No pain, no gain," overestimated risk of injury such as heart attack).
What are some other strategies that might move these people closer to trying some physical activity?
- Provide messages that link physical activity to values or issues relevant to your target audience.
- Help them weigh the pros and cons of a physically active lifestyle. Focus on the costs of changing (effort, energy, and the things they must give up to overcome a sedentary lifestyle) and how they might deal with them.
- Encourage them to start off slowly (e.g., a 5- or 10-minute walk) and build gradually (add 5 minutes per day per week) and explain how to reward themselves when they achieve their goals.
- Give out self-assessment questionnaires such as the Physical Activity Readiness Questionnaire (PAR-Q, found in chapter 7) and the decisional balance questionnaire (questionnaire 4.4 in appendix A).
- Help people to visualize success-to visualize a happy, healthy, and active lifestyle.
How might you show community support for trying some physical activity?
- Host health fairs that include exercise testing, blood pressure screenings, or body fat composition assessments. Relate how these are affected by physical activity.
- Choose a spokesperson that the target audience trusts, respects, believes, or can identify with. Identify role models within the community. Recruit local people to endorse your program (USDHHS et al., 1999).
- Encourage health care providers to advise these patients on how they might benefit from physical activity and some steps they could take to begin a physically active lifestyle.
- Conduct targeted informational campaigns and sessions (USDHHS et al., 1999) such as the following:
- Lunch-'n'-learn or community lectures
- Workshops, seminars, or adult education classes
- Youth group programs
- One-on-one counseling or instruction
- Guest talk-show appearances on television and radio
- Columns or featured articles in the newspaper
- Give informative presentations at work sites, in schools, and to community organizations such as Rotary Clubs, Business and Professional Women, or the American Association of Retired Persons (USDHHS et al., 1999).
- Set up physical activity hotlines that people can call with questions about physical activity (USDHHS et al., 1999).
Questionnaire measures readiness to change physical activity behavior
The processes of change are the strategies and techniques people use to change their thinking and their behavior; your clients are therefore likely to increase their use of many of the processes of change long before they are meeting national guidelines for a physically active lifestyle.
Measuring Processes of Change
A client's use of the processes of change for physical activity behavior can be measured with questionnaire 4.1 in appendix A, which we and our colleagues developed (Marcus, Rossi, Selby, Niaura, & Abrams, 1992). This questionnaire has been used in many exercise studies. When people's scores on these items increase, it is usually a good indicator that they are becoming more active (Dunn et al., 1997). The processes of change are the strategies and techniques people use to change their thinking and their behavior; your clients are therefore likely to increase their use of many of the processes of change long before they are meeting national guidelines for a physically active lifestyle.
You may want to have clients complete this questionnaire every 3 months so that you can learn whether they are making progress toward behavior change even if they are not meeting their specific physical activity goals. Recall that a person's stage of motivation for change when she first comes to see you has a great impact on how quickly she increases her use of the processes of change. The setting in which you work might also affect which processes of change increase first and how quickly the client puts them to use. For example, if you are a personal trainer at a health club, you are more likely to start working with clients on behavior change, and thus you are more likely to see increases in the behavioral processes of change. However, if you work at a community center, YMCA, or YWCA implementing a program such as the Active Living Program (Blair, Dunn, Marcus, Carpenter, & Jaret, 2001), you may see changes in your clients' cognitive processes before changes in their behavioral processes. Most published studies indicate that it is important for people to first increase their use of the cognitive processes and then of the behavioral processes. However, some studies indicate that the order is not important; people need to increase their use of all (or most) of the processes of change to become and stay regularly active (Marcus et al., 1992).
For each process of change, the average score can range from 1 to 5. Table 4.2 shows typical scores for the four items in each process group for people in each stage of motivational readiness for change. Use this as a guide for understanding where your client is in the change process and on which areas to focus to help her start and stick with a program of regular physical activity. If the survey results are similar on a number of processes, you can choose either a single process or, in collaboration with your client, several processes to work on.
Scoring Processes of Change
For each process, average the individual items by adding each group together and dividing by 4. Do not score an individual process if fewer than three items were answered.
Readiness to change important when designing community physical activity interventions
Implement stage-specific strategies for your community physical activity programs.
Stage-Specific Strategies for Community Physical Activity Programs
We created the following list of intervention strategies to help you design your own community program. As we have tried to stress in this and other chapters, no one program works for everyone, so we do not provide a step-by-step program development guide. Rather, we hope you pick some of the following strategies plus generate some of your own ideas so that you create a program that addresses the needs of your target audience, your community's stage of change, any time constraints you may be working under, and your financial resources.
Stage 1
Not Thinking About Change
For this segment of the population, your goal is to help increase awareness about the (a) benefits of physical activity, (b) support for it in the local community, and (c) acceptance of physical activity by other community members. Here are some strategies for increasing awareness and encouraging people to begin to think about the role physical activity could play in their lives.
What communication channels might you use to reach people not considering becoming active?
- Distribute print materials targeted toward people who are presently not thinking about becoming more physically active.
- Work with the media to gain visibility for your messages. You might achieve this by doing the following (USDHHS et al., 1999):
- Invite newspaper reporters to visible or newsworthy events.
- Work with reporters in writing feature stories.
- Provide timely news releases or newspaper articles.
- Participate as a guest on radio or television talk shows.
- Purchase radio, television, or cable advertising time.
- Display key messages and your program logo in storefront windows, on community bulletin boards, on billboard signs, and on banners strung across the main street or at major community locations (USDHHS et al., 1999).
- Design bumper stickers with physical activity and health promotion messages (USDHHS et al., 1999).
- Ask utility companies, banks, physicians, and others to place promotional and educational information in their monthly billings. Ask to place promotional and educational materials in waiting rooms of hospitals and health maintenance organizations, private physicians' offices, clinics, mental health centers, and senior citizen centers (USDHHS et al., 1999).
What types of information are most relevant to people in this earliest stage?
- Host health fairs that include exercise testing, blood pressure screenings, or body fat composition assessments. Relate how these are affected by physical activity.
- Emphasize the short-term benefits of being active (e.g., feeling invigorated, sleeping better, reducing stress, feeling better about oneself) rather than the long-term benefits that these people might believe are unobtainable.
- Dispel misconceptions about physical activity (e.g., "No pain, no gain," overestimated risk of injuries such as heart attack).
- Increase awareness of what they might miss by choosing not to be active (e.g., enjoyment from being active, better self-esteem).
What are some other strategies that might move these people closer to considering change?
- Help people to visualize success-to visualize a happy, healthy, and active lifestyle.
- Encourage these people to read or think about how physical activity might benefit them. For this group, it is better to focus on the benefits of physical activity and not to dwell on the risks of a sedentary lifestyle.
- Link the benefits of a physically active lifestyle to people's highest priorities and values in life (e.g., relationship with family, personal faith, health, or happiness).
- Encourage these people to see how their sedentary behavior affects them personally and others in their lives (e.g., a sedentary parent models an unhealthy lifestyle to her children).
How might you show community support for physical activity?
- Encourage health care providers to advise their patients on how they might benefit from physical activity.
- Choose a spokesperson that the target audience trusts, respects, believes, or can identify with to help increase awareness. Identify role models within the community. Recruit local people to endorse your program (USDHHS et al., 1999).
- Conduct targeted informational campaigns and sessions (USDHHS et al., 1999) such as the following:
- Lunch-'n'-learn or community lectures
- Workshops, seminars, or adult education classes
- Youth group programs
- One-on-one counseling or instruction
- Guest talk-show appearances on television and radio
- Columns or featured articles in the newspaper
- Give informative presentations at work sites, in schools, and to community organizations such as Rotary Clubs, Business and Professional Women, or the American Association of Retired Persons (USDHHS et al., 1999).
Stage 2
Thinking About Change
For this segment of the community, one of your goals is to increase awareness of the benefits of physical activity, community support, and the social norms for this behavior. Another goal is to move these people closer to actually trying out the behavior. Here are some ideas for achieving these goals.
What communication channels might you use?
- Distribute print materials targeted toward people who are thinking about becoming more physically active or include health and physical activity tips in general publications (USDHHS et al., 1999).
- Increase awareness by working with the media to gain visibility for your messages (USDHHS et al., 1999):
- Invite newspaper reporters to visible or newsworthy events.
- Work with reporters in writing feature stories.
- Provide timely news releases or newspaper articles.
- Participate as a guest on radio or television talk shows.
- Purchase radio, television, or cable advertising time.
- Display key messages and your program logo in storefront windows, on community bulletin boards, on billboard signs, and on banners strung across the main street or at major community locations (USDHHS et al., 1999).
- Design bumper stickers with physical activity and health promotion messages.
- Ask utility companies, banks, physicians, and others to place promotional and educational information in their monthly billings. Ask to place promotional and educational materials in waiting rooms of hospitals and health maintenance organizations, private physicians' offices, clinics, mental health centers, and senior citizen centers (USDHHS et al., 1999).
- Make health videos available at video stores and libraries.
- Set up a Web site with links to relevant stage-appropriate physical activity and health sites.
What types of information are most relevant to people who are considering becoming more active?
- Provide basic information about what is needed to achieve a physically active lifestyle such as selecting the appropriate shoes or clothing (USDHHS et al., 1999).
- Describe a variety of activities available to most people that can be done alone or with family and friends.
- Suggest ways to build in some activity into one's daily routine (e.g., taking the stairs at work).
- Dispel misconceptions about physical activity (e.g., "No pain, no gain," overestimated risk of injury such as heart attack).
What are some other strategies that might move these people closer to trying some physical activity?
- Provide messages that link physical activity to values or issues relevant to your target audience.
- Help them weigh the pros and cons of a physically active lifestyle. Focus on the costs of changing (effort, energy, and the things they must give up to overcome a sedentary lifestyle) and how they might deal with them.
- Encourage them to start off slowly (e.g., a 5- or 10-minute walk) and build gradually (add 5 minutes per day per week) and explain how to reward themselves when they achieve their goals.
- Give out self-assessment questionnaires such as the Physical Activity Readiness Questionnaire (PAR-Q, found in chapter 7) and the decisional balance questionnaire (questionnaire 4.4 in appendix A).
- Help people to visualize success-to visualize a happy, healthy, and active lifestyle.
How might you show community support for trying some physical activity?
- Host health fairs that include exercise testing, blood pressure screenings, or body fat composition assessments. Relate how these are affected by physical activity.
- Choose a spokesperson that the target audience trusts, respects, believes, or can identify with. Identify role models within the community. Recruit local people to endorse your program (USDHHS et al., 1999).
- Encourage health care providers to advise these patients on how they might benefit from physical activity and some steps they could take to begin a physically active lifestyle.
- Conduct targeted informational campaigns and sessions (USDHHS et al., 1999) such as the following:
- Lunch-'n'-learn or community lectures
- Workshops, seminars, or adult education classes
- Youth group programs
- One-on-one counseling or instruction
- Guest talk-show appearances on television and radio
- Columns or featured articles in the newspaper
- Give informative presentations at work sites, in schools, and to community organizations such as Rotary Clubs, Business and Professional Women, or the American Association of Retired Persons (USDHHS et al., 1999).
- Set up physical activity hotlines that people can call with questions about physical activity (USDHHS et al., 1999).
Questionnaire measures readiness to change physical activity behavior
The processes of change are the strategies and techniques people use to change their thinking and their behavior; your clients are therefore likely to increase their use of many of the processes of change long before they are meeting national guidelines for a physically active lifestyle.
Measuring Processes of Change
A client's use of the processes of change for physical activity behavior can be measured with questionnaire 4.1 in appendix A, which we and our colleagues developed (Marcus, Rossi, Selby, Niaura, & Abrams, 1992). This questionnaire has been used in many exercise studies. When people's scores on these items increase, it is usually a good indicator that they are becoming more active (Dunn et al., 1997). The processes of change are the strategies and techniques people use to change their thinking and their behavior; your clients are therefore likely to increase their use of many of the processes of change long before they are meeting national guidelines for a physically active lifestyle.
You may want to have clients complete this questionnaire every 3 months so that you can learn whether they are making progress toward behavior change even if they are not meeting their specific physical activity goals. Recall that a person's stage of motivation for change when she first comes to see you has a great impact on how quickly she increases her use of the processes of change. The setting in which you work might also affect which processes of change increase first and how quickly the client puts them to use. For example, if you are a personal trainer at a health club, you are more likely to start working with clients on behavior change, and thus you are more likely to see increases in the behavioral processes of change. However, if you work at a community center, YMCA, or YWCA implementing a program such as the Active Living Program (Blair, Dunn, Marcus, Carpenter, & Jaret, 2001), you may see changes in your clients' cognitive processes before changes in their behavioral processes. Most published studies indicate that it is important for people to first increase their use of the cognitive processes and then of the behavioral processes. However, some studies indicate that the order is not important; people need to increase their use of all (or most) of the processes of change to become and stay regularly active (Marcus et al., 1992).
For each process of change, the average score can range from 1 to 5. Table 4.2 shows typical scores for the four items in each process group for people in each stage of motivational readiness for change. Use this as a guide for understanding where your client is in the change process and on which areas to focus to help her start and stick with a program of regular physical activity. If the survey results are similar on a number of processes, you can choose either a single process or, in collaboration with your client, several processes to work on.
Scoring Processes of Change
For each process, average the individual items by adding each group together and dividing by 4. Do not score an individual process if fewer than three items were answered.
Readiness to change important when designing community physical activity interventions
Implement stage-specific strategies for your community physical activity programs.
Stage-Specific Strategies for Community Physical Activity Programs
We created the following list of intervention strategies to help you design your own community program. As we have tried to stress in this and other chapters, no one program works for everyone, so we do not provide a step-by-step program development guide. Rather, we hope you pick some of the following strategies plus generate some of your own ideas so that you create a program that addresses the needs of your target audience, your community's stage of change, any time constraints you may be working under, and your financial resources.
Stage 1
Not Thinking About Change
For this segment of the population, your goal is to help increase awareness about the (a) benefits of physical activity, (b) support for it in the local community, and (c) acceptance of physical activity by other community members. Here are some strategies for increasing awareness and encouraging people to begin to think about the role physical activity could play in their lives.
What communication channels might you use to reach people not considering becoming active?
- Distribute print materials targeted toward people who are presently not thinking about becoming more physically active.
- Work with the media to gain visibility for your messages. You might achieve this by doing the following (USDHHS et al., 1999):
- Invite newspaper reporters to visible or newsworthy events.
- Work with reporters in writing feature stories.
- Provide timely news releases or newspaper articles.
- Participate as a guest on radio or television talk shows.
- Purchase radio, television, or cable advertising time.
- Display key messages and your program logo in storefront windows, on community bulletin boards, on billboard signs, and on banners strung across the main street or at major community locations (USDHHS et al., 1999).
- Design bumper stickers with physical activity and health promotion messages (USDHHS et al., 1999).
- Ask utility companies, banks, physicians, and others to place promotional and educational information in their monthly billings. Ask to place promotional and educational materials in waiting rooms of hospitals and health maintenance organizations, private physicians' offices, clinics, mental health centers, and senior citizen centers (USDHHS et al., 1999).
What types of information are most relevant to people in this earliest stage?
- Host health fairs that include exercise testing, blood pressure screenings, or body fat composition assessments. Relate how these are affected by physical activity.
- Emphasize the short-term benefits of being active (e.g., feeling invigorated, sleeping better, reducing stress, feeling better about oneself) rather than the long-term benefits that these people might believe are unobtainable.
- Dispel misconceptions about physical activity (e.g., "No pain, no gain," overestimated risk of injuries such as heart attack).
- Increase awareness of what they might miss by choosing not to be active (e.g., enjoyment from being active, better self-esteem).
What are some other strategies that might move these people closer to considering change?
- Help people to visualize success-to visualize a happy, healthy, and active lifestyle.
- Encourage these people to read or think about how physical activity might benefit them. For this group, it is better to focus on the benefits of physical activity and not to dwell on the risks of a sedentary lifestyle.
- Link the benefits of a physically active lifestyle to people's highest priorities and values in life (e.g., relationship with family, personal faith, health, or happiness).
- Encourage these people to see how their sedentary behavior affects them personally and others in their lives (e.g., a sedentary parent models an unhealthy lifestyle to her children).
How might you show community support for physical activity?
- Encourage health care providers to advise their patients on how they might benefit from physical activity.
- Choose a spokesperson that the target audience trusts, respects, believes, or can identify with to help increase awareness. Identify role models within the community. Recruit local people to endorse your program (USDHHS et al., 1999).
- Conduct targeted informational campaigns and sessions (USDHHS et al., 1999) such as the following:
- Lunch-'n'-learn or community lectures
- Workshops, seminars, or adult education classes
- Youth group programs
- One-on-one counseling or instruction
- Guest talk-show appearances on television and radio
- Columns or featured articles in the newspaper
- Give informative presentations at work sites, in schools, and to community organizations such as Rotary Clubs, Business and Professional Women, or the American Association of Retired Persons (USDHHS et al., 1999).
Stage 2
Thinking About Change
For this segment of the community, one of your goals is to increase awareness of the benefits of physical activity, community support, and the social norms for this behavior. Another goal is to move these people closer to actually trying out the behavior. Here are some ideas for achieving these goals.
What communication channels might you use?
- Distribute print materials targeted toward people who are thinking about becoming more physically active or include health and physical activity tips in general publications (USDHHS et al., 1999).
- Increase awareness by working with the media to gain visibility for your messages (USDHHS et al., 1999):
- Invite newspaper reporters to visible or newsworthy events.
- Work with reporters in writing feature stories.
- Provide timely news releases or newspaper articles.
- Participate as a guest on radio or television talk shows.
- Purchase radio, television, or cable advertising time.
- Display key messages and your program logo in storefront windows, on community bulletin boards, on billboard signs, and on banners strung across the main street or at major community locations (USDHHS et al., 1999).
- Design bumper stickers with physical activity and health promotion messages.
- Ask utility companies, banks, physicians, and others to place promotional and educational information in their monthly billings. Ask to place promotional and educational materials in waiting rooms of hospitals and health maintenance organizations, private physicians' offices, clinics, mental health centers, and senior citizen centers (USDHHS et al., 1999).
- Make health videos available at video stores and libraries.
- Set up a Web site with links to relevant stage-appropriate physical activity and health sites.
What types of information are most relevant to people who are considering becoming more active?
- Provide basic information about what is needed to achieve a physically active lifestyle such as selecting the appropriate shoes or clothing (USDHHS et al., 1999).
- Describe a variety of activities available to most people that can be done alone or with family and friends.
- Suggest ways to build in some activity into one's daily routine (e.g., taking the stairs at work).
- Dispel misconceptions about physical activity (e.g., "No pain, no gain," overestimated risk of injury such as heart attack).
What are some other strategies that might move these people closer to trying some physical activity?
- Provide messages that link physical activity to values or issues relevant to your target audience.
- Help them weigh the pros and cons of a physically active lifestyle. Focus on the costs of changing (effort, energy, and the things they must give up to overcome a sedentary lifestyle) and how they might deal with them.
- Encourage them to start off slowly (e.g., a 5- or 10-minute walk) and build gradually (add 5 minutes per day per week) and explain how to reward themselves when they achieve their goals.
- Give out self-assessment questionnaires such as the Physical Activity Readiness Questionnaire (PAR-Q, found in chapter 7) and the decisional balance questionnaire (questionnaire 4.4 in appendix A).
- Help people to visualize success-to visualize a happy, healthy, and active lifestyle.
How might you show community support for trying some physical activity?
- Host health fairs that include exercise testing, blood pressure screenings, or body fat composition assessments. Relate how these are affected by physical activity.
- Choose a spokesperson that the target audience trusts, respects, believes, or can identify with. Identify role models within the community. Recruit local people to endorse your program (USDHHS et al., 1999).
- Encourage health care providers to advise these patients on how they might benefit from physical activity and some steps they could take to begin a physically active lifestyle.
- Conduct targeted informational campaigns and sessions (USDHHS et al., 1999) such as the following:
- Lunch-'n'-learn or community lectures
- Workshops, seminars, or adult education classes
- Youth group programs
- One-on-one counseling or instruction
- Guest talk-show appearances on television and radio
- Columns or featured articles in the newspaper
- Give informative presentations at work sites, in schools, and to community organizations such as Rotary Clubs, Business and Professional Women, or the American Association of Retired Persons (USDHHS et al., 1999).
- Set up physical activity hotlines that people can call with questions about physical activity (USDHHS et al., 1999).
Questionnaire measures readiness to change physical activity behavior
The processes of change are the strategies and techniques people use to change their thinking and their behavior; your clients are therefore likely to increase their use of many of the processes of change long before they are meeting national guidelines for a physically active lifestyle.
Measuring Processes of Change
A client's use of the processes of change for physical activity behavior can be measured with questionnaire 4.1 in appendix A, which we and our colleagues developed (Marcus, Rossi, Selby, Niaura, & Abrams, 1992). This questionnaire has been used in many exercise studies. When people's scores on these items increase, it is usually a good indicator that they are becoming more active (Dunn et al., 1997). The processes of change are the strategies and techniques people use to change their thinking and their behavior; your clients are therefore likely to increase their use of many of the processes of change long before they are meeting national guidelines for a physically active lifestyle.
You may want to have clients complete this questionnaire every 3 months so that you can learn whether they are making progress toward behavior change even if they are not meeting their specific physical activity goals. Recall that a person's stage of motivation for change when she first comes to see you has a great impact on how quickly she increases her use of the processes of change. The setting in which you work might also affect which processes of change increase first and how quickly the client puts them to use. For example, if you are a personal trainer at a health club, you are more likely to start working with clients on behavior change, and thus you are more likely to see increases in the behavioral processes of change. However, if you work at a community center, YMCA, or YWCA implementing a program such as the Active Living Program (Blair, Dunn, Marcus, Carpenter, & Jaret, 2001), you may see changes in your clients' cognitive processes before changes in their behavioral processes. Most published studies indicate that it is important for people to first increase their use of the cognitive processes and then of the behavioral processes. However, some studies indicate that the order is not important; people need to increase their use of all (or most) of the processes of change to become and stay regularly active (Marcus et al., 1992).
For each process of change, the average score can range from 1 to 5. Table 4.2 shows typical scores for the four items in each process group for people in each stage of motivational readiness for change. Use this as a guide for understanding where your client is in the change process and on which areas to focus to help her start and stick with a program of regular physical activity. If the survey results are similar on a number of processes, you can choose either a single process or, in collaboration with your client, several processes to work on.
Scoring Processes of Change
For each process, average the individual items by adding each group together and dividing by 4. Do not score an individual process if fewer than three items were answered.
Readiness to change important when designing community physical activity interventions
Implement stage-specific strategies for your community physical activity programs.
Stage-Specific Strategies for Community Physical Activity Programs
We created the following list of intervention strategies to help you design your own community program. As we have tried to stress in this and other chapters, no one program works for everyone, so we do not provide a step-by-step program development guide. Rather, we hope you pick some of the following strategies plus generate some of your own ideas so that you create a program that addresses the needs of your target audience, your community's stage of change, any time constraints you may be working under, and your financial resources.
Stage 1
Not Thinking About Change
For this segment of the population, your goal is to help increase awareness about the (a) benefits of physical activity, (b) support for it in the local community, and (c) acceptance of physical activity by other community members. Here are some strategies for increasing awareness and encouraging people to begin to think about the role physical activity could play in their lives.
What communication channels might you use to reach people not considering becoming active?
- Distribute print materials targeted toward people who are presently not thinking about becoming more physically active.
- Work with the media to gain visibility for your messages. You might achieve this by doing the following (USDHHS et al., 1999):
- Invite newspaper reporters to visible or newsworthy events.
- Work with reporters in writing feature stories.
- Provide timely news releases or newspaper articles.
- Participate as a guest on radio or television talk shows.
- Purchase radio, television, or cable advertising time.
- Display key messages and your program logo in storefront windows, on community bulletin boards, on billboard signs, and on banners strung across the main street or at major community locations (USDHHS et al., 1999).
- Design bumper stickers with physical activity and health promotion messages (USDHHS et al., 1999).
- Ask utility companies, banks, physicians, and others to place promotional and educational information in their monthly billings. Ask to place promotional and educational materials in waiting rooms of hospitals and health maintenance organizations, private physicians' offices, clinics, mental health centers, and senior citizen centers (USDHHS et al., 1999).
What types of information are most relevant to people in this earliest stage?
- Host health fairs that include exercise testing, blood pressure screenings, or body fat composition assessments. Relate how these are affected by physical activity.
- Emphasize the short-term benefits of being active (e.g., feeling invigorated, sleeping better, reducing stress, feeling better about oneself) rather than the long-term benefits that these people might believe are unobtainable.
- Dispel misconceptions about physical activity (e.g., "No pain, no gain," overestimated risk of injuries such as heart attack).
- Increase awareness of what they might miss by choosing not to be active (e.g., enjoyment from being active, better self-esteem).
What are some other strategies that might move these people closer to considering change?
- Help people to visualize success-to visualize a happy, healthy, and active lifestyle.
- Encourage these people to read or think about how physical activity might benefit them. For this group, it is better to focus on the benefits of physical activity and not to dwell on the risks of a sedentary lifestyle.
- Link the benefits of a physically active lifestyle to people's highest priorities and values in life (e.g., relationship with family, personal faith, health, or happiness).
- Encourage these people to see how their sedentary behavior affects them personally and others in their lives (e.g., a sedentary parent models an unhealthy lifestyle to her children).
How might you show community support for physical activity?
- Encourage health care providers to advise their patients on how they might benefit from physical activity.
- Choose a spokesperson that the target audience trusts, respects, believes, or can identify with to help increase awareness. Identify role models within the community. Recruit local people to endorse your program (USDHHS et al., 1999).
- Conduct targeted informational campaigns and sessions (USDHHS et al., 1999) such as the following:
- Lunch-'n'-learn or community lectures
- Workshops, seminars, or adult education classes
- Youth group programs
- One-on-one counseling or instruction
- Guest talk-show appearances on television and radio
- Columns or featured articles in the newspaper
- Give informative presentations at work sites, in schools, and to community organizations such as Rotary Clubs, Business and Professional Women, or the American Association of Retired Persons (USDHHS et al., 1999).
Stage 2
Thinking About Change
For this segment of the community, one of your goals is to increase awareness of the benefits of physical activity, community support, and the social norms for this behavior. Another goal is to move these people closer to actually trying out the behavior. Here are some ideas for achieving these goals.
What communication channels might you use?
- Distribute print materials targeted toward people who are thinking about becoming more physically active or include health and physical activity tips in general publications (USDHHS et al., 1999).
- Increase awareness by working with the media to gain visibility for your messages (USDHHS et al., 1999):
- Invite newspaper reporters to visible or newsworthy events.
- Work with reporters in writing feature stories.
- Provide timely news releases or newspaper articles.
- Participate as a guest on radio or television talk shows.
- Purchase radio, television, or cable advertising time.
- Display key messages and your program logo in storefront windows, on community bulletin boards, on billboard signs, and on banners strung across the main street or at major community locations (USDHHS et al., 1999).
- Design bumper stickers with physical activity and health promotion messages.
- Ask utility companies, banks, physicians, and others to place promotional and educational information in their monthly billings. Ask to place promotional and educational materials in waiting rooms of hospitals and health maintenance organizations, private physicians' offices, clinics, mental health centers, and senior citizen centers (USDHHS et al., 1999).
- Make health videos available at video stores and libraries.
- Set up a Web site with links to relevant stage-appropriate physical activity and health sites.
What types of information are most relevant to people who are considering becoming more active?
- Provide basic information about what is needed to achieve a physically active lifestyle such as selecting the appropriate shoes or clothing (USDHHS et al., 1999).
- Describe a variety of activities available to most people that can be done alone or with family and friends.
- Suggest ways to build in some activity into one's daily routine (e.g., taking the stairs at work).
- Dispel misconceptions about physical activity (e.g., "No pain, no gain," overestimated risk of injury such as heart attack).
What are some other strategies that might move these people closer to trying some physical activity?
- Provide messages that link physical activity to values or issues relevant to your target audience.
- Help them weigh the pros and cons of a physically active lifestyle. Focus on the costs of changing (effort, energy, and the things they must give up to overcome a sedentary lifestyle) and how they might deal with them.
- Encourage them to start off slowly (e.g., a 5- or 10-minute walk) and build gradually (add 5 minutes per day per week) and explain how to reward themselves when they achieve their goals.
- Give out self-assessment questionnaires such as the Physical Activity Readiness Questionnaire (PAR-Q, found in chapter 7) and the decisional balance questionnaire (questionnaire 4.4 in appendix A).
- Help people to visualize success-to visualize a happy, healthy, and active lifestyle.
How might you show community support for trying some physical activity?
- Host health fairs that include exercise testing, blood pressure screenings, or body fat composition assessments. Relate how these are affected by physical activity.
- Choose a spokesperson that the target audience trusts, respects, believes, or can identify with. Identify role models within the community. Recruit local people to endorse your program (USDHHS et al., 1999).
- Encourage health care providers to advise these patients on how they might benefit from physical activity and some steps they could take to begin a physically active lifestyle.
- Conduct targeted informational campaigns and sessions (USDHHS et al., 1999) such as the following:
- Lunch-'n'-learn or community lectures
- Workshops, seminars, or adult education classes
- Youth group programs
- One-on-one counseling or instruction
- Guest talk-show appearances on television and radio
- Columns or featured articles in the newspaper
- Give informative presentations at work sites, in schools, and to community organizations such as Rotary Clubs, Business and Professional Women, or the American Association of Retired Persons (USDHHS et al., 1999).
- Set up physical activity hotlines that people can call with questions about physical activity (USDHHS et al., 1999).
Questionnaire measures readiness to change physical activity behavior
The processes of change are the strategies and techniques people use to change their thinking and their behavior; your clients are therefore likely to increase their use of many of the processes of change long before they are meeting national guidelines for a physically active lifestyle.
Measuring Processes of Change
A client's use of the processes of change for physical activity behavior can be measured with questionnaire 4.1 in appendix A, which we and our colleagues developed (Marcus, Rossi, Selby, Niaura, & Abrams, 1992). This questionnaire has been used in many exercise studies. When people's scores on these items increase, it is usually a good indicator that they are becoming more active (Dunn et al., 1997). The processes of change are the strategies and techniques people use to change their thinking and their behavior; your clients are therefore likely to increase their use of many of the processes of change long before they are meeting national guidelines for a physically active lifestyle.
You may want to have clients complete this questionnaire every 3 months so that you can learn whether they are making progress toward behavior change even if they are not meeting their specific physical activity goals. Recall that a person's stage of motivation for change when she first comes to see you has a great impact on how quickly she increases her use of the processes of change. The setting in which you work might also affect which processes of change increase first and how quickly the client puts them to use. For example, if you are a personal trainer at a health club, you are more likely to start working with clients on behavior change, and thus you are more likely to see increases in the behavioral processes of change. However, if you work at a community center, YMCA, or YWCA implementing a program such as the Active Living Program (Blair, Dunn, Marcus, Carpenter, & Jaret, 2001), you may see changes in your clients' cognitive processes before changes in their behavioral processes. Most published studies indicate that it is important for people to first increase their use of the cognitive processes and then of the behavioral processes. However, some studies indicate that the order is not important; people need to increase their use of all (or most) of the processes of change to become and stay regularly active (Marcus et al., 1992).
For each process of change, the average score can range from 1 to 5. Table 4.2 shows typical scores for the four items in each process group for people in each stage of motivational readiness for change. Use this as a guide for understanding where your client is in the change process and on which areas to focus to help her start and stick with a program of regular physical activity. If the survey results are similar on a number of processes, you can choose either a single process or, in collaboration with your client, several processes to work on.
Scoring Processes of Change
For each process, average the individual items by adding each group together and dividing by 4. Do not score an individual process if fewer than three items were answered.
Readiness to change important when designing community physical activity interventions
Implement stage-specific strategies for your community physical activity programs.
Stage-Specific Strategies for Community Physical Activity Programs
We created the following list of intervention strategies to help you design your own community program. As we have tried to stress in this and other chapters, no one program works for everyone, so we do not provide a step-by-step program development guide. Rather, we hope you pick some of the following strategies plus generate some of your own ideas so that you create a program that addresses the needs of your target audience, your community's stage of change, any time constraints you may be working under, and your financial resources.
Stage 1
Not Thinking About Change
For this segment of the population, your goal is to help increase awareness about the (a) benefits of physical activity, (b) support for it in the local community, and (c) acceptance of physical activity by other community members. Here are some strategies for increasing awareness and encouraging people to begin to think about the role physical activity could play in their lives.
What communication channels might you use to reach people not considering becoming active?
- Distribute print materials targeted toward people who are presently not thinking about becoming more physically active.
- Work with the media to gain visibility for your messages. You might achieve this by doing the following (USDHHS et al., 1999):
- Invite newspaper reporters to visible or newsworthy events.
- Work with reporters in writing feature stories.
- Provide timely news releases or newspaper articles.
- Participate as a guest on radio or television talk shows.
- Purchase radio, television, or cable advertising time.
- Display key messages and your program logo in storefront windows, on community bulletin boards, on billboard signs, and on banners strung across the main street or at major community locations (USDHHS et al., 1999).
- Design bumper stickers with physical activity and health promotion messages (USDHHS et al., 1999).
- Ask utility companies, banks, physicians, and others to place promotional and educational information in their monthly billings. Ask to place promotional and educational materials in waiting rooms of hospitals and health maintenance organizations, private physicians' offices, clinics, mental health centers, and senior citizen centers (USDHHS et al., 1999).
What types of information are most relevant to people in this earliest stage?
- Host health fairs that include exercise testing, blood pressure screenings, or body fat composition assessments. Relate how these are affected by physical activity.
- Emphasize the short-term benefits of being active (e.g., feeling invigorated, sleeping better, reducing stress, feeling better about oneself) rather than the long-term benefits that these people might believe are unobtainable.
- Dispel misconceptions about physical activity (e.g., "No pain, no gain," overestimated risk of injuries such as heart attack).
- Increase awareness of what they might miss by choosing not to be active (e.g., enjoyment from being active, better self-esteem).
What are some other strategies that might move these people closer to considering change?
- Help people to visualize success-to visualize a happy, healthy, and active lifestyle.
- Encourage these people to read or think about how physical activity might benefit them. For this group, it is better to focus on the benefits of physical activity and not to dwell on the risks of a sedentary lifestyle.
- Link the benefits of a physically active lifestyle to people's highest priorities and values in life (e.g., relationship with family, personal faith, health, or happiness).
- Encourage these people to see how their sedentary behavior affects them personally and others in their lives (e.g., a sedentary parent models an unhealthy lifestyle to her children).
How might you show community support for physical activity?
- Encourage health care providers to advise their patients on how they might benefit from physical activity.
- Choose a spokesperson that the target audience trusts, respects, believes, or can identify with to help increase awareness. Identify role models within the community. Recruit local people to endorse your program (USDHHS et al., 1999).
- Conduct targeted informational campaigns and sessions (USDHHS et al., 1999) such as the following:
- Lunch-'n'-learn or community lectures
- Workshops, seminars, or adult education classes
- Youth group programs
- One-on-one counseling or instruction
- Guest talk-show appearances on television and radio
- Columns or featured articles in the newspaper
- Give informative presentations at work sites, in schools, and to community organizations such as Rotary Clubs, Business and Professional Women, or the American Association of Retired Persons (USDHHS et al., 1999).
Stage 2
Thinking About Change
For this segment of the community, one of your goals is to increase awareness of the benefits of physical activity, community support, and the social norms for this behavior. Another goal is to move these people closer to actually trying out the behavior. Here are some ideas for achieving these goals.
What communication channels might you use?
- Distribute print materials targeted toward people who are thinking about becoming more physically active or include health and physical activity tips in general publications (USDHHS et al., 1999).
- Increase awareness by working with the media to gain visibility for your messages (USDHHS et al., 1999):
- Invite newspaper reporters to visible or newsworthy events.
- Work with reporters in writing feature stories.
- Provide timely news releases or newspaper articles.
- Participate as a guest on radio or television talk shows.
- Purchase radio, television, or cable advertising time.
- Display key messages and your program logo in storefront windows, on community bulletin boards, on billboard signs, and on banners strung across the main street or at major community locations (USDHHS et al., 1999).
- Design bumper stickers with physical activity and health promotion messages.
- Ask utility companies, banks, physicians, and others to place promotional and educational information in their monthly billings. Ask to place promotional and educational materials in waiting rooms of hospitals and health maintenance organizations, private physicians' offices, clinics, mental health centers, and senior citizen centers (USDHHS et al., 1999).
- Make health videos available at video stores and libraries.
- Set up a Web site with links to relevant stage-appropriate physical activity and health sites.
What types of information are most relevant to people who are considering becoming more active?
- Provide basic information about what is needed to achieve a physically active lifestyle such as selecting the appropriate shoes or clothing (USDHHS et al., 1999).
- Describe a variety of activities available to most people that can be done alone or with family and friends.
- Suggest ways to build in some activity into one's daily routine (e.g., taking the stairs at work).
- Dispel misconceptions about physical activity (e.g., "No pain, no gain," overestimated risk of injury such as heart attack).
What are some other strategies that might move these people closer to trying some physical activity?
- Provide messages that link physical activity to values or issues relevant to your target audience.
- Help them weigh the pros and cons of a physically active lifestyle. Focus on the costs of changing (effort, energy, and the things they must give up to overcome a sedentary lifestyle) and how they might deal with them.
- Encourage them to start off slowly (e.g., a 5- or 10-minute walk) and build gradually (add 5 minutes per day per week) and explain how to reward themselves when they achieve their goals.
- Give out self-assessment questionnaires such as the Physical Activity Readiness Questionnaire (PAR-Q, found in chapter 7) and the decisional balance questionnaire (questionnaire 4.4 in appendix A).
- Help people to visualize success-to visualize a happy, healthy, and active lifestyle.
How might you show community support for trying some physical activity?
- Host health fairs that include exercise testing, blood pressure screenings, or body fat composition assessments. Relate how these are affected by physical activity.
- Choose a spokesperson that the target audience trusts, respects, believes, or can identify with. Identify role models within the community. Recruit local people to endorse your program (USDHHS et al., 1999).
- Encourage health care providers to advise these patients on how they might benefit from physical activity and some steps they could take to begin a physically active lifestyle.
- Conduct targeted informational campaigns and sessions (USDHHS et al., 1999) such as the following:
- Lunch-'n'-learn or community lectures
- Workshops, seminars, or adult education classes
- Youth group programs
- One-on-one counseling or instruction
- Guest talk-show appearances on television and radio
- Columns or featured articles in the newspaper
- Give informative presentations at work sites, in schools, and to community organizations such as Rotary Clubs, Business and Professional Women, or the American Association of Retired Persons (USDHHS et al., 1999).
- Set up physical activity hotlines that people can call with questions about physical activity (USDHHS et al., 1999).
Questionnaire measures readiness to change physical activity behavior
The processes of change are the strategies and techniques people use to change their thinking and their behavior; your clients are therefore likely to increase their use of many of the processes of change long before they are meeting national guidelines for a physically active lifestyle.
Measuring Processes of Change
A client's use of the processes of change for physical activity behavior can be measured with questionnaire 4.1 in appendix A, which we and our colleagues developed (Marcus, Rossi, Selby, Niaura, & Abrams, 1992). This questionnaire has been used in many exercise studies. When people's scores on these items increase, it is usually a good indicator that they are becoming more active (Dunn et al., 1997). The processes of change are the strategies and techniques people use to change their thinking and their behavior; your clients are therefore likely to increase their use of many of the processes of change long before they are meeting national guidelines for a physically active lifestyle.
You may want to have clients complete this questionnaire every 3 months so that you can learn whether they are making progress toward behavior change even if they are not meeting their specific physical activity goals. Recall that a person's stage of motivation for change when she first comes to see you has a great impact on how quickly she increases her use of the processes of change. The setting in which you work might also affect which processes of change increase first and how quickly the client puts them to use. For example, if you are a personal trainer at a health club, you are more likely to start working with clients on behavior change, and thus you are more likely to see increases in the behavioral processes of change. However, if you work at a community center, YMCA, or YWCA implementing a program such as the Active Living Program (Blair, Dunn, Marcus, Carpenter, & Jaret, 2001), you may see changes in your clients' cognitive processes before changes in their behavioral processes. Most published studies indicate that it is important for people to first increase their use of the cognitive processes and then of the behavioral processes. However, some studies indicate that the order is not important; people need to increase their use of all (or most) of the processes of change to become and stay regularly active (Marcus et al., 1992).
For each process of change, the average score can range from 1 to 5. Table 4.2 shows typical scores for the four items in each process group for people in each stage of motivational readiness for change. Use this as a guide for understanding where your client is in the change process and on which areas to focus to help her start and stick with a program of regular physical activity. If the survey results are similar on a number of processes, you can choose either a single process or, in collaboration with your client, several processes to work on.
Scoring Processes of Change
For each process, average the individual items by adding each group together and dividing by 4. Do not score an individual process if fewer than three items were answered.