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BACKGROUND: Fear of fat is a relevant variable in initiating weight regulation behaviors in adolescents. However, little is known about the experiential and behavioral change processes that mediate the choice between healthy and unhealthy weight regulation behaviors in this population. METHOD: The general objective was to examine the predictive role of fear of fat on weight-related behaviors (healthy and unhealthy weight control behaviors) through the mediation of experiential and behavioral change processes (consciousness raising, counterconditioning, helping relationships, reinforcement management, self-liberation, self-reevaluation, stimulus control, substance use) in 838 adolescents aged 15-19 years from Mexico and Spain using parallel mediation analysis. Additionally, the study examined the correlations between the variables with regard to gender and country, as well as the differences in the use of processes of change across stages of change through the use of a multivariate analysis of variance. The Spanish version of the Fear of Fat, Stages of Change, Processes of Change, and Weight-Related Behaviors scales were used. RESULTS: The mediation analysis showed that fear of fat predicted healthy weight control behaviors through consciousness raising, self-liberation, and stimulus control. On the other hand, fear of fat predicted unhealthy weight control behaviors through counterconditioning, stimulus control, and the use of weight loss substances. Intervening to reduce fear of fat may be a way to modify the processes of change used by adolescents to regulate their weight. CONCLUSIONS: The results of this study indicate that adolescents may initiate weight control behaviors as a result of fear of fat. This process is mediated by experiential and behavioral processes that influence weight regulation.

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OBJECTIVE: The Transtheoretical Model of Change (TTM) is an established model outlining five stages of change within a psychotherapeutic context: pre-contemplation, contemplation, preparation, action, and maintenance. Research shows that these models benefit patients and clinicians by enhancing their understanding of complex processes and identifying optimal therapeutic support for individuals at specific times. This study aimed to apply the TTM to personal recovery following a suicidal episode. METHOD: A meta-synthesis was conducted on qualitative studies that outlined distinct phases or stages of recovery from a suicidal episode. The identified recovery stages were mapped onto corresponding TTM stages. RESULTS: Recovery processes followed a pattern aligning with TTM stages, but the action, maintenance, and termination stages were not clearly distinguished in the context of personal recovery. A three-stage model was proposed instead: (1) precontemplation, where recovery is not seen as possible or meaningful; (2) contemplation, during which there is growing awareness and consideration of the possibility of recovery and change; and (3) active growth, which is characterized by ongoing progress and engagement in at least one personal recovery process. CONCLUSIONS: The proposed three-stage model condenses the later TTM stages and may better reflect personal recovery from a suicidal episode. Applying the model in clinical settings could help with case conceptualization and inform recovery approaches to an individual's current stage. Future research should evaluate the benefits of incorporating stages of change into suicide-focused recovery interventions to develop more effective interventions.

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Regular physical activity (PA) improves the psychological well-being of those who practice it. However, female university students are a risk group due to their low level of PA. Based on the transtheoretical model of behavioural change, the main aim of this study was to examine whether the relationship between PA and subjective vitality was mediated by cognitive-emotional variables such as decisional balance (perceived benefits and barriers) and enjoyment associated with PA in a group of female university students. Participants were asked to complete self-administered questionnaires, which were available for one month via a Google Form. The results showed the existence of a statistically significant, relative, and indirect effect between the stage of change and subjective vitality via both mediating variables. Compared to females in the pre-contemplation stage, those in the action and maintenance stages achieved higher subjective vitality scores as a result of the effect of being in a more advanced stage on decisional balance and enjoyment of PA. It is concluded that female university students who reported regular PA found the activity to be more revitalising, stimulating, and exciting; all positive feelings and cognitions that translated into a more energetic and vital perception of themselves.

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BACKGROUND: Current treatments for people with obesity emphasise the need for person-centred approaches that consider complex biopsychosocial factors and value the lived experience of people when attempting to lose weight. METHODS: Narrative interviews (n = 20) were conducted with people living with obesity to explore the causes of their weight gain and their expectations and engagement with treatment at a Weight Management Clinic. A mixed inductive and deductive qualitative analysis identified utterances that represented psychological constructs used to understand self-appraisal and health behaviour. A narrative analysis was used to situate these findings in the context of a participant's life story. RESULTS: Locus of control was a dominant construct evidenced through a person's attributional style and self-efficacy. Transcripts represented a heightened sense of self-understanding and shifts in control, and styles of attribution and efficacy resulted in either stasis or self-actualisation. The Stages of Change model could be applied to narratives to ascertain a patient's motivation to access treatment. Importantly, narrative interviews also allowed for the consideration of how a person's systemic context influenced their weight. CONCLUSION: Narrative interaction supports both self- and shared understandings of the causes and consequences of obesity for individuals, in a non-blaming or shaming manner. It provides an opportunity to enhance engagement through tailored, person-centred treatments.

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Background: Physical activity is an important predictor of quality of life in older adults with type 2 diabetes (T2D). Unfortunately, most T2D adults adopt a sedentary lifestyle. The randomized, controlled TRIPL-A trial aims to verify the effect of a personalized, discontinuous exercise program on a sedentary lifestyle of T2D older adults. Methods: A total of 305 T2D patients (mean age ± SD: 68.8 ± 3.3 years) were divided into a control arm receiving only behavioral counseling and an intervention arm of an 18-month supervised discontinuous exercise program (ERS). The primary outcomes were the changes in sitting time (ST) and metabolic equivalent (MET) values, both evaluated by the International Physical Activity Questionnaire short form. A repeated measures ANOVA with Bonferroni correction for multiple comparisons was used to compare study outcomes. Results: The ST and MET differed significantly during the study compared to the control group (p = 0.028 and p = 0.004, respectively). In the intervention group, a decrease from baseline in ST at 6 months (p = 0.01) and an increase in MET values at 6 months (p = 0.01) up to 12 months (p < 0.01) were found. No significant differences were found for the other variables. Conclusions: Beneficial lifestyle changes were found within the first year of intervention. These results align with the theory of change.

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BACKGROUND: In high- and low-income countries, declining birth rates have become a global concern. Couples do not have enough information about the complications of delaying and reducing childbearing and this leads them to make inappropriate decisions. Therefore, this study aims to evaluate whether an educational program based on integrating the Theory of Planned Behavior (TPB) and the Trans-Theoretical Model (TTM) affects child-free couples' intention to have children and minimizes the consequences of this decline. METHODS: Thirty couples (intervention, n = 15; control, n = 15) will be enrolled in this cluster randomized controlled trial. After collecting baseline data and separating participants in the pre-contemplation and contemplation stages based on the TTM, the samples were randomly assigned to the intervention and control groups. The intervention group will receive 60-min training based on TPB components for 4 weeks. The first follow-up assessment was performed immediately after the intervention and the final assessment 6 months later. For all 3 time assessments, three questionnaires will be used: The knowledge questionnaire, the TTM, and the TPB questionnaire. The most important consequences are changes in knowledge, attitudes, subjective norms, perceived behavioral control, and stages of intentions to have children. DISCUSSION: Decision-makers will use the results of this study as a basis to design appropriate, transparent, and useful policies and interventions to improve or stop the decline of the fertility rate at the national level. Also, this study will help young couples who wish to have a child in their lifetime by providing relevant information so that they do not miss this opportunity and face the consequences of delaying having a child. Trial registration This study was approved by the Iranian Registry of Clinical Trials (IRCT), Number: IRCT20220618055210N2, Date of registration: 2023-10-03.

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OBJECTIVE: Cigarette smoking is highly prevalent, despite being a primary preventable cause of disease and mortality. This study examined the effect of a Transtheoretical Model (TTM)-based psychoeducational intervention for smoking cessation (SC) on knowledge, SC-related parameters, and progression through the TTM stages of change among rural smokers. METHODS: This quasi-experimental study recruited 200 smokers from an outpatient clinic. The comparison group was recruited before the experimental group to address possible self-selection bias. Structured questionnaires were administered pre- and post-intervention (three months) and at follow-up (six months). RESULTS: A generalised estimation equation model indicated that the TTM-based intervention significantly increased participants' SC-knowledge and improved progression through TTM stages by the six-month follow-up. No significant group differences were found in self-efficacy and nicotine dependence scores or daily cigarette consumption. CONCLUSIONS: A TTM-based intervention enhances SC-knowledge and fosters progress through change stages. However, it does not directly impact nicotine dependence or cigarette consumption. Outpatient settings may employ TTM-based programmes for SC education and motivation. Detecting anticipated effects may require a longer intervention duration exceeding six months. PRACTICE IMPLICATIONS: Such TTM-based programmes may facilitate SC-knowledge and motivation in outpatient settings. Further research to comprehend patients' context and experiences during the stages of change is required.

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PURPOSE: To identify predictive factors associated with US adolescents' transition through the stages of change for potentially quitting e-cigarettes using the Trans-theoretical model of behavior change. DESIGN: Prospective cohort study. SETTING: United States. SUBJECTS: We utilized data from adolescents (12-17 years) in Wave 3 of the Population Assessment of Tobacco and Health study who used e-cigarettes exclusively over the past 30 days (n = 177) and were followed up with in Wave 4. MEASURES: Outcome variables were 3 transition categories: those who remained stagnant, those who progressed, and those who regressed in their stage of quitting e-cigarettes. Predictor variables were socio-demographics, e-cigarette harm perception, e-cigarette use at home or by important people, social norms, e-cigarette and anti-tobacco advertisements, and e-cigarette health warnings. ANALYSIS: Weighted-adjusted multinomial regression analysis was performed to determine the association between predictor and outcome variables. RESULTS: From Wave 3 to Wave 4, 19% of adolescents remained stagnant; 73.3% progressed; and 7.7% regressed. Adolescents were less likely to progress in their stage of change if they perceived nicotine in e-cigarettes to be "not at all/slightly harmful" (AOR = .26 [95% CI: .25, .27], P < .001); reported important people's use of e-cigarettes (AOR = .18 [95% CI: .05, .65, P = .009); and "rarely" noticed e-cigarette health warnings (AOR = .28 [95% CI: .08, .98, P = .054). CONCLUSION: Intervention efforts must target specific predictive factors that may help adolescents quit e-cigarettes.

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PURPOSE: To examine differences across gender and sexual orientation in cigarette smoking motives and stages of change in smoking cessation among Veterans. DESIGN: Secondary data analysis of cross-sectional baseline surveys from a prospective cohort study. SETTING: United States, self-administered online survey. PARTICIPANTS: Cisgender Veterans who reported past-year smoking (N = 146); 66.4% identified as lesbian, gay, or bisexual and 52.1% were men. MEASURES: Smoking motives (i.e., social, self-confidence, boredom relief, and affect regulation), with higher scores indicating stronger motivation to smoke. Stages of change categories included precontemplation, contemplation/preparation, and action/maintenance. ANALYSIS: Analyses were stratified by gender and sexual orientation. Age-adjusted linear regression models estimated differences in smoking motives scores and multinomial logistic regression models estimated differences in stages of change categories relative to the precontemplation stage (reference category). RESULTS: In this Veteran sample, gay men reported higher social smoking motives vs heterosexual men (ß = 1.50 (95% CI: .04, 2.97), P-value = .045) and higher boredom relief smoking motives vs bisexual men (ß = 1.53 (95% CI: .06, 2.29), P-value = .041) in age-adjusted models. Lesbian women were more likely to be in the action/maintenance stage relative to the precontemplation stage when compared to both heterosexual women (aRRR = 4.88 (95% CI: 1.00, 23.79) P-value = .050) and bisexual women (aRRR = 16.46 (95% CI: 2.12, 127.57), P-value = .007) after adjusting for age. CONCLUSION: Smoking cessation interventions may benefit from enhancing peer support for gay men. Given bisexual and heterosexual women were in less advance stages of change, there may be a greater need for motivational interventions to encourage quitting and additional support to assist with cessation efforts. Overall, findings highlight the diversity of cigarette use within LGB communities.

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Restaurants, canteens, residential care, hospitals and other out-of-home food service locations can play an important role in improving people's diet quality by offering healthier and more sustainable food choices. However, the effectiveness of implementing sustainable and healthy food practices at these locations is, at least partly, dependent on the extent to which they are accepted and implemented by the staff members. This study aims to assess staff members' motivation, perceived capability, perceived opportunity and their readiness to change their behaviour (i.e., stages of change) in offering more healthy and sustainable food options to their customers or patients. Eleven out-of-home locations that wanted to adjust their assortment towards more healthy and sustainable product offerings participated in this study and were able to distribute a comparable questionnaire among their staff members to assess their perceived readiness to change. Results among 268 participants show that staff members find both a healthy and sustainable food assortment important and also seem to be motivated to improve their food assortment regarding health and sustainability. Perceived opportunity seems to be the largest barrier for staff members, although there is also room for improvement regarding their perceived capability. In addition, personal motivation seems to play the dominant role in staff members' readiness to change the health of the assortment, whereas perceived capability seems to play the dominant role in their perceived readiness to change the sustainability of the assortment. This study shows that taking into account the perspective of the catering staff members may help to effectively implement healthy and sustainable food practices in out-of-home food service locations.

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Resumen El proceso de cambio hacia la práctica de actividad física todavía no ha sido adecuadamente caracterizado. Uno de los asuntos en discusión es si este proceso puede ser descrito en términos de etapas. Se llevó a cabo un estudio con el objetivo de examinar patrones de continuidad o discontinuidad de variables del Modelo Procesual de Acción en Salud dentro de las etapas propuestas por el Modelo Transteórico, y así valorar en qué medida la evidencia apoya la existencia de etapas. Para ello, se recogieron datos transversales de estudiantes universitarios (N = 490, edad = 22.5 años, DT = 6.57) y se hicieron ANOVA, contrastes planeados y análisis de tendencias polinómicas, siguiendo las recomendaciones de Sutton (2000). Los resultados para varias de las variables fueron compatibles con supuestos sobre la existencia de etapas. Sin embargo, para otras variables, los resultados no apoyan la existencia de etapas. Estos hallazgos proveen información útil para esfuerzos de integración de distintos modelos. Se discute sobre las implicaciones teóricas y prácticas de estos.

Abstract The process of change towards the practice of physical activity has not yet been adequately characterized. One issue under discussion is whether this process can be described in terms of stages. A study was carried out in order to examine patterns of continuity or discontinuity in variables of the Health Action Process Model within the stages proposed by the Transtheoretical Model, and thus assess to what extent the evidence supports the existence of stages. For this, cross-sectional data of university students (N = 490, mean age 22.5 years (SD = 6.57) were collected, and ANOVAs, planned contrasts, and polynomial trend analyses were performed, as recommended by Sutton (2000). The results for several variables were compatible with assumptions about the existence of stages. However, for other variables results did not support the existence of stages. These findings provide useful information for efforts to integrate different models. The theoretical and practical implications are discussed.

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Men aged 50 or older (50 plus) represent a hard-to-reach target group for health-enhancing physical activity (PA) interventions. However, a considerable percentage of men 50 plus do not entirely fail to achieve the PA milestones set by the World Health Organization (WHO) guidelines. They show fluctuating PA behavior, influenced by various barriers hindering or preventing regular PA participation. As "one-size-fits-all" behavioral change interventions are only partially effective in specific subgroups, it is essential to tailor PA promotion measures to the particular needs of male fluctuators 50 plus. The standardized questionnaire included validated instruments measuring participants' current stage of behavioral change, their perceived barriers to PA, questions on selected psychosocial correlates of PA, and sociodemographic variables. Out of 1,013 participants, 133 men (13.1%) classified themselves as fluctuators. Using a person-centered approach, we formed groups with similar intra-individual relevant barrier profiles using hierarchical cluster analysis (Ward method) followed by k-means clustering. We identified four clusters. Cluster 1 (n = 31) involves men predominantly perceiving physical constraints. Cluster 2 (n = 33) represents men lacking self-motivation and struggling with their weaker selves. Men in Cluster 3 (n = 51) primarily indicate professional and private obligations that prevent them from being physically active. Finally, men in Cluster 4 (n = 18) miss appropriate sports courses that meet their individual needs. Our findings support identifying individually tailored strategies designed to promote regular PA in male fluctuators 50 plus. Further research is required to determine the effectiveness of this approach in improving adherence to PA guidelines and corresponding health-enhancing effects for men 50 plus.

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The number of Americans living with chronic health conditions has steadily increased. Chronic diseases are the leading causes of death and disability in the United States and cost the healthcare system an estimated $4.1 trillion dollars a year. The role of social workers in assisting patients in the management of their chronic diseases is vital. The behavioral health changes often required of chronic care management (CCM) patients require support and intervention by professionals to help the patient improve self-management of their chronic health conditions. Motivational interviewing (MI) is an evidence-based practice that helps people change by paying attention to the language patients use as they discuss their change goals and behaviors. Applying the principles and strategies of MI within the stages of change model (transtheoretical model of change) can help social workers better understand and assist patients receiving CCM. This article outlines specific strategies the social worker can use to address motivation at different stages of change.

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BACKGROUND: Pediatric Early Warning Systems (PEWS) assist early detection of clinical deterioration in hospitalized children with cancer. Relevant to successful PEWS implementation, the "stages of change" model characterizes stakeholder support for PEWS based on willingness and effort to adopt the new practice. METHODS: At five resource-limited pediatric oncology centers in Latin America, semi-structured interviews were conducted with 71 hospital staff involved in PEWS implementation. Purposive sampling was used to select centers requiring variable time to complete PEWS implementation, with low-barrier centers (3-4 months) and high-barrier centers (10-11 months). Interviews were conducted in Spanish, professionally transcribed, and translated into English. Thematic content analysis explored "stage of change" with constant comparative analysis across stakeholder types and study sites. RESULTS: Participants identified six interventions (training, incentives, participation, evidence, persuasion, and modeling) and two policies (environmental planning and mandates) as effective strategies used by implementation leaders to promote stakeholder progression through stages of change. Key approaches involved presentation of evidence demonstrating PEWS effectiveness, persuasion and incentives addressing specific stakeholder interests, enthusiastic individuals serving as models for others, and policies enforced by hospital directors facilitating habitual PEWS use. Effective engagement targeted hospital directors during early implementation phases to provide programmatic legitimacy for clinical staff. CONCLUSION: This study identifies strategies to promote adoption and maintained use of PEWS, highlighting the importance of tailoring implementation strategies to the motivations of each stakeholder type. These findings can guide efforts to implement PEWS and other evidence-based practices that improve childhood cancer outcomes in resource-limited hospitals.

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Home cooking is an emerging strategy to improve nutrition; however, the literature lacks reports about patient expectations from culinary interventions. Personalized medicine utilizes knowledge about a person's genes; yet, behavioral factors, such as participant "readiness" to make a change, may also impact treatment preferences and outcomes. The purpose is to explore the expectations of participants in different stages of change from a home cooking intervention. Participants were recruited to a randomized controlled trial evaluating the impact of a home cooking intervention on weight. Stage of change assessed by a validated University of Rhode Island Change Assessment scale and expectations through an open-ended questionnaire. Sixteen (21%) participants were in the action stage of change, and 59 (79%) were in the contemplation stage. Participants from both groups shared similar expectations to achieve healthy eating and lifestyle goals and to adopt sustainable change. However, action group expectations also included expanding existing culinary knowledge and change of habits; the contemplation group expectations also included acquiring culinary knowledge, improving self-regulatory skills, and obtaining guidance and support. While action group participants were looking to expand existing knowledge and techniques, contemplation group participants were focusing on acquiring culinary knowledge and skills. This can potentially contribute to developing effective, personalized nutrition interventions.

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INTRODUCTION: Detecting the risk of stillbirth during pregnancy remains a challenge. Continuous-wave Doppler ultrasound (CWDU) can be used to screen for placental insufficiency, which is a major cause of stillbirths in low-risk pregnant women. This paper describes the adaptation and implementation of screening with CWDU and shares critical lessons for further rollout. Screening of 7088 low-risk pregnant women with Umbiflow™ (a CWDU device) was conducted in 19 antenatal care clinics at nine study sites in South Africa. Each site comprised a catchment area with a regional referral hospital and primary healthcare antenatal clinics. Women with suspected placental insufficiency as detected by CWDU were referred for follow-up at the hospital. A 35-43% reduction in stillbirths was recorded. METHODS: The authors followed an iterative reflection process using the field and meeting notes to arrive at an interpretation of the important lessons for future implementation of new devices in resource-constrained settings. RESULTS: Key features of the implementation of CWDU screening in pregnancy combined with high-risk follow-up are described according to a six-stage change framework: create awareness; commit to implement; prepare to implement; implement; integrate into routine practice; and sustain practice. Differences and similarities in implementation between the different study sites are explored. Important lessons include stakeholder involvement and communication and identifying what would be needed to integrate screening with CWDU into routine antenatal care. A flexible implementation model with four components is proposed for the further rollout of CWDU screening. CONCLUSIONS: This study demonstrated that the integration of CWDU screening into routine antenatal care, combined with standard treatment protocols at a higher-level referral hospital, can be achieved with the necessary resources and available maternal and neonatal facilities. Lessons from this study could contribute to future scale-up efforts and help to inform decisions on improving antenatal care and pregnancy outcomes in low- and middle-income countries.

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BACKGROUND: There is evidence that showing motivated people with a less-than-ideal BMI (>25 kg/m2) digital and personalized images of their future selves with reduced body weight will likely trigger them to achieve that new body weight. OBJECTIVE: The purpose of this study is to assess whether digital avatars can trigger weight management action and identify some of the measurable factors that distinguish those who may be triggered. METHODS: A prospective cohort study followed participants for 12 weeks through 5 recorded interviews. Participants were screened for suitability for the study using the Cosmetic Procedure Screening Questionnaire as a measure of body dysmorphia. At interview 1, participants were shown 10 images from a "Food-pics" database and invited to estimate their calorie value. The intervention, the FutureMe app, delivered at interview 2, provided each participant an opportunity to see and take away a soft copy of an avatar of themselves as they might appear in the future depending on their calorie consumption and exercise regimen. Participants completed the readiness for change (S-Weight) survey based on Prochaska Stages of Change Model and the processes of change (P-Weight) survey. Any changes in diet, exercise, or weight were self-reported. RESULTS: A total of 87 participants were recruited, and 42 participants completed the study (48% of recruited participants). Body dysmorphia was a rare but possible risk to participation. The majority (88.5%) of the participants were female and older than 40 years. The average BMI was 34.1 (SD 4.8). Most people wanted to reduce to a BMI of 30 kg/m2 or lose on average 10.5 kg within 13 weeks (-0.8 kg per week). Most participants stated that they would achieve these results by limiting their calorie intake to 1500 calories per day and taking the equivalent of 1 hour of bicycling per day. At interview 1, more participants were in the preparation stage of behavior change than in subsequent interviews. By interview 5, most of the participants were at the maintenance stage. Participants who overestimated the recommended number of calories were more likely to be in the contemplation stage (P=.03). CONCLUSIONS: Volunteers who participated in the study were mainly women older than 40 years and beyond the contemplation stage of change for weight management, and those who took weight management action were demonstrated to have a more accurate idea of the calorie content of different foods. Most participants set ambitious targets for weight loss, but few, if any, achieve these goals. However, most people who completed this study were actively taking action to manage their weight. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12619001481167; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=378055&isReview=true.

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Meat reduction is gaining attention among consumers, marketers, policymakers and scientists. Yet little is known about decision-making processes and behaviour change towards meat reduction. This paper explores the applicability of the decisional balance (DB) framework to the field of meat reduction. A novel DB scale to measure the perceived importance of beliefs about meat reduction at different stages of behaviour change was developed and validated in two studies with German meat eaters. In Study 1 (N = 309), the item inventory was tested using an exploratory factor analysis and then validated in Study 2 (N = 809). The results yielded two higher-order DB factors (pros and cons), which were subdivided into five lower-order factors (perceived benefits of a plant-based diet, downsides of factory farming, health barriers, legitimation barriers and feasibility barriers). The pros and cons were summarised in a DB index. All DB factors and the DB index were tested for internal consistency (Cronbach's alpha ≥.70) and aspects of validity. The typical DB pattern of the pros and cons of behaviour change was confirmed: the cons outweighed the pros for consumers who did not intend to reduce meat consumption, while the pros outweighed the cons for consumers who intended to reduce meat consumption. The new DB scale for meat reduction has proven to be a suitable measure to gain insights into consumers' decision making and could be used to develop targeted meat reduction interventions.

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The transtheoretical model has been used as a model of behavior change for tobacco users. However, it does not account for perceptions of past behavior that may provide additional guidance toward smoking cessation. No studies have examined associations between the transtheoretical model, content themes of smoking experiences, and counterfactual thoughts (i.e. "If only. . .then. . ."). Mturk participants (N = 178; 47.8% female) completed measures of smoking attitudes, behavior, and stage and processes of change use. Participants described a past negative smoking event and an event-related counterfactual thought-listing task. Participants in the precontemplation stage endorsed fewer processes of change. Also, participants in the action stage reported significantly more counterfactuals about cravings (e.g. If only I could have controlled my urge to smoke. . .) inferring that they may be identifying cravings or urges as relevant barriers toward smoking cessation. Identifying these self-relevant thoughts may provide additional ways to address and overcome barriers toward achieving long-term smoking cessation.

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OBJECTIVE: Help patients make necessary life changes to reach desired health outcomes. METHODS: By combining the transtheoretical stages of the change model with motivational interviewing, nurse practitioners can hone powerful skills to enable patients to make their desired life changes. RESULTS: Nurses and nurse practitioners can make a difference in patients' lives by connecting and partnering with them to create positive change for improved health outcomes. CONCLUSIONS: Nurse educators should provide opportunities for nurses at all levels to learn and incorporate these skills into their practice.