Is the sequencing of change processes by stage consistent across health problems? A meta-analysis

Clinicians and researchers applying the transtheoretical model (J.O. Procha ska, C.C. DiClemente, & J.C. Norcross, 1992) to health promotion often assu me that relationships of processes and stages observed in smoking cessation can be generalized to other problems. A reanalysis of 47 cross-sectional s tudies determined that use of change processes varies by stage, but the seq uencing of processes is not consistent across health problems. In smoking c essation, cognitive processes were used in earlier stages than were behavio ral processes. In exercise adoption and diet change, use of behavioral and cognitive processes increased together. Results for substance abuse and psy chotherapy were less consistent Substituting new behaviors, making a commit ment, considering consequences, seeking information, controlling cues, and using rewards varied most by stage. Future longitudinal studies should asse ss these processes as potential mediators of lifestyle change.