The applicability of the stage of change construct of the transtheoretical model of behavior change to the problem of Type II diabetic adherence

The purpose of this study was to determine the applicability of the Stages of Change Construct of the Transtheoretical Model of Behavior Change to the problem of adherence of Type II diabetic patients to taking prescribed diabetes medications, monitoring blood glucose, diet, and exercise. Demographic questionnaires and Stage of Change Algorithms for each of the 4 treatment behaviors were administered to the 101 male Veteran outpatients who participated in the study. Composite Stage of Change scores were neither found to be significantly correlated with hemoglobin A_1c (HbA_1c) levels (r=-0.031; p<.759), nor to be predictive of attendance of a diabetes-related educational class (squared semi-partial r=.165 , p<.100)There was no significant difference in HbA1c levels depending upon diabetes class attendance for those with high Composite Stage of Change scores (n=79; t = -0.992, df=77, p<.324) There was no significant relationship found between the number of behaviors in Action or Maintenance and HbA1c levels (x²=2.263; df=4). Of the 4 diabetic treatment behaviors, only the Medication Stage of Change was significantly predictive of HbA1c levels (squared semi- partial r=.039, p<.047) The present study found no evidence of a significant relationship between the Stage of Change construct of the Transtheoretical Model of Behavior Change. However, the acceptance of a lack of relationship would be premature since this study identified many difficulties with the current design that might be resolved in future research, including a high probability of social desirability bias and/or self-report error, and problems with the current format of the Stage of Change Algorithms. Recommendations are made for further research to attempt to resolve these unexpected findings.