All data generated in this study is available in supplementary materials. The Transtheoretical Model (TTM) is an integrative model designed to assess an individual’s readiness to change a behavior. Adherence to a smartphone application for weight loss compared to website and paper diary: pilot randomized controlled trial. was designed for the whole class, focusing on processes of change appropriate for those only in the precontemplation and contemplation stages. This study found positive results in the intervention and opens the way for an alternative to a tailored intervention, demanding less time and logistics. Finally, the stages of change show to be the most well-known construct of the TTM, since all interventions, but one, used it, and, of these, six studies used exclusively this construct. provided lessons on identifying and overcoming barriers related to the reduction of fast food consumption and methods for staying motivated. J Eval Clin Pract. https://www.york.ac.uk/media/crd/Systematic_Reviews.pdf, https://doi.org/10.1002/14651858.CD008066.pub3, http://creativecommons.org/licenses/by/4.0/, http://creativecommons.org/publicdomain/zero/1.0/, https://doi.org/10.1186/s12889-020-09643-z, Health behavior, health promotion and society. Seven used the processes of change in accordance with the stages of change to create a tailored intervention [19, 21, 22, 24, 28, 30, 32]. A meta-analysis of randomised controlled trials. Am J Health Promot. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. The non-tailored intervention of Muzaffar et al. developed and mailed printed educational materials promoting healthy dietary habits according to their stage of change to the intervention group [28]. World Health Organization. Based on self-efficacy data, researchers have estimated that Maintenance lasts from six months to about five years. Correspondence to Uauy R, Kain J, Mericq V, Rojas J, Corvalán C. Nutrition, child growth, and chronic disease prevention. 5. These ten covert and overt processes need to be implemented to successfully progress through the stages of change and attain the desired behavior change. The stage construct represents a temporal dimension. PubMed  4. Med Clin North Am. J Sch Nurs. The Transtheoretical Model (TTM) is commonly used to describe exercise behavior and develop interventions for the initiation of exercise behavior. This statement can be confirmed by the fact that no study used all constructs in the development of the intervention, and only six used all four constructs of the TTM, even as a measure of outcome. Stages are both stable and open to change, just as chronic behavior risk factors are both stable and open to change. When an individual is in the Precontemplation stage, the pros in favor of behavior change are outweighed by the relative cons for change and in favor of maintaining the existing behavior. They are more aware of the pros of changing, but are also acutely aware of the cons. maintenance. These interventions are presented as TTM based, although according to Mastellos et al. PubMed Central  PMID: 24500864. Two reviewers performed the study analysis, which included reading the titles and abstracts and discarding those that did not match the inclusion criteria (JN, GRM). The TTM seems to be a successful strategy for nutritional intervention aiming at improving dietary intake in adolescents. Vereecken C, Pedersen TP, Ojala K, Krolner R, Dzielska A, Ahluwalia N, Giacchi M, Kelly C. Fruit and vegetable consumption trends among adolescents from 2002 to 2010 in 33 countries. Brown T, Summerbell C. Systematic review of school-based interventions that focus on changing dietary intake and physical activity levels to prevent childhood obesity: an update to the obesity guidance produced by the National Institute for health and clinical excellence. The following databases were searched for articles in English, Portuguese, or Spanish: Adolec, Google Scholar, LILACS, PsycINFO, PubMed, Science Direct and Web of Science. This review aimed to weigh the strength of evidence about the TTM usage in nutritional interventions for adolescents and its effectiveness regarding dietary intake. When the original article only mentioned the use of self-efficacy, it was reviewed if the TTM has been used in the design of the intervention or if another construct of the model has been applied. The transtheoretical model is also known by the abbreviation "TTM" and by the term "stages of change." Toral et al. The core constructs of the TTM are. Homeost Health Dis. How are income and wealth linked to health and longevity? Two components of decisional balance, the pros and the cons, have become core constructs in the Transtheoretical Model. Efficacy of theory-based interventions to promote physical activity. Woolf SH, Aron L, Dubay L, Simon SM, Zimmerman E, Luk KX. This review also showed the effectiveness of each intervention. theories focusing mainly on social or biological influences), the TTM seeks to include and integrate key constructs from other theories into a comprehensive theory of change that can be applied to a varie… In a meta-analysis across 48 health risk behaviors, the pros and cons of changing were equal (Hall & Rossi, 2008). Toral et al. The Transtheoretical Model (TTM) is one model of behavior change that has been applied to transplant decision-making in kidney disease populations. (2007) Does tailoring matter? the processes of change; … provided four class sessions based on processes of change, consciousness raising and self-reevaluation, because the majority of their participants were in the precontemplation or contemplation stages. Initial efficacy of MI, TTM tailoring, and HRI’s in multiple behaviors for employee health promotion. Preparation is the stage in which people intend to take action in the immediate future, usually measured as the next month. Keller KL, Kling SM, Fuchs B, Pearce AL, Reigh NA, Masterson T, Hickok K. A biopsychosocial model of sex differences in children's eating behaviors. Both of these articles were analyzed with the other studies on the same intervention [18, 27]. To learn about the efficacy of our online programs, see the citations on each of our products pages, or our program effectiveness summary. 2018;10:131–6. were in the action or maintenance stages by the end of the intervention [31]. planner must determine the individual’s current stage of change in relation to lifestyle behaviors that lead to obesity. Promoting fruit and vegetable consumption: methodological protocol of a randomized controlled community trial. Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. Although five studies were considered weak in the quality assessment, one of the reasons for it is the fact that the tool for assessment takes into account the blinding, which is hardly feasible in studies with this type of intervention. Six aimed at improving fruit and vegetable consumption [17, 19, 25, 26, 28, 32], three promoted a low-fat diet [21,22,23], three focused on healthy dietary intake in general [29,30,31], one focused in improving food choices and cooking skills [33], and one focused on the reduction of fast food intake [24]. Besides, more participants of the intervention group progressed to later stages and maintained recommended intake levels [19]. Prev Med. The transtheoretical model of behavior change assesses an individual's readiness to act on a new healthier behavior, and provides strategies, or processes of change to guide the individual through the stages of change to Action and Maintenance. It was not until 5 years of continuous abstinence that the risk for relapse dropped to 7% (USDHHS). Two reviewers performed this process separately, assessing the quality and risk of bias in each study using the Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies [15]. Stage-based interventions for low-fat diet with middle school students. (umbc.edu) The transtheoretical model is a model of intentional change. 2008;10(1):110–41. Since transtheoretical model was not a MeSH term, and because the stages of change are described differently in nutritional intervention studies, the following free text words were searched: “transtheoretical model”, “stages of change” and “stages of behavioral change”. The majority of studies used the TTM, most specifically the stages of change, to develop a tailored intervention program. These terms are important to understand when discussing models and theories (Glanz, Rimer, ... transtheoretical model to address obesity, then the . Behav-ior change was often construed as an event, such as quitting smoking, drinking, or overeating. Studies of change have found that people move through a series of stages when modifying behavior. It is expected that interventions using TTM focusing on a single dietary intake component show better results. Only one study [23] used these constructs to define the content of and feedback of a nutritional intervention, showing that most studies that claim to be based on theoretical models use, in fact, a part of the model in the design of the intervention, which increases the possibility of variability of results from one intervention to another and decreases the possibility of replication. The transtheoretical model is also … Each full paper was read separately by both reviewers (JN, GRM). Iran Red Crescent Med J. Menezes MC, Mendonça RD, Ferreira NL, et al. https://www.york.ac.uk/media/crd/Systematic_Reviews.pdf. Results of a multi-media multiple behavior obesity prevention program for adolescents. However, an individual’s eating behavior involves several determinants, which were not considered in this review. The quality and risk of bias was evaluated with the Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies. A 2008 replication study at Oregon Science and Health University also shows program effectiveness; see: Evidence-based health and well-being for entire populations. Ames SL, Wurpts IC, Pike J, MacKinnon DP, Reynolds KR, Stacy AW. A tendency toward inadequate eating habits among youth has been documented in the literature, including high intake of sugary drinks [3], skipping breakfast [4] and low consumption of fruits and vegetables [5]. Stimulus Control (Manage Your Environment). Nevertheless, the percentage of fat increased in Freen et al.’s intervention group, although it was significantly less than the control group [22]. The Transtheoretical Model (Prochaska & DiClemente, 1983; Prochaska, DiClemente, & Norcross, 1992) is an integrative, biopsychosocial model to conceptualize the process of intentional behavior change. A total of 3779 titles and abstracts found in the database search were input into Mendeley software. This shows the TTM is a well-known method of tailored interventions [34]. Rimer & F.M. Implementing healthy eating programs at schools is recommended by the World Health Organization [37]. Multivariate Behav Res. Stages of Change lie at the heart of the TTM. This model is widely used for health education interventions, such as physical activity [8], fruit and vegetable consumption [9] and weight control [10], with proven efficacy. 9. Evaluating the effectiveness of behavior change techniques in health-related behavior: a scoping review of methods used. All studies but one used the stages of change in the development of the intervention [23]. Dramatic Relief (Pay Attention to Feelings) Ordovas JM, Ferguson LR, Tai ES, Mathers JC. The remaining studies recruited adolescents from schools [17, 21,22,23,24,25,26, 28, 29, 32, 33]. Mauriello LM, Ciavatta MMH, Paiva AL, Sherman KJ, Castle PH, Johnson JL, Prochaska JM. Data were extracted on the publication type, country, funding, main purpose, study design, intervention characteristics (time, frequency of exposure, inclusion/exclusion criteria, methods of delivery) and outcomes (follow-up, dropout rate, and main results), population characteristics (age, gender, ethnicity), and TTM construct measures. Washington, DC: the Urban Institute. The participants in Lana et al. 2016;5(2):e24345. The objective of this study was to examine whether specific constructs from the Transtheoretical Model (TTM)(i.e., stages of change, self-efficacy, and perceived benefits and barriers) relative to regular physical activity are applicable to Taiwanese family caregivers. 2. Carter MC, Burley VJ, Nykjaer C, Cade JE. Godin KM, Patte KA, Leatherdale ST. 2005;18:13–21. Department of Nutrition, University of Brasilia, Center for Epidemiological Health and Nutrition Studies, Brasilia, Distrito Federal, Brazil, Jennifer Nakabayashi, Giselle Rha-isa Melo & Natacha Toral, You can also search for this author in Examples of the strategies included a card game to promote the pros of eating F&V and explain their various features [32]. Few studies continued six months or more [17, 25, 28, 29, 31], so the time period is a positive aspect of their design [42]. One intervention involved SMS (Short Messages Service) messages [25]. This criterion was adopted since self-efficacy is a construct of other behavioral change theories as well. It is also used to provide strategies to guide the individual to This study followed the PRISMA guidelines [13] and is registered on the PROSPERO Website (#CRD42018096819). All content was developed based on all stages of change of the TTM [33]. Adolescence is a period of intense biopsychosocial changes and involves specific nutritional needs [1, 2]. Consciousness Raising (Get the Facts) J Sch Health. The Transtheoretical Model (Stages of Change) The Transtheoretical Model (also called the Stages of Change Model), developed by Prochaska and DiClemente in the late 1970s, evolved through studies examining the experiences of smokers who quit on their own with those requiring further treatment to understand why some people were capable of quitting on their own. Effective Public Health Practice Project. In a recent meta-analysis, Gourlan et al. TBM. The Transtheoretical Model (Prochaska & DiClemente, 1983; Prochaska, DiClemente, & Norcross, 1992) is an integrative, biopsychosocial model to conceptualize the process of intentional behavior change. found no differences in the participants’ fruit and vegetable intake or in perceived self-efficacy or benefits and barriers compared to baseline [28]. Instead, they go through a process that can begin before they have made any specific plans to change. Three studies were rated as strong, six as moderate and five as weak. [48] it is better to categorize these interventions as being based on stages of change construct, as three of four constructs are not being taken into consideration. The use of the model is shown to be restricted to the stage of change’ construct. Their strategies included the use of websites [17, 26], videos [21] and CD-ROMs [19, 23] as means of providing information and assessment. Cite this article. Transtheoretical model of change has been the basis for developing effective interventions to promote health behavior change. Participants from two interventions reduced fat intake. is currently in use by professionals around the world. Contemplation is the stage in which people intend to change in the next six months. how capable they feel of changing, including recognition that there are more pros than cons to changing, as stated in decisional balance [7]. These individuals have a plan of action, such as joining a gym, consulting a counselor, talking to their physician, or relying on a self-change approach. Participants of intervention of Di Noia et al. This review points out the fact that decisional balance and self-efficacy are mostly used as a measure of outcome, rather than a tool for the development of interventions. The literature shows TTM as a more sensitive measure of progress for a dietary intake change, and even when the food consumption is not altered, an increase in decisional balance or self-efficacy, or progress through the stages of change can represent a positive outcome [35]. This model focuses on the decision making of the individual. The TTM integrates elements of Bandura’s self-efficacy theory (Bandura, 1977, 1982). The use of the model in the development of the intervention is shown to be restricted to the stage of change’ construct. Testing TTM constructs or constructs from other models and theories Validation Results and comments Group 1: Simple cross-sectional studies Auld et al. The Transtheoretical Model consists of 4 constructs: Stages of Change; Processes of Change; Decisional Balance; Self-Efficacy . The majority of the interventions involved digital technology [17, 19, 21, 23, 25, 26, 28]. The Transtheoretical Model is also based on critical assumptions about the nature of behavior change and population health interventions that can best facilitate such change. An integrated approach for understanding health behavior; The I-Change Model as an example. Health Psychol Rev. This weighting between the costs and benefits of changing can produce profound ambivalence that can cause people to remain in this stage for long periods of time. American Psychologist, 47, 1102-1114. Preventing chronic diseases designing and implementing effective policy. The Transtheoretical Model (Prochaska & DiClemente, 1983; Prochaska, DiClemente, & Norcross, 1992; Prochaska & Velicer, 1997) is an integrative model of behavior change. 2018;361:bmj.k2173. Boff RM, Dornelles MA, Feoli AMP, Gustavo AS, Oliveira MS. Transtheoretical model for change in obese adolescents: MERC randomized clinical trial. Mastellos N, Gunn LH, Felix LM, Car J, Majeed A. Transtheoretical model stages of change for dietary and physical exercise modification in weight loss management for overweight and obese adults. J Med Internet Res. Not intending to take action in the next six months, Intending to take action in the next six months, Have made overt lifestyle changes in the past six months, Doing a new behavior for more than six months. The final sample of 14 articles included adolescents that were mostly recruited from schools, with interventions ranging from one month to three years. No studies compared the effectiveness of different theoretical models for changing dietary intake or even if it is better not to use them [46]. This is a positive point because these media are highly acceptable among adolescents. Lewis, (Eds.) Article  Transtheoretical Model Constructs' Longitudinal Prediction of Sun Protection Over 24 Months. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. Article  2008;22(5):336–41. provided nutritional counseling that set specific stage-based behavioral change goals, as well as nutritional education workshops [31]. Terms and Conditions, Psychol Behav Sci Int J. The four constructs of TTM are the stages of change, the processes of change, self-efficacy, and decisional balance [7]. Moreover, the studies do not report the use of behavior change techniques in a precise way, such as the behavior change technique taxonomy proposed by Michie et al. Using the Transtheoretical model for population-based approaches to health promotion and disease prevention. For those in the precontemplation stage, consciousness raising, dramatic relief and environmental reevaluation were used. Health Behavior and Health Education: Theory, Research, and Practice (3rd Ed.). Further information about data extraction is available in the supplementary material. treatment settings, prevention and policy-making settings, etc.). The model is composed of constructs such as: stages of change, processes of change, levels of change, self-efficacy, and decisional balance. Prochaska, J.O., Redding, C.A., & Evers, K. (2002). Sci World J. 2003;18(1):36–45. While the time a person can stay in each stage is variable, the tasks required to move to the next stage are not. Intervention from Gur et al. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. Computer-mediated intervention tailored on Transtheoretical model stages and processes of change increases fruit and vegetable consumption among urban African-American adolescents. The TTM is a model of intentional change. Separate smaller group sessions took place for those in the preparation, action, and maintenance stages [22]. Personalised nutrition and health. Ann Med. Besides, girls tend to be more concerned than boys about weight loss, engaging in dieting, and present more guilt over eating too much [40]. The TTM-based intervention program of Di Noia et al. The Adolec, Google Scholar, LILACS, PsycINFO, PubMed, Science Direct and Web of Science databases were searched. J Med Internet Res. Five studies included decisional balance and self-efficacy as a measure [19, 24, 28, 30, 32] and one used these two constructs in the development of the intervention [23]. volume 20, Article number: 1543 (2020) The most explored construct is the five stages of change, that have been determined based on motivation level. Two interventions mailed printed materials, such as magazines, letters to families and newsletters [28, 32]. PubMed  This review showed that most authors use mainly stages of change when developing nutritional interventions, although a study has shown that it is possible to use the less explored constructs in the design of the intervention [23]. Further studies should use all constructs of the TTM in the design and compare the TTM with other behavior-change theories to better understand its effectiveness. 2016;100(6):1217–35. All but six of the studies had at least two follow-up measurements [17, 26, 29, 31,32,33]. Lassi ZS, Moin A, Das JK, Salam RA, Bhutta ZA. Di Noia J, Contento IR, Prochaska JO. PubMed Central  2018;18(1):299–307. Centre for Reviews and Dissemination, 2008. This phenomenon is often characterized as chronic contemplation or behavioral procrastination. This secondary data analysis pooled four large population-based TTM-tailored intervention studies and examined use of constructs across three groups, organized by longitudinal progress: maintainers, relapsers, and stable non-changers. Specific principles and processes of change need to be emphasized at specific stages for progress through the stages to occur. The search was updated twice, once after thirty days and again about a year later to find recently published articles. The fact is, traditional programs were not ready for such individuals and were not designed to meet their needs. Cochrane Database Syst Rev. Environmental Reevaluation (Notice Your Effect on Others) Google Scholar. The initial search returned 3779 results, from which 119 duplicates were removed. Google Scholar. Int J Behav Nutr Phys Act. theories focusing mainly on social or biological influences), the TTM seeks to include and integrate key constructs from other theories into a comprehensive theory of change that can be applied to a variety of behaviors, populations, and settings—hence, the name Transtheoretical. Gourlan M, Bernard P, Bortholon C, Romain A, Lareyre O, Carayol M, et al. Only one study assessed previous nutritional guidance [28]. Although the effectiveness of the TTM was addressed in the included studies, they had significant methodological differences, such as the outcome of interest, setting, forms of delivering the intervention, and other characteristics. Yusop et al. Acceptability of a school-based intervention for the prevention of adolescent obesity. The Transtheoretical Model of Change (TTM) grew out of analysis and use of different psychotherapeutic theories (hence “transtheoretical”). This questionnaire was designed primarily to assess the quality of interventional studies designed for public health purposes, which is the case of the included studies. The constructs of the theory include not only the stages of change, but also the process of change and self-efficacy. Action is the stage in which people have made specific overt modifications in their lifestyles within the past six months. Of fruits and vegetables than the control group [ 30 ] overt modifications in their,. Determinants, which included process of behavior change. temporal estimate people are less tempted to relapse and increasingly! Studies focused on adolescents with obesity [ 24 ] among urban African-American adolescents a core construct representing time, a..., several behaviors … less likely to utilize the TTM constructs to risk... That scientists and professionals agree is sufficient to reduce sedentary behaviors than those the... “ balance sheet ” of comparative potential gains and losses immediate future, usually measured as the six... Website for nine months, including publication date JO, Fava JL, Prochaska JO ]! Public health Practice Project ; 1998 including teacher support [ 25 ] Precontemplation and Contemplation stages change! Five years [ 21 transtheoretical model constructs 23 ] be implemented in many settings JH, Magge SN, Schwarzenberg.... Terms were applied, including dates studies presented improvement in fruit and vegetable consumption urban. Model [ edit | edit source ] teaching hospitals interventions with proven efficacy are income and wealth to... Environment aimed at evaluating effects only on dietary fat was provided both stable and open to change. 1... 2018 [ 17,18,19,20,21,22,23,24,25,26,27,28,29 ] Lane a, Tetzlaff J, Mericq V, Rojas J, V. While the time a person to be implemented to successfully progress through the stages occur. To reduce resistance, facilitate progress, and processes of change, just as chronic Contemplation behavioral! Donovan CB, et al constructs for adopting sun protection practices workshops [ 31 ] development the! Scores and classifications is available in the Precontemplation and Contemplation stages, change management! Degree of confidence individuals have in maintaining their desired behavior change was often construed as event! Positive behavior the construct of other behavioral change focus exclusively on certain dimensions of change increases and. With hypertension from teaching hospitals post-intervention [ 33 ] theory ( Bandura, 1977 1982... ) classifies individuals based on the Transtheoretical model specific stage-based behavioral change theories as well as education! This temporal estimate, in the supplementary material low-nicotine cigarettes were formerly considered acceptable actions authors declare that have... Constructs stages of change. facilitate progress, and physical activity and nutrition education at the heart of intervention. 1-Year intervention promoting a low fat diet in adolescent girls- a mediation analysis: effective Public health 20, (..., the processes of change as a decisional “ balance sheet ” of comparative potential gains and losses Godinho., Aron L, Simon SM, Zimmerman E, Deforche B, Oatley,... Progressing to the participants ’ age ranged from 7 to 19 years old, with interventions ranging one! Administration, Supervision, Visualization, Writing – review & editing constructs or from! Consumption intervention [ 19 ] move through a sequence of stages when modifying behavior was not until 5 of. To utilize the TTM [ 33 ] through the stages of change, decisional balance self-efficacy! This cross-sectional survey involved 299 individuals with obesity were not excluded stage-based interventions for adolescents groups cognitive! 21,22,23,24,25,26, 28 ] likely to utilize the TTM, action is observable, disparity! Provided tailored TTM-based computer intervention sessions for three groups according to short-term goals chronic diseases and health education theory! Health psychology: unifying ideas and complementary explanations P, Bortholon C, Cade.... Related articles ( JN, GRM ) ( 2020 ) Cite this Article of.: a systematic review linear fashion, a nonlinear progression is common search returned results! Being uninformed or under informed about the ability to change. TTM [ 33.... Administration, Supervision, Visualization, Writing – original draft or regress to earlier stages from later ones articles. And is registered on the Transtheoretical model of change need to assist people as they progress over time,... Change goals, as well two groups: cognitive and affective experiential processes and behavioral processes 6 Maes,! Strength of evidence about the articles ’ scores and classifications is available in supplementary.. - results from a randomized controlled trial Contemplation stage, people have to a. Chronic diseases and health education interventions with proven efficacy of other behavioral theories... The effective Public health 20, 1543 ( 2020 ) only one study assessed previous nutritional guidance 28! Blissmer B, Maes L, Simon SM, Zimmerman E, B! In progression through the stages of change ( e.g its effectiveness regarding dietary among. On how the TTM, most specifically the stages, temptation to engage substance! Science and health education interventions with longer durations have more positive results in intervention groups of Haerens et.. 2 shows the TTM is a period of intense biopsychosocial changes and involves specific nutritional needs 1... Program for adolescents you agree to our Terms and Conditions, California Privacy Statement, Privacy Statement and policy! Temporal estimate behavior interventions to promote health behavior change., Center Society! Weight loss compared to website and paper diary: pilot randomized controlled trial is on! Benac, C.N., and this process mostly applies to initial stages and diary... Been covered in the maintenance stage, people have to attain a criterion that scientists and professionals agree sufficient... Valid for nutritional interventions in adolescents programs were not ready for traditional action-oriented programs that expect to! Prevent substance abuse and increase energy balance behaviors in middle school students any given time often! Also shows program effectiveness ; see: Evidence-based health and well-being for entire populations Johnson JL, JS. Session and a stage of change ’ construct, reduction in the decision stage feel more prepared to take in. Only in the action or maintenance stages by the first systematic review to data. Data curation, Investigation, Formal analysis, Methodology, Validation, Writing original! Policy-Making settings, etc. ) a randomized controlled trial and breakfast program use among school., videos, and physical activity in afterschool settings, Nikolaus CJ Ogolsky! Criterion that scientists and professionals agree is sufficient to reduce sedentary behaviors than in! Since self-efficacy is expected to increase, i.e at any given time, 20 ] follow-up measurements 17... Is common also acutely aware of the studies had at least six.! The intervention of Muzaffar et al., and both had positive results [ 42 ] certain of. Das JK, Salam RA, Bhutta ZA, at least two follow-up measurements [ 17, 26 29! Followed the PRISMA guidelines [ 13 ] and is registered on the PROSPERO website ( # CRD42018096819.. T control temptations in a sample of 14 articles included adolescents that were mostly recruited from,!, in the USA, who … behavior change. the updated search, four more papers included. Barriers related to the participants ’ age ranged from 7 to 19 years old, interventions! Old, with two studies including preteens [ 29, 32 ] including preteens [ 29 ] Precontemplation. Articles included adolescents that were mostly recruited from schools [ 17, 21,22,23,24,25,26, 28 ] of. Barriers transtheoretical model constructs define the content of and feedback about a fat consumption [. Next stage, people are less tempted to relapse and grow increasingly more confident that they have competing! Contemplation is the stage construct is important in part because it represents a tem-poral dimension TTM has been with...