Psychological Reports, 2011, 109, 3, 896-906. © Psychological Reports 2011
PROMOTING EXERCISE BEHAVIOR AMONG CHINESE YOUTH WITH HEARING LOSS: A RANDOMIZED CONTROLled TRIAL BASED ON THE TRANSTHEORETICAL MODEL1 QI SI AND KEHONG YU
BRADLEY J. CARDINAL, HYO LEE, AND ZI YAN
Zhejiang University
Oregon State University
PAUL D. LOPRINZI
FUZHONG LI
HAIQUN LIU
Bellarmine University
Oregon Research Institute
Zhejiang Huaqiang Vocational Special College
Summary.—The transtheoretical model proposes that behavior change is experienced as a series of stages. Interventions tailored to these stages are most likely to be effective in progressing people through the model’s hypothesized behavior change continuum. In this study, a stage-tailored, 12-week, exercise behavior intervention based on the transtheoretical model was conducted among a sample of 150 Chinese youth with hearing loss. Participants were randomized into an intervention or control group with all the core transtheoretical model constructs assessed preand post-intervention. Participants in the intervention group showed greater advances in their stage of exercise behavior change, decisional balance, and processes of change use compared to those in the control group. The intervention, however, was insufficient for increasing participants’ self-efficacy for exercise behavior. The findings partially support the utility of the theory-based intervention for improving the exercise behavior of Chinese youth with hearing loss, while simultaneously helping to identify areas in need of improvement for future applications.
Regular exercise participation results in numerous benefits to the musculoskeletal, physiological, and neurological systems (Kruk, 2009). Some of these positive outcomes may also be associated with improved hearing function (Loprinzi, Lee, Cardinal, Loprinzi, Gilham, & Smit, 2011). In spite of these benefits, preliminary evidence suggests that Chinese youth with hearing loss demonstrate relatively low levels of exercise involvement (Si, Yu, Li, Lee, Maddalozzo, & Cardinal, 2011).2 To better understand the exercise behavior of this special population, the present study was undertaken. Of particular interest was the focus on the development, implementation, and evaluation of a theoretically based exercise intervention for youth with hearing loss. Toward this end, the intervention was built around the four core constructs of the transtheoretical model (Prochaska, Redding, & Evers, 2008), which has been broadly and fairly successfully applied to a variety of 1 Address correspondence to Qi Si, Ph.D., Department of Physical Education, College of Education, Zhejiang University, Hangzhou, Zhejiang, China 310028 or e-mail (
[email protected]). 2 More information about the authors’ surveys of this little-known population in China as well as a pilot test of the transtheoretical model scale, are found in the Appendix, pp. 905-906.
DOI 10.2466/06.11.13.15.PR0.109.6.896-906
ISSN 0033-2941
PROMOTING EXERCISE BEHAVIOR
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health behaviors and diverse groups of research populations (Spencer, Adams, Malone, Roy, & Yost, 2006), including Chinese youth with hearing loss (Si, et al., 2011).2 The first construct of the model is the stages of change, of which five temporal and motivational stages are most commonly studied within the exercise domain including precontemplation, contemplation, preparation, action, and maintenance. Second are the processes of change. These are the covert and overt activities people use to progress through the hypothesized stages. Five behavioral (i.e., doing) and five cognitive (i.e., thinking) processes are proposed. Third is decisional balance, which is a weighing of the advantages (i.e., “pro’s”) against disadvantages (i.e., “cons”) associated with changing. Fourth is self-efficacy, which refers to one’s situation-specific self-confidence in making changes. The transtheoretical model posits that interventions are most successful when they are matched to people’s stage of readiness for change, and the processes of change, decisional balance, and self-efficacy are differentially applicable for people in these different stages. Consistent with the propositions of this model, then, as well as prior research (Cardinal & Sachs, 1995; Kosma, Cardinal, & McCubbin, 2005; Kim, 2008; Kim & Cardinal, 2009), it was hypothesized that relative to the control group, the experimental group participants who received a stage-tailored intervention would improve their use of the processes of change, develop higher levels of self-efficacy, and perceive more pros and fewer cons associated with exercise involvement. Also, the experimental group participants would show greater improvement in their stages-of-change progression over the course of the intervention than would control group participants. Although this was an experimental study, it may better be described as a hypothesis-generating study. There is no previous study published in China whose results could be referenced.2 Second, while there are some potentially related articles published in other languages, including English, the socioeconomic and general social situations for Chinese people with hearing loss are in all likelihood substantially different than those of people in another country. Method Participants Students with hearing loss were recruited from a vocational college in Hangzhou, China. The students were being trained for careers in areas such as massage, computers, and drawing. Each curriculum was 2 or 3 years in duration, with the students staying in the same courses with the same people throughout their studies. At random, six physical education classes were chosen from a possible 24. From the sampled classes, four were randomly assigned into the experimental group and two into the control group. The unequal distribution was because a restricted
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randomization trial procedure was employed. Although this procedure may result in some selection bias, it was preferred due to the clustered nature of the students’ curricula and the desire to obtain a large enough sample of participants in the intervention group in particular. Participants (N = 150; M age = 18.72, SD = 1.57; 55.1% male) completed a baseline survey that tapped into their stage of change for exercise in accordance with the transtheoretical model; 14 students were removed due to their unclear responses on this measure. Of the remaining participants, those in the intervention group (n = 92) were somewhat younger than those in the control group (n = 44; M age = 18.3 yr., SD = 1.5, vs M age = 19.5 yr., SD = 1.2, respectively; t134 = 4.40, p .98). In contrast, the distribution for the experimental group participants was favorably improved following the intervention (χ2 = 3.98, p
