title: The transtheoretical model of change in adolescents: implications for injury prevention.
abstract: BACKGROUND
  Many injury prevention interventions require changes in human behavior to reduce self-risk or risk to others. Promising injury prevention interventions may be discarded if they lack power to create a significant difference in outcomes when judging their ability to "move a person from nonaction or negative action to positive action (safety)." The transtheoretical model of change (TMC) allows greater sensitivity in detecting along the change process where an intervention may be effective. The stages of change consist of precontemplation, contemplation, preparation, action, maintenance, and termination. Change is not viewed as an "all or none phenomenon."
  
  
  METHODS
  Use of the TMC was examined using a quasiexperimental, cross-over design involving high school agriculture students enrolled in 21 schools in Kentucky (n=9), Iowa (n=7), and Mississippi (n=5). A series of physical and narrative simulations (safety training exercises) were developed with a focus on preventing amputation, spinal cord injury, hypersensitivity pneumonitis, and noise-induced hearing loss. Contemplation and action, as part of the TMC, were measured using a 10-item, Likert-type, stages of change (SOC) instrument comprised of two subscales (reliability coefficients were.88 and.81, respectively). The final sample consisted of 790 students (373 treatment and 417 control).
  
  
  RESULTS
  There was a significant group effect for both contemplation, F(1,732)=197.4; p<.0001, and action, F(1,730)=106.1; p<.0001. A convenience sample of 29 of the participating students was selected for follow-up farm visits 1 year postparticipation. Of these students, 25 (86%) had made safety behavior changes in their farm work.
  
  
  CONCLUSIONS
  The use of the TMC model can provide researchers with greater precision in examining intervention effectiveness in promoting change.
authors.affiliation: College of Nursing, University of Kentucky, 553HSLC/CON, Lexington, KY 40536, USA.
authors.forename: Pamela
authors.initials: P
authors.lastname: Kidd
authors.forename: Deborah
authors.initials: D
authors.lastname: Reed
authors.forename: Lori
authors.initials: L
authors.lastname: Weaver
authors.forename: Susan
authors.initials: S
authors.lastname: Westneat
authors.forename: Mary Kay
authors.initials: MK
authors.lastname: Rayens
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior / Q000523:psychology*; D000383:Agriculture; D001521:Behavior Therapy; D018592:Cross-Over Studies; D006801:Humans; D007484:Iowa; D007629:Kentucky; D008922:Mississippi; D008960:Models, Psychological; D015203:Reproducibility of Results; D012309:Risk-Taking; D014947:Wounds and Injuries / Q000517:prevention & control* / Q000523:psychology