Evaluación de los procesos de cambio propuestos por el modelo transteórico, en estudiantes de secundaria y universitarios consumidores de alcohol.

Abstract

A questionnaire was constructed for the measurement of the change processes that are proposed by the Transtheoretical Model (TTM), applied to understanding of the consumption of alcohol in high school and university students from Bogota (Colombia). The instrument supplements others that had intended before as a part of the Questionnaire of Stages for the Modification of the Abuse (CEMA). The questionnaire was applied to 2473 subjects, most of which were high school students that participated in a program of primary prevention of the excessive consumption of alcohol. The results showed that the questionnaire has a good construction validity and a high reliability, although recommendations are suggested for its improvement toward future applications. A progression was observed in the use of cognitive-affective (experiencial) processes as the participants advance from early stages (non-contemplation, precontemplation, and contemplation), and of action processes as participants advance to preparation and action stages; this observation is coherent with the previous literature about the processes of change proposed by the TTM and its integration with the motivational stages of change in substance consumers. It is suggested that the processes of change represent copping strategies that are adjusted to the handling of psychosocial variables proposed by the cognitive-social models about the healthy behavior change, which play a differential role through the stages of change proposed by the TTM. This fact has implications of importance in the design and execution of the programs of primary and secondary prevention of the excessive consumption of alcohol.

Keywords:

Transtheoretical model Change processes Change stages Alcohol abuse High school University students

References

Armitage, Ch., Sheeran, P., Conner, M., & Arden, M.A. (2004). Stages of change or changes of stage? Predicting transitions in transtheoretical model stages in relation to healthy food choice. Journal of Consulting and Clinica Psychology, 72(3), 491-499.

Ayala, H.E., Cárdenas, G., Echeverría, L. & Gutiérrez, M. (1998). Manual de autoayuda para personas con problemas en su forma de beber. México: Facultad de Psicología, UNAM.

Cabrera, G.A. (2001). Etapas de cambio en consumidores de cigarrillo en Zarzal, Colombia, 1999. Revista de la Facultad Nacional de Salud Pública, 19(2), 33-42.

Conner, M. & Norman, P. (Eds.) (1995). Predicting Health Behaviour. Buckingham: Open University Press.

Courneya, K.S. & Bobick, T.M. (2000). Integrating the theory of planned behavior with the processes and stages of change in the exercise domain. Psychology of Sport and Exercise, 1, 41-56.

CPRC. Alcohol: Processes of Change. Página web. Recuperada de: http://www.uri.edu/research/cprc/Measures/Alcohol06.htm Visitada en Marzo de 2005.

Cunningham, J.A., Sobell, L.C., Gavin, D.R., Sobell, M.B., & Breslin, F.C. (1997). Assessing motivation for change: Preliminary development and evaluation of a scale measuring the costs and benefits of changing alcohol or drug use. Psychology of Addictive Behaviors, 11(2), 107-114.

DeVries, H., Mudde, A.N., Dijkstra, A., & Willemsen, M.C. (1998). Differential beliefs, perceived social influences, and selfefficacy expectations among smokers in various motivational phases. Preventive Medicine: An International Devoted to Practice and Theory, 27(5, Pt. 1), 681-689.

DiClemente, C.C., Prochaska, J.O., Fairhurst, S.K., Velicer, W.F., Velasquez, M.M., & Rossi, J.S. (1991). The process of smoking cessation: An analysis of precontemplation, contemplation, and preparation stages of change. Journal of Consulting and Clinical Psychology, 59(2), 295-304.

Flórez-Alarcón, L. (2000 a). Análisis del consumo de alcohol, con fundamento en el Modelo Transteórico, en estudiantes universitarios. Acta Colombiana de Psicología, 4, 79-98.

Flórez-Alarcón, L. (2000 b). El proceso psicológico de la promoción y de la prevención. Avances en Psicología Clínica Latinoamericana, 18, 13-22.

Flórez-Alarcón, L. (2001a). Baremación preliminar de un cuestionario para la modificación del consumo de alcohol, elaborado con fundamento en el modelo transteórico. Acta Colombiana de Psicología, 5, 99-122.

Flórez-Alarcón, L. (2001b). Clasificacion de estudiantes universitarios bogotanos consumidores de alcohol en etapas conforme al modelo transteórico. Adicciones, 13(2), 199-209.

Flórez-Alarcón, L. (2001c). Diseño e instrumentación de un programa basado en el modelo transteórico para la modificación del consumo abusivo de alcohol en estudiantes de secundaria. Psicología y Salud, 11(1), 99-111.

Flórez-Alarcón, L. (2003). Cuestionario de etapas integrado a un programa (CEMAPEMA) para la modificación del consumo abusivo de alcohol: evaluación de etapas y de variables intermediarias. Acta Colombiana de Psicología, 9, 83-104.

Flórez-Alarcón, L. & Sarmiento, D.M. (2004). Programa «TIPICA» para la promoción de factores psicosociales de protección, mediante la educación para la salud en la es cuela. Revista Colombiana de Psicología, 13, 113-128.

Gantiva, C., Gómez Villamizar, C. & FlórezAlarcón, L. (2003). Evaluación del impacto de un programa de autoayuda dirigida: Una alternativa para el tratamiento de personas que abusan del consumo de alcohol. Revista Colombiana de Psicología, 12, 38-48.

Freeman, A. & Dolan, M.J. (2001). Revisiting Prochaska and DiClemente’s stages of change theory: An expansion and specification to aid in treatment planning and outcome evaluation. Cognitive and Behavioral Practice, 8, 224-234.

Hannover, W., Thyrian, J.R., Hapke, U., Rumpf, H.J., Meyer, Ch., & John, U. (2002). The readiness to change questionnaire in subjects with hazardous alcohol consumption, alcohol misuse and dependence in a general population survey. Alcohol and Alcoholism, 37(4), 362-369.

Herzog, Th.A., Abrams, D.B., Emmons, K.M., Linnan, L.A., & Shadel, W.G. (1999). Do processes of change predict smoking stage movements? A prospective analysis of the Transtheoretical Model. Health Psychology, 18(4), 369-375.

Humphreys, A.S., Thompson, N.J., & Miner, K.R. (1998). Assessment of breastfeeding intention using the Transtheoretical Model and the Theory of Reasoned Action. Health Education Research, 13(3), 331-341.

Levesque, L., Gauvin, L. & Desharnais, R. (2003). Maintaining exercise involvement: The role of learned resorcefulness in processes of change use. Psychology of Sport and Exercise, 4, 237-253.

Stark, M., Tesselaar, H.M., O´Connell, A.A., Person, B., Galavotti, Ch., Cohen, A. & Walls, C. (1998). Psychosocial factors associated with the stages of change for condom use among women at risk for HIV and STDs: Implications for intervention development. Journal of Consulting and Clinical Psychology, 66(6), 967-978.

Migneault, J.P., Pallonen, U.E., & Velicer, W.F. (1997). Decisional balance and stage of change for adolescent drinking. Addictive Behaviors, 22(3), 339-351.

Migneault, J.P., Velicer W.F., Prochaska, J.O., & Stevenson, J.F. (1999). Decisional balance for inmoderated drinking in college students. Substance Use & Misuse, 34(10), 1325-1346.

Miller, W.R. & Tonigan, J.S. (1996). Assessing drinkers´ motivation for change: The stages of change readiness and treatment eagerness scale (SOCRATES). Psychology of Addictive Behaviors, 10(2), 81-89.

Oswald, A.L. (1999). Utility of the CAGE-Test as a Screening Tool for Alcoholism in Public Health. Tesis Doctoral. Universidad de Génova. Recuperada de: http://www.unige.ch/cyberdocuments/theses2000/OswaldA/these_front.html Visitada en Marzo de 2005.

Perz, C.A., DiClemente, C.C., & Carbonari, J.P. (1996). Doing the right thing at the right time? The interaction of stages and processes of change in successful smoking cessation. Health Psychology, 15(6), 452-468.

Prochaska, J.O., DiClemente, C.C. & Norcross, J.C. (1992). In search of how people change: Applications to addictive behaviors. American Psychologist, 47(9), 1102-1114.

Prochaska, J.O., Norcross, J.C. & DiClemente, C.C. (1994). Changing for Good. New York: Avon Books.

Prochaska, J.O & Prochaska, J.M. (1993). Modelo transteórico de cambio para conductas adictivas. En: M.C. Brugué & M. Gossop (Eds.) Tratamientos Psicológicos en Drogodependencias: Recaida y Prevención de Recaidas. Barcelona: Ediciones Neurociencias, pgs. 85-136.

Prochaska, J.O., Velicer, W.F., Rossi, J.S., Goldstein, M.G., Marcus, B.H., Rakowski, W., Fiore, Ch., Harlow, L.L., Redding, C.A., Rosenbloom, D. & Rossi, S.R. (1994). Stages of change and decisional balance for 12 problem behaviors. Health Psychology, 13(1), 39-46.

Riso, W. (2004). Pensar Bien, Sentirse Bien. Bogotá: Editorial Norma.

Rumbos (2002). Juventud y Consumo de Sustancias Psicoactivas: Resultados de la Encuesta Nacional de 2001 en Jóvenes Escolarizados de 10 a 24 Años. Bogotá: Presidencia de la República de Colombia.

Rosen, C.S. (2000). Is the sequencing of change processes by stage consistent across health problems? A meta-analysis. Health Psychology, 19(6), 593-604.

Schwarzer, R. (2001). Social-cognitive factors in changing health-related behavior. Current Directions in Psychological Science, 10, 47-51.

Segan, C.A., Borland, R., & Greenwood, K.M. (2004). What is the right thing at the right time? Interactions between stages and processes of change among smokers who make a quiet attempt. Health Psychology, 23(1), 86-93.

Stark, M.J., Tesselaar, H.M., O´Connell, A.A., Person, B., Galavotti, Ch., Cohen, A., & Walls, C. (1998). Psychosocial factors associated with the stages of change for condom use among women at risk for HIV and STDs: Implications for intervention development. Journal of Consulting andClinical Psychology, 66(6), 967-978.

Weinstein, N.D. (1987). Unrealistic optimism about susceptibility to health problems: Conclusions from a community wide sample. Journal of Behavioral Medicine, 10, 481-500.

Weinstein, N.D. (1988). The precaution adoption process. Health Psychology, 7(4): 355-386.

Weinstein, N.D., & Sandman, P.M. (2002). The precaution adoption process model and its application. En: K. Glanz, B.K. Rimer, & F.M. Lewis (Eds.), Health Behavior and Health Education: Theory, Research and Practice. San Francisco: Jossey Bass, 121-143.