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Purpose. In the United States, 36% of human papillomavirus (HPV)–related cancers occur among men. HPV vaccination can substantially reduce the risk of HPV infection; however, the vast majority of men are unvaccinated. This study developed and validated transtheoretical model–based measures for HPV vaccination in young adult men. Design. Cross-sectional measurement development. Setting. Online survey of young adult men. Subjects. Three hundred twenty-nine mostly college-attending men, ages 18 to 26. Measures. Stage of change, decisional balance (pros/cons), and self-efficacy. Analysis. The sample was randomly split into halves for exploratory principal components analysis (PCA), followed by confirmatory factor analyses (CFA) to test measurement models. Multivariate analyses examined relationships between scales. Results. For decisional balance, PCA revealed two uncorrelated five-item factors (pros α = .78; cons α = .83). For the self-efficacy scale, PCA revealed a single-factor solution (α = .83). CFA confirmed that the two-factor uncorrelated model for decisional balance and a single-factor model for self-efficacy. Follow-up analyses of variance supported the theoretically predicted relationships between stage of change, pros, and self-efficacy. Conclusion. This study resulted in reliable and valid measures of pros and self-efficacy for HPV vaccination that can be used in future clinical research.

Purpose In the United States (US), individuals vary widely in their readiness to get vaccinated for COVID-19. The present study developed measures based on the transtheoretical model (TTM) to better understand readiness, decisional balance (DCBL; pros and cons), self-efficacy (SE), as well as other motivators for change such as myths and barriers for COVID-19 vaccination. Design Cross-sectional measurement development. Setting Online survey. Sample 528 US adults ages 18-75. Measures Demographics, stage of change (SOC), DCBL, SE, myths, and barriers. Analysis The sample was randomly split into halves for exploratory factor analysis using principal components analysis (EFA/PCA), followed by confirmatory factor analyses (CFA) to test measurement models. Correlation matrices were assessed and multivariate analyses examined relationships between constructs and sub-constructs. Results For DCBL, EFA/PCA revealed three correlated factors (one pros, two cons) ( n 1 = 8, α = .97; n 2 = 5, α = .93; n 3 = 4, α = .84). For SE, two correlated factors were revealed ( n 1 = 12, α = .96; n 2 = 3, α = .89). Single-factor solutions for Myths ( n = 13, α = .94) and Barriers ( n = 6, α = .82) were revealed. CFA confirmed models from EFAs/PCAs. Follow-up analyses of variance aligned with past theoretical predictions of the relationships between SOC, pros, cons, and SE, and the predicted relationships with myths and barriers. Conclusion This study produced reliable and valid measures of TTM constructs, myths, and barriers to understand motivation to receive COVID-19 vaccination that can be used in future research.

Purpose: Previous studies found that treatment effects can change two behaviors, but not one. This study examined baseline transtheoretical model constructs as three alternative predictors (stage of change, effort, and severity) of singular action among participants with co-occurring health behavior risks. Design: The study examined participants at risk for three pairs of behaviors (sun and smoking; smoking and diet; and diet and sun). Analyses were conducted with participants who changed only one behavior in a pair (singular action). Setting: School and home-based behavior change programs recruited participants via schools, worksites, and physician practices. School, worksite, medical, and home-based prevention programs were the study setting. Subjects: The sample (N = 3213) was age 44.6 years (SD, 11.1 years), 94.6% white, and 63.7% female. Measures: Stages of change, effort, and severity variables were measured. Analysis: Pooled data were analyzed using logistic regressions from three randomized controlled trials. Results: Across all three behaviors, stage of change, effort, and severity effects were consistently related to behavior change at 24 months. Change efforts on one behavior were related to change on another behavior. Baseline sun severity (odds ratio, .97 [.94, 1.00]; p = .046) and smoking severity (odds ratio, .89 [.80, .98]; p = .019) were significant predictors of change on diet at final follow-up. Conclusion: Stage of change was the biggest predictor. Problem severity was the smallest predictor of change at 2-year follow-up. Four of six predictors were within behaviors, whereas two were between.

Purpose: Anxiety is the most common and costly mental illness in the United States. Reducing avoidance is a core element of evidence-based treatments. Past research shows readiness to address avoidance affects outcomes. Investigating avoidance from a transtheoretical model (TTM) perspective could facilitate tailored approaches for individuals with low readiness. This study developed and examined psychometric properties of TTM measures for addressing anxiety-based avoidance. Design: Cross-sectional survey. Setting: Community centers, online survey. Participants: Five hundred ninety-four individuals aged 18 to 70 with clinically significant anxiety. Measures: Overall Anxiety Severity Questionnaire, stages of change, decisional balance, and self-efficacy. Analysis: The sample was randomly split into halves for principal component analyses (PCAs) and confirmatory factor analyses (CFAs) to test measurement models. Further analyses examined relationships between constructs. Results: For decisional balance, PCA indicated two 5-item factors (pros and cons). Confirmatory factor analysis supported a 2-factor correlated model, Satorra-Bentler scaled chi-square [Formula: see text], comparative fit index (CFI = 0.94), root mean square error of approximation (RMSEA = 0.07), pros: α = 0.87, ρ = 0.87, cons: α = 0.75, and ρ = 0.75. For self-efficacy, PCA indicated one 6-item factor supported by CFA, [Formula: see text], P < .01, CFI = 0.98, RMSEA = 0.09, α = 0.90, ρ = 0.87. As hypothesized, significant cross-stage differences were observed for pros and self-efficacy, and significant relationships between anxiety severity and pros, cons, and self-efficacy were found. Conclusion: Findings show strong psychometric properties and support the application of a readiness-based model to anxiety. In contrast to findings of other behaviors, cons remain high in action and maintenance. These measures provide a solid empirical foundation to develop TTM-tailored interventions to enhance engagement in treatment.

Purpose. African-Americans have high rates of physical inactivity-related morbidity and mortality, thus effective interventions to increase exercise are necessary. Tailored interventions show promise, but measures need validation in this population. This study validated transtheoretical model measures for exercise in an African-American sample. Design. Cross-sectional measure development. Setting. Telephone survey of individuals in North Carolina. Subjects. 521 African-American adults. Measures. Stages of change, decisional balance (pros and cons), self-efficacy and processes of change (POC) for regular exercise. Analysis. Confirmatory factor analyses tested measurement models. Multivariate analyses examined relationships between each construct and stages of change. Results. For decisional balance, the two-factor uncorrelated model was the most parsimonious good-fitting model (χ235 = 158.76; comparative fit index [CFI], .92; average absolute standardized residual [AASR], .04), and alphas were good (pros α = .85 and cons α = .74). The one-factor model for self-efficacy (α = .80) revealed an excellent fit (χ29 = 45.51; CFI, .96; AASR, .03). For the POC subscales with good alphas (α = .62–.91), a 10-factor fully correlated model fit best (χ2[360] = 786.75; CFI, .91; AASR, .04). Multivariate analyses by stage of change replicated expected patterns for the pros, self-efficacy, and POC measures with medium-sized effects (η2 = .05–.13). Results by stage of change did not replicate for the cons scale. Conclusions. The structures of these measures replicated with good internal and external validity, except for the cons scale, which requires additional development. Results support the use of these measures in tailored interventions to increase exercise among African-Americans.

Purpose. Women younger than 25 years are at greatest risk for human papillomavirus (HPV) infection, including high-risk strains associated with 70% of cervical cancers. Effective model-based measures that can lead to intervention development to increase HPV vaccination rates are necessary. This study validated Transtheoretical Model measures of Decisional Balance and Self-Efficacy for seeking the HPV vaccine in a sample of female college students. Design. Cross-sectional measurement development. Setting. Online survey of undergraduate college students. Subjects. A total of 340 female students ages 18 to 26 years. Measures. Stage of Change, Decisional Balance, and Self-Efficacy. Analysis. The sample was randomly split into halves for exploratory principal components analyses (PCAs), followed by confirmatory factor analyses (CFAs) to test measurement models. Multivariate analyses examined relationships between constructs. Results. For Decisional Balance, PCA indicated two 4-item factors (Pros –α = .90; and Cons –α = .66). CFA supported a two-factor correlated model, χ2(19) = 39.33; p < .01; comparative fit index (CFI) = .97; and average absolute standardized residual statistic (AASR) = .03; with Pros α = .90 and Cons α = .67. For Self-Efficacy, PCA indicated one 6-item factor (α = .84). CFA supported this structure, χ2(9) = 50.87; p < .05; CFI = .94; AASR = .03; and α = .90. Multivariate analyses indicated significant cross-stage differences on Pros, Cons, and Self-Efficacy in expected directions. Conclusion. Findings support the internal and external validity of these measures and their use in Transtheoretical Model–tailored interventions. Stage-construct relationships suggest that reducing the Cons of vaccination may be more important for HPV than for behaviors with a true Maintenance stage.