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Original ArticleApplication of the Transtheoretical Model (TTM) toexercise behaviour among Macedonian collegestudentsABDULLA ELEZIM1, GRESA ELEZI2 11Faculty, SERYOZHA GONTAREV3, GEORGI GEORGIEV3of Physical Education and Sport, University of Pristina, Kosovo2American Hospital, Pristina, Kosovo3Facultyof Physical Education, Sport, and Health, Ss. Cyril and Methodius University, Skopje, Republic ofNorth MacedoniaABSTRACTBackground: This study examined the applicability of trans-theoretical model (TTM) to understand exercise behaviouramong students in University "St. Cyril and Methodius" in Skopje. Methods: A cross-sectional descriptive study wasconducted. The dependent variables analysed were exercise self-efficacy expectation, decisional balance (pros andcons), social support for physical activity and exercise enjoyment. The independent variable was stage of exercisebehaviour change. 1066 students representing various disciplines on campus completed a valid and reliablequestionnaire during regularly scheduled classes. More than 67 percent of sample were sedentary (pre contemplation,contemplation, or preparation) whereas 17,6% were in the action stage (regularly active 6 months) and 14,9% werein the maintenance stage (regularly active 6 months). Results: All of the TTM constructs differed significantly acrossexercise stages. Students who are in the action and maintenance stage show greater self-efficacy, social support fromparents and peers, and they receive greater benefit from physical activity, compared to students who are in the prethinking and thinking stage. In addition, students who are in the action and maintenance stage, enjoy physical activitymore than students who are in the pre-thinking stage. Students who are in the stage of preparedness show greaterself-efficacy than students who are in the pre-thinking and thinking stage and they receive greater social support fromparents and peers, compared to students who are in the pre-thinking stage. Conclusion: Results supported the use ofthe entire TTM in examining exercise behaviour among college students. Keywords: Trans-theoretical model; Exercisebehaviour; Student.Cite this article as:Elezim, A., Elezi, G., Gontarev, S., & Georgiev, G. (2019). Application of the Transtheoretical Model (TTM) toexercise behaviour among Macedonian college students. Journal of Human Sport and Exercise, in 91Corresponding author. American Hospital, Industrial Zone. 10000 Prishtinë, Kosovo.E-mail: [email protected] for publication July 2019Accepted for publication September 2019Published in press October 2019JOURNAL OF HUMAN SPORT & EXERCISE ISSN 1988-5202 Faculty of Education. University of Alicantedoi:10.14198/jhse.2020.153.19VOLUME -- ISSUE - 2019 1

Elezim et al. / TTM to exercise behaviour among Macedonian college studentsJOURNAL OF HUMAN SPORT & EXERCISEINTRODUCTIONThe World Health Organization in all its acts indicates the importance of physical activity in the preservationof health, especially in the procedures for the prevention and treatment of chronic diseases (WHO, 2004).Numerous scientific-professional studies emphasize the casual relation between physical activity, physicalfitness and the health of the individual (Mišigoj-Duraković, 2008). The indicated studies point out causes suchas: insufficient physical activity, sedentary lifestyle, inadequate nutrition, increased body weight, cigarettesmoking, alcohol and drug consumption, and the increasingly present eating disorder which is manifestedthrough anorexia or bulimia. The studies so far emphasized the problem of insufficient physical activity andpropensity to risky behaviours, especially among the student population (Mandac et al., 2001; Kuzman et al,2004; Huddleston et al., 2002). Students are a part of the population of young people who are getting readyfor an important role in social life. As academically educated people, with their knowledge and experience,they will influence the future generations of children and youth. The sharp decline in physical activity isparticularly expressed in the period of adolescence (15-19 years) and in young age categories (20-25 years),which puts students in the risk group (Wallace et al., 2000; Han et al., 2017; Jahan et al., 2017; Liu et al.,2018).The theoretical conception that this research rests on is the trans-theoretical model. The point of departurein the trans-theoretical model is the fact that the change in behaviour progresses through five stages (levelsof motivational readiness for change), as follows: pre-thinking stage (the individual does not intend to changehis/her behaviour in the near future), thinking stage (the individual thinks there is some problem), readinessstage (the individual may have set a goal to change), action stage (the individual has changed his/herbehaviour in the last 6 months) and maintenance stage (the new behaviour is automated, the individual feelsgood, and invests less conscious effort) (Prochaska and DiClemente, 1982, 1984). During this process theindividual often moves forward and backward through these stages, before reaching the last level, themaintenance stage (automation of the behaviour). Therefore, the stages of change would be better describedas spiral or cyclic rather than linear. In this model, people use different processes of change as they movefrom one stage to another. According to this theory, the intervention is directed to correspond to theappropriate stage or to a particular individual (the intervention is specific to each stage or individual). Changesthat take place step by step, progressing from one stage to another, will have a greater effect than directencouragement of the person to engage in action.The trans-theoretical has a multidimensional foundation, because it also includes other components such as:movement through the separate stages, cognitive-affective and behavioural changes, decision-makingprocess (for and against change), perceived self-efficacy (self-sufficiency) and successful change of the newbehaviour. These constructs are conceptualized as factors that enable better understanding of the behaviourchange across the five separate stages. The model is described as a trans-theoretical model because itinvolves several cognitive and motivational theories, such as the social learning theory, the socio cognitivetheory and the theory of planned behaviour.The aim of this study was to identify the relation between the level of physical activity and the structures ofTTM. Therefore, we sought to identify the factors affecting the change in behaviour, in order to designinterventions that would lead to the promotion of physical activity in a sample of Macedonian CollegeStudents.2 2019 ISSUE - VOLUME -- 2019 University of Alicante

Elezim et al. / TTM to exercise behaviour among Macedonian college studentsJOURNAL OF HUMAN SPORT & EXERCISEMETHODS OF WORKA sample of respondentsThe survey was conducted on a sample of 1066 respondents randomly selected from several faculties withinSs. Cyril and Methodius University in Skopje. The sample consisted of 419 (39.31%) male respondents and647 (60.69%) female respondents. The average age of the respondents of both genders was 19.3 years.The respondents were treated in accordance with the Helsinki Declaration.A sample of variablesThe data are collected using the structured questionnaire method of research. The dependent variablesanalysed were exercise self-efficacy expectation, decisional balance (pros and cons), social support forphysical activity and exercise enjoyment.Description of the measurement instrumentsPhysical Activity Stages of Change Questionnaire (PASCQ)The PASCQ (Marcus & Simkin, 1993) scale consists of four items (questions) that determine the five stagesof the student’s current motivational readiness to change the physical activity habits. The answers of thequestions are yes or no, and they are evaluated using the scoring algorithm. For example, a student isclassified in the pre-thinking stage if he/she answered “no” to the first two questions. The student is classifiedin the maintenance stage if he/she answered “yes” to questions one, three, and four. The reliability of theinstrument was checked with the test-retest method in the studies so far and ranges between .78 and .85,according to Marcus & Forsyth (2003). The validity of the instrument was determined by comparing directmeasurements of physical activity with an accelerometer, also by comparing with other instruments forphysical activity assessment, and on the basis of maximal oxygen consumption VO 2max, and it wassatisfactory (Cardinal, 1995; Marcus & Simkin, 1993; Wyse 1995).The Decisional Balance Scale (DBS)The Decisional Balance scale (DBS) according to Marcus, Rakowski and Rossi (1992) is used forassessment of the perceived advantages and disadvantages (pros and cons) that can affect the behaviourchange. The scale consists of 10 items and it is 5-point Likert-type scale, ranked from 1 (I completelydisagree) to 5 (I completely agree). For example, the questions by which the perceived advantages wereassessed: “Regular physical activity will help me get rid of stress” and a question for assessing perceivednegativities: “If I am physically active regularly, I will have less time for my family and friends.” The resultsare obtained by summarizing the items through which the perceived advantages are assessed and bysummarizing the items through which the perceived negativities are assessed, and the difference betweenthe two sums determines the balance index for and against the change.Physical Exercise Self-Efficacy Scale (PESES)The Exercise Self-Efficacy Scale was constructed by Schwarzer and Renner, and the measurementcharacteristics were checked by Brown (2005). It is used for an estimation of the self-efficacy of therespondent to engage in physical activities even though he is faced with certain difficulties (for example, badweather, bad mood, a lot of work, etc.). The scale consists of 5 items and it is Likert-type scale, with 5 points(levels), ranked from 1 (I am sure that I can not) to 5 (I am that sure I can). The result is obtained as theaverage value of the answers to all 5 items. Higher score suggests that the respondent has a higher level ofperceived self-efficacy to practice physical activity. The reliability (internal consistency) of the scale isapproximately .87 (Cronbach-α. .87). One variable is obtained from the scale. Brown (18) found that theintercorrelation between the items was relatively good (r .40 to .76), while the internal consistency wasVOLUME -- ISSUE - 2019 3

Elezim et al. / TTM to exercise behaviour among Macedonian college studentsJOURNAL OF HUMAN SPORT & EXERCISEexcellent (Cronbach-α .88). The validity of the scale showed moderate correlation with the intent to practice(r .33) and the motivational readiness of the respondent to change the physical activity habits (r .39)observed within a period of 6 months.Exercise Enjoyment ScaleThe scale which is used to assess how much the respondent enjoys physical activities, is constructed byKendzierski & DeCarlo (1991). It is a graphic scale, with 7 points (levels), and comprises of 18 items. Theresult is obtained as the average value of all particles.Measuring Social Support for Physical ActivityThe scale for assessing social support from parents and peers is constructed by Sallis et al. (1987). It is aLikert-type scale, with 5 points (levels), ranging from 1 (never) to 5 (very often) (for example: “in the last threemonths the members of my immediate family verbally encouraged me to participate in physical activities”)and it comprises of 10 items. The respondent should answer each question both about the family and aboutthe peers/friends (in a separate column for the family and friends). The result is obtained as the averagevalue of the answers to all items, separately for parents and friends.Data processing methodsFor all quantitative variables, the basic descriptive statistical parameters are calculated, as follows: arithmeticmean (X), standard deviation (SD), curvature (KURT), distribution asymmetry (SKEW). The normaldistribution of the variables was tested with the Kolmogorov-Smirnov test. For all qualitative variables,frequencies, relative frequencies, and percentages of individual responses were calculated and χ 2-tests wereapplied. In order to determine which psychosocial factors are significant in the differentiation of therespondents who have a different level of motivational readiness to change the habits for physical activity, amultivariate and univariant analysis of covariance (MANCOVA and ANCOVA) was applied with partializationof gender and age (gender and age were treated as a covariance in order to neutralize the eventual impact),and post-hoc tests were also applied (Bonferroni test). The data is processed with the SPSS statisticalpackage for Windows Version 22.0.RESULTSTable 1 shows the classification of the respondents in 5 (five) categories according to their motivationalreadiness to change their physical activity habits. From the overview of the table it can be seen that 11.8%of the respondents are in the pre-thinking stage (respondents who are not physically active and do not eventhink about the need of physical activity), 43.5% of the respondents are in the thinking stage (respondentswho are not physically active, however they are considering the need of physical activity), 12.1% of therespondents are in the readiness stage (respondents who are occasionally physically active or are preparedto start regular physical activity), 17.6% of the respondents are in the action stage (respondents who havebeen physically active for less than 6 months), 14.9% of the respondents are in the maintenance stage(respondents who are physically active for more than 6 months). The values of the χ2-test (χ2 92.311; p ,000) indicate that there are statist