Explaining Handwashing Behavior in a Sample of College Students during COVID-19 Pandemic Using the Multi-Theory Model (MTM) of Health Behavior Change: A Single Institutional Cross-Sectional Survey

Amidst the COVID-19 pandemic, handwashing offers a simple and effective hygienic measure for disease prevention. Reportedly, a significant proportion of college students did not follow handwashing recommendations provided by the Centers for Disease Control and Prevention (CDC) in the pre-COVID era. The purpose of this cross-sectional study was to explore and explain the handwashing behavior among college students during the COVID-19 pandemic using a contemporary fourth-generation multi-theory model (MTM) of health behavior change. Data were collected from 713 college students at a large public university in the Southern U.S. in October 2020 using a validated 36-item survey. Statistical analyses included independent samples t-tests, Pearson correlation, and hierarchical regression modeling. Among students not following handwashing recommendations, the constructs of participatory dialogue (β = 0.152; p < 0.05) and behavioral confidence (β = 0.474; p < 0.0001) were statistically significant and accounted for 27.2% of the variance in the likelihood of initiation of the behavior. Additionally, the constructs of emotional transformation (β = 0.330; p < 0.0001), practice for change (β = 0.296; p < 0.0001), and changes in the social environment (β = 0.180; p < 0.05) were statistically significant and accounted for 45.1% of the variance in the likelihood of sustaining handwashing behavior. This study highlights the applicability and usability of the MTM in designing and testing behavior change interventions and media messaging in campaigns targeting college students.

Download Full-text

Applications of the fourth-generation multi-theory model (MTM) of health behavior change toobesogenic behaviors in college students

Advances in Obesity Weight Management & Control ◽

10.15406/aowmc.2020.10.00308 ◽

2020 ◽

Vol 10 (3) ◽

pp. 65-69

Author(s):

Manoj Sharma

Keyword(s):

College Students ◽

Health Behavior ◽

Behavior Change ◽

Health Behavior Change ◽

Theory Model ◽

Fourth Generation ◽

Psychological Consequences ◽

Long Term Effects ◽

Health Crisis ◽

Obesogenic Behaviors

Obesity is a public health crisis that has reached pandemic proportions. It has multifactorial etiology and multiple negative physical and psychological consequences. Controlling the problem by altering obesogenic behaviors among college students is especially important because there is growing prevalence in this subgroup, there are long term effects for this subgroup, they are in formative years for obesogenic behaviors, and these behaviors are widely prevalent in this subgroup. The multi-theory model (MTM) of health behavior change is a new fourth-generation behavioral theory that has been applied to study obesogenic behaviors among college students. The purpose of this review was to examine the robustness and utility of MTM in designing efficacious and effective interventions to address obesogenic behaviors among US college students. A total of five studies published in MEDLINE, CINAHL, or ERIC met the inclusion criteria.The mean adjusted R2 for the initiation model based on the five studies was 0.38 (s.d. 0.15) and the mean adjusted R2 for the sustenance model was 0.34 (s.d. 0.14). The construct of behavioral confidence in the initiation model and the construct of emotional transformation in the sustenance model were significant in all five studies. MTM offers a feasible and practical framework for designing health promotion interventions for college students to address obesogenic behaviors

Download Full-text

Factors Associated with Initiation and Sustenance of Stress Management Behaviors in Veterinary Students: Testing of Multi-Theory Model (MTM)

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17020631 ◽

2020 ◽

Vol 17 (2) ◽

pp. 631 ◽

Cited By ~ 1

Author(s):

Vinayak K. Nahar ◽

Julia K. Wells ◽

Robert E. Davis ◽

Elizabeth C. Johnson ◽

Jason W. Johnson ◽

...

Keyword(s):

United States ◽

Health Behavior ◽

Behavior Change ◽

Stress Management ◽

Health Behavior Change ◽

The United States ◽

Theory Model ◽

Veterinary Students ◽

Cross Sectional ◽

Management Behaviors

Veterinary students across the United States face the challenge of stress during school every day. When managed improperly, stress can become chronic and manifest in physical and emotional consequences. The purpose of this study was to examine the utility of the multi-theory model (MTM) of health behavior change in predicting the initiation and sustenance of stress management behaviors among veterinary students. A cross-sectional design was used to study the efficacy of the MTM in predicting initiation and sustenance of stress management behaviors among veterinary students at a private College of Veterinary Medicine in the Southeast United States. Researchers collected data using a 54-item valid and reliable survey. Only students who did not already engage in daily stress management behaviors were included in the study. After recruitment and exclusion, a total of 140 students remained and participated in the study. Hierarchical multiple regression revealed that, for initiation of stress management behaviors, 49.5% of the variance was explained by depression, academic classification, and behavioral confidence. Regarding sustenance of stress management behaviors, 50.4% of the variance was explained by perceived stress, depression, academic classification, and emotional transformation. MTM serves as a promising framework for predicting initiation and sustenance of health behavior change. Based on the results of this study, interventions aimed to promote stress management behaviors in veterinary students should focus on the MTM constructs of behavioral confidence and emotional transformation.

Download Full-text

Can the Multi-Theory Model (MTM) of Health Behavior Change Explain the Intent for People to Practice Meditation?

Journal of Evidence-Based Integrative Medicine ◽

10.1177/2515690x211064582 ◽

2021 ◽

Vol 26 ◽

pp. 2515690X2110645

Author(s):

Manoj Sharma ◽

Matthew Asare ◽

Ram Lakhan ◽

Amar Kanekar ◽

Vinayak K. Nahar ◽

...

Keyword(s):

Behavior Change ◽

Structural Equation ◽

Online Survey ◽

Well Being ◽

Health Behavior Change ◽

Theory Model ◽

Fourth Generation ◽

Equation Modeling ◽

Behavior Change Interventions ◽

Demographic Covariates

Meditation is gaining popularity as adjuvant therapy for many chronic ailments, mental well-being, and spiritual growth. Behavioral theories have been underutilized in understanding meditation behavior. This study aimed to test if a fourth-generation multi-theory model (MTM) could explain the intent for starting and maintaining meditation behavior in a sample of US adults. A face and content valid 48-item instrument based on MTM was administered in a cross-sectional design through an online survey (n = 330). Internal consistency (Cronbach's alpha > 0.70) and construct validation using structural equation modeling of the subscales were all acceptable. Hierarchical multiple regression revealed that, after controlling for demographic covariates, the MTM constructs of participatory dialogue (β = 0.153; P = .002) and behavioral confidence (β = 0.479; P < .001) were statistically significant in predicting intent for starting meditation behavior and accounted for 32.9% of the variance. Furthermore, after controlling for demographic covariates, the MTM constructs of emotional transformation (β = 0.390; P < .001) and changes in the social environment (β = 0.395; P < .001) were statistically significant and accounted for 52.9% of the variance in the intent for maintaining meditation behavior. Based on this study, it can be concluded that MTM offers a pragmatic framework to design, implement, and evaluate evidence-based (theory-based) meditation behavior change interventions.

Download Full-text

Using the Multi-Theory Model (MTM) of Health Behavior Change to Explain Intentional Outdoor Nature Contact Behavior among College Students

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17176104 ◽

2020 ◽

Vol 17 (17) ◽

pp. 6104

Author(s):

Manoj Sharma ◽

Erin Largo-Wight ◽

Amar Kanekar ◽

Hana Kusumoto ◽

Stephanie Hooper ◽

...

Keyword(s):

College Students ◽

Health Behavior ◽

Behavior Change ◽

Perceived Stress ◽

Health Behavior Change ◽

The United States ◽

Theory Model ◽

Contact Behavior ◽

Nature Contact ◽

The Impact

Nature contact is an emerging health behavior and is defined as the interaction between human beings and animals, plants, natural scenic views, or outdoor activities. Studies have shown that exposure to the outdoors (as a means of contact with nature) reduces perceived stress and promotes health and wellbeing among varying populations in many settings. To date, however, there are few studies exploring the impact of nature contact among college students, especially in the United States. In addition, the determinants of nature contact behavior have not adequately been explored using behavioral theories. The purpose of this study was to use the multi-theory model (MTM) of health behavior change, a contemporary fourth-generation behavioral theory in explaining intentional outdoor nature contact behavior among college students. Using a cross-sectional design, 401 students completed the validated survey based on MTM. Of these, 281 met the inclusion criteria. The mean score for perceived stress based on the Perceived Stress Scale (PSS-10) in the sample was 21.60 (7.08) units, with a possible minimum and maximum scores ranging from 0 to 40 units. Constructs of behavioral confidence (standardized coefficient = 0.591, p < 0.001) and changes in the physical environment (standardized coefficient = 0.271, p < 0.001) from MTM accounted for 57.5% of the variance in the initiation for intentional outdoor nature contact behavior. All the three constructs of MTM—namely, emotional transformation (standardized coefficient = 0.173, p = 0.021), practice for change (standardized coefficient = 0.317, p < 0.001), and changes in the social environment (standardized coefficient = 0.204, p = 0.002)—were statistically significant and contributed substantively toward the variance (31.0%) in sustenance. MTM provides a useful and pragmatic framework for designing interventions to promote intentional nature contact behavior among college students.

Download Full-text

Utilizing Multi-Theory Model in Determining Intentions to Smoking Cessation Among Smokers

Tobacco Use Insights ◽

10.1177/1179173x19843524 ◽

2019 ◽

Vol 12 ◽

pp. 1179173X1984352 ◽

Cited By ~ 2

Author(s):

Vinayak K Nahar ◽

Amanda H Wilkerson ◽

Falguni C Patel ◽

Richard W Kim ◽

Philip M Stephens ◽

...

Keyword(s):

Smoking Cessation ◽

Behavior Change ◽

Health Behavior Change ◽

Cross Sectional Study ◽

Theory Model ◽

Shopping Mall ◽

Fourth Generation ◽

Moderate Amount ◽

Cross Sectional ◽

Convenience Sample

Background: Smoking is a risk factor for lung cancers, and a myriad of other acute and chronic ailments. The purpose of this study was to predict initiation and sustenance of smoking cessation among smokers using a fourth-generation behavioral framework, multi-theory model (MTM) of health behavior change. Methods: A convenience sample of smokers from a shopping mall in rural, Appalachian Kentucky county was invited to participate in this cross-sectional study. A 38-item, face and content validated, MTM-based survey instrument was administered to the participants. Results: A total of 148 participants completed the study. The mean age of the participants was 35.53 (SD = 14.52) years. Most were male (58.1%) and Caucasian (95.9%). Participants reported smoking for an average of 16.45 (SD = 13.12) years. Participatory dialogue (β = 0.235, P = .003) and behavioral confidence (β = 0.305, P = .005) were significant predictors of intention for initiation for smoking cessation behavior. Emotional transformation (β = 0.319, P = .001) was a significant predictor of intention for sustenance for smoking cessation behavior. Discussion: Two of the MTM constructs for initiation and one of the MTM constructs for sustenance of change accounted for a moderate amount of variance in initiation and sustenance of smoking cessation behavior among community members in a rural, Kentucky county. MTM has utility for predicting both initiation and sustenance of smoking cessation behavior. Future interventions using MTM constructs should be developed for smoking cessation behavior change.

Download Full-text