Background. The Transtheoretical Model of Change (TTM) has been investigated as a model of health behavior change; however, it has only begun to gain recognition in the diabetic population, and has not yet been investigated as it relates to the full-spectrum of diabetes self-care behaviors.

Purpose. The purpose of this study was to compare the pattern of stages of change across four self-care behaviors between intervention and control groups, and examine psychosocial and health outcome variables.

Method. In a cross-sectional design, a sample of 132 adult subjects with type 2 diabetes completed surveys. The survey assessed stages of change among self-care behaviors (self- monitoring blood glucose, diet, exercise, and weight management), psychosocial variables (understanding of diabetes, self-efficacy, ability to manage diabetes, attitude toward diabetes, mental well-being, and social support), and health outcomes (blood glucose level, BMI, fitness, perceived physical health, and number of diabetes-related symptoms). Subjects in the control group received standard care, and those in the intervention group participated in a three-day, multi-disciplinary intervention program in addition to standard care.

Results. 1) Treatment differences. There were more subjects in the action stages (action and maintenance) than in the pre-action stages (precontemplation, contemplation, and preparation) in the intervention group than the control group. This was statistically significant for diet (71% vs. 26%, p < .001), blood glucose monitoring (79% vs. 58%, p < .01), and weight management (31% vs. 19%, p < .05), but not for exercise (45% vs. 61%, n.s.). Those in the intervention group also had significantly better understanding of diabetes (p < .01); however, there were no significant differences found for the other psychosocial variables measured. 2) Stage patterns. With treatment groups combined, subjects in the higher stages (action and maintenance) demonstrated significantly greater understanding of diabetes, better self-efficacy, more positive attitudes toward diabetes, and better mental well-being across self-care behaviors excluding weight management. Of the self-care behaviors, exercise and self-monitoring of blood glucose were linked with better health outcomes.

Conclusions. The results of this study support the application of TTM to understanding diabetes self-management across several behaviors. More research is needed applying all constructs of TTM to different aspects of self-care in diabetes, with exercise and smoking as key components.


School of Public Health and Graduate School

First Advisor

Helen Hopp Marshak

Second Advisor

Kelly R. Morton

Third Advisor

John K. Testerman

Degree Name

Doctor of Public Health (DrPH)

Degree Level


Year Degree Awarded


Date (Title Page)




Library of Congress/MESH Subject Headings

Diabetes Mellitus, Type 2 -- prevention and control; Self Care; Health Behavior; Blood Glucose Self-Monitoring; Health Promotion -- methods



Page Count

xi; 154

Digital Format


Digital Publisher

Loma Linda University Libraries

Usage Rights

This title appears here courtesy of the author, who has granted Loma Linda University a limited, non-exclusive right to make this publication available to the public. The author retains all other copyrights.


Loma Linda University Electronic Theses and Dissertations

Collection Website



Loma Linda University. Del E. Webb Memorial Library. University Archives