(P28-021-23) Stage Progression Following a Behavioral Lifestyle Intervention for Diabetes Prevention

Objectives: Stage models of health behavior assume that individuals progress through stages of behavioral change from contemplation, to initiation, to maintenance of newly adopted behaviors. Stage progression becomes the variable of interest for intervention evaluation. The Health Action Process Approach (HAPA) framework specifies three stages: non-intenders, intenders, and actors. Following intention formation, planning and self-efficacy promote behavioral action. The impact of a behavioral weight loss intervention on stage progression was examined.
Methods: Adults ≥ 21 years old with prediabetes (n=182) were enrolled in a 16-week, group-based, behavioral intervention to promote a lower-fat diet and greater physical activity (PA); change in HAPA constructs was compared across stage. Stage was assessed by asking if participants: (1) consumed a low-fat diet most days of the week; (2) engaged in PA ≥ 5 days/week for ≥ 30 minutes/day. A 7-point response was used to assess HAPA constructs.

Results: At baseline, 21.5%, 33.9%, and 44.6%, and 28.6%, 29.7%, and 41.8% of participants were in the pre-intender, intender, and actor stage for PA and diet, respectively. Analysis for PA indicated 23.7% and 52.6% of pre-intenders moved to the intender and actor stage, respectively post-intervention. Among intenders for PA at baseline, 65% became actors post-intervention. For eating a lower fat diet, 7.8% and 84.3% of pre-intenders moved to the intender and actor stage, respectively post-intervention. Among intenders for diet at baseline, 88.9% became actors post-intervention. Mixed effect models found actors had greater change in action planning and recovery self-efficacy for PA (P < 0.001) compared to pre-intenders. Improvement in action, coping, and recovery self-efficacy, and action and coping planning for PA (all P < 0.01) was observed across all stages.

Conclusions: Findings indicate participants can be stratified by stage, and the behavioral intervention moved individuals forward in stage progression for engaging in PA and eating a low-fat diet. Future research is needed to assess behavioral measures by stage classification.

Funding Sources: Funding provided by the NIDDK.