Testing the transtheoretical model for fruit intake: comparing web-based tailored stage-matched and stage-mismatched feedback Emely de Vet 1,2 *, Jascha de Nooijer 2 , Nanne K. de Vries 2 and Johannes Brug 3 Abstract A match–mismatch test was conducted to test the transtheoretical model applied to fruit intake. Precontemplators and contemplators were ran- domly assigned to receive a web-based individ- ualized precontemplation feedback (PCF), contemplation feedback (CF) or action feedback (AF) letter promoting fruit intake. Immediately and 1 week after reading this letter, post-test measures were obtained. Fruit intake increased significantly between pre- and post-test in con- templators, but not in precontemplators. No differences between the feedback conditions were found in fruit intake, stage progression, use or credibility of the feedback in precontemplators and contemplators. In precontemplators, also no differences between the conditions were found in personal relevance of the feedback. Contemplators, however, rated AF as more personally relevant than PCF or CF. To conclude, the present study failed to show superiority of stage-matched information in the promotion of fruit intake. Introduction According to the transtheoretical model (TTM) of behavior change, health behavior change involves progress through a series of five discrete, qualita- tively different, stages of change (SOC). The first stage is precontemplation, which is characterized by a lack of motivation. Precontemplation is fol- lowed by contemplation, preparation, action and maintenance. In maintenance, a healthy behavior is adopted and maintained for >6 months [1, 2]. People in these different stages are assumed to dif- fer on important and relevant stage-specific factors. The TTM defines several of these factors, i.e. de- cisional balance, self-efficacy and processes of change. Decisional balance reflects the individual’s weighing of the importance of pros and cons of a behavior. Self-efficacy reflects the situation-specific confidence people have that they can cope with high-risk situations for unhealthy habits. Processes of change are the experiential and behavioral strat- egies that individuals use to progress through the stages [2]. Interventions should be matched to the relevant stage-specific factors in order to produce progress through the stages [3]. A relevant goal for such stage-matched information is forward stage transition to the next SOC [2]. The TTM has been subject to criticism (e.g. 4–6). However, the TTM is still widely applied by clini- cians and practitioners in various fields of health behavior change. This is probably because the TTM seems relatively easy to apply, while critical experimental theory tests are largely lacking. A match–mismatch test has been proposed as a strong and definite test of the TTM [3]. A match–mismatch study experimentally tests whether individuals in 1 Institute of Health Sciences, Vrije Universiteit, Amsterdam, the Netherlands, 2 Department of Health Education and Promotion, Universiteit Maastricht, Maastricht, the Netherlands and 3 EMGO Institute, VU University Medical Centre, Amsterdam, the Netherlands *Correspondence to: E. de Vet, Institute of Health Sciences, Faculty of Earth and Life Sciences, Vrije Universiteit, De Boelelaan 1085, 1081 HV Amsterdam, the Netherlands. E-mail: emely.de.vet@falw.vu.nl Ó The Author 2007. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oxfordjournals.org doi:10.1093/her/cym019 HEALTH EDUCATION RESEARCH Vol.23 no.2 2008 Pages 218–227 Advance Access publication 25 June 2007 Downloaded from https://academic.oup.com/her/article/23/2/218/628733 by guest on 22 August 2023