215
Institute for Christian Teaching
Education Department of Seventh-Day Adventists
TRANSTHEORETICAL MODEL
AS APPLIED TO ADVENTIST HEALTH BEHAVIOR CHANGE AMONG UNIVERSITY STUDENTS
by
523-03 Institute for Christian Teaching 12501 Old Columbia Pike Silver Spring, MD 20904 USA
Prepared for
The 30th The International Faith and Learning
Seminar
held at
June 16 – 28, 20
216
CONTENTS
I.
INTRODUCTION
A.
Background
B.
Definition of Health
The
Definition of Health
The
Five Dimensions of Health
C.
Adventist Health Principles
D.
Purpose of Study
II . TRANSTHEORETICAL MODEL
A.
Circumstances
that Led to the Development of The Model
B.
Theoretical Framework of the
Transtheoretical Model
1.
Stages of Change
2.
Process of change
II.
TRANSTHEORETICAL MODEL OF THE ADVENTIST
HEALTH
BEHAVIOR CHANGE
A.
Adventist Health Behavior
1. Target Behaviors: NEWSTART
2. Expected Outcomes
B.
Application of Stages of
Change to ¡°NEWSTART¡± Behaviors
III.
CONCLUSION
References
TRANSTHEORETICAL MODEL
AS APPLIED TO ADVENTIST HEALTH BEHAVIOR CHANGE AMONG UNIVERSITY STUDENTS
217
I. INTRODUCTION
A. Background
The change process is complex and interesting.
Health education and health promotion are concerned about changes that can
occur at the level of the individual, the organization, the community, or the
government. Many theoretical and conceptual approaches have been developed to
help explain health behavior and the methods that foster health behavior
change. Health Educators are challenged to develop learning experiences that
motivate learners to change their health behaviors. The Transtheoretical Model
is now one of the most widely used models of health behavior. Christian
teachers have equally adopted the theory in encouraging Adventist health
behaviors as well as enhancing academic performance.
The Adventist philosophy of education is the
integration of faith and learning. Thus, the purpose of this essay is to
introduce and adopt the Transtheoretical Model to change students¡¯ Christ-like
attitudes and actions. I want to focus specifically on Adventist health
behaviors called the
B. Definition of Health
Many people think of good health, which is the
absence of disease, pain, and disability. Or they consider health in terms of
vitality - being able to function with vigor. Or they think of longevity. Being
without illness, pain and disability, having vitality, and living long are part
of good health. But health is more than this.
The Definition of Health
According to the definition of World Health
Organization (WHO, 1978), health represents ¡°complete physical, mental, and
social well-being and not merely the absence of disease and infirmity.¡± Recent
definition of health adds two aspects-emotional and spiritual well being as
holistic health, which look at the whole person rather than the parts (Williams
and Knights, 1995). The view of holism can be found in Genesis 1: 27 – ¡°God
created man in His own image.¡± Seventh-Day Adventists believe that each human
being is a union of the body. Spirit, which ¡°function in close cooperation,
revealing an intensely sympathetic relationship between a person¡¯s spiritual,
mental and physical faculties. Deficiencies in one are will hamper the other
two.¡±(Seventh-day Adventist Believe¡¦, 1988. p 84).
218
Satan
is the originator of disease. Following Satan¡¯s way leads to disease and death
while following God¡¯s way lead to life and health. Therefore, a truly health¤Ë person from the Biblical
perspective is one who has physical, mental or intellectual, emotional, social
and spiritual well- being. As stated in 3 John 2, ¡° Beloved,
I pray that you may prosper in all things and be in health, just as your soul
prospers,¡± a healthy life is the perfection of Christ-like actions. Healthy
life results in happiness. There is merit in thinking and acting positively,
but the Bible declares that true spiritual well-being begins deep inside us, then spreads to physical, mental, emotional and social well-being.
In Proverbs 15: 13 -15, ¡° A merry heart makes a
cheerful countenance, but sorrow of the heart the sprit is broken¡¦He who is of
a merry heart has continual feast.¡± ¡°Rejoice in the Lord always, ¡± Paul wrote from prison. ¡°Again I will say, rejoice!¡±
(Philippians 4: 4) Many studies show that a spiritual or religious life is
associated with better health and longevity (Matthews, Larson, and Barry,
1993).
The
five dimensions of health from the Biblical perspectives are as follows:
The Five Dimensions of Health
l Physical: Physical health means
three aspects: 1) functioning body systems and the absence of disease or
disability; 2) physical fitness; and 3) minimal exposure to abuse.
l Mental or intellectual: Mental health or
intellectual health means well-being in thinking, or cognition, as opposed to
feeling.
l Emotional: Emotional health is
concerned with well-being in feeling, as opposed to thinking.
l Social: Social health has to do
with one¡¯s well-being in interaction with others.
l Spiritual: Spiritual health could
be defined as one¡¯s ability to love or trust and to accept love God.
All five health dimensions overlap and affect
one another. Thus, improvements in one area of well-being may affect several
other areas. Trust in God, for example, may improve you mood and give you
spiritual energy that allows you to study more efficiently, lessen your study worries
and improve your social interactions.
The
goal of
C. Adventist Health Principles
Genesis states that God created all life. Man
was made from the dust of the ground. In Genesis 1: 29-30, instructions were
given to him to eat fruit, nuts, and grains. Then in Genesis 9: 3,4, man is allowed to eat flesh but not blood. Men were given
directives regarding Adventists diet and lifestyle that come from the Biblical
promises of Deuteronomy 7: 11, 12 and 15. Abstinence from blood and fat are
stated in Leviticus 7: 23-27.
219
The
eight laws of health, called to the
D. Purpose of Study
The
purpose of this essay is: 1) to introduce and adopt the Transtheoretical Model
to change students¡¯ Christ-like attitudes and actions such as, the
II. TRANSTHEORETICAL
MODEL
220
A. Circumstances That Led to the Development of the
Model
As early as the 1950's, there were already about
36 distinct systems of psychotherapy and by 1975, there were 130. At about the
time Dr. Prochaska was in school studying to be a psychotherapist, his father
died of alcoholism and depression. He was unable to help or understand why his
father died distrusting psychotherapy.
According to Dr. Prochaska's original book on Systems
of Psychotherapy: A Transtheoretical Analysis published
in 1979 (Prochaska, 1979), there were so many theories in the field of
psychotherapy that this encouraged him to pursue his own research. In this
book, he did a comparative analysis of 18 major theories of psychotherapy and
behavioral change such as consciousness raising from the Freudian school of
thought, contingency management from the Skinnerian tradition, and helping
relationships from the Rogerians. Thus, the term is called transtheoretical.
The
comparative analysis was limited to 18 systems because the other systems
"seem to be dying a natural death with age and are best left undisturbed
because they are so poorly developed that they have no theories of personality
or pathology, or because they are primarily variations on major themes that are
already included in the book. The final exclusion is less open to bias and that
is that no system was excluded if more than 3% of surveyed therapists
considered themselves followers of it," Prochaska (1979) wrote.
And
in 1994, Changing for Good was co-authored by Dr. Prochaska (Prochaska, Norcross,
& DiClemente, 1994). It was in the first chapter that he mentioned the
circumstances about his father's death that helped make him delve more into
psychotherapy, leading to the transtheoretical analysis. In this search for
common principles of change, instead of finding separate change processes in
each of the 18 leading systems of therapy, only 10 processes of change (the
mechanisms people use) were identified that can be applied to the level of
either the individual's experience or environment to produce the change in
behavior: consciousness raising, social liberation, dramatic relief (emotional
arousal), self-reevaluation, commitment, stimulus control, countering (or counter
conditioning), environmental control(environmental reevaluation), reward, and
helping relationships.
The
18 different systems differed in terms of: which of the processes were
emphasized and whether the processes were applied more experientially or more
environmentally. There was more agreement, however, on the importance of
Particular processes in producing change. This became more evident in 1982 when
Dr. DiClemente worked with Dr. Prochaska at the Texas Research Institute of
Mental Sciences when they did an empirical analysis of self-changers compared
to smokers taking professional treatments. The participants were found to be
using different processes at different times of their challenges with smoking.
It was during this research that they noted the 6 stages of change (the
phases people go through) individuals used to
change their troubled behavior: precontemplation, contemplation,
preparation or determination, action, maintenance, and termination (Prochaska
& DiClemente, 1982).
221
B. Theoretical Framework of the
Transtheoretical Model
The core constructs of
the transtheoretical model are stages of change and processes of change.
1. Stages of Change
The stage of construct is important because it
represents a temporal dimension. The Transtheoretical Model conceives behavior
change as a process involving progress through a series of five or six stages.
l Precontemplation:
Has no
intention to take action within the next 6 months
l Contemplation:
Intends to
take action within the next 6 months.
l Preparation:
Intends to
take action within the next 30 days and has taken some behavioral steps in this
direction.
l Action:
Has changed
overt behavior for less than 6 months
l Maintenance:
Has changed
overt behavior for more than 6 months.
l Termination:
Overt behavior
will never return, and there is complete confidence that you can cope without fear
of relapse.
2. Process of Change
Processes of change are
the covert and overt activities that health educators initiate to help modify their
thinking, feeling or behavior through the six stages.
Consciousness
Raising
Involves providing information regarding the nature and risk
of unsafe behaviors and the value and drawbacks of the safer behavioral
alternatives.
It involves increased awareness the importance of changed lifestyle.
Dramatic
Relief
Fosters
the identification, experiencing, and expression of emotions related to the
risk the safer alternatives in order to work toward adaptive. Psychodrama,
role-playing, grieving, personal testimonies are used to move people
emotionally.
Environmental
Control (or Environmental revaluation)
Allows the individual to reflect on the consequences of his
or her behavior for other people. It can include reconsideration of perceptions
of social norms and the opinions of people important to him or her. It includes
the awareness that one can serve as a positive or negative role model for
others.
Self
Reevaluation
Entails the reappraisal of one's problem. It combines both
cognitive and affective assessment of one¡¯s self image with and without an
unhealthy lifestyle, such as one¡¯s image as a couch potato and one¡¯s different
image as a cheerful and spiritual person.
222
Commitment
(or Self-liberation)
Encourages the person to consider their confidence in their
ability to change and their commitment to doing so. New Year¡¯ resolutions,
public testimonies, etc can enhance will power.
Social
Liberation
Seeking to help others with similar situations. It requires an increase
in social opportunities or alternatives, especially people who are relatively
deprived.
Stimulus
Control
Removes
cues for unhealthy habits and adds prompts for
healthier alternative. Avoidance, environmental reengineering, and self-help
groups can provide stimuli that support change and reduce risks for relapse.
Helping
Relationships
Assists the person in a variety of ways, including providing
emotional support, modeling a set of moral beliefs, and serving as a sounding
board.
Rapport building, therapeutic alliances, counselor calls, and buddy systems can
be sources of social support.
Reward
Developing
internal and external rewards and making them readily but contingently
available to improve the probability of the new behavior occurring or
continuing. Teacher¡¯s compliments and group recognition can increase the
probability of the new behavior.
Countering
Weighing the "pros" and "cons" of the
behavior change.
The challenge is to tip the balance in favor of making positive changes.
III.
TRANSTHEORETICAL MODEL OF THE ADVENTIST HEALTH BEHAVIOR CHANGE
223
This is an example of how the Transtheoretical
Model was applied to a case involving improving the motivation and changing
lifestyles of college students. The first portion lists to behaviors the task
force was interested in changing. The second portion described the Model in
terms student readiness to change.
A. Adventist Health Behavior
The following is list that expected behaviors
and outcomes are the targets of this change effort.
1. Target Behaviors:
NEWSTART
Nutrition: Eat more plant foods but fewer animal
foods.
Exercise: Exercise with useful work.
Water: Drink pure water frequently.
Sunlight: Exposure mild sunlight.
Temperance: Avoid the use of dangerous
substances and judicious use of non-harmful foods.
Air: Obtain the purest air as possible.
Rest: Try to get suitable rest and sleep
regularly
Trust in God: love or trust God and to accept
love God completely.
Integrating and Learning in the Teaching of
Adventist Health Behavior from the Biblical Perspectives of NEWSTART
The
Nutrition
In Genesis 1: 29-30, man was given fruits, nuts,
and grains as food. Then in Genesis 9: 3,4, man is
allowed to eat flesh but not blood. Abstinence from blood and fat are stated in
Deut. 7: 11, 12 and 15. and Lev.
224
Exercise
In Genesis 1: 28, part of the prescription for
health and happiness was useful labor. According to E.G White (Recreation that
yields¡¦), ¡°Some have received the idea that it is dangerous to exercise,
because they are sick. Such ones cannot get well without exercise. God made man
a moving working machine. He designed that the muscles, and every organ of the
body, should be put to use. But some guided by their feelings, will tell you
that they cannot walk, or exercise in labor. They will relate their experience,
that when they attempted to exercise it has greatly wearied them. Yet all the
works of the human machinery were there. No organ was missing. Why, then, could
they not be set in motion? The motive will power was wanting.¡±
Water
Water is one of God¡¯s great Gifts. According to
White (1942, 1974), ¡°in health and in sickness, pure water is one of heaven¡¯s
choicest blessings. Its proper use promotes health. It is the beverage that God
provided to quench the thirst of animals and man. Drunk freely, it helps to
supply the necessities of the system and assists nature to resist disease. The
external application of water is one of the easiest and most satisfactory ways
of regulating the circulation of the blood. A cold or cool bath is an excellent
tonic. Warm baths open the pores and thus aid in the elimination of impurities.
Both warm and neutral baths soothe the nerves and equalize the circulation.¡±
Water is very important to maintain of good health.
Sunlight
Life is not possible without sunlight like
water. Many studies focus that too much exposure can bring harmful effects
because of pollution of the atmosphere (Neer, 1975). However, exposure to mild
sunlight is essential for the formation of Vitamin D. According to White (1942,
1974) ¡°¡¦.plenty of sunlight ¡¦is essential¡¦to cheerfulness and vigor of the
inmates of the home.¡± In Malachi 4: 2, ¡°But for you who revere my name, the sun
of righteousness will rise with healing in its wings¡¦¡± Sunlight is greatly
benefit individual health.
Temperance: Moderation and Abstemiousness
According to White, she advised us to avoid the
use of harmful substances and to have balanced diet-judicious use of
non-harmful foods. SDAs believe (Church Bulletin¡¦), ¡°in healthful living by
moderate use of that which is good and total abstinence from harmful, unclean
foods, alcoholic beverages, tobacco, narcotics or other drugs.¡± ¡°According to
White (1946), ¡°The human has brought upon themselves disease of various forms
by their own wrong habits. They have not studied how to live healthfully, and
their transgression of the laws of their being has produced a deplorable state
of things. The people have seldom accredited their sufferings to the true cause
– their own long course of action. They have indulged in intemperance in
eating, and made a good of their appetite.¡±
225
Air
Like water and
sunlight, we cannot live without air. White stated that lack of air could cause
the following health problems, ¡° The system becomes
weak and unhealthy, the circulation is depressed, the blood moves sluggishly
through the system because it is not purified and ventilated by the pure,
invigorating air of heaven. The mind becomes depressed and gloom, while whole
system is enervated, and fevers and other acute diseases are liable to be
generated.¡±
Rest
Adequate rest is
necessary to maintain health. God created a rest day at the end of creation
week. In Num 15: 32-36, the importance of the Sabbath was emphasized. The
following sentences by White (1890) was emphasized the needs of adequate rest
for vital living. ¡°Those who make great exertions to accomplish just so much
work in a given time, and continued to labor when their judgment tells them
they should rest, are never gainers. They are living on borrowed capital. They
are expending the vital force that they will need at a future time. And when
the energy they have so recklessly used is demanded. They fail for want of it¡¦.¡±
Trust in God
In Luke 12:22, ¡°Do not
worry about your life; what you will eat; not about the body, what you will put
on,¡± we should not be concerned about our tomorrow. We must trust him and
follow his guiding. Jesus taught that worrying about the future is futile. We
shouldn¡¯t be traumatized by what might happen. Worry about our future and our
present condition may cause stress that results in many diseases such as
cardiovascular diseases, cancers, and psychiatric problems. White (Mind,
Character ¡¦) stated that nine tenths of diseases originate in mind. Jesus
assured us in Matthew 28: 20 that ¡°I am with you always even to the end of the
age.¡± If we trust Him, we don¡¯t need worry about anything. He is actively at
work on earth through His obedient children. Many studies have found the
effects of prayer on the health and recovery of the patients. With God there is
meaningful to life (John
The goal of the
226
2. Expected Outcomes
The following is list of expected outcomes if
students adopt Adventist health behaviors.
l Strong beliefs and
attitudes.
l Increased awareness of
the importance of Adventist lifestyle
l Changed life styles
-Adventist health behaviors.
l Improved quality of
life.
l Promoted health /Prevented ill health.
l Improved academic
performance.
l Increased activities in
church including Bible study, baptisms, Sabbath school programs, etc.
l Development of intrinsic
motivation to live a holy life.
B. Application of
Stages of Change to ¡°NEWSTART¡± Behaviors
For the purpose of our study of student
motivation, if we are going to attempt to Adventist health behavior change
(eating more plant foods but fewer animal foods, exercising with useful work,
drinking pure water, exposure mild sunlight, avoiding the use of harmful
substance and practicing judicious use of non-harmful foods, obtaining pure
air, and trying to get suitable rest and sleeping regularly), this model is
likely to help us design appropriate change strategies for students in
different stages of this change process.
I
am aware that our university students are very heterogeneous with respect to
interest in, concern about, and experience with SDA and Adventist health
behavior. In the Transtheoretical Model, students may go through a logical
series of decision stages on their way to adopting Adventist health behaviors.
Below are the Stages of Change as proposed by the Transtheoretical Model and
applied to student behavioral change.
227
Figure
1. Stages of Adventist Health Behaviors
Stage 1: Precontemplation
Students in this stage can be are those not
practicing Adventist health behavior, and generally are not motivated to change
their health behavior. Furthermore, those in this stage are not intending to
change Adventist health behaviors in the near future. Students in this stage
are generally either uninformed about the consequences of their behavior, or
may have attempted change in the past with unsuccessful results. These students
most likely avoid thinking about these behaviors and God. They can be characterized
as resistant or unmotivated to adopt Adventist health behaviors. These students
should be informed Adventist health behaviors are very Biblical, helpful and
scientific to prevent disease and to promote health. Adopting Adventist health
behaviors is a way to recover the ¡°image of God.¡± This strategy (consciousness raising) can move them cognitively and affectively and help
them shift to contemplation stage.
l Expected Outcome:
Awareness
l Education Approach:
Novel information, persuasive communications, experiences
228
Stage 2: Contemplation
Students in contemplation are aware that
Adventist health behaviors may give them many benefits. However they also see a
number of costs of change. The balance between the costs and benefits produces
ambivalence, creating a block to successful Adventist health behavior change.
Students in this stage could be encouraged to take small steps like drinking
pure water, exposure mild sunlight, obtaining pure air, and trying to get
suitable rest and sleeping regularly. They could choose several Adventist
health behaviors that they perceive their ability to change their behaviors.
The small steps can increase their self-efficacy, their confidence in their
ability to take action, and help them become better prepared for adopting
Adventist health behaviors.
l
Expected Outcome: Knowledge acquisition
l
Education Approach: Information,
persuasive communications, experiences
Stage 3: Preparation
Where in the preparation
stage, students are intending to make a change in the immediate future. The preparation stage is a stage of psychological preparation on the idea of
change, imagine themselves behaving in the new way, even shares the idea
with some other people to learn how to react. If preparation goes smoothly,
then action is likely, but if preparation is accompanied by misgivings,
perceived barriers, and action may not occur. They generally have a plan of
action such as studying Adventist health principles, consulting a pastor or
professor, reading the Bible, or relying on a self-change approach. Teacher can
assist them in a variety of ways such as emotional support. Students could
realize the fact that they are still the objects of God¡¯s love and they can be
returned to Him and restored by responding to His love and following His law.
l
Expected Outcome: Deciding
l
Education Approach: How-to information,
skill development, attitude change (Strong beliefs and attitudes)
Stage 4: Action
During the action or trial stages, students
learn a lot about Adventist health behavior, how much they like it and how much
effort it requires. Students in this stage are characterized by observable
change in behaviors, that is, they are eating more plant foods but fewer animal
foods, exercising with useful work, drinking pure water, exposure mile sunlight,
avoiding the use of harmful substance and practicing judicious use of
non-harmful foods, obtaining pure air, and trying to get suitable rest and
sleeping regularly.
l Expected Outcome:
Changed behavior
l
229
Education
Approach: Skill, reinforcement, support, self-management, attitude change
Stage 5: Maintenance
In the maintenance stage, students work to stop
from reverting back to their previous pattern of their behavior.
l Expected Outcome:
Continuation
l Education Approach:
Relapse prevention skills, self-management, social and environmental support
Stage 6: Termination
One in the termination stage, students have adopted a new pattern of Adventist health behavior,
which should last into this
Relapse
Relapse may be gradual
or sudden (Wierenga, 1991). It is important to keep in mind that relapse is
more common than linear progression through these stages (Prochaska and
Goldstein, 1991). It is helpful to think of the stage and relapse as cyclical.
We, as a Christian teacher, trying to change students¡¯ attitude and behavior
toward SDA, often view relapse as a failure. This stage description allows us
to see relapse as part of the learning or adopting process, so we should not be
disappointed or give up.
IV.
CONCLUSION
230
What does this model
tell us about changing students' Adventist health behaviors. Students need to progress through these
stages. If they are in the early stages (precontemplation
stage), action oriented advice and interaction is likely to be ineffective.
Health educators as Christian teachers should help students have increased
awareness about the importance of Adventist values in health. We must be able
to identify students who do not exhibit these behaviors as our target
population. We must be able to identify which stage each student in our target
population is in. Multiple strategies must be developed to students in each of
the various stages. The Biblical Adventist worldview of the human and health
can help students understand God¡¯s original plan. The greater responsibility
lies with the educators. Adventist institutions should endeavor to put into
practice health message to teach them a Biblical view. The teaching methods to
increase awareness of the importance of Adventist health principles should be
applied to students according to their stage of change.
In
light of Proverbs 3, it is awesome to contemplate what can become of our students.
They could be well-known doctors, musicians, missionaries, etc. If I find the
fact they were my students who attended the
REFERENCES
231
1.
Church Bulletin: Fundamental Beliefs of
Seventh-day Adventist.
2.
Glanz, K., Lewis, F.M., & Rimer, B.K.
(Eds.) (1997). Health Behavior and Health Education: Theory Research and
Practice.
3.
Graeff J.A., Elder, J.P., & Booth,
E.M. (1993). Communication for Health and Behavior Change: A Developing Country
Perspective
4.
Matthews, D.A., Larson D.B., Barry C.P.
(1993). The Faith Factor: An Annotated Bibliography of Clinical Research on
Spiritual Subjects, Vol. 1,
5.
Neer,
R.M. (1975). The evolutionary significance of Vitamin D skin pigment and ultra
violet light. Am J Phys Anthropot. Nov, 43(3): 409-16.
6.
Prochaska, J. and DiClemente, C. (1992). Stages of change in the
modification of problem behaviors. Progress in Behavior Modification 28,
pp. 183-218.
7.
Prochaska, J.O. (1979). Systems of
Psychotherapy: a Transtheoretical Analysis. Pacific, CA:Brooks-Cole.
8.
Prochaska, J.O., & DiClemente, C.C.
(1982). Transtheoretical therapy toward a more integrative model of change.
Psychotherapy: Theory, Research and Practice, 19(3), 276-287.
9.
Prochaska, J.O., Norcross, J.C., &
DiClemente, C.C. (1994). Changing for Good.
10. Seventh-Day Adventist Believe: A
Biblical Exposition of 27 Fundamental Doctrines. 1988. p.84.
11. Williams
and Knight (1995). Health for life. Brooks/Core Publi
12. White,
E.G. (1890). Christian Temperance and Bible Hygiene.
13. White,
E.G. (1942). Ministry of Healing.
14. White,
E.G. (1946). Counsels on Diet and Foods. Vol. 1.
15. White,
E.G. (1974). Ministry of Healing.
16. White,
E.G. Hygiene. Healthful Living. p. 155.
17. White,
E.G. Medical Ministry. p.225.
18. White,
E.G. Mind, Character, and Personality: Guidelines to Mental and Spiritual
Health, p.60.
19. White,
E.G. Recreation that yields enduring satisfaction, p.506.
20. WHO
(1978). Primary Health Care
21. Wierenga, M. (1991).
The smoking cessation process.
APPENDIX: Questionnaire
232
Stages of Change
Algorithm
NEWSTART
Nutrition:
Eat more plant foods but fewer animal foods.
Exercise:
Exercise with useful work.
Water:
Drink pure water frequently.
Sunlight:
Exposure mild sunlight.
Temperance:
Avoid the use of dangerous substances and judicious use of non-harmful foods.
Air:
Obtain the purest air as possible.
Rest:
Try to get suitable rest and sleep regularly
Trust
in God: love or trust God and to accept love God completely.
1. I
currently do not practice NEWSTART behaviors
1) True 2)
False.
2. I
intend to change NEWSTART behaviors in the next 6 months.
1) True 2)
False
3. I
currently practice NEWSTART behaviors regularly.
1) True 2)
False
4. I
have practiced NEWSTART behaviors for the past 6 months.
1) True 2)
False
Note:
The scoring
instructions for each stage:
If Item 1=true and
Item 2=false, then =Precontemplation.
If Item 1=true and Item2=true,
then=Contemplation.
If Item1=false and
Item3=false, then=Preparation.
If Item3=true and
Item4=false, then=Action.
If Item3=true and
Item4=true, then=Maintenance