Motivation Factors for Stages of Behavioral Change among Individuals with Metabolic Syndrome

Rhayun Song; Moonkyoung Park

doi:10.7475/KJAN.2018.30.1.60

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Motivation Factors for Stages of Behavioral Change among Individuals with Metabolic Syndrome

Rhayun Song¹, Moonkyoung Park²

Korean Journal of Adult Nursing 2018;30(1):60-69.
Published online: February 18, 2018

DOI: https://doi.org/10.7475/KJAN.2018.30.1.60

¹College of Nursing, Chungnam National University, Daejeon, Korea

²Department of Nursing, Woosong College, Daejeon, Korea

Corresponding author: Park, Moonkyoung https://orcid.org/0000-0001-6693-0540 Department of Nursing, Woosong College, 171 Dongdeajeon-ro, Dong-gu, Daejeon 34518, Korea. Tel: +82-42-629-6745, Fax: +82-42-629-6749, E-mail: mkpark@wsi.ac.kr,

- This research was supported by basic science research program through the National Research Foundation of Korea (2013R-1A-1A-2065536).

• Received: October 14, 2017 • Accepted: February 18, 2018

This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/ by-nc/3.0), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Abstract
REFERENCES

Abstract

Purpose
The study aims were to examine motivation factors for behavioral modification among individuals with metabolic syndrome at each stage of behavioral change.
Methods
The correlational research design was used to explore motivation factors of self-efficacy, perceived benefits, perceived barriers, and emotional salience to explain health behaviors. Total of 239 patients with metabolic syndrome completed the structured questionnaire and the data were analyzed by SPSS/WIN 22.0 for ANOVA and multiple regression analysis.
Results
The average age of participants were 59 years old, and 52.3% perceived their health relatively worse than others. The motivation and health behaviors except for smoking cessation were significantly different at each stage of planning, preparation, and action-maintenance. The motivation factors explained 25% of variance in health behavior at planning stage, 38% at preparation stage, and 31% at action-maintenance stage. Self-efficacy and perceived barriers were significant pre-dictors at the planning and action-maintenance stages, while self-efficacy was a significant predictor at preparation stage.
Conclusion
The performance of health behaviors was significantly different at the stages of change along with a different set of motivation factors. Nursing strategies should focus on cognitive and emotional motivation factors to lead initiation and maintenance of behavioral modification in individuals with metabolic syndrome.
Key Words: Metabolic syndrome; Motivation; Health behavior; Nursing theory

Figure 1.

Conceptual framework.

Table 1.

General Characteristics of Participants according to the Stages of Behavioral Change (N=239)

Variables	Categories	Planning (n=84)	Preparation (n=74)	Action (n=81)	Total (N=239)	x² or F (p)
Variables	Categories	n (%) or M± SD	n (%) or M± SD	n (%) or M± SD	n (%) or M± SD	x² or F (p)
Age (year)		59.83±12.75	57.76±11.87	59.44±10.77	59.06±11.82	0.67 (.513)
Years of formal education received		11.42±4.20	12.54±3.72	12.00±3.32	11.96±3.78	1.75 (.176)
Gender	Male	38 (45.2)	31 (41.9)	46 (56.8)	115 (48.4)	2.86 (.145)
Gender	Female	46 (54.8)	43 (58.1)	35 (43.2)	124 (51.9)
Perceived economic status	High	3 (4.1)	3 (4.5)	4 (4.9)	10 (4.2)	3.75 (.440)
	Middle	59 (70.2)	58 (78.4)	65 (80.2)	182 (76.2)
	Low	22 (26.2)	13 (17.6)	12 (14.8)	47 (19.7)
Marital status	Married	61 (72.6)	52 (70.3)	68 (84.0)	181 (75.7)	7.86 (.248)
Marital status	Single/others	23 (27.4)	22 (29.8)	13 (16.0)	58 (24.3)
Chronic illness^†	Arthritis	19 (22.6)	17 (23.0)	17 (21.0)	53 (22.2)	1.97 (.741)
	Neuralgia	12 (14.3)	2 (2.7)	4 (4.9)	18 (7.5)	8.76 (.013)
	Respiratory disease	5 (6.0)	6 (8.1)	4 (4.9)	15 (6.3)	0.68 (.710)
	Vascular disease	22 (26.2)	20 (27.0)	29 (35.8)	71 (29.7)	2.19 (.334)
	Others	8 (9.5)	1 (1.4)	10 (12.3)	19 (7.9)	6.82 (.033)
Family history^†	Diabetes	24 (28.6)	18 (24.3)	30 (37.0)	72 (30.1)	3.11 (.210)
	Hypertension	29 (34.5)	32 (43.2)	31 (38.3)	92 (38.5)	1.26 (.531)
	Cardiovascular disease	8 (9.5)	4 (5.4)	10 (12.3)	22 (9.2)	2.24 (.326)
	Others	7 (8.3)	5 (6.8)	4 (4.9)	16 (6.7)	0.76 (.683)
Risk factors of metabolic syndrome^†	Central obesity	69 (82.1)	65 (87.8)	67 (82.7)	201 (84.1)	1.13 (.568)
	High triglycerides	52 (61.9)	51 (68.9)	46 (56.8)	149 (62.3)	2.43 (.296)
	Low HDL cholesterol	47 (56.6)	40 (54.1)	40 (49.4)	128 (53.6)	0.56 (.755)
	Insulin resistance	47 (56.6)	38 (51.4)	48 (60.0)	134 (56.1)	0.72 (.696)
	High blood pressure	69 (82.1)	57 (78.1)	66 (81.5)	193 (80.8)	0.15 (.924)
Health perception compared to peers	Much worse	19 (22.6)	6 (8.1)	8 (9.9)	33 (13.8)	13.14 (.107)
	Worse	34 (40.5)	29 (39.2)	29 (35.8)	92 (38.5)
	Similar	24 (28.6)	27 (36.5)	31 (38.3)	82 (34.3)
	Better/much better	7 (8.3)	11 (16.3)	13 (16.1)	32 (13.4)
Smoking status	Never	47 (56.0)	46 (62.2)	44 (54.3)	137 (57.3)	4.35 (.361)
	Quit	16 (19.2)	17 (23.0)	23 (28.4)	56 (23.4)
	Current smoker	21 (24.9)	11 (14.9)	14 (16.3)	46 (19.2)
Exercise habits	None or rarely	57 (71.2)	21 (25.3)	6 (7.9)	84 (35.1)	151.99 (＜.001)
	Irregularly	21 (26.3)	45 (54.2)	8 (10.5)	74 (31.0)
	Regularly ＞2 times a week	2 (2.5)	17 (20.5)	62 (81.6)	81 (33.9)

^†Multi-morbidity.

Table 2.

Performance of Health Behaviors according to the Stages of Behavioral Change (N=239)

Variables (range)	Planning ^a (n=84)	Preparation ^b (n=74)	Action ^c (n=81)	F	p	Scheffé
Variables (range)	M± SD	M± SD	M± SD	F	p	Scheffé
Health Behavior (4~100)	62.06±11.00	67.31±10.48	76.76±9.58	42.27	＜.001	a＜b＜c
Health responsibility (6~~24)	15.57±3.54	16.45±3.49	18.77±3.46	18.20	＜.001	a, b＜c
Exercise (4~16)	7.48±2.19	9.15±2.89	11.76±2.78	55.36	＜.001	a＜b＜c
Diet (7~28)	17.57±4.52	19.02±4.50	22.32±4.08	25.42	＜.001	a, b＜c
Stress management (5~20)	12.27±3.22	12.72±2.34	14.00±2.72	8.29	＜.001	a, b＜c
Smoking cessation (3~12)	9.16±3.15	9.94±2.50	9.90±2.64	1.99	.138

Table 3.

Motivation Factors according to the Stages of Behavioral Change (N=239)

Variables (range)	Planning ^a (n=84)	Preparation ^b (n=74)	Action ^c (n=81)	F	p	Scheffé
Variables (range)	M± SD	M± SD	M± SD	F	p	Scheffé
Self-efficacy (10~70)	38.14±7.67	45.75±8.21	51.63±7.63	61.55	＜.001	a＜b＜c
Perceived benefit (7~49)	38.74±4.73	39.62±4.99	42.30±4.47	12.52	＜.001	a, b＜c
Perceived barrier (10~70)	39.06±7.69	43.78±8.32	49.34±8.58	32.50	＜.001	a＞b＞c
Perceived barrier (10~70)	39.06±7.69	43.78±8.32	49.34±8.58	32.50	＜.001	a＜b＜c
Emotional salience (12~84)	46.77±7.78	50.68±6.97	57.81±7.13	47.96	＜.001	a＜b＜c

Table 4.

Motivation Factors to Predict Health Behaviors according to the Stages of Behavioral Change (N=239)

Model	B	SE	β	t (p)	VIF	Adj. R²	F (p)
Planning stage (n=84)						0.25	7.81 (＜.001)
(Constant)	39.47	11.39		3.46 (.001)
Self-efficacy	0.67	0.15	0.47	4.48 (＜.001)	1.19
Perceived benefit	0.44	0.24	0.19	1.89 (.064)	1.13
Perceived barrier	-0.31	0.14	-0.21	-2.22 (.029)	1.02
Emotional salience	-0.16	0.15	-0.11	-1.05 (.295)	1.30
Preparation stage (n=74)						0.38	12.24 (＜.001)
(Constant)	12.53	11.47		1.09 (.278)
Self-efficacy	0.59	0.14	0.46	4.28 (＜.001)	1.38
Perceived benefit	0.38	0.22	0.18	1.74 (.086)	1.26
Perceived barrier	0.01	0.13	0.01	0.11 (.913)	1.23
Emotional salience	0.24	0.17	0.16	1.44 (.156)	1.46
Action stage (n=81)						0.31	10.05 (＜.001)
(Constant)	55.53	13.59		4.16 (＜.001)
Self-efficacy	0.40	0.16	0.32	2.49 (.015)	1.94
Perceived benefit	0.02	0.25	0.01	0.07 (.942)	1.54
Perceived barrier	-0.29	0.13	-0.26	-2.16 (.034)	1.65
Emotional salience	0.13	0.19	0.10	0.70 (.488)	2.26

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Motivation Factors for Stages of Behavioral Change among Individuals with Metabolic Syndrome

Korean J Adult Nurs. 2018;30(1):60-69. Published online February 28, 2018

DOI: https://doi.org/10.7475/kjan.2018.30.1.60

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Motivation Factors for Stages of Behavioral Change among Individuals with Metabolic Syndrome

Korean J Adult Nurs. 2018;30(1):60-69. Published online February 28, 2018

DOI: https://doi.org/10.7475/kjan.2018.30.1.60

Figure

Motivation Factors for Stages of Behavioral Change among Individuals with Metabolic Syndrome

Figure 1. Conceptual framework.

Figure 1.

Motivation Factors for Stages of Behavioral Change among Individuals with Metabolic Syndrome

Table 1.

General Characteristics of Participants according to the Stages of Behavioral Change (N=239)

Variables	Categories	Planning (n=84)	Preparation (n=74)	Action (n=81)	Total (N=239)	x² or F (p)
Variables	Categories	n (%) or M± SD	n (%) or M± SD	n (%) or M± SD	n (%) or M± SD	x² or F (p)
Age (year)		59.83±12.75	57.76±11.87	59.44±10.77	59.06±11.82	0.67 (.513)
Years of formal education received		11.42±4.20	12.54±3.72	12.00±3.32	11.96±3.78	1.75 (.176)
Gender	Male	38 (45.2)	31 (41.9)	46 (56.8)	115 (48.4)	2.86 (.145)
Gender	Female	46 (54.8)	43 (58.1)	35 (43.2)	124 (51.9)
Perceived economic status	High	3 (4.1)	3 (4.5)	4 (4.9)	10 (4.2)	3.75 (.440)
	Middle	59 (70.2)	58 (78.4)	65 (80.2)	182 (76.2)
	Low	22 (26.2)	13 (17.6)	12 (14.8)	47 (19.7)
Marital status	Married	61 (72.6)	52 (70.3)	68 (84.0)	181 (75.7)	7.86 (.248)
Marital status	Single/others	23 (27.4)	22 (29.8)	13 (16.0)	58 (24.3)
Chronic illness^†	Arthritis	19 (22.6)	17 (23.0)	17 (21.0)	53 (22.2)	1.97 (.741)
	Neuralgia	12 (14.3)	2 (2.7)	4 (4.9)	18 (7.5)	8.76 (.013)
	Respiratory disease	5 (6.0)	6 (8.1)	4 (4.9)	15 (6.3)	0.68 (.710)
	Vascular disease	22 (26.2)	20 (27.0)	29 (35.8)	71 (29.7)	2.19 (.334)
	Others	8 (9.5)	1 (1.4)	10 (12.3)	19 (7.9)	6.82 (.033)
Family history^†	Diabetes	24 (28.6)	18 (24.3)	30 (37.0)	72 (30.1)	3.11 (.210)
	Hypertension	29 (34.5)	32 (43.2)	31 (38.3)	92 (38.5)	1.26 (.531)
	Cardiovascular disease	8 (9.5)	4 (5.4)	10 (12.3)	22 (9.2)	2.24 (.326)
	Others	7 (8.3)	5 (6.8)	4 (4.9)	16 (6.7)	0.76 (.683)
Risk factors of metabolic syndrome^†	Central obesity	69 (82.1)	65 (87.8)	67 (82.7)	201 (84.1)	1.13 (.568)
	High triglycerides	52 (61.9)	51 (68.9)	46 (56.8)	149 (62.3)	2.43 (.296)
	Low HDL cholesterol	47 (56.6)	40 (54.1)	40 (49.4)	128 (53.6)	0.56 (.755)
	Insulin resistance	47 (56.6)	38 (51.4)	48 (60.0)	134 (56.1)	0.72 (.696)
	High blood pressure	69 (82.1)	57 (78.1)	66 (81.5)	193 (80.8)	0.15 (.924)
Health perception compared to peers	Much worse	19 (22.6)	6 (8.1)	8 (9.9)	33 (13.8)	13.14 (.107)
	Worse	34 (40.5)	29 (39.2)	29 (35.8)	92 (38.5)
	Similar	24 (28.6)	27 (36.5)	31 (38.3)	82 (34.3)
	Better/much better	7 (8.3)	11 (16.3)	13 (16.1)	32 (13.4)
Smoking status	Never	47 (56.0)	46 (62.2)	44 (54.3)	137 (57.3)	4.35 (.361)
	Quit	16 (19.2)	17 (23.0)	23 (28.4)	56 (23.4)
	Current smoker	21 (24.9)	11 (14.9)	14 (16.3)	46 (19.2)
Exercise habits	None or rarely	57 (71.2)	21 (25.3)	6 (7.9)	84 (35.1)	151.99 (＜.001)
	Irregularly	21 (26.3)	45 (54.2)	8 (10.5)	74 (31.0)
	Regularly ＞2 times a week	2 (2.5)	17 (20.5)	62 (81.6)	81 (33.9)

^†Multi-morbidity.

Table 2.

Performance of Health Behaviors according to the Stages of Behavioral Change (N=239)

Variables (range)	Planning ^a (n=84)	Preparation ^b (n=74)	Action ^c (n=81)	F	p	Scheffé
Variables (range)	M± SD	M± SD	M± SD	F	p	Scheffé
Health Behavior (4~100)	62.06±11.00	67.31±10.48	76.76±9.58	42.27	＜.001	a＜b＜c
Health responsibility (6~~24)	15.57±3.54	16.45±3.49	18.77±3.46	18.20	＜.001	a, b＜c
Exercise (4~16)	7.48±2.19	9.15±2.89	11.76±2.78	55.36	＜.001	a＜b＜c
Diet (7~28)	17.57±4.52	19.02±4.50	22.32±4.08	25.42	＜.001	a, b＜c
Stress management (5~20)	12.27±3.22	12.72±2.34	14.00±2.72	8.29	＜.001	a, b＜c
Smoking cessation (3~12)	9.16±3.15	9.94±2.50	9.90±2.64	1.99	.138

Table 3.

Motivation Factors according to the Stages of Behavioral Change (N=239)

Variables (range)	Planning ^a (n=84)	Preparation ^b (n=74)	Action ^c (n=81)	F	p	Scheffé
Variables (range)	M± SD	M± SD	M± SD	F	p	Scheffé
Self-efficacy (10~70)	38.14±7.67	45.75±8.21	51.63±7.63	61.55	＜.001	a＜b＜c
Perceived benefit (7~49)	38.74±4.73	39.62±4.99	42.30±4.47	12.52	＜.001	a, b＜c
Perceived barrier (10~70)	39.06±7.69	43.78±8.32	49.34±8.58	32.50	＜.001	a＞b＞c
Perceived barrier (10~70)	39.06±7.69	43.78±8.32	49.34±8.58	32.50	＜.001	a＜b＜c
Emotional salience (12~84)	46.77±7.78	50.68±6.97	57.81±7.13	47.96	＜.001	a＜b＜c

Table 4.

Motivation Factors to Predict Health Behaviors according to the Stages of Behavioral Change (N=239)

Model	B	SE	β	t (p)	VIF	Adj. R²	F (p)
Planning stage (n=84)						0.25	7.81 (＜.001)
(Constant)	39.47	11.39		3.46 (.001)
Self-efficacy	0.67	0.15	0.47	4.48 (＜.001)	1.19
Perceived benefit	0.44	0.24	0.19	1.89 (.064)	1.13
Perceived barrier	-0.31	0.14	-0.21	-2.22 (.029)	1.02
Emotional salience	-0.16	0.15	-0.11	-1.05 (.295)	1.30
Preparation stage (n=74)						0.38	12.24 (＜.001)
(Constant)	12.53	11.47		1.09 (.278)
Self-efficacy	0.59	0.14	0.46	4.28 (＜.001)	1.38
Perceived benefit	0.38	0.22	0.18	1.74 (.086)	1.26
Perceived barrier	0.01	0.13	0.01	0.11 (.913)	1.23
Emotional salience	0.24	0.17	0.16	1.44 (.156)	1.46
Action stage (n=81)						0.31	10.05 (＜.001)
(Constant)	55.53	13.59		4.16 (＜.001)
Self-efficacy	0.40	0.16	0.32	2.49 (.015)	1.94
Perceived benefit	0.02	0.25	0.01	0.07 (.942)	1.54
Perceived barrier	-0.29	0.13	-0.26	-2.16 (.034)	1.65
Emotional salience	0.13	0.19	0.10	0.70 (.488)	2.26

Table 1. General Characteristics of Participants according to the Stages of Behavioral Change (N=239)

†

Multi-morbidity.

Table 2. Performance of Health Behaviors according to the Stages of Behavioral Change (N=239)

Table 3. Motivation Factors according to the Stages of Behavioral Change (N=239)

Table 4. Motivation Factors to Predict Health Behaviors according to the Stages of Behavioral Change (N=239)

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Motivation Factors for Stages of Behavioral Change among Individuals with Metabolic Syndrome

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