The International Electronic Journal of Health Education

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IEJHE, Vol. 2(4), 178-179, October 1, 1999, Copyright 1999

Book Review:
Step Up to Wellness: A Stage-Based Approach.
Jan Galen Bishop and Steven G. Aladana. Boston: Allyn and Bacon, 1999.
Reviewed by Debbe Thompson1
1 MS, Doctoral Candidate, Department of Human Performance and Health Promotion, University of New Orleans
Corresponding author: Debbe Thompson, MS, Doctoral Candidate, Department of Human Performance and Health Promotion, University of New Orleans 70148; 504-280-6361 (phone), 504-280-6018 (fax), DFTHP@UNO.EDU

The Transtheoretical Model is an innovative theory that offers an integrative view of intentional behavior change. It posits that behavior change is a multi-step process that involves progression through a series of stages from precontemplation (not considering behavior change) to termination (no longer susceptible to cues to revert to the original behavior). Each stage has a specific task that must be accomplished before progressing to the next stage, and certain tools, called Processes of Change, play a primary role in accomplishing these stage-specific tasks by helping to develop skills and/or attitudes needed to progress along the continuum. Other important constructs in this model include decisional balance (which is the weighting that occurs between the pros and cons of changing the behavior) and self-efficacy. The literature contains a wealth of articles demonstrating the efficacy of this model and its ability to predict and/or explain volitional behavior. Stages of Change is the core construct of the model, and the model is commonly referred to as Stages of Change (Prochaska & Velicer, 1997).

Step Up to Wellness: A Stage-Based Approach is an entry-level college text on personal health and wellness topics which incorporates Stages of Change into its structure. Chapters 3 - 14 begin with a series of questions that helps the reader identify his/her stage for the behavior in question. Following presentation of the chapter material, stage-specific labs are offered, and the reader is directed to complete the lab that matches his/her current stage. At the conclusion of the final chapter (Chapter 15), behaviors addressed in the previous chapters are listed, and the reader is asked to identify his/her initial and current stage for each. The reader is then asked to complete a final lab in which s/he is asked to select a behavior that has not reached the maintenance stage and is then guided through a series of questions/activities designed to set goals for behavior change and to develop a plan to achieve these goals.

The guide's layout is easily navigated, and the titles are eye-catching. Each of the chapters has activities and each activity is segmented into how much time it will take to complete, what the purpose is, what materials are needed, the process of how to conduct the activity, and closing thoughts and hints. In most instances, the time is short (with a range for adjustments) and the materials are either the handouts contained in the appendix or simply one's "imagination." The closing thoughts and hints are from experienced teachers who have used the activities.

The text also has a strong emphasis on wellness, and Chapter 1 begins with an introduction to the concept of personal wellness. Wellness is presented in relation to quality of life, balance, and personal potential, with emphasis on the concepts of self responsibility and personal choice. Stages of Change is also introduced to the reader in this chapter, and it is followed by a discussion of goal setting and motivation. The concepts presented in Chapter 1 serve as the foundation for the text and are skillfully woven into the subsequent chapters in a manner that emphasizes the importance of personal choice and self responsibility on long-term health and quality of life.

Following the initial chapter, the remainder of the text is focused on topics related to fitness and health. Chapters 2 introduces the concept of physical fitness and distinguishes between health-related fitness and skill-related fitness. The components of fitness are introduced to the reader in this section and are elaborated on in Chapters 3 (cardiorespitory endurance), 4 (flexibility), 5 (muscular strength and endurance), and 7 (body composition). Additionally, this chapter discusses how to start an exercise program, what an exercise session needs to include, and how to maintain an exercise program. The chapters expanding on the components of fitness include current information as well as numerous assessments, charts, graphs, and/or illustrations. The chapters on muscular strength and endurance and flexibility are particularly useful in that they provide many illustrations demonstrating how to use weights and on how to stretch the body properly.

Starting with Chapter 6 and continuing with Chapters 8 through 15, the text shifts to a greater emphasis on health and includes topics such as nutrition (Chapter 6), weight management (Chapter 8), cardiovascular health (Chapter 9), cancer and other diseases (Chapter 10), stress (Chapter 11), healthy relationships (Chapter 12), sexually transmitted diseases (Chapter 13), substance abuse (Chapter 14), and personal wellness from a global perspective (Chapter 15). There are also abundant charts, graphs, figures, and illustrations throughout the text which help clarify, expand, and/or emphasize the written information. Numerous assessments located throughout the text help the reader identify personal risk levels, thereby helping make the information presented in the chapters more personal and relevant. Additionally, the text contains four appendices (Recommended Dietary Allowances, Nutritive Value of Selected Foods, Nutritive Value of Selected Fast Foods, and Common Sports Injuries) which serve as a useful resource for both course instructors and students. The text concludes with a comprehensive glossary that defines terms using easy-to-understand language.

Each chapter in the text also contains clearly stated, realistic behavioral objectives, key concepts, and a series of boxed information designed to enhance knowledge and/or mastery of the topic. Boxed information include "Barrier Busters" which address common barriers to behavior change and "Cognitive Corners" which provide additional information on a particular aspect of the topic or a related topic. Chapters conclude with a succinct summary that emphasizes and reinforces key ideas and concepts.

In general, the text is informative, provides current information, and is designed to be motivational and encourage behavior change. It is visually pleasing in that it makes liberal use of color, font changes, figures, tables, and assessments which reduces the number of text-only pages. Additionally, it is written in a straightforward manner that makes an outstanding effort to avoid the use of jargon. The text also places an emphasis on wellness and encourages the reader to view current behavior in terms of longterm health and quality of life.

Although the authors are to be commended on incorporating the Stages of Change model into the text, this reviewer questions the format of the stage-matched labs. The labs are primarily a series of questions that encourage the reader to examine current attitudes, perceptions, and/or behaviors that may interfere with healthy lifestyle practices. Although the questions asked in the labs are important and necessary for behavior change, this reviewer questions whether someone in the pre-action stages, particularly precontemplation, would have the requisite motivation to complete the labs. Precontemplators, by definition, are not yet convinced of the need to change and are therefore more resistant to change, making them less likely to appreciate the value of answering a series of questions about their behavior. Perhaps a way to overcome this would be to offer shorter, more focused, action-oriented labs that emphasize the primary task of each stage using stage-appropriate Processes of Change. For example, Precontemplators are typically unaware/under-aware of the need to change their behavior. Therefore, the "task" that needs to be accomplished before moving to Contemplation is increased awareness of the need to change. The Process of Change that may help accomplish this task is Consciousness Raising. This could be achieved by a targeted assessment that helps the individual become more aware of personal risk.

Additionally, Prochaska and Velicer (1997) contend that for a number of volitional behaviors, as individuals move from Precontemplation to Action, perception of benefits increases one standard deviation whereas the perception of barriers decreases one-half a standard deviation. Labs which concentrate on these tasks using stage-appropriate Processes and focused activities may offer an effective alternative to the question/answer format emphasized in the labs. Action-oriented labs which emphasize role playing, interviewing or observing role models who engage in the behavior, focused self-assessments, etc are only a few of the activities that could be offered in the pre-action stages. Varying the types of activities, keeping them focused, and making them relevant may be an effective technique for maintaining interest and encouraging participation in the labs, thereby promoting progression through the pre-action stages.

In summary, Step Up To Wellness: A Stage-Based Approach is an innovative text that emphasizes the importance of personalizing behavior change efforts. It addresses many of the topics included in college-level personal health and wellness courses and contains a wealth of information designed to help the reader progress along the behavior change continuum and/or maintain current healthy lifestyle choices. The authors are to be commended on the incorporation of Stages of Change into their text in an effort to promote more wellness-oriented lifestyle choices. In this reviewer's opinion, Step Up To Wellness: A Stage-Based Approach is an excellent text that would be appropriate for use in a college-level personal health and wellness course. Additionally, the wealth of current information, charts, graphs, and assessments contained in the text make it an excellent reference for both students and health education professionals.

Notice to Book Publishers:

To have your books reviewed, please send two (2) copies to:
Mark J. Kittleson, Ph.D.
Editor-in-Chief, IEJHE
307 Pulliam Hall, MS 4632
Southern Illinois University
Carbondale, IL 62901

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Copyright 1999 by IEJHE.