A New Approach for Motivational Stage Assessment in PROVEN-DIA

Resumo

Introduction: The PROVEN-DIA is a multicenter randomized clinical trial evaluating a lifestyle change program for the prevention of type 2 diabetes in 1,590 individuals with prediabetes. The motivational stage is pivotal for lifestyle changes, yet no standardized tool pragmatically assesses it. In this study, we proposed a pragmatic approach to assess motivational stage for diet and physical activity (PA).

Objective: To describe the approach for assessing motivational stage, based on the Transtheoretical Model of Behavior Change, applied in the PROVEN-DIA study.

Methods: As part of the PROVEN-DIA intervention, two validated tools are used to establish SMART goals for dietary and PA changes. Diet is assessed with the Wheel of Cardiovascular Health Diet, a self-perception tool that evaluates intake across 12 food groups relevant to diabetes prevention, rated on a five-point Likert scale. PA is assessed with the International Physical Activity Questionnaire (IPAQ) to verify compliance with the WHO recommendation of ≥150 minutes/week of moderate-to-vigorous activity for chronic disease prevention. Based on these instruments and the Transtheoretical Model, we propose a classification of participants’ motivation for lifestyle change.

Results: Although the Transtheoretical Model describes five stages, results were categorized into three: precontemplation, contemplation/preparation, and action/maintenance. This simplification was chosen to facilitate the practical guidance of lifestyle changes within the intervention. To identify the motivational stage of dietary habits, responses of each food group “excellent” or “very good” are classified as action/maintenance. Responses of “good,” “poor,” or “very poor” prompted an additional question on intention to change; affirmative answers are classified as contemplation/preparation, and negative as precontemplation. For PA, ≥150 minutes/week of MVPA is classified as action/maintenance. Participants below this threshold are asked about their intention to become active; affirmative responses are categorized as contemplation/preparation, and negative as precontemplation.

Conclusion: This pragmatic approach shows promise for assessing motivational stage, though limitations remain as the method has not yet been validated. Importantly, this classification will also guide how study professionals tailor SMART goals for each participant.