kjan Korean Journal of Adult Nursing Korean J Adult Nurs 1225-4886 2288-338X Korean Society of Adult Nursing 10.7475/KJAN.2018.30.1.60 kjan-30-60 Original Research Motivation Factors for Stages of Behavioral Change among Individuals with Metabolic Syndrome SongRhayun 1 ParkMoonkyoung 2 College of Nursing, Chungnam National University, Daejeon, Korea Department 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).

 02 2018 18 02 2018 30 1 60 69 14102017 27012018 18022018 © 2018 Korean Society of Adult Nursing 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. 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.

 Metabolic syndrome Motivation Health behavior Nursing theory REFERENCES Panel NCEPE Third report of the national cholesterol education program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III) final report Circulation. 2002 106 25 3143421 Hong AR Lim S Clinical characteristics of metabolic syndrome in Korea, and its comparison with other Asian countries Journal of Diabetes Investigation. 2015 6 5 50815 https://doi.org/10.1111/jdi.12313 Jeong KS Korea health statistics 2015 Korea national health and nutrition examination survey (KNHANES VI-3) Seoul Korea Centers for Disease Control & Prevention 2016 December Report No.: 11-1351159-000027-10 Seong SC 2016 National health screening statistical yearbook Seoul National Health Insurance Service 2017 November. Report No.: 11-B550928-00004810 Bianchi C Penno G Daniele G Benzi L Del Prato S Miccoli R Optimizing management of metabolic syndrome to reduce risk: focus on life-style Internal and Emergency Medicine. 2008 3 2 8798 https://doi.org/10.1007/s11739-008-0122-6 Koh G Woo JT Prevention of metabolic syndrome Journal of the Korean Medical Association. 2005 48 12 118894 https://doi.org/10.5124/jkma.2005.48.12.1188 Jellinger PS Handelsman Y Rosenblit PD Bloomgarden ZT Fonseca VA Garber AJ American association of clinical endocrinologists and American college of endocrinology guide-lines for management of dyslipidemia and prevention of cardiovascular disease Endocrine Practice. 2017 23 Suppl 2 187 https://doi.org/10.4158/EP171764.APPGL Park JK Kweon S Kim Y Jang MJ Oh K Dietary behaviors re-lated to metabolic syndrome in Korean adults Korean Journal of Community Nutrition. 2012 17 5 66475 https://doi.org/10.5720/kjcn.2012.17.5.664 Oh EG Bang SY Hyun SS Chu SH Jeon YJ Kang MS Knowledge, perception and health behavior about metabolic syndrome for an at risk group in a rural community area Jour-nal of Korean Academy of Nursing. 2007 37 5 790800 https://doi.org/10.4040/jkan.2007.37.5.790 Bassi N Karagodin I Wang S Vassallo P Priyanath A Massaro E Lifestyle modification for metabolic syndrome: a systematic review The American Journal of Medicine. 2014 127 12 1242.e1-10. https://doi.org/10.1016/j.amjmed.2014.06.035 Tougas ME Hayden JA McGrath PJ Huguet A Rozario S A systematic review exploring the social cognitive theory of self- regulation as a framework for chronic health condition inter-ventions PLoS One. 2015 10 8 e0134977 https://doi.org/10.1371/journal.pone.0134977 Song R Analyzing motivational factors to predict health behaviors among older adults Journal of Korean Academy of Adult Nursing. 2006 18 4 52332 Rosenstock IM Strecher VJ Becker MH Social learning theory and the health belief model Health Education and Behavior. 1988 15 2 17583 https://doi.org/10.1177/109019818801500203 Kang JS Kang HS Yun EK Choi HR Factors influencing health behavior compliance of patients with metabolic syndrome Korean Journal of Adult Nursing. 2012 24 2 1919 https://doi.org/10.7475/kjan.2012.24.2.191 Beer JS What do we know about emotional influences on social cognition? A social neuroscience perspective Emotion Review. 2017 9 2 17280 https://doi.org/10.1177/1754073916650492 Williams DM Evans DR Current emotion research in health behavior science Emotion Review. 2014 6 3 27787 https://doi.org/10.1177/1754073914523052 Prochaska JO Velicer WF The transtheoretical model of health behavior change American Journal of Health Promotion. 1997 12 1 3848 https://doi.org/10.4278/0890-1171-12.1.38 Al-Otaibi HH Measuring stages of change, perceived barriers and self efficacy for physical activity in Saudi Arabia Asian Pacific Journal of Cancer Prevention. 2013 14 2 100916 https://doi.org/10.7314/apjcp.2013.14.2.1009 Hwang HJ Lee EN Choi EJ Discriminating factors of stages of change for exercise among patients with metabolic syndrome Journal of Muscle and Joint Health. 2014 21 1 4654 https://doi.org/10.5953/JMJH.2014.21.1.46 Faul F Erdfelder E Buchner A Lang AG Statistical power analyses using G∗Power 3.1: tests for correlation and regression analyses Behavioral Research Methods. 2009 41 4 1149- 60. https://doi.org/10.3758/BRM.41.4.1149 Velicer WF Prochaska JO Fava JL Norman GJ Redding CA Smoking cessation and stress management: applications of the transtheoretical model of behavior change Homeostasis. 1998 38 5-6 21633 Song R June KJ Ro YJ Kim CG Effects of motivation-enhancing program on health behaviors, cardiovascular risk factors, and functional status for institutionalized elderly women Jour-nal of Korean Academy of Nursing. 2001 31 5 85870 https://doi.org/10.4040/jkan.2001.31.5.858 Song R June KJ Kim CG Jeon MY Comparisons of motivation, health behaviors, and functional status among elders in residential homes in Korea Public Health Nursing. 2004 21 4 36171 https://doi.org/10.1111/j.0737-1209.2004.21410.x Kang KJ Yu SJ Health behavior and influencing factors in patients with coronary artery disease admitted to hospital Jour-nal of Korean Academy of Fundamental of Nursing. 2010 17 1 1625 Köpetz CE Lejuez CW Wiers RW Kruglanski AW Motivation and self-regulation in addiction: a call for convergence Perspectives on Psychological Science. 2013 8 1 324 https://doi.org/10.1177/1745691612457575 Vancampfort D Moens H Madou T De Backer T Vallons V Bruyninx P Autonomous motivation is associated with the maintenance stage of behaviour change in people with af-fective disorders Psychiatry Research. 2016 240 26771 https://doi.org/10.1016/j.psychres.2016.04.005S Figures and Tables

Conceptual framework.

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)
n (%) or M± SD n (%) or M± SD n (%) or M± SD n (%) or M± SD
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)
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)
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.

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
M± SD M± SD M± SD
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  

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
M± SD M± SD M± SD
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
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

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