Stages of change for physical activity, diet, and smoking among HMO members with chronic conditions

Purpose. This paper investigated whether stage of change for health behaviors was associated with the presence of chronic conditions. Design. A stratified cross-sectional survey by mail with telephone followup. Settings. This study was conducted at a mixed-model HMO with 650,000 members based in Minnesota. Subjects. The sample consisted of a random sample of 8000 HMO members age 40 or over with systematic oversampling of members with hypertension, diabetes, dyslipidemia, or heart disease. Measures. In addition to demographics, readiness to change for physical activity, fat intake, fruit anti vegetable intake, and smoking were assessed. Results. The adjusted response rate was 82.4%. In a logistic regression analysis, members with one or more than one chronic condition had greater readiness to change for three out of four risk factors compared to members with no chronic conditions. Conclusions. The stage-of-change distribution of HMO members with chronic conditions suggests that members at highest risk of adverse health outcomes have the greatest readiness to change behavioral risk factors. Based on these observations, targeted, stage-specific efforts to support behavior change are likely to be both acceptable and effective in HMO members with chronic conditions. Improving stage of change for behavioral risk factors for members with diabetes may present special problems and opportunities.