研究生: |
林旭龍 Shiuh-long Lin |
---|---|
論文名稱: |
應用跨理論模式於大學女生身體活動之主客觀評價的研究 Application of Transtheoretical Model with Objective and Subjective Evaluation of Physical Activity on College Female Students |
指導教授: |
呂昌明
Lu, Chang-Ming |
學位類別: |
博士 Doctor |
系所名稱: |
健康促進與衛生教育學系 Department of Health Promotion and Health Education |
論文出版年: | 2000 |
畢業學年度: | 88 |
語文別: | 中文 |
論文頁數: | 243頁(含目錄﹑參考文獻及附錄等) |
中文關鍵詞: | 跨理論模式 、身體活動 、運動行為 、三度空間加速器 、七日回憶訪談法 、三日回憶記錄法 、女大學生 、能量消耗 |
英文關鍵詞: | transtheoretical model, physical activity, exercise behavior, TriTrac-R3D accelerometer, 7-d PAR, 3-d PAL, college female students, energy expenditure |
論文種類: | 學術論文 |
相關次數: | 點閱:354 下載:44 |
分享至: |
查詢本校圖書館目錄 查詢臺灣博碩士論文知識加值系統 勘誤回報 |
中文摘要
本研究運用自我研發之結構式問卷(內含運動自我效能、知覺運動障礙與知覺運動利益三個分量表)、Marcus & Simkin (1993)之運動階段分類量表、身體活動客觀測量法之TriTrac-R3D三度空間加速器、身體活動主觀估計法之七日回憶訪視問卷(seven-day physical activity recall,以下簡稱7-d PAR)以及三日回憶記錄問卷(three-day physical activity log,以下簡稱3-d PAL),其目的旨在驗證跨理論模式中之改變階段模式(The Stage of Change Model)是否具有良好之構念效度(construct validity),能否區別跨理論模式中運動自我效能、衡量作決定(知覺運動障礙與知覺運動利益)三個心理變項之差異,以及是否也能區別由主客觀方法中所估計之能量消耗之差異。本研究也以TriTrac-R3D作為效標探討7-d PAR與3-d PAL之信度和效度,並比較其間之差異、關聯與實用性。
研究對象共73名,係由88學年度上學期在學之大學院校女生中募集而來。每名研究對象均佩戴TriTrac-R3D八天(共7個完整日),監測其身體活動情形。在訪視員解說後,填寫結構式問卷,並攜回3-d PAL三份,藉以記錄週六、週日及平日任選一日之身體活動情形。一週後接受以訪視員為主(interviewer-administered)之7-d PAR訪視。兩週後,相同之結構式問卷、3-d PAL 與7-d PAR予以重複施測。使用之統計方法包括:敘述統計、驗證式因素分析、one-way MANOVA、two-way repeated measures ANOVA、獨立樣本t 考驗、配對樣本t考驗、線性迴歸、斯皮爾曼等級相關、kappa一致性分析等。本研究所得重要發現與結論如下:
一、本研究所研發之結構式問卷量表,具有良好之內部一致性信度(r=.87~.89)、再測信度(r=.77~.90)與構念效度,可用於影響大學女生運動行為心理變項(運動自我效能、知覺運動障礙與知覺運動利益)之施測。
二、Marcus & Simkin (1993)所研發之運動階段分類量表具有良好之內部一致性信度(KR20=.84)、再測信度(The Kappa coefficient of agreement=.81)與構念效度。其再測信度愈高,對於改變階段模式之構念效度也會隨之提升。
三、跨理論模式中之改變階段模式(The stage of change model)具有良好之構念效度,可區別影響運動行為之心理變項(Pillai’s Trace=.793, F(12,204)=6.106, P< .001, multivariate η2 =.264)以及身體活動量(Pillai’s Trace=.456, F(12, 204)=3.05, P< .001, multivariate η2 =.152)。
四、跨理論模式中之自我效能理論與衡量作決定理論中之知覺障礙呈現負相關,Spearman rho= -.89(p< .001),與知覺利益間呈現正相關Spearman rho= .50(p< .001)。知覺障礙與知覺利益間呈現負相關Spearman rho= -.41(p< .001)。運動自我效能、知覺運動障礙與知覺運動利益三者皆可預測身體活動量,其中以運動自我效能可解釋之變異量13.6%最大,其次為知覺運動障礙11.5%,而以知覺運動利益10.5%較低。
五、衡量作決定理論中,知覺運動障礙與知覺運動利益在五個不同運動階段間,兩者均呈現線性關係,而兩線交叉於準備期,其分數略低於平均值。此意味著位於準備期之研究對象雖尚未採取規律運動,但即將產生行為改變。
六、7-d PAR與3-d PAL具有良好之同時效度(分別為.86與.81,P< .001),與再測信度(分別為.97與.95,p< .001)。其中以7-d PAR與客觀能量消耗數據(TriTrac-R3D數據)較為接近,3-d PAL則有較大之落差。但於大規模社會調查研究或流行病學研究時,3-d PAL施測較為簡便,7-d PAR則須花費較多的人力與時間成本。
關鍵字:跨理論模式、身體活動、運動行為、三度空間加速器、七日回憶訪談法、三日回憶記錄法、女大學生、能量消耗
Abstract
The purpose of this research was to examine the construct validity and utility of the stages of Change Model that is one part of the Transtheoretical Model created by Prochaska and DiClemente. A self-developed structured questionnaire included self-efficacy for exercise scale, perceived barriers to exercise scale, perceived benefits of exercise scale, with Exercise Stage instrument created by Marcus & Simkin were using to this research. Also, the TriTrac-R3D accelerometer as an objective instrument for estimation of physical activity and two subjective instruments: interviewer-administered seven-day physical activity recall questionnaire (7-d PAR), and three-day physical activity log (3-d PAL) were using to examine the construct validity of the stages of change model too. Meanwhile, The concurrent validity and test-retest reliability of 7-d PAR and 3-d PAL were examined and compared by TriTrac-R3D, which was used as a criterion.
73 female college students were recruited to join this research. They were instructed by interviewer to wear correctly the TriTrac-R3D on their waist site for 7 days, and to record the 3-d PAL seriously 3 days (Saturday, Sunday and one of the weekdays as they preferred). As regard to 7-d PAR the subjects were interviewed one week later. The same structured questionnaire, 7-d PAR and 3-d PAL were retested two weeks later. As the end of data collection the Statistics analytical method such as descriptive statistics, confirmatory factor analysis, one-way MANOVA, two-way repeated measures ANOVA, paired samples t-test, independent samples t-test, univariate linear regression, Spearman rank correlation and The Kappa agreement of measures etc. were used for data analysis. From which the following conclusion were drawn:
1.The self-developed structured questionnaire has high cofficient of internal consistency (r= .87~ .89), test-retest reliability (r= .77~ .90) and construct validity. They might be used for further research of physical activity in female college students.
2.The Exercise Stage Instrument created by Marcus & Simkin, which was used in this research, also revealed high coefficient of internal consistency (KR20= .84), test-retest reliability (The Kappa coefficient of agreement= .81) and construct validity. The higher the test-retest reliability be got, the higher construct validity of the stages of change model will be.
3.The construct validity of the stages of Change Model was verified. Significant differences were revealed in three psychological variables (self-efficacy for exercise, perceived barriers to exercise, and perceived benefits of exercise). (Pillai’s Trace= .793, F (12,204)=6.106, P< .001, multivariate η2 = .264). Also, Significant differences were revealed in TriTrac-R3D, 7-d PAR and 3-d PAL variables. (Pillai’s Trace= .456, F (12, 204)=3.05, P < .001, multivariate η2 = .152).
4.Negative association found between self-efficacy for exercise and perceived barriers to exercise Spearman rho= -.89(p< .001), it was also found negative association between perceived barriers and perceived benefits of exercise Spearman rho= -.41(p< .001), but positive association found between self-efficacy for exercise and perceived benefits of exercise Spearman rho= .50(p< .001). Linear regression analysis revealed that these three psychological variables could predict physical activity (kcal/d) estimated by TriTrac-R3D. The variance accounted for by self-efficacy was 13.6%, by perceived barriers was 11.5% and by perceived benefits was 10.5%.
5.At a glance of line chart, it revealed a linear relationship of perceived barriers between pre-contemplation, contemplation, preparation, action and maintenance stage. And conversely linear relationship of perceived benefits between the 5 exercise stages was found. The two lines cross at preparation stage, which T-score was below average. It implies that the subjects in this stage are not ready for exercise but soon will take action when they make decision about the pros and cons of exercise.
6.Using Spearman rank correlation method to examine the concurrent validity and test-retest reliability of 7-d PAR and 3-d PAL. The concurrent validity of 7-d PAR was .86(p< .001), and 3-d PAL was .81(p< .001), respectively. The test-retest reliability of 7-d PAR was .97(p< .001), and 3-d PAL was .95(p< .001), respectively. For comparison of 7-d PAR and 3-d PAL, The data of estimation of physical activity by 7-d PAR closely followed TriTrac-R3D but underestimated, whereas 3-d PAL had relatively large difference and overestimated compared by TriTrac-R3D. Nevertheless, 3-d PAL is low-cost and practical for large population community-based social survey or epidemiological research.
Key words: transtheoretical model, physical activity, exercise behavior, TriTrac-R3D accelerometer, 7-d PAR, 3-d PAL, college female students, energy expenditure.
參考文獻
方進隆(民86) 健康體能的理論與實際。台北:漢文書店。
王文科(民86) 教育研究法(增訂新版)。台北市:五南圖書。
江界山、吳慧君(民87) 八十六年度提昇國民體能專案體能檢測報告。華岡理科學報,15,87-126。
行政院衛生署(民83) 台灣北部地區30-50歲就業人口運動量及健康體能常模之測定。台北市:行政院衛生署編印。
行政院衛生署(民87) 中華民國公共衛生概況。台北市:行政院衛生署編印。
行政院衛生署(民88) 國民營養現況1993,1996國民營養健康狀況變遷調查結果。台北市:行政院衛生署編印。
行政院衛生署保健處(民87) 工作項目及成果。台北市:行政院衛生署保健處業務報告資料(公佈於網際網路)。
行政院衛生署食品衛生處(民82) 每日營養素建議攝取量(Recommended Daily Nutrient Allowances; RDNA)。台北市:行政院衛生署修訂。
吳明隆(民89) SPSS統計應用實務。台北市:松崗電腦圖書資料股份有限公司。
呂昌明、李明憲、楊啟賢(民86) 都市學童規律運動行為及其影響因素之研究。衛生教育論文集刊,10,53-66。
呂昌明、林旭龍、黃奕清、李明憲(民88) 體能活動自我報告量表之效度及信度的研究。行政院國科會專題研究計畫成果報告(NSC 88-2413-H-003-040)。
李明憲(民87) 國小、國中學生體能活動、健康體能相關影響因素之調查研究─以花蓮縣宜昌國民小學、宜昌國民中學兩所學校為例。台北市:國立台灣師範大學衛生教育研究所博士論文。
李蘭、陸玓玲、李隆安、黃美維、潘怜燕、鄧肖琳(民84) 台彎地區成人的健康行為探討,分布情形、因素結構和相關因素。中華公共衛生雜誌,14(4),358-367。
季瑋珠、符春美(民81) 社區民眾從事體能活動之研究。中華公共衛生雜誌,11(4),328-340。
張春興(民87) 張氏心理學辭典二版四刷。台北市:東華書局。
教育部(民84) 八十三學年度學生體能檢測報告書。台北市:教育部體育司編印。
教育部(民85) 教育部八十五年度提昇國民體能專案體能檢測報告書。台北市:教育部體育司編印。
教育部(民89) 中華民國大專院校概況統計。台北市:教育部統計處編印。
郭生玉(民87) 心理與教育研究法(第15版)。中和市:精華書局。
蔡淑菁(民85) 台北市國小學童體能活動及其影響因素之研究。台北市:國立台灣師範大學衛生教育研究所碩士論文。
Ajzen, I. (1985). From intentions to actions: A theory of planned behavior. In Kuhl, J. & Beckman, J. (Eds.) Action control: From cognition to behavior (pp. 11-39). New York: SpringerVerlag.
Ajzen, I., & Fishbein, M. (1980). Understanding Attitudes and Predicting Social Behavior. Englewood Cliffs, New Jersey: Prentice Hall.
American College of Sports Medicine (1995). Guidelines for Exercise Testing and Prescription. Philadelphia: Lea & Febiger.
Armstrong, C. A. (1998). The Stage of change in exercise adoption and adherence: Evaluation of measures with self-report and objective data. Unpublished doctoral dissertation. University of California, San Diego.
Armstrong, C. A., Sallis, J. F., Hovell, M. F., & Hofstetter, C. R. (1993). Stages of change, self-efficacy, and the adoption of vigorous exercise: A prospective analysis. Journal of Sport and Exercise Psychology, 15, 390-402.
Bandura, A. (1977). Self-efficacy: Toward a unifying theory of behavior change. Psychological Bulletin, 84, 191-215.
Bandura, A. (1986). Social Foundations of Thought and Action. Englewood Cliffs, New Jersey: Prentice Hall.
Bender, S. J., Neutens, J. J., Skonie-Hardin, S., & Sorochan, W. D. (1997). Teaching Health Science: Elementary and Middle School. (4th ed.). Massachusetts: Jones and Bartlett Publishers.
Blair, S. N. (1984). How to assess exercise habits and physical fitness. In Behavioral Health: A Handbook of Health Enhancement and Disease Prevention. Matarazzo, J. D., Herd, J. A. Miller,
N. E. and Weiss, S. M. (Eds.). New York: John Wiley & Sons, pp. 424-447.
Bouchard, C., Tremblay, A., LeBlang, C., Lortie, G., Sauard, R., & Therialt, G. A. (1983). Method to assess energy expenditure in children and adults. American Journal of Clinical Nutrition, 37, 461-467.
Cardinal, B. J. (1995). The stages of exercise scale and stages of exercise behavior in female adults. Journal of Sports Medicine and Physical Fitness, 35, 87-92.
Cardinal, B. J. (1997). Construct validity of stages of change for exercise behavior. American Journal of Health Promotion, 12(1): 68-74.
Caspersen, C. J., Powell, K. E., & Christenson, G. M. (1985). Physical activity, exercise, and physical fitness: Definition and distinctions for health-related research. Public Health Reports, 100, 126-131.
Cicchetti, D. V., & Sparrow, S. A. (1981). Developing criteria for establishing interrater reliability of specific items: Application to assessment of adaptive behavior. American Journal of Mental Deficiency, 86(2), 127-137.
Cohen, J. (1988). Statistical Power Analysis for the Behavioral Sciences. (2nd ed.). Hillsdale, NJ: Erlbaum.
DiClemente, C. C., Prochaska, J. O., & Gibertini, M. (1985). Self-efficacy and the stages of self-change of smoking. Cognitive Therapy and Research. 9(2), 181-200.
Diclemente, C. C., Prochaska, J. O., Fairhurst, S. K., Velicer, W. F., Velasquez, M. M., & Rossi, J. S. (1991). The process of smoking cessation: An analysis of precontemplation, contemplation, and preparation stages of change. Journal of Consulting and Clinical Psychology, 59, 295-304.
Dishman, R. K. (1994). The measurement conundrum in exercise adherence research. Medicine and Science in Sports and Exercise, 26(11), 1382-1390.
Dishman, R. K. (1994) Advances in Exercise Adherence. Champaign, IL: Human Kinetics Publishers Inc.
Fleiss, J. L. (1981). Statistical Methods for Rates and Proportions (2nd ed.). New York: John Wiley & Sons.
Glanz, K., Lewis, F. M., & Rimer, B. K. (1997). Health Behavior and Health Education. San Francisco, CA: Jossey-Bass.
Green, S. B., Salkind, N. J., & Akey, T. M. (2000). Using SPSS for Windows-Analyzing and Understanding Data (2nd ed.). New Jersey: Prentice-Hall Inc.
Grimm, L.G., & Yarnold P. R. (1998). Reading and Understanding Multivariate Statistics. Washington, DC: American Psychological Association.
Gross, L. D., Sallis, J. F., Buono, M. J., Roby, J. J., & Nelson, J. A. (1990). Reliability of interviewers using the Seven-Day Physical Activity Recall. Research Quarterly for Exercise and Sport, 61(4), 321-325.
Huang, Y.C. (1994). Relationship of sociodemographic and physical activity variables to physical fitness of Taiwanese junior high school students. Unpublished doctoral dissertation .The University of Texas at Austin.
Janis, I. L., & Mann, L. (1977). Decision Making. New York: Macmillan.
Kochersberger, G., McConnell, E., Kuchibbatla, M. N., & Pieper, C. (1996). The reliability, validity, and stability of a measure of physical activity in the elderly. Archives of Physical Medicine and Rehabilitation, 77, 793-795.
LaPorte, R. E., Montoye, H. J., and Caspersen C. J. (1985). Assessment of physical activity in epidemiological research: Problems and Prospects. Public Health Report, 100,131-146.
Marcus, B. H., Selby, V. C., Niaura R. S., & Rossi, J. S. (1992). Self-efficacy and the stages of exercise behavior change. Research Quarterly for Exercise and Sport, 63(1), 60-66.
Marcus, B.H., & Owen, N. (1992). Motivational readiness, self-efficacy and decision-making for exercise. Journal of Applied Social Psychology, 22, 3-16.
Marcus, B.H., Pinto, B.M., Simkin, L.R., Audrain, J.E., & Taylor, E.R. (1994). Application of theoretical models to exercise behavior among employed women. Journal of Health Promotion, 9(1), 49-55.
Marcus, B.H., Rakwoski, W., & Rossi, J.S. (1992). Assessing motivational readiness and decision-making for exercise. Health Psychology, 11, 257-261.
Marcus. B. H., & Simkin. L. R. (1993). The stages of exercise behavior. The Journal of Sports Medicine and Physical Fitness, 33(1), 83-88.
Mathews, C. E., & Freedson, P. S. (1995). Field trial of a three-dimensional physical activity monitor: Comparison with self-report. Medicine and Science in Sports and Exercise, 27(7), 1071-1078.
Miller, D. J., Freedson, P. S., & Kline, G. M. (1994). Comparison of activity levels using the Caltrac accelerometer and five questionnaires. Medicine and Science in Sports and Exercise, 26(3), 376-382.
Montoye, H. J., Kemper, H. C. G., Sarris, W. H. M., & Washburn, R. A. (1996). Questionnaires and interviews (chap.6). In Measuring Physical Activity and Energy Expenditure. IL: Human Kinetics Publishers Inc., pp.42-62.
National Institutes of Health Consensus Development Panel on Physical Activity and Cardiovascular Health. (1996). Physical activity and cardiovascular health. Journal of the American Medical Association, 276, 241-246.
Nichols, J. F., Morgan, C. G., Sarkin, J. A. Sallis, J. F., & Calfas, K. J. (1999). Validity, reliability, and calibration of the TriTrac accelerometer as a measure of physical activity. Medicine & Science in Sports & Exercise. 31(6), 908-912.
Noland, M.P., & Feldman, R.H.L. (1984). Factors related to the leisure exercise behavior of returning women college students. Health Education, 15(2), 32-36.
Pate, R. R., Pratt, M, Blair, S. N., Haskell, W. L., Macera, C. A., Bouchard, C., Buchner, D., Ettinger, W., Heath, G. W., King, A. C., Kriska, A., Leon, A. S., Marcus, B. H., Morris, J., Paffenbarger, R. S., Patrick, K., Pollock, M. L., Rippe, J. M., Sallis, J. F., & Willmore, J. H. (1995). Physical activity and public health: A recommendation from the Centers for Disease Control and Prevention and the American College of Sports Medicine. Journal of the American Medical Association 273(5), 402-407.
Prochaska, J. O., & DiClemente, C. C. (1982). Transtheoretical therapy: Toward a more integrative model of change. Psychotherapy: Theory Research and Practice 19, 276-288.
Prochaska, J. O., & DiClemente, C. C. (1983). Stages and processes of self-change of smoking: Toward an integrative model of change. Journal of Consulting and Clinical Psychology, 51(3), 390-395.
Prochaska, J. O., & Marcus, B. H. (1994). The transtheoretical model: Applications to exercise. In R. K. Dishman (Ed.), Advances in Exercise Adherence (pp. 161-180). Champaign, IL: Human Kinetics Publishers Inc.
Prochaska, J. O., & Velicer, W. F. (1997). The transtheoretical model of health behavior change. American Journal of Health Promotion, 12(1), 38-48.
Prochaska, J. O., DiClemente, C. C., & Norcross, J. C. (1992). In search of how people change: Applications to addictive behaviors. American Psychologist, 47(9), 1102-1114.
Prochaska, J. O., Norcross, J. C., & DiClemente, C. C. (1994). Changing for Good. New York: Avon books.
Reining International (1998). TriTrac-R3D Research Ergometer Operation. Wisconsin: Professional Products-Division of Reining International, Ltd.
Sallis J. F., Haskell, W. L., Fortmann, S. K., Vranizan, K. M. Taylor, K. B., & Solomon, D.S. (1986). Predictors of adoption and maintenance of physical activity in a community sample. Preventive Medicine, 15, 331-341.
Sallis, J. F., & Owen, Neville (1999). Physical Activity & Behavioral Medicine. London: Sage Publications, Inc.
Sallis, J. F., Calfas K. J., Nichols, J. F., Sarkin, J. A., Johnson, M. F., Caparosa, S., Thompson, S., & Alcaraz J.E. (1999). Evaluation of a University Course to Promote Physical Activity: Project GRAD. Research Quarterly for Exercise & Sport, 70(1): 1-10.
Sallis, J. F., Haskell, W. L., & Wood, P. D. (1985) Physical activity assessment methodology in the Five-City Project. American Journal of Epidemiology, 121, 91-106.
Sallis, J. F., Hovell, M. F., Hofstetter, W. L., Faucher, P., Elder, J. P., Blanchard, J., Caspersen, C. J., Powell, K. E., & Christenson, G.M. (1989). A multivariate study of determinants of vigorous exercise in a community sample. Preventive Medicine, 18, 20-34.
Sallis, J. F., Hovell, M.F., Hofstetter, C. R., & Barrington, E. (1992b). Explanation of vigorous physical activity during two years of using social learning variables. Social Science and Medicine, 34,25-32.
Sallis, J. F., Hovll, M. F., & Hofstetter, C. R. (1992a). Predictors of adoption and maintenance of vigorous physical activity in men and women. Preventive Medicine, 21, 237-251.
Sallis, J. F., Nadar, P. R., Broyles, C. C., Berry, J. P., Elder, J. P., & McKenzie, T. L. (1993). Correlates of physical activity at home in Mexican-American and Anglo-American preschool children. Health Psychology, 12, 390-398.
Sallis, J. F., Pinsiki, R. B., Grossman, R. M., Patterson, T. L., & Nader, P. R. (1988). The development of self-efficacy scales for health-related diet and exercise behaviors. Health Education and Research, 3, 283-292.
Sarkin, J. A., Nichols, J. F., Sallis, J. F., & Calfas, K. J. (2000). Self-report measures and scoring protocols affect prevalence estimates of meeting physical activity guidelines. Medicine & Science in Sports & Exercise. 32(1), 149-56.
Sarkin, J., Campbell, J., Gross, L., Roby, J., Bazzo, S., Sallis, J. F., & Calfas, K. J. (1997). Seven-Day Physical Activity Recall. Medicine and Science in Sports and Exercise, 29 (Supplement 6), S89-S103.
Shumaker, S. A., Schron, E. B., Ockene, J. K., & McBee, W. L. (1998). The Handbook of Health Behavior Change. New York: Springer Publishing Company.
Sonstroem, R. J. (1988). Psychological Models. In R. K. Dishman (Ed.), Exercise Adherence: Its Impact of Public Health (pp. 125-154). Champaign, IL: Human Kinetics Publishers Inc.
Tabachnick, B.G. & Fidell, L.S. (1996). Using Multivariate Statistics. (3rd ed.). NY: HarperCollins College Publisher Inc.
U.S. Department of Health and Human Services (1991). Healthy People 2000: National Health Promotion and Disease Prevention Objectives. Washington, DC: U.S. Government Printing Office DHHS Pub No. (PHS) 91-50212.
U.S. Department of Health and Human Services (1996). Physical Activity and Health: A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, International Medical Publishing.
US Centers for Disease Control and Prevention (1999). School Health Program: An Investment in Our Nation’s Future. AT-A-GLANCE 1999. http://www.cdc.gov/
Willis, J. D., & Campbell, L. F. (1992). Exercise Psychology. Champaign, IL: Human Kinetics Publishers Inc.
Wyse, J., Mercer, T., Ashford, B., Buxton, K., & Gleeson, N. (1995). Evidence for the validity and utility of the stages of exercise behavior change scale in young adults. Health Education Research, 10(3): 365-377.