JSSOpen Journal of Social Sciences2327-5952Scientific Research Publishing10.4236/jss.2015.39037JSS-60374ArticlesBusiness&Economics Social Sciences&Humanities Relationship between Stage of Change for Three Health Behaviors and Perceived Stress in Chinese Adults KeDeng1AkiraTsuda2Department of Psychology, Kurume University, Kurume, JapanInstitute of Comparative Studies of International Cultures and Societies, Kurume University, Kurume, Japan15092015030929529914 September 2015accepted 26 September 30 September 2015© Copyright 2014 by authors and Scientific Research Publishing Inc. 2014This work is licensed under the Creative Commons Attribution International License (CC BY). http://creativecommons.org/licenses/by/4.0/

We propose stress management behavior, exercise, and scheduled sleep to represent the general intention and actual practices aimed to relieve stress by the application of the transtheoretical model (TTM). Randomly selected Chinese adults aged 18 - 64 were tested through an internet survey. The stage distributions for the three health behaviors were different across the Chinese adults. Stress was significantly higher in action and maintenance stages than in precontemplation and contemplation stages across three health behaviors. Our findings have provided preliminary findings on the applicability of TTM on the three health behaviors in Chinese adults with evidence of concurrent criterion validity.

Stage of Change Exercise Sleep Behavior Stress Management1. Introduction

Public health programs that are aimed at combating stress will have to include health behavior change as a major focus. Stressful experiences have been found to be linked to numerous chronic diseases such as cardiovascular diseases [1]. Thus, it is important to prevent stress-related health problems [2]. Approaches for assessing stress focus on individual health behavior. For example, stress was reported to be simultaneously associated with physical inactivity [3], unhealthy sleep behavior [4] and stress management behavior [5]. This interrelationship between specific behaviors contributes to a greater or lesser extent to the practice of specific health-related behaviors. Here, we assume that people with the general intention to relieve stress are more likely to adopt specific health promotion activities. In contrast, stressed people who are unaware of health promotion are unwilling to proactively engage in desirable health-related behaviors such as regular physical and healthy sleep. We further assume that this general intention and actual practice to relieve stress is associated with health behavior that may be intended for relieving stress. Moreover, although there are considerable overlaps in the constructs which major health behavior models identify as important in predicting behavior [6], intention plays a role in many of the most widely applied models [7].

Based on this concept, we first assess whether an individual has any intention to adopt any practice to promote health. If so, we find out if there is an actual plan to execute the practice and which stage it has reached. The transtheoretical model (TTM) is used to describe people intending to change behaviors through five stages, i.e., precontemplation (there is no intention to change in the next six months), contemplation (intending to change in the next six months), preparation (intending to change in the next one month), action (practice to change lasts less than six months), and maintenance (practice to change lasts at least six months) [8]. Although the TTM has been applied widely to health behaviors in western countries, few studies have been conducted in Asian populations, not mention the specific behaviors of exercise, stress management, and sleep behavior. This study had three principal goals: 1) to collect information from participants in terms of the five TTM stages as basis for future comparison and intervention; 2) to correlate the information gathered with three health behaviors; and 3) to study whether different stages of change in health behaviors are positively related to stress-relief.

2. Method2.1. Study Design and Sample

This study was a longitudinal study which was conducted three times. This study provides the results of the first leg. The participants were Chinese, aged 18 - 64 years old who were randomly selected using multistage sampling. A total of 1599 respondents were successfully interviewed from March to September 2014.

2.2. Instrument

In this study, participants were eventually classified into five stages: 1) “No. I have no intention to begin in the next sixmonths.” (precontemplation); 2) “No. But I intend to begin in the next six months.” (contemplation); 3) “No. But I intend to begin in the next month.” (preparation); 4) “Yes. I have been practicing for less than sixmonths.” (action); or 5) “Yes. I have been practicing for at least six months.” (maintenance).

Health behaviors were measured regardless of whether they were intended to promote health. Exercise was assessed by asking the participants whether they had performed exercises that lasted for at least 30 min in the past 1 month [9]. Effective stress management was referred to any form of healthy activity practiced at least 20 min per day to manage stress [5]. Scheduled sleep was defined by asking the participants whether they woke up at the same time everyday (with an acceptable difference of 30 min).To examine the validity of the stage of scheduled sleep, the relationships between the stages and stress were examined using ANOVAs. Sample characteristics assessed included gender, age, education, marital status, and perceived stress. Stress was assessed by means of the Chinese Perceived Stress Scale.

2.3. Statistical Analysis

All analyses were conducted using SPSS for Windows version 22.0. Descriptive statistics were used to describe sample characteristics and stage distribution for the three selected health behaviors. Three one-way analyses of variance (ANOVAs) were conducted. The model assumes that stress causes stage transitions [10]; thus, they were entered into the ANOVAs as independent variables. However, this study aimed to examine the relationship between the stages and stress. In previous cross-sectional studies of the relationships between depression and stages of change for effective stress management, depression was entered into the analyses as a dependent variable [10]. Therefore, this study described stress as the dependent variable.

3. Results3.1. Sample Characteristics

Table 1 indicates that more half of the participants were female. Age was normally distributed, with the age group 25 - 34 years old being the largest category. Two-thirds of the participants were married. Most of the participants were college education. The demographic characteristics of this sample were comparable to those of the general Chinese population.

 3.2. Stage Distribution

Table 2 provides the estimate of stage distribution of the three health behaviors. The pattern of similarities and

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