The TTM is useful for explaining and predicting
how and when individuals end high-risk behaviors
and adopt healthy ones.50 TTM has been applied to,
and demonstrated empirical support for, a number of
health behaviors including smoking cessation,51
diabetes self-management,52 exercise adoption,53Y58
and dietary fat intake reduction.58Y60 It offers a
promising approach to behavior change in CR,
although it has not been formally tested for women
in a randomized controlled trial. The model integrates
4 concepts central to change: (1) stages of change or
readiness to act; (2) decision balance (pros and cons
of changing); (3) self-efficacy (confidence to make
changes in difficult situations); and (4) processes of
change, which refers to 10 cognitive and behavioral
strategies that facilitate change.61