Commitment to health: a predictor of dietary change


Cynthia W Kelly, Associate Professor of Nursing, School of Nursing, Xavier University, 3800 Victory Parkway, Cincinnati, OH 45207, USA. Telephone: 513-745-1915.


Aims and objectives.  To determine the predictive validity of three behavioural variables on changes in diet: commitment to health (commitment), confidence in ability to change dietary behaviours (confidence) and belief about the importance of changing dietary behaviours (importance).

Background.  Literature supports the Transtheoretical Model of Behavior Change as a framework for understanding dietary behaviour change. Less certain are behavioural variables associated with stage movement for action to maintenance stage for dietary behaviour change. This research considered three variables: self-efficacy (‘confidence’), decisional balance scale (‘importance’) and ‘commitment’. Published literature supports the importance of each of these behavioural variables, but not their predictive abilities.

Design.  A cross-sectional survey was used for 499 manufacturing workers from multiple work-sites.

Methods.  Subjects’ dietary health behaviours were measured by determining how long they consistently ate a low-fat diet, with analysis of variance addressing the stages-of-change model: precontemplation, contemplation, preparation, action, maintenance.

Results.  Commitment best predicted change from action to maintenance stage (p < 0·05). Importance (p < 0·05) was somewhat significant, but confidence (p > 0·05) was not.

Conclusions.  Commitment was the best predictor of dietary change, from the action to the maintenance stage of change.

Relevance to clinical practice.  Clinicians working with patients in the action stage of dietary change can use a stage-based approach and should evaluate commitment to health as part of an overall assessment. Those with high-level commitment will successfully change from action to maintenance with minimal professional assistance. Those with middle-level commitment risk relapse to a pre-action stage will benefit most from professional intervention. Those in the lower level of commitment are most likely to revert to a pre-action stage of change and may be not be ready for dietary change.