A Stage-of-Change Classification System Based on Actions and Beliefs regarding Dietary Fat and Fiber

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Abstract
Purpose.: The objectives of this study were to develop a stage-of-change classification system and to determine the degree to which various adult subgroups have adopted the behavioral changes necessary to achieve a low-fat and/or high-fiber diet as recommended by the Dietary Guidelines for Americans. Design.: The study used a mail survey randomly sent to 7110 adults. Setting.: The survey was conducted in 11 states and the District of Columbia. Subjects.: The random sample included males and females over age 18. Of the eligible respondents, 3198 (51.5%) were included in this analysis, with 2004 and 2066 unambiguously classified into stages of change for fat and fiber, respectively. Measures.: Stage of change was defined by an algorithm based on self-reported intent and behaviors to limit fat and/or increase fiber. Results.: 45% of the respondents were classified as being in action/maintenance for fat and 38% for fiber. Women, older adults, individuals with advanced education, persons with diet-related chronic disease, people with higher levels of relevant nutrition knowledge and attitudes, and persons who indicated that health concerns were a primary influence on their diet were more likely to be in action/maintenance than other respondents. Conclusions.: The algorithm in this study presents a model that more closely reflects the proportions of the adult population that have achieved low-fat diets and classifies a greater proportion in the preparation stage than classification systems in previous studies.