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Table 1 The stages of change and corresponding TTM processes, MTSM activities, variables measured at baseline, and integration with previous adolescent sleep interventions

From: Evaluating the effectiveness of the Motivating Teens To Sleep More program in advancing bedtime in adolescents: a randomized controlled trial

Stage of change Example of TTM process Example of a MTSM program activity designed to enhance the process Variables measured at baseline that allow to tailor this activity Integration with previous sleep promotion programs
Precontemplation Consciousness raising: Raising awareness about sleep deprivation Sleep education: Discussing with the adolescent in an interactive way about sleep-related facts and consequences related to sleep deprivation. • Knowledge Sleep hygiene education (Bakotić et al. 2009; Bootzin and Stevens 2005; Cain et al. 2011; Cortesi et al. 2004; Moseley and Gradisar 2009)
• Risk perception
• Information needs
• Personal values
Contemplation Self-reevaluation: Examining how one thinks and feels about oneself with respect to the current behaviour Decisional balance: Eliciting from the adolescent thoughts on the pros and cons of going to bed earlier, while the interventionist highlights and elaborates on statements that reveal discrepancy between current sleep behaviour and future goals and values, thus encouraging behaviour change. • Attitudes towards sleep Cognitive restructuring (Bootzin and Stevens 2005; Cain et al. 2011; Moseley and Gradisar, 2009)
Personal values
Preparation Dramatic relief: Experiencing and expressing feelings to help motivate change Role playing and personal testimonies: Improvising a situation where the adolescent focuses on the consequences of delayed bedtime in his/her life and then relieving this evoked emotional discomfort by providing personal testimonies of individuals who have successfully changed their bedtime and enjoy the positive ramifications of that change. • Self-efficacy Sleep-related role playing (Cain et al. 2011; Moseley and Gradisar 2009)
Action Self-liberation: Choosing to act or belief in ability to go to bed earlier Sleep hygiene action plan: Offering the participant an agenda setting chart (please see Figure 2) from which to autonomously choose a sleep hygiene behaviour to improve. • Personal values Personal action34, goal setting exercises (Cain et al. 2011)
    • Sleep hygiene behaviour  
Maintenance Stimulus control: Avoiding or countering stimuli that make the adolescent go to bed late Stimulus control exercise: Presenting the adolescent with instructions on ways to: (i) remove cues from the environment that promote late bedtimes, and (ii) add prompts for earlier bedtimes. • Social influence (identifying positive and negative influences) Stimulus control (Bootzin and Stevens 2005; Cain et al. 2011; Moseley and Gradisar 2009)
  1. Note. The activity included in Table 1. Corresponding to each stage of change is one of several examples. A single activity may be suitable for multiple stages of change. Furthermore, the process by which one proceeds through the stages of change is fluid. Although all participants included in the study report being in the contemplation stage of change during the screening phase, they may revert back to the precontemplation stage at a later time in the intervention.