The Associations between Multi-Theory Model (MTM) Constructs and Health Behavior Change among College Students: A Systematic Review and Meta-Analysis

Summary

This meta-analysis of 13 studies (2,605 college students) quantifies MTM construct associations with health behavior change and identifies key stage-specific factors.

Abstract

This study aims to explore the role of the Multi-Theory Model (MTM) in health behavior change among college students, to quantify the strength of the association between each MTM construct and such changes, and to provide empirical evidence for designing stage-specific intervention strategies. Databases including CNKI, Wanfang, PubMed, Web of Science, Scopus, and Embase were searched from their inception to October 2024. After the studies were screened according to the inclusion and exclusion criteria and the data were extracted, a meta-analysis was performed using RevMan 5.4 software. Statistical significance was set at P < 0.05. Thirteen studies involving 2,605 participants were included. In the initiation stage, behavioral confidence (BC) demonstrated the strongest association with health behavior change (OR=1.12). In the maintenance stage, practice for change (PC) had the strongest association (OR=1.15), whereas changes in the social environment (CSE) exhibited high stability (I²=0%). The Multi-Theory Model (MTM) constructs are significantly associated with health behavior change among college students. This study provides quantitative evidence on the stage-specific associations of MTM constructs, which may inform the future design of targeted interventions. It further recommends focusing on behavioral confidence (BC) for initiation and practice for change (PC), along with changes in the social environment (CSE) for maintenance to improve adherence.

Introduction

College students, as a core group of young adults with high educational potential, play a pivotal role in driving global social progress and sustainable development¹. They are in a critical period of physical and psychological development, and face challenges such as academic pressure, social adaptation, and independent living. Consequently, their health is increasingly influenced by lifestyle habits and campus environments². For example, heavy study loads, irregular routines, a lack of exercise, and poor self-management often lead to both mental and physical health issues³. A growing body of evid....

Protocol

This systematic review and meta-analysis protocol was registered on PROSPERO with a registration number of CRD 420251012795. This study was designed and conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)²⁴ guidelines (Supplementary File 1).

1. Literature search strategy

The relevant literature was retrieved by searching PubMed, Embase, Web of Science, Scopus, Wanfang, and Chinese National Knowledge Infrastructure (CNKI) databases for studies published from the inception of each database to October 2024. The Chinese se....

Results

Literature search
A total of 90 articles were initially identified. After 43 duplicate records were removed using EndNote software combined with manual screening, 47 articles were retained. By reviewing the titles and abstracts, 19 articles that were clearly irrelevant or did not meet the study's subject and design criteria were excluded. After the full texts were read, 15 additional articles were excluded because of irrelevance to the research topic, incomplete data, or unavailability of full .......

Discussion

This meta-analysis quantified the cross-sectional associations between MTM constructs and health behavior change among college students. A novel finding is the identification of key stage-specific and behavior-specific constructs: behavioral confidence was paramount for initiation, whereas practice for change (PC), particularly for physical activity (OR=1.22), had the strongest association for maintenance. Furthermore, changes in the social environment (CSE) demonstrated high stability across studies (I²=0%), highli.......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
EndNote	Clarivate	X21	Software used for literature management and screening
Review Manager (RevMan)	The Cochrane Collaboration	5.3	Software used for meta-analysis
stata	StataCorp LLC	18	Software used for statistical analysis and data management