week 3,2
Transtheoretical Model
Note: Make sure you are able to view the notes for this lecture.
1
Lesson objectives
By the of this presentation students will be able to:
describe the Stages of Change
discuss the Processes of Change
identify founders of the Transtheoretical Model (TTM)
examine when to use the TTM
describe the criticisms and weaknesses in TTM
3
Stage One: Pre-Contemplation
No intention to take action within the next 6 months.
Unaware of the problem.
Uninterested in the problem.
Example: smoking
Smokers in this stage are not receptive to people advising them to quit.
Critical for doctors and other health care professionals to advise smokers to quit every time they visit.
A person may be in this stage because he or she is uninformed about the consequences of their behavior.
Some people in this stage have tried to make a change but have become demoralized about their ability to change.
4
Stage Two: Contemplation
Person intends to take action within the next 6 months.
Person is weighing the pros and cons of changing their behavior.
Smoking example
The smoker is seriously considering quitting.
Encourage the smoker to set a quit date.
A statement of intending to quit is a positive predictor of tobacco cessation.
In this stage, people are usually not yet ready to make a change.
This stage can sometimes be referred to as:
Consciousness.
Weighing the pros and cons is critical to influencing their attitudes.
5
Stage Three: Preparation
People intend to take action in the immediate future, within the next 30 days.
People get ready to achieve their goals.
Smoking example:
The smoker intends to quit smoking within a month or so.
In this stage the smoker needs to develop confidence in his or her ability to stop.
People in this stage create a personal plan of action. (Taking a health class, talking to a physician, obtaining information from the web, etc…)
Programs that provide actions steps are appropriate for these people such as fitness seminar, stress reduction program, & smoking cessation.
6
Stage Four: Action
In this stage a person has recently taken action towards change or made specific modification in their lifestyle but for less than 6 months.
Smoking example:
The patient attempts to quit by using the cessation plan he or she created in the Preparation Stage.
Not all actions count. Only actions (overt) that are known to prevent or reduce risks for the health issue, mark progress. i.e., it is not enough to discuss the health issue
7
Stage Five: Maintenance
Changed behavior for more than 6 months, now focused on keeping that behavior change.
Smoking example
A smoker who has completely quit smoking.
A smoker in this stage has not smoked for over 6 months.
The goal is to steadily decrease the temptation to smoke over time.
The smoker is trying to avoid relapse, which 43 % of smokers experience in their first year.
Relapse
At any point, an individual may relapse and regress back to an earlier stage.
Keep in mind, use this as a learning and growing lesson
Consider what may cause some to relapse. Does that mean they have to start all over at the pre-contemplation stage?
9
A few other points
TTM in based on the concept of decisional balance
Weighing potential gains and losses (pros.cons)
Self-efficacy
The belief and confidence that you can achieve desired outcome even in challenging situations
Temptation
Those challenging situations and urges
Previous iterations of the TTM included “termination stage,” however, there have been arguments that one may never reach that stage. Smokers may always have the urge or temptation to smoke and due to specific circumstance (death, job loss, end of a relationship), may experience a short relapse before reaching maintenance stage again. Due to its cyclical nature, the termination stage has been widely disregarded
10
Assumptions of the TTM
No single theory can account for all complexities of behavior change.
Behavior change unfolds over time through a series of stages.
Stages are both stable and open to change, just like chronic risk behaviors.
Most at-risk populations are not prepared for action and will not be served effectively by traditional action-oriented behavior change programs.
Specific processes should be emphasized at specific stages.
11
Processes of change
There are a number of change processes that can contribute to progressing from one stage to another.
These change processes serve as guides for interventions intended to move people across stages.
Processes of change are "covert and overt activities that people use to progress through the stages”
These Processes are most emphasized at different transitions between the Stages of Change
10 Processes of change
These are divided into two categories:
Cognitive-affective processes
Behavioral processes
Cognitive-affective
Consciousness-raising - gathering information
Self-evaluation - reconsidering consequences on oneself
Dramatic relief - experiencing and expressing affect (experiencing negative emotions associated with unhealthy behavior)
Environmental evaluation - considering how one’s actions effects others
Social liberation - attending to changing social norms. Belief that one can change, making a firm commitment to change
14
Behavioral processes
Counterconditioning - Substituting new behavior
Stimulus control - Controlling environmental cues
Reinforcement management - being rewarded by self or others for healthy behavior
Helping relationships - using social support
Self-liberation - committing to change
Where the processes fit in:
The movement from Pre-contemplation Stage to Contemplation Stage, include the following Processes:
Consciousness Raising
Dramatic Relief
Environmental Re-Evaluation
Processes that mediate progression from Contemplation to Preparation:
Self-evaluation
Where they fit in continued:
Processes that mediate progression from Action
Self-liberation
Processes for Maintenance
Helping Relationship
Counter Conditioning
Reinforcement Management
Stimulus Control
Criticisms
Read TTM criticisms article
Whitelaw and colleagues note the following concerns with classifying people in “Stages.”
Not every person (or behavior) can be fixed in specific time-sensitive “stages”
Further, studies have varied in their use of the model: some use “fixed” patterns in accordance to the original intent, while others allow for more flexible patterns
Difficult to assess the “validity” of the model.
References
Glanz, K., & Rimer, B. K. (1997). Theory at a glance: a guide for health promotion practice. Bethesda, Md.: U.S. Dept. of Health and Human Services, Public Health Service, National Institutes of Health, National Cancer Institute.
Glanz, K., Rimer, B. K., & Viswanath, K. (2008). Health behavior and health education: Theory, Research, and Practice 4th edition. San Francisco, CA: Jossey-Bass.