The Transtheoretical Model/Stages of Change
Leticia R. Leaks
Nebraska Methodist College
Abstract
This is a review of the Transtheoretical Model/Stages of Change Model developed by J. O. Prochaska and C.C. DiClemente to assess an individual’s readiness to change a behavior. In this paper, we will discuss the history of the theory and its constructs. We will also examine a diabetes study and the impact of TTM in conjunction with Social Cognitive and the Theory of Reasoned Action as applied urban African Americans with Type 2 Diabetes. In the application of TTM, what does success look like and how is failure measured?
Keywords: Transtheoretical Model
The Transtheoretical Model/Stages of Change
The Transtheoretical Model (TTM) is an
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“But they’re not particularly conscious of that, so it’s not a focused, rational decision-making process (Sholl, 2011).” If the individual has heard from their support system that they need to lose weight, quit smoking or drinking, and instead of taking the advice, they ignore them, shut down or change the subject, then they are in the stage of precontemplation. Unlike the precontemplation stage, an individual in the contemplation stage actually thinks about taking action within six months. They understand the pros and the cons of changing the behavior and are open to receiving information and advice. Contemplators are often characterized as behavioral procrastinators who can get stuck here for long periods of time. The individual in the preparation stage is ready to make a change within the next 30 days. This individual has developed a plan and is ready for an action-oriented program such as smoking cessation or weight loss. Action is the next stage in the TTM model. This is the stage where the individual has actually made modifications; gotten off the couch and exercising. The action is observable and measurable. “This stage is where all those small steps, small choices, and mini sacrifices make a huge difference,” notes Larsen (Larsen, 2007). Individuals in this stage benefit from emotional and physical support, and from having people around them recognize their progress and help keep them accountable. When an individual reaches the
The process of change describes how people change. These processes of change are divided into two categories; cognitive and behavioral. Cognitive is the thinking process of change and behavioral is the action process of change. The transtheoretical model suggests that people use different strategies, techniques or different amounts of each at different stages in their change process. Self-efficacy refers to confidence and an individual’s experience with confidence to perform specific behaviors in specific situations. Self-efficacy is a good predictor of behavior change. An individual with higher self-efficacy may be more likely to change a behavior even if the situation doesn’t have any positive reinforcements (Campbell, Eichhorn, Early, Caraccioli, Greely, 2012).
This model was developed to determine and predict change in addictive and health-promoting behaviors. TTM can also be used to understand abusive behavior. Individuals are divided into four stages of change based on their attitudes and behaviors. Pre-contemplation describes individuals who are not ready to change. The contemplation stage includes individuals who are starting to think about changing but have not begun the change. Action occurs when individuals start the process of changing their behavior, experiences, and environments to resolve their problems. Maintenance is the last stage and occurs when people want to remain changed and not go back to their previous behavior. Chances for positive outcomes increase when individuals are matched at the appropriate level that determines their readiness to change (Hellman et al., 2010). Based on research, individuals who are in the contemplation stage are the most likely to change their battering behavior (Scott & Wolfe,
The Transtheoretical Model of Change has become popular over the past few decades in explaining health behaviors like substance and alcohol abuse, dieting, and smoking cessation. It has four parts to it, the first being the stages of change. The Stages of Change Model gives explanations for different points on the path to intentional behavioral change (Vilela, Jungerman, Laranjeira, & Callaghan, 2009). Intentional behavioral changes are changes in the habitual patterns of behavior that are related to issues such as substance or alcohol abuse. There are six steps in the Stages of Change Model: precontemplation, contemplation, preparation, action, maintenance, and
The change models are change agents that could explain the ways of implementing a change process. These models explain the reason for the change, what to expect during the process and the way a change occurs. Thus, these models help one understand the various aspects of the change process (Agriculture & Life Sciences: Texas A & M University, n.d.). The transtheoretical model of health behavior change could explain my evidence-based practice (EBP) project implementation plan.
Prochaska & DiClemente’s (1984) research suggests the Prochaska & DiClemente’s model of change is effective and has an impact in health promotion. The Prochaska & DiClemente’s model of change is becoming a more popular and widely used resource for health promotion; this is because it can be applied with a number of addictive behaviours such as smoking, drug use and alcohol abuse (Whitelaw, et al, 2000). The Prochaska & DiClemente’s model of change has six stages these include, Pre contemplation this is when the patient is not seriously considering change, Contemplation This is when the patient is thinking about change, Preparation when the
The Transtheoretical Model does not only consist of the stages of change. Self-efficacy, or one’s self confidence in engaging in action, also plays a huge factor in this theory. A person is less likely to engage in a positive health behavior if there self-efficacy is low. Decision balance is the balancing of pros and cons towards the behavior change the person takes into account. In early stages, such as precontemplation and contemplation, cons outweigh the pros, and a behavior change is unlikely. In contrary, the pros outweigh the cons in the later stages. Throughout all stage of the Transtheoretical Model, there are situational temptations, which are external triggers that can cause a person to relapse. These include negative emotions associated with the behavior change such as anger or sadness, and social
Ex: Joe and Sally both smoke, would like to quit. Joe may have thought about quitting but have not made any active efforts to seek professional help: CONTEMPLATION stage. Sally has tried to quit but to no avail : PREPARATION stage. For Joe next stage is PREPARATION. For Sally, next stage is ACTION. Once we know person’s stage, diverse array of STRATEGIES will be used to promote desired behavior change.
This model can be used to explain the different stages of readiness to change. There are six stages: pre-contemplation, contemplation, preparation, action, maintenance and relapse [Figure
The Transtheoretical Model or Stages of Change is a model that integrates biological, psychological and social influences that analyzes the process of intentional behavioral changes, Prochaska, DiClemente and Norcross (1992). This model incorporates six stages of an individual’s behavior which focuses on the decision making of the individual. The six stages are: Pre-Contemplation, Contemplation, Preparation, Action, Maintenance and Relapse. According to Prochaska, DiClemente and Norcross (1992) the process is cyclical and operates on the assumption that people do not change behaviors quickly instead habitual behaviors occurs continuously through this cyclical process.
The five stages in the Transtheoretical Model are used to describe how people progress through changing their health behaviors. Stage one is Precontemplation. In this stage, people are not serious on changing their behavior. Stage two is Contemplation. People who are in this stage know that they need to change and are serious about changing their health behaviors.
19. At the intrapersonal level, theories of health behavior assume individuals exist within and are influenced by a
There are five stages of change from the transtheoretical model of change and these are precontemplation, contemplation, preparation, action and maintenance. This model could be applied for many situations, for this instance, Jeff who has a high salt intake is being analyzed and compared through this model. First is the stage of precontemplation where a person may not be aware of his or her problem and may not even think about changing their ways. Jeff may not have the intention of changing, most likely because of the fact that he does not know that he has a problem of consuming too much sodium. A friend of his may tell him that he's noticing Jeff consuming too much salt and Jeff may not think too much about it. Next is contemplation and this
The Transtheoretical Model of Behavior Change (TTM) was created by Prochaska and DiClemente. It is based on “(1) the stages of change, (2) the decisional balance scale, (3) the strong and weak principle, (4) self-efficacy, and (5) the processes of change” (Kelly, 2008, p. 149). A person’s progression through the stages depends on their perception of the advantages of adopting a healthy lifestyle (Kelly, 2008).
Another model, Transtheoretical Model of Behavior Change is a biopsychosocial model that suggests six stages of behavior change. The stages included in this model are pre-contemplation, contemplation, determination/preparation, action, maintenance, and relapse of batterers. This model is usually used to help individuals overcome addictive behaviors. The first stage, pre-contemplation, is the stage in which batterers cannot admit their problem when it comes to violence. Batterers will claim their actions are against their partner was a normal reaction. (Alexander & Morris, 2008; Popescu et al., 2009). In the second stage, contemplation, individuals slowly arrive at the conclusion that they have a problem and reflect the benefits to changing their actions. Determination/preparation is the stage in which individuals determine how they will approach solving the issue or decide on the best course of action. The action stage is when the individuals are heavily involved in the changing process. The final stage of the trans-theoretical model is maintenance, which is when the individual is tries to prevent reverting back to their previous behaviors. Individuals must try to sustain all of the advancements and change they have made to their behaviors throughout the process (Popescu et al.,
A theory of change is a method used in community or organizational planning that identifies preconditions for a desired change to occur. The theory of change process works by first articulating an ultimate goal; the desired change. The next step is to work backwards from the ultimate goal by identifying outcomes that lie along the road to change. Outcomes occurring in both the short-term and long-term are defined, as are the prerequisites to arrive at them. Next, a proposed intervention for initiating action that will theoretically lead to the short-term and long-term outcomes, and eventually the ultimate goal, is clearly outlined. The resources required to support the success of the proposed intervention are then identified.