7.4 -

Transtheoretical Model
of Behavioural Change

A structured means of change that harness social support of your patients

Learning Journey "Stop-See-Learn" Spot #5 of 6

The School of Health Sciences, Ngee Ann Polytechnic, Singapore

Part 1 Overview of the Transtheoretical Model (TTM)

It will not be easy to shift human behaviour. In fact even if someone is willing, that person may be sure of where to start. What a theory such as the Transtheoretical Model (TTM) does is to give behavioural change a structured approach so that patients can see the path to behavioural changes as a series of logical steps that are connected. In this video, we shall map the TTM to actions of a government from a low-income country in its bit to bring about better healthcare outcome from its citizens. The TTM was proposed by James O. Prochaska, Carlo Di Clemente and colleagues in the late 1970s. Below is a very simple introduction to the TTM.

7.4 An Overview of the TTH Model.m4v

Part 2 Making Behavioural Changes using the TTM Structure

In this e-Lecture, Nathan Smith (2013) from the University of Birmingham explained the use of the TTM to create a potential shift of behaviour to shift people from not exercising to exercising, Smith explanations take us through the different stages of changes using examples from real life.

7.4 Trans-Theoretical Model of Behaviour Change.mp4

This web-lecture by Nathan Smith can be found in Youtube via this link: https://youtu.be/oO80XyBDrl0

If wish to read up further on the TTM, this website has a fairly detailed academic write-up on it (Ranta, Pulak, & Hockstad, n.d.). Click here to access the website.

Part 3 TTM Mapped to Social Factors

At each stage of the TTM, we can ask questions of our patients background to see what social obstacles might they be facing that might have held them back in each stage or cause a relapse to occur.

We should seek for answers by looking at the patients' social factors. Social factors include a person's gender, ethnicity, age, socio-economic status (education, financial status and occupation) etc. Each of these factors would have an impact on how the patients (or any humans really) thin. This is due to the process of socialisation that impacted on the way they see themselves as you had briefly been introduced to in the previous 2 sections of this stop of your learning journey (or, Chapter) in this webbook.

Here are some examples of how social factors may impact on patients ability to enter the TTM stages

Ethnicity - Religon and cultural beliefs may be blocking any recommended course of health action
Gender - Lack of access to social resources (such as a housewife with no savings nor income) may hinder medical compliance where the solutions might be costly.
Education - Lack of an academic foundation to fully understand the medical implications of not doing anything.
Financial Status - Lack of income might impede ability to change.
Occupation - Occupation may expose person to risk that amplify the effect of illness, such as a diabetic whose job is a dessert chef.
Age - Socially constructed behaviour that hinders the person from pursuing healthy lifestyle thinking its for the young or seeking treatment thinking they are too old.

Who and where should we look for resources to enable our patients to help them navigate the TTM more efficiently? Try the groups of people and social institutions that help with their socialisations. Collectively, these entities are known as Agents of Socialisations. These might be the people and institutions that can help or place obstacles before your future patients learn how to harness the benefits and side-step the obstacles placed by these Agents of Socialisation.

Illustration below is from WebstockReview and hosted in this link: https://webstockreview.net/images/group-clipart-socialisation-7.png

Five Stages of the Transtheoretical Model

Click to reveal the definition of the key terms as defined by Wayne LaMorte of Boston University School of Public Health (LaMorte, n.d.). LaMorte's materials can be found in this link . The full URL can be found in the Reference section at the bottom of the page.

Precontemplation

(LaMorte, n.d.)

In this stage, people do not intend to take action in the foreseeable future (defined as within the next 6 months). People are often unaware that their behavior is problematic or produces negative consequences. People in this stage often underestimate the pros of changing behavior and place too much emphasis on the cons of changing behavior.

Contemplation

(LaMorte, n.d.)

In this stage, people are intending to start the healthy behaviour in the foreseeable future (defined as within the next 6 months). People recognise that their behaviour may be problematic, and a more thoughtful and practical consideration of the pros and cons of changing the behaviour takes place, with equal emphasis placed on both. Even with this recognition, people may still feel ambivalent toward changing their behaviour.

Preparation (Determination)

(LaMorte, n.d.)

In this stage, people are ready to take action within the next 30 days. People start to take small steps toward the behaviour change, and they believe changing their behavior can lead to a healthier life.

Action

(LaMorte, n.d.)

In this stage, people have recently changed their behavior (defined as within the last 6 months) and intend to keep moving forward with that behavior change. People may exhibit this by modifying their problem behavior or acquiring new healthy behaviors.

Maintenance

(LaMorte, n.d.)

In this stage, people have sustained their behaviour change for a while (defined as more than 6 months) and intend to maintain the behaviour change going forward. People in this stage work to prevent relapse to earlier stages.

Termination

(LaMorte, n.d.)

In this stage, people have no desire to return to their unhealthy behaviours and are sure they will not relapse. Since this is rarely reached, and people tend to stay in the maintenance stage, this stage is often not considered in health promotion programs

Next Section

We have come to the end of this week's lesson. We will revisit the main thinking learning points of this various theories and concepts that were introduced to you in this chapter.

References

LaMorte, W. W. (n.d.). Behavioral Change Models. Boston University School of Public Health Retrieved February 25, 2020, from http://sphweb.bumc.bu.edu/otlt/MPH-Modules/SB/BehavioralChangeTheories/BehavioralChangeTheories6.html

Prochaska, J.O., Velicer, W.F., 1997. The transtheoretical model of health behavior change. American journal of health promotion 12, 38-48.

Ranta, E., Pulak, C., & Hockstad, A. (n.d.). The Transtheoretical model. Retrieved February 23, 2020, from https://transtheoreticalhl250.weebly.com/

Smith, N. (2013, November 2). Trans-Theoretical Model of Behaviour Change. Retrieved February 23, 2020, from https://youtu.be/oO80XyBDrl0