Transtheoretical Model Expert Answer

Tobacco smoking is the preventable negative behavior that causes health problems and is responsible for 25% of the deaths in individuals younger than 65 years of age (Fidanci et al., 2017). Easy access and legal use of cigarette smoking and low awareness about the dangerous effects of tobacco smoking result in increased use of cigarettes worldwide (Bakan & Erci, 2018).  A study shows that one-third of smokers have low motivation to change their habit of smoking. This essay will aim to describe the Transtheoretical model and its stages of change by utilizing the example of a case study with the negative behavior of smoking. Techniques used to help the individual address their healthcare challenge behavior will be discussed. By utilizing the evidence-based studies the evaluation of the techniques used will be made and in the end, a conclusion of the essay will be made.

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Transtheoretical Model

The Transtheoretical Model (TTM) was developed in 1970 by James O. Prochaska along with collaboration with Carlo DiClemente and James Norcross. This model was developed to change the behavior of individuals towards a positive and healthy lifestyle (Li et al., 2020). TTM is also known as the stages of the change as this model shows that individuals go through different stages of behavior before a change occurs. (Friman et al., 2017). Another property of this model is that the strategies used to change the behavior of the individuals towards a positive and healthy lifestyle are different in every stage of the change (Hashemzadeh et al., 2019). So, the purpose of this model is to change the behavior of the individual gradually towards the positive change and not to jump straight to the change.

Stages of Changes

TTM contains six stages through which the individuals must pass to implement positive behavioral change fully. These stages are precontemplation, contemplation, preparation, action, maintenance, and termination (Bakan & Erci, 2018). The first stage is the precontemplation. In this stage, the individuals are unaware of the negative consequence of their habit and deny that their behavior is problematic. Individuals in this stage neglect and oppose the pros of the change in behavior and argue about the cons of changing the behavior (Li et al., 2020). The second stage is contemplation. In this stage, the individuals intend to start a positive change shortly (within the next six months). Individuals may recognize that their behavior could be problematic or having a negative effect on their health or life. They start considering the pros and cons of changing their behavior. In contemplation, the individuals may feel ambivalent about the positive change of their behavior (Rios et al., 2019). The third stage knows as preparation. In this stage, individuals are ready to implement actions for positive change to behavior within the next thirty days. They begin to take small steps to change their behavior and think that this may lead to a healthier life (Hashemzadeh et al., 2019).  The fourth stage is “Action” in which individuals recently change behavior (within in the last 6 months) and tend to modify their negative behavior or follow new health behavior (Hashemzadeh et al., 2019). The fifth stage is “Maintenance” in which individuals try to sustain the behavior change for more than six months. Individuals try to avoid relapse to the earlier stage. The last stage in TTM is “Termination”. In this stage, individuals do not have desires for the negative behavior, and they have confidence that they will not relapse to earlier stages. This stage is not considered in the health promotion program as this stage is rarely achievable. Individuals mostly remain in the maintenance stage (Hashemzadeh et al., 2019).

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A fifty-year-old male Mr. James (pseudonym) was admitted to the medical ward with the diagnosis of COPD. His Sp02 was 89% at room air with shortness of breath. On health assessment interview Mr. James told me that he was smoking at least 40 cigarettes a day from the last 20 years. Mr. James was informed about his smoking habit is the factor behind his current condition. However, Mr. James didn’t want to accept that and said that he had been smoking from the last twenty years and will not quit it. He was more concerned about the cons of changing habits rather than the pros of the change. Mr. James was fitting into the first stage of the TTM which is precontemplation as Mr. James was unaware of the cons of his negative habit and its effect on his health. Also, Mr. James had concerns about the cons of the change in behavior rather than the pros of the change (Hashemzadeh et al., 2019).

The different technique has been used to address the health challenges or behavior of Mr. James. These techniques include showing empathy, providing patient education by the use of reading materials, arranging a special counseling room for the motivational interview, using different videos for pros and cons changing the negative behavior.

After utilizing the techniques and motivational interview Mr. James had sound knowledge of the cons of his negative behavior and its effect on his health. He was aware of the pros of changing the habit and also the cons of not changing his habit of smoking. He told me that he wanted to change his habit of smoking and will plan to act on it within six months after he gots discharge from the ward. According to TTM Mr. James moved on to the contemplation stage (Hashemzadeh et al., 2019).

Analysis and Discussion

Empathy is the specific and useable skill used, especially during behavior change therapy, to understand the meanings of other individuals through the use of reflective listening (Lord et al., 2015). Evidence shows that empathy is helpful in developing rapport between health professional and the patient. Once the rapport built then the patient starts showing trust and communicate effectively for a positive change in their behavior (Lord et al., 2015). Evidence shows that empathy before and during the motivational interview had a positive effect on the change in the talk and behavior of the patient (Fischer & Moyers, 2014).

Mr. James had little knowledge about the negative effect of his behavior of smoking. It was necessary to give him information about smoking and its effect on health. A brochure and a pamphlet were given to Mr. James about the cons of smoking on health. Study shows that internal motivation is necessary for the patient to move on to the next stage in TTM (Hardcastle et al., 2015). This internal motivation cannot be achieved from the pressure from outside like family members, friends, or health professionals. However, it can be achieved by improving the knowledge of the patient about the pros and cons of the negative behavior on the person’s health (Hardcastle et al., 2015). The knowledge of the pros and cons after the change of the behavior also plays an important role as the patient has to decide what is better for their health (Rios et al., 2019). Reading material is one of the best techniques in providing information to the patient about the negative behavior (Rios et al., 2019).

TTM along with motivational interview proved to be effective in behavioral problem especially in smoking cessation, alcohol withdrawal, eating healthy food, and motivating physical activities and exercise (Tas et al., 2016). This technique had been known as a patient-centered and collaborative way of addressing the issue of ambivalence about the change (Codern-Bové et al., 2014). Motivational interviews contain open and closed-end questions and use of active listening skills along with adoptive questions within the environment of acceptance, empathy, and cooperation to help the patients to realize the pros and cons of their current habit. It improves personal motivation and commitment to gain the desired goal by exploring the patient’s own need for the change (Codern-Bové et al., 2014).

Smoking has a negative effect not only on the individual using it but also on the environment and the surroundings. The study suggests that passive smoking is even more dangerous (Cao et al., 2015). A sense of protecting the environment and people surrounding can motivate the patients to change the behavior (Bakan & Erci, 2018). For this Mr. James was shown videos about passive smoking and its effect on the environment and surrounding people especially children. A sense of responsibility towards the society is a good motivational factor in deciding to go for a change (Zidarn & Kolenko, 2016).

Proper information about the pros and cons of the negative habit and motivational techniques to change the habit can be effective in TTM for a change in behavior. In the near future if the same situation happens then I would like to use health IT to motivate the patient in changing the habit of smoking. During the hospital stay, patients have plenty of free time and they use their mobile phones to pass the time. Motivational mobile phone applications to stop smoking can be used. Mobile health applications are useful in motivating the patients towards a positive change in their behavior like smoking cessation (van Agteren et al., 2018). These applications contain informative modules in different gaming styles that provide information about the pros and cons of negative habits and motivational modules to motivate users to change their behavior for a healthy lifestyle (McKay et al., 2018).

Conclusion

Transtheoretical Model is effective in changing the behavior of the individuals towards a healthier lifestyle. Utilizing TTM and motivational techniques can improve the self-motivation of individuals and make them committed to taking action for change without any external pressure. Negative behavior like smoking can be changed step by step by utilizing TTM. However, different motivational techniques are required at every step for a successful change in behavior. The latest technologies like mobile phone applications could be beneficial in improving the motivation for the change.

References

Bakan, A. B., & Erci, B. (2018). Comparison of the effect of trainings based on the transtheoretical model and the health belief model on nurses’ smoking cessation. International Journal of Caring Sciences, 11(1), 213–224.

Cao, S., Yang, C., Gan, Y., & Lu, Z. (2015). The health effects of passive smoking: An overview of systematic reviews based on observational epidemiological evidence. PloS One, 10(10).

Codern-Bové, N., Pujol-Ribera, E., Pla, M., González-Bonilla, J., Granollers, S., Ballvé, J. L., Fanlo, G., Cabezas, C., & ISTAPS Study Group. (2014). Motivational interviewing interactions and the primary health care challenges presented by smokers with low motivation to stop smoking: A conversation analysis. BMC Public Health, 14(1), 1225.

Fidanci, I., Ozturk, O., & Mustafa, U. (2017). Transtheoretic model in smoking cessation. Journal of Experimental and Clinical Medicine, 34(1).

Fischer, D. J., & Moyers, T. B. (2014). Is there an association between empathic speech and change talk in motivational interviewing sessions? Alcoholism Treatment Quarterly, 32(1), 3–18.

Friman, M., Huck, J., & Olsson, L. E. (2017). Transtheoretical model of change during travel behavior interventions: An integrative review. International Journal of Environmental Research and Public Health, 14(6), 581.

Hardcastle, S. J., Hancox, J., Hattar, A., Maxwell-Smith, C., Thøgersen-Ntoumani, C., & Hagger, M. S. (2015). Motivating the unmotivated: How can health behavior be changed in those unwilling to change? Frontiers in Psychology, 6, 835.

Hashemzadeh, M., Rahimi, A., Zare-Farashbandi, F., Alavi-Naeini, A. M., & Daei, A. (2019). Transtheoretical model of health behavioral change: A systematic review. Iranian Journal of Nursing and Midwifery Research, 24(2), 83.

Li, X., Yang, S., Wang, Y., Yang, B., & Zhang, J. (2020). Effects of a transtheoretical model-based intervention and motivational interviewing on the management of depression in hospitalized patients with coronary heart disease: A randomized controlled trial. BMC Public Health, 20(1), 1–12.

Lord, S. P., Sheng, E., Imel, Z. E., Baer, J., & Atkins, D. C. (2015). More than reflections: Empathy in motivational interviewing includes language style synchrony between therapist and client. Behavior Therapy, 46(3), 296–303.

McKay, F. H., Cheng, C., Wright, A., Shill, J., Stephens, H., & Uccellini, M. (2018). Evaluating mobile phone applications for health behaviour change: A systematic review. Journal of Telemedicine and Telecare, 24(1), 22–30.

Rios, L. E., Herval, A. M., Ferreira, R. C., & Freire, M. do C. M. (2019). Prevalences of Stages of Change for Smoking Cessation in Adolescents and Associated Factors: Systematic Review and Meta-Analysis. Journal of Adolescent Health, 64(2), 149–157.

Tas, F., Sevig, E., & Gungormus, Z. (2016). Use of motivational interview technique with transtheoretical model for behavioral change in smoking addiction. Current Approaches in Psychiatry, 8(4), 380–393.

van Agteren, J. E., Lawn, S., Bonevski, B., & Smith, B. J. (2018). Kick. It: The development of an evidence-based smoking cessation smartphone app. Translational Behavioral Medicine, 8(2), 243–267.

Zidarn, M., & Kolenko, A. (2016). Effectiveness of motivational interview for smoking cessation in hospital setting.