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Trans Theoretical Model

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Introduction: Developed by Prochaska and DiClemente in 1983, the Trans-Theoretical Model is one of many popular theories, which is used to describe the event of changing a behavior. It is said that the Trans-Theoretical Model (TTM) is a theory of behavioral changes which "intentional behavior change is a process occurring in a series of stages, rather than a single event and that motivation is required for the focus, effort and energy needed to move through the stages” (Miller, W.R., Rollnick, S., 2002). What makes the Trans-Theoretical Model so unique, is that it describes how change occurs over time and not immeadiately. According to Prochaska & DiClemente (1983), this theory proposes that a person may progress through five stages of change when trying to modify their behaviors. In the first stage titled pre-contemplation, we have people who have no intentions of taking action, or wanting to change their behavior in the near future. Many peers suggest that the desire to change a behavior is usually measured within the next six months (Prochaska, DiClemente, & Norcross, 1992). Individuals in this stage are unaware or uninformed of the consequences of their behavior (Scholl, 2002), or they may have had a number of failed attempts and are reluctant to try again (Prochaska & Velicer, 1997). Prochaska et al. (1992), says the main component of pre-contemplation, is the person shows resistance to recognize or modify problem behavior. For an individual to move out of this stage they must experience cognitive dissonance, which is describe as a negative affective state, where the individual acknowledges the problem (Scholl, 2002).
In the next stage of change, we are presented with contemplation. This is where an individual is intending on making a change within the next six months (Patten, Vollman, & Thurston, 2000). People in this stage tend to weigh their pros and cons of changing their behavior, which in turn, can cause them to remain here for long periods of time (Patten et al., 2000). People among this stage are deciding if they need to correct their actions, and whether or not the pros and cons of making a change, outweigh the pros and cons of continuing their behavior (Scholl, 2002). Prochaska & Velicer (1997), state that being stuck in this stage is known as chronic contemplation or behavioral procrastination. During contemplation, the person will still participate in their risky behavior but they are aware that their behavior is causing a problem (Patten et al., 2000). An individual will move on to the next stage, once they perceive that their pros outweigh their cons, and if their force of motivation is strong (Scholl, 2002).
In our third stage, preparation, we begin to plan our behavior change within the next month (Patten et al., 2000). A person in this stage may have tried some sort of action to change their behavior within the last year, but are still engaging in such high-risk behaviors (Patten et al., 2000). Individuals in this stage may be uncertain on how to proceed in making a change, and are known to be nervous about their ability to change (Scholl, 2002). A plan of action is made up to eliminate and/ or reduce the problem behavior. During this time, a person chooses between alternative solutions (Velicer, Prochaska, Fava, Norman, & Redding, 1998). Individuals will move to the next stage once they select a plan of action, and feel confident in knowing they can follow through with their plan (Scholl, 2002).
In the action stage, individuals have already made efforts to change their behaviors, experiences, or environments within the last six months (Patten et al., 2000). The action stage requires a substantial amount of commitment. This is a stage where the individual gets recognition from others because of their visible results and efforts (Patten et al., 2000). Prochaska, DiClemente, and Norcross (1992), insist that the main ways of recognizing someone who is involved within the action stage, is by observing their significant efforts made to change, and by modifying their problem behavior. Movement into the next stage can occur when an individual sees evidence of improvement, has a positive affective state, and/ or receives positive social and performance feedback (Scholl, 2002).
The next stage of the Trans-Theoretical Model is maintenance (Prochaska et al., 1992). In this stage people work on preventing relapse, and securing their advancements made during their time within the action phrase (Velicer et al., 1998). Individuals in the maintenance stage are less tempted to relapse, and more confident that they will be able to continue such positive changes (Prochaska et al., 1997). According to Prochaska and colleagues (1992), in order to remain free from their problem behavior, personals must participate in their new healthy behaviors for more than six months (1992). Research recognizes that maintenance is a continuation of change, not an absence of it (Patten et al., 2000).
When Prochaska and DiClemente developed the Trans-Theoretical Model of Change in 1983, there were only five stages. With recent research a lot of newer illustrations of the Trans-Theoretical Model include the final stage as termination. Dr. Gold believes this stage is known as the ultimate goal in the change process (2006). Here, the individual no longer finds their negative behavior present, or as temptation; he or she has complete confidence that they can cope without any fear of relapse (Gold, 2016). In the image below, there is a complete illustration of all six stages of change with in the Trans Theoretical Model. This image was provided by Communication4Health, 2013. Methods: The author will use peer reviewed articles reported by professionals employed in public health, through google scholar. A search was conducted, and details were identified by terms. Terms used were: Trans-Theoretical, model, behavior change, changing behavior, stages of change, concepts of change and smoking cessation. The author will provide the main components of the Trans Theoretical Model, and its uses for healthy behavior change obtained from the National Center for Biotechnology Information (NCBI) webpage, and the Oxford Journals webpage. He will also provide certain factors and issues that drive individuals to want to change their behavior, using public health journals, scholar articles, and the Center of Disease Control (CDC) website. For any other additional information, this author will utilize the FAMU library for any documents, journals, catalogs, and/ or articles provided on this subject. To ensure proper indication, the author will list all references following APA format and guidelines throughout his paper.
Results:
The Trans Theoretical Model of Change can be applied to numerous health changes. This is a model that relies solely on emotions, cognitions, and behavior. A huge component of Trans Theoretical Model is “self-report”. One behavior change that receives predominantly accurate self-reporting is smoking cessation (Velicer, Prochaska, Rossi, & Snow 1992). When we are measuring behavior change, it is important that the application of the model includes short, reliable, and valid measures of key constructs (Velicer, Prochaska, Fava, Rossi, Redding, Laforge, Robbins, 2000). Velicer et al. (2000), states that Change implies phenomena occurring over time. Hence, the five stages of change. “Temporal dimension”, is another term used to describe these varying stages. Velicer and his colleagues have stated, “before the target behavior can change, the temporal dimension is visualized. Once the behavior change has occurred, the temporal dimension is developed” (2000). There was a study conducted by Velicer, Fava, Prochaska, Abrams, Emmons, & Pierce (1995), which showcased smoker’s distribution across the first three Stages of Change. The study found that approximately 40% of smokers were in the pre-contemplation stage, where 40% were in the contemplation stage, and only 20% were in the preparation stage (Velicer et al. 1995).
However, the distributions may be different in different countries (Velicer et al., 1998). Recent data provided by Etter, Perneger, & Ronchi (1997), summarized the stage circulation from four recent samples, these samples came from different countries in Europe, including Spain, Netherlands, and Switzerland. The distributions of smokers were very similar across the European samples, but were very different from the American samples. For example, in Europe, approximately 70% of the smokers were in the pre-contemplation stage, where 20% were in the contemplation stage, and ony 10% were in the preparation stage (Etter et al., 1997).
Within this model, the term regression can be implied. This is when an individual reverts back to an earlier stage of change (Velicer et al., 2000). When we are dealing with people who are trying to quit smoking, relapse can occur. As provided by the examples above, many smokers revert back and forth between the first three stages of change. However, people can regress from any stage to an earlier stage (Velicer et al., 2000). More so, Velicer and his peers provided that only 15% of people regress all the way back to the pre-contemplation stage, vast majority of people only regress back towards the contemplation or preparation stage (2000).
Kipfer, (2005) said that “self-efficacy” plays a massive role in the Trans Theoretical Model, for it “involves capability, strength, competence, power, or ability with the emphasis on self-change”. Self-efficacy was first introduced by Bandura in 1977, where it was portrayed in his Social Learning Theory. Prochaska and colleagues’ (1994) adopted self-efficacy into the Trans Theoretical Model, stating that individual gains of one stage of change to another, ensures confidence, and self-efficacy. Success is defined by individuals who make the attempt. Motivation to change incorporates self-confidence, and the person’s perception of positive and negative outlooks (Peterson, 2009).
As a result of the Trans Theoretical Model, “decisional balance” was another element mentioned by numerous peers. Decisional balance can be described as the positive and negative reasons to change a behavior (Peterson, 2009). A study was conducted by Velicer, DiClemente, Prochaska, & Brandenburg (1985), where they performed an analysis on twenty-four factors dealing with smoking cessation. Prochaska, & Brandenburg (1985), resulted in a decision making process where the “pros and cons” are weighed. We must remember when a behavior change is implemented, the individual must investigate all the pros and cons of changing their behavior. Redding, Rossi J., Rossi S., Velicer, & Prochaska, (2000) state, making a decision to move towards the next stage of change, depends on the importance of weighing the positives and negatives. Failure to do so, can set the individual up for relapse, or regression.
Conclusion:
A number of unhealthy behaviors are preventable. Lifestyle choices are known to contribute to the development of many of these. The key to success in avoiding such unhealthy behavior is by prevention, and being able to successfully change the behavior and maintaining such changes. The Trans Theoretical Model of Change assessing the patient’s knowledge about the condition and their readiness to change. With this approach we allow the patient to choose personal goals, and to determine the motivators and barriers in reaching such accomplishments. Although the stages of change are portrayed to be more individually based, we as professionals need to be cautious when we are conducting evaluations. Edelson (2009), believes “Shifting the paradigm from a strict medical model of expert and student, to a more collegial exchange between equals may be the answer”. How we engage with the individual who is wanting to change is crucial. One’s body language or tone of voice can really alter one’s confidence.
It is important we take our time when planning an intervention. Someone that is experiencing pre-contemplation may be very resistant in wanting to change their behaviors. If we as professional come on “too strong”, we may push the individual even further away from recovery. When presenting the Trans Theoretical Model to someone, it is important that we include education with in our description of explaining change. Someone who knows the outcomes, and benefits of changing a behavior are more susceptible in becoming successful. The Trans Theoretical Model is a great tool in predicting health behaviors, because it ensures us to believe that behavior change does not happen overnight. That healthy behaviors take time to develop, but with good social support, guidance, and most importantly confidence the road to success is near.

References
Communication4Health. (2013, February 6). Retrieved July 27, 2016, from http://communication4health.wordpress.com/tag/stages-of-change/
Edelson, M. (May & June, 2009). Coaching: New skills for a new time. Educational Seminar. Roxbury, MA.
Etter, J-F, Perneger, T. V., & Ronchi, A. (1997). Distributions of smokers by stage: International comparison and association with smoking prevalence. Preventive Medicine, 26, 580-585.
Gold, M. (2006). Stages of Change. Retrieved July 27, 2016, from http://psychcentral.com/lib/stages-of-change/2/
Kipfer, B.A. (Ed.). (2005). Roget’s 21st century thesaurus in dictionary form. New York, N.Y.: Bantam Dell.
Miller, William R., Rollnick, Stephen. (2002). Motivational Interviewing: Preparing People for Change [preview] (2nd Ed). New York: Guilford Press.
Patten, S., Vollman,A., & Thurston,W. (2000). The utility of the transtheoretical model of behavior change for HIV risk reduction in injection drug users. Journal of the Association of Nurses in AIDS Care,11(1), 57-66.
Peterson, J. (2009). Using the Transtheoretical Model in Primary Care Weight management: Tipping the Decisional Balance Scale for Exercise. 15-19. Retrieved July 27, 2016, from http://scholarworks.umass.edu/cgi/viewcontent.cgi?article=1002&context=nursing_dnp_capstone
Prochaska, J., & DiClemente, C. (1983). Stages and processes of self-change of smoking: Toward an integrative model of change. Journal of Consulting and Clinical Psychology, 51(3),390-395.
Prochaska, J., DiClemente, C., & Norcross, J. (1992). In search of how people change: Applications to addictive behaviors. American Psychologist, 47(9),1002-1114.
Prochaska, J.,& Velicer, W.(1997). The Transtheoretical model of health behavior change. American Journal of Health Promotion,12(1),38-48.
Prochaska, J., Velicier, W., Rossi, J., Goldstein, M., Marcus, B., Rakowski, W., Fiore, C., Harlow, L., Redding, C., Rosenbloom, D., & Rossi, S., (1994). Stages of change and decisional balance for 12 problem behaviors. Health Psychology, 13(1), 39-46.
Redding, C., Rossi, J., Rossi, S., Velicer, W., Prochaska, J. (2000). Health behavior models. The International Electronic Journal of Health Education, 3, 180-193.
Scholl, R. (2002). The transtheoretical model of behavior change. Retrieved July 23, 2016, from http://www.cba.uri.edu/Scholl/Notes/TTM.html
Velicer, W., DiClemente, C., Prochaska, J., & Brandenburg, N., (1985). A decisional balance measure for prediction smoking cessation. Journal of Personality and Social Psychology, 48, 1279-1289.
Velicer, W., Fava, J., Prochaska, J., Abrams, D., Emmons, K., & Pierce, J. (1995). Distribution of smokers by stage in three representative samples. Preventive Medicine, 24: 401-411
Velicer, W., Prochaska, J., Fava, J., Norman, G., & Redding, C. (1998). Smoking cessation and stress management: Applications of the Transtheoretical Model of behavior change. Homeostasis, 38, 216-233. Retrieved July 24, 2016, from Http://www.uri.edu/research/cprc/TTM/detailedoverview.htm
Velicer, W., Prochaska, J., Fava, J., Rossi, J., Redding, C., Laforge, R., Robbins, M. (2000). Using the Transtheoretical Model for Population-based Approaches to Health Promotion and Disease Prevention. Homeostasis in Health and Disease, 40, 174-195.
Velicer, W., Prochaska, J., Rossi, J., & Snow, M., (1992). Assessing outcome in smoking cessation studies. Psychological Bulletin, 111, 23-41.…...

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