ALEISTER LEYTHAM

HEALTH AND WELL BEING

SHN 1612

ALEISTER LEYHTAM

0703320

WORD COUNT 2000

HEALTH AND WELL BEING

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Discuss how health practitioners can use the transtheoretical model in

client based interventions. Reflect on all aspects of the model in your
discussion.

The transtheoretical model started in the late 70s by Prochaska and

DiClemente. It was first designed to help people stop high risk health
behaviours. However, later it became useful for promoting exercise
(Marcus and Simkin, 1994). This model gives and aids a better
understanding of health behaviours and the effects of having bad health.
It uses a structured method to help change behaviours by the use of steps
and procedures. The job of the practitioner is to provide the client with the
necessary skills to be able to combat bad behaviours and change them. If
it is used correctly the model is thought to aid an individual to be able to
maintain and carry out new healthy behaviours. The model helps to
explain why a person is ‘stuck’ or needs help in changing habits. It helps
many behavioural changes such as; smoking, weight control, sunscreen
use, reduction of dietary fat, exercise acquisition, quitting cocaine,
condom use and many more (Prochaska, et al, 1994). . Practitioners help
to plan out necessary steps, and give individuals healthy behaviours to
overcome unhealthy behaviours. Prochaska and DiClemente(1983), also
imply that the creation of a model is able to help individuals predict what
level of change is being undertaken.

There are different parts of the model which are categorized into sections.
Firstly the individual is assessed and goes through a series of changes
starting with; Pre-contemplation, where the individual has no intent on
changing behaviour in the nearby future. This is thought because there is
a lack of awareness that life can be improved by changes in behaviour.
This is followed by the contemplation stage, where the individual is
starting to see that there can be benefits of change. This then moves on
to the preparation stage, where the individual intends to take the
necessary steps and desires to change. Following on is the action stage,
here the individual has made the changes and is carrying out different
lifestyle behaviours such as attending exercise classes. The maintenance

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stage follows on from this as the individual needs to stick to the new
behaviours to prevent relapses, this is seen to help strengthen self
efficacy, where a person builds up the belief to carry out changes,
influencing confidence to abstain from previous behaviours.

This also provides the client with healthy appraisal and aids throughout
the stages of change, this model tackles the problem behaviour by
breaking down the new behaviours into bite size chunks, which may help
in the early stages as change from an addiction may be quite hard. This
may allow the client to take the procedure of change one step at a time,
progressively instilling the new behaviour.

Here is a table which may better explain the model:

There is also a fifth stage which is called the relapse. This is when the
participant may regress back a level or so in the stages of the model.
However a good thing about the model is that if a participant using the
stages happens to have a relapse; resulting in carrying out the behaviour
or doesn’t carry out the new behaviour. Generally only goes down one to
two levels at a time which is called the spiral model. This is a key part to
the model as it considers and takes relapse into account. Normally if the
participant drops back a level or to, it may help the participant to
overcome any necessary problems learn from mistakes made and go back
up before dropping back too far. This is due to the increase already

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created in the participant’s self-efficacy, also the decision making

strategies which have already been installed into the participants mind.

A study was undertaken on 1063 government employees and 429 hospital

employees. This measured stages of exercise behaviour change and
exercise self-efficacy. It was found that self-efficacy steadily increased
from precontemplation maintenance, (Marcus et al, 1992). At this stage
the individual may have reached the termination stage where previous
behaviours are no longer perceived as desirable. However in various
situations individuals can go back through the stages regressing back to
earlier behaviours. This is called the spiral stage.

The process of change provides the individual with self evaluation and
processes to focus on when undergoing self change. Here is a table to
explain the processes.

Processes of Change Definition / Interventions

Efforts by the individual to seek new information and to

gain understanding and feed-back about the problem
Consciousness Raising
behavior / observations, confrontations, interpretations,
bibliotherapy.

Substitution of alternatives for the problem behavior /

Counterconditioning relaxation, desensitization, assertion, positive self-
statements.

Experiencing and expressing feelings about the problem

Dramatic Relief behavior and potential solutions / psychodrama, grieving
losses, role playing.

Consideration and assessment of how the problem

Environmental Reevaluation behavior affects the physical and social environment /
empathy training, documentaries.

Trusting, accepting, and utilizing the support of caring

Helping Relationships
others during attempts to change the problem behavior.

Rewarding oneself or being rewarded by others for making

Reinforcement Management changes / contingency contracts, overt and covert
reinforcement, self-reward.

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Choice and commitment to change the problem behavior,

including belief in the ability to change / decision-making
Self-Liberation
therapy, New Year's resolutions, logotherapy techniques,
commitment enhancing techniques.

Emotional and cognitive reappraisal of values by the

Self-Reevaluation individual with respect to the problem behavior / value
clarification, imagery, corrective emotional experience.

Awareness, availability, and acceptance by the individual

Social Liberation of alternative, problem-free lifestyles in society /
empowering, policy interventions.

Control of situations and other causes which trigger the

problem behavior / adding stimuli that encourage
Stimulus Control
alternative behaviors, restructuring the environment,
avoiding high risk cues, fading techniques.

(Velicer, et al, 1998). As is shown in the table there is a very in depth

explanation for each stage which needs to be followed to go through the
necessary stages in order to change. This evaluation provides the client
with useful and awarding feedback to aid in moving through the levels.

The progression through stages can vary as particular stages can be

tailored more to the individual or the behaviour change. For example, a
study of smoking cessation program for cardiac patients found that an
intense action-and maintenance-oriented approach was highly successful
for patients in the action stage, but failed with those in the
precontemplation and contemplation stages. (Ockene, Ockene, &
Kristellar, 1988). Treatment programmes tend to be action oriented
(Orleans et al, 1988). This may be hard in cases of addicts who may need
more help. Or may struggle to help themselves.

This model however may be problematic in cases where an individual’s

lifestyle undergoes a dramatic change. It may also be hard if an individual
has time or money problems, or other influences such as family or
relationship ties which may hold the individual back. The model provides
self evaluation so the individual has better understanding of the stages
keeping track of one’s own record. This can provide help due to
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influencing the individual to learn from previous mistakes and keep track
in order to follow the stages back up again. The model provides useful self
help so is valuable for people who may not want to undergo any treatment
by the use of medication. It also provides the individual with
developments in self-efficacy with an understanding for future health
behaviours. An experiment carried out by Calleghan, Russel C et al
(Journal of aging & health), was to see if older women would conform to
the transtheoretical model by following the stages and sticking to an
exercise programme. 272 women were used at age 70. The findings
showed that after one year over 60 % of the group were either in the
action stage or the maintenance. This was compared to a control group
who only 16% were active. This proved that self-efficacy learned and
developed from the models stages helped with long term exercise.

This model may be time consuming. The individual will have to want to
change and be prepared to work hard at the stages in order to do so.
Scott, Katreena L. (2004) (Journal of Family Violence). Found by assessing
the contribution of the men’s stage of change for attending a batterer
treatment programme. Found that over the course of a year 61% had
dropped out of treatment. The contemplation stage was the highest rate
for dropping out in. It also found that men in the higher stages were less
likely to drop out. This shows that the stages may need modifications at
the beginning to ensure the participant stays on the course.

The initial aim of the health practitioner is to influence, inform and

motivate the client to help work through the different stages. Many
behaviours of interest are novel behaviours for example, attending a
cervical cytology test, attending rehabilitation after a heart attack. The
benefits of the transtheoretical model seem to be that the practitioner
influences the client by using techniques such as instilling fear arousal,
appraisal, coping mechanisms and motivation. Firstly at the beginning
stages the practitioner might focus on increasing the individuals
understanding and awareness of the behaviour and its causes, and how
they may affect the body. The practitioner may then address topics like
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increasing awareness of activity for instance if the individual needed to

lose weight for instance. The practitioner would provide the client with
useful research and of the benefits of activity and start to focus more on
encouraging the client to think about possible steps in order to gain new
behaviours. By this time the practitioner would try to get the client to start
focusing on exercising and may suggest strategies for maintaining an
active lifestyle. This may be by working through a timetable to fit
sufficient times when the client could carry out the task if necessary. The
practitioner would offer advice on how to reward oneself for reaching
goals which have been created and other cues to help the client stay on
track such as reminders put around an office or the home. While this is
being learned the practitioner will be working to help the client’s increase
self-confidence with regards to the ability which may have been gained
through staying physically active(Bandura, 1977, class handout). With the
clients moving through the stages the practitioner will need to keep the
client aware of how much has been achieved and how many benefits have
been gained, this will help to keep the client on track and feel that a
positive difference has been made. With clients at high stages the
practitioner may not be quite as influential as the client may feel enough
self-efficacy to carry on regardless as results have shown. However, still
support from the practitioner may be necessary to maintain the focus and
to keep on track. If a relapse occurs then the practitioner may provide the
client with an understanding non-judgemental approach, informing the
client that it’s alright and quite normal. Here the practitioner provides
support and awareness of the stage which the client may have dropped
back to. However usually by this stage the client can carry out the
necessary procedures to maintain the behaviour effectively.

The treatment will be expensive as the participant will need a health

practitioner, finding a suitable one maybe an issue as the individual is
different and may have certain issues with relationships or authority
figures. The client will need to feel comfortable and in good hands. The
transtheoretical model seems to provide a good service and an effective
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strategy to combat bad behaviour and develop new healthy behaviours. It

provides good information and learning of what specific health behaviour
may be addressed. This is also useful because it seems once the client
has reached a certain stage then has the understanding and ability to
carry out the process alone and use the technique in association with
other health behaviours.

BIBLIOGRAPHY

Conner, M 2005 Predicting Health

Behaviours

Norman, P (Open University Press,

Shoppenhangers Rd,
Maiden-

Head, Berkshire, England,

SL6 2QL)

O’Donnell, M 1994 Health Promotion

in the Workplace

Harris, J (Delmar Publishers inc.)

Rutter, D 2002 Changing

Health Behaviour

Quine, L (Open
University Press, Celtic Court

Buckingha
m, MK18 1XW)

Marks, D 2005 Health

Psychology Theory Research
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Murray, M and Practice

(SAGE
publications ltd,

1 Oliver’s
yard, 55 City Road

London
EC1Y 1SP)

Marcus, B. H. 1994 The

Transtheoretical Model:
Simkin, L. R. Application
to Exercise Behaviour.

JOURNALS

Findorff, M, J 2007 Journal of

Aging & Health

Stock, H, H (Vol. 19
issue 6, p 985-1003)

Scott, K, L 2004 Journal of

Family Violence

(Vol. 19
issue 1, p 37-47)

INTERNET

(http://www.uri.edu/research/cprc/TTM/processofchange.htm)

CLASS HANDOUTS

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