ARBA MINCH UNIVERSITY

COLLEGE OF MEDICINE AND HEALTH SCINCE

SCHOOL OF NURSING

DEPARTMENT OF COMPERHENSIVE NURSING

HEALTH EDUCATION

GROUP FOUR ASSIGNMENT

GROUP MEMBERS
NAME ID No

SALEAMLAK BAYE NSR/2011/13

SAMUEL DEBELA NSR/2045/13

SAMUEL TESHOME NSR/2049/13

SENAIET SEIFU NSA/026/13

SHUMI NAGESO NSR/2135/13

SIHAME HUSSEN NSR/2139/13

SOLOMON LEUL NSR/2174/13

TADIE WASIE NSR/2219/13

TEGENG MILKIYAS NSR/2251/13

TEKLU FAKATA NSA/022/13

TIGIST BIRHANU NSA/002/13

WELE WANGELA NSA/040/13

YONATAN TESSEMA NSR/2575/13

ZENAW ASMAMAW NSR/2627/13

Introduction

Transtheoretical Model (TTM)

The Transtheoretical Model (TTM) is a theoretical framework that explains behaviour change as
a process that unfolds over time, with individuals progressing through different stages of change.
The model consists of five stages of change: pre contemplation, contemplation, preparation,
action, and maintenance. The TTM also includes several constructs, such as self-efficacy,
decisional balance, and processes of change, that play a role in behaviour change.

1. Pre-contemplation: There is no intention of taking action.

2. Contemplation: There are intentions to take action and a plan to do so in the near future.
3. Preparation: There is intention to take action and some steps have been taken.
4. Action: Behaviour has been changed for a short period of time.
5. Maintenance: Behaviour has been changed and continues to be maintained for the long-
term.
6. Termination: There is no desire to return to prior negative behaviors. To progress through
the stages of change, people apply cognitive, affective, and evaluative processes. Ten
processes of change have been identified with some processes being more relevant to a
specific stage of change than other processes. These processes result in strategies that help
people make and maintain change.

1. Consciousness Raising - Increasing awareness about the healthy behaviour.

2. Dramatic Relief - Emotional arousal about the health behaviour, whether positive or
negative arousal.
3. Self-revelation - Self reappraisal to realize the healthy behaviour is part of who they want
to be.
4. Environmental Re-evaluation - Social reappraisal to realize how their unhealthy
behaviour affects others.
5. Social Liberation - Environmental opportunities that exist to show society is supportive
of the healthy behaviour.
6. Self-Liberation - Commitment to change behaviour based on the belief that achievement
of the healthy behaviour is possible.
7. Helping Relationships - Finding supportive relationships that encourage the desired
change.
 8. Counter-Conditioning - Substituting healthy behaviors and thoughts for unhealthy
behaviors and thoughts.
9. Reinforcement Management - Rewarding the positive behaviour and reducing the
rewards that come from negative behaviour.
10. Stimulus Control - Re-engineering the environment to have reminders and cues that
support and encourage the healthy behaviour and remove those that encourage the
unhealthy behaviour.

Queastion 4

Suppose family planning use in SNNP, Gamo zone, Mirab Abaya woreda was very low and
rare. Assume urban health health workers were assigned there and struggling with
introduction of this family planning utilization behaviour use the individual theory or model.
I.e TTM

A) Assume FP utilization behaviour change is a process that unfolds over time …. use TTM
and apply it how to change the behaviour discuss in detail

Family Planning (FP) is a critical aspect of public health that promotes informed decision-
making regarding reproductive health. It is an essential tool for reducing maternal and child
mortality rates, combating poverty, and enhancing gender equality. However, the utilization of
FP in Gamo zone, Mirab Abaya woreda, is significantly low and rare, posing a significant
challenge to public health officials. To address this issue, urban health extension workers have
been assigned to the area, but they are struggling with introducing FP utilization behaviour. This
essay explores how the Transtheoretical Model (TTM) can be applied to effect behaviour change
towards FP utilization in Gamo zone.

Stage 1: Pre contemplation

In the pre contemplation stage, individuals are not yet considering the adoption of FP utilization
behaviour. The individuals does not use of FP consider as problematic; does not want to change their
behaviour The focus in this stage is on increasing awareness and knowledge about FP and its
benefits. Urban health extension workers can utilize various educational interventions, such as
community meetings and educational materials, to disseminate information on the importance of
FP utilization. The workers can also engage community leaders and influential individuals to
endorse FP utilization.

Stage 2: Contemplation
In the contemplation stage,the individuals expresses a desire to learn more about FP utilization
method; thinks FP is important; states that she does not want more children; expresses a desire to
use FP more effectively but have not yet taken any action. The focus in this stage is on resolving
ambivalence and increasing motivation to adopt FP utilization behaviour. Urban health extension
workers can use motivational interviewing techniques to facilitate an open discussion on the
perceived advantages and disadvantages of FP utilization. They can also engage individuals in a
discussion of their values, preferences, and concerns to promote decisional balance.

Stage 3: Preparation

In the preparation stage, individuals are ready to adopt FP utilization behaviour and are making
plans to do so. The focus in this stage is on increasing self-efficacy and developing concrete
action plans. Urban health extension workers can assist individuals in developing action plans
that are tailored to their specific needs and preferences. They can also provide support and
guidance to enhance self-efficacy, such as addressing any concerns or misconceptions about FP
utilization.

stage 4: action

In the action stage, individuals have adopted FP utilization behaviour and are actively engaging
in it. The individuals has changed lifestyle to avoid unplanned pregnancy; has begun effectively
using a FP utilization method. The focus in this stage is on maintaining the behaviour change and
addressing any challenges that may arise. Urban health extension workers can provide ongoing
support and reinforcement to individuals to sustain FP utilization behaviour. They can also
address any barriers or challenges that individuals may face and provide solutions to overcome
them.

Stage 5: Maintenance

In the maintenance stage, individuals have sustained FP utilization behaviour for an extended
period, and the behaviour change has become a part of their lifestyle. The focus in this stage is
on preventing relapse and maintaining the behaviour change in the long term. Urban health
extension workers can provide ongoing support and encouragement to individuals to prevent
relapse. They can also provide resources and information to help individuals sustain their
behaviour change.

How to change behavior for FP utilization

Experiential Steps:
 1,Consciousness-Raising:

Individuals in the Pre-Contemplation stage do not think about FP utilization. As such, the goal
here is to increase awareness about FP utilization. In this step, health extension workers may
help individuals to learn new facts and discuss new ideas about FP utilization method.

2,Dramatic Relief:

Again, for individuals who are in the Pre-Contemplation stage, if they are not thinking about it,
they are also probably not experiencing it emotionally. And in order to implement change, we
need some level of emotional commitment to that change. This step encourages individuals to
experience some of the negative emotions associated with In FP utilization , this could be a
visualization discussion where the individual faces the idea that, unless they implement some
change, they won’t get their desired outcome and how they feel about that.

3, Environmental Re-evaluation

While we want Pre-Contemplation stage individuals to think about themselves, we also want
them to think about others (social reappraisal). health extension worker in this step may help
individuals consider who else might be impacted by a decision.

4, Self-revelation

Moving out of the Pre-Contemplation stage to the Contemplation and Preparation stages is where
the individuals will experience some self-reappraisal. Said another way, changing is part of a
person’s identity, and when there is resistance to change, the individual is encouraged to express
that they may feel disappointed in themselves. .

5, Social Liberation

individuals in all stages can use this step. Social liberation is the recognition that there are parts
of society that support the positive change the individual is trying to implement FP utilization
method. In financial planning,.

Behavioral Processes:

6, Self-Liberation:

This step is very useful in the Preparation and Action stages; it is all about making
commitments. In family planning utilization, health extension workers can work with individuals
to set goals and reinforce and support their commitment to those goals.

7, Counter Conditioning:
 Found predominately in the Action and Maintenance stages, this is the process by which the
individuals actually substitutes healthy behaviour for negative behaviour. New habits take
practice and effort, and Counter Conditioning, in many ways, is a reflection of how that effort
happens in real time. In family planning utilization, this can be seen in individuals who make
behaviour changes.

8, Stimulus Control

Similar to Counter Conditioning, this process is often a mix of physical and emotional re-
engineering. Stimulus Control involves removing reminders and cues related to unhealthy
behaviour and replacing them with reminders and cues for healthy behaviour. In family planning,
this could be a simple brainstorming exercise, thinking of when it is tough to resist the old habit
and then putting some healthy reminders around it.

9, Reinforcement Management

This process is huge for the Action and Maintenance stages. Basically, people need feedback
when making changes. HEW can do this in two ways. One, they can tell individuals when they
are doing well and two, they can tell individuals that they know when they are not doing so well.

10, Helping Relationships

This step is also important in the Action and Maintenance stages and is about seeing and using
social support for healthy behaviour change

Conclusion

The utilization of FP is essential for promoting maternal and child health, reducing poverty, and
enhancing gender equality. However, in Gamo zone, Mirab Abaya woreda, FP utilization
behaviour is significantly low and rare. The Transtheoretical Model (TTM) provides a theoretical
framework that can be applied to effect behaviour change towards FP utilization in the area.
Urban health extension workers can utilize TTM to tailor interventions that address the specific
needs and preferences of individuals at different stages of change. By increasing awareness and
knowledge, promoting decisional balance, enhancing self-efficacy, and providing ongoing
support and reinforcement, TTM can facilitate the adoption and maintenance of FP utilization
behavior in Gamo zone.

Furthermore, the success of behaviour change interventions based on TTM relies on the
availability of resources, organizational support, and the engagement of the community.
Therefore, collaboration between urban health extension workers, health facilities, policy-
makers, and community leaders is crucial to implementing effective behaviour change
interventions that promote FP utilization behaviour in Gamo zone.
In conclusion, TTM provides a useful framework for promoting behaviour change towards FP
utilization in Gamo zone, Mirab Abaya woreda. By understanding the different stages of change
and tailoring interventions to specific needs and preferences, urban health extension workers can
facilitate the adoption and maintenance of FP utilization behaviour, leading to improved
maternal and child health outcomes, reduced poverty rates, and enhanced gender equality.