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Home  ›  (Gsm) -- In What Stage Of The Transtheoretical Model Does A Person Actively Plan To Change?

(Gsm) -- In What Stage Of The Transtheoretical Model Does A Person Actively Plan To Change?

Written By Wednesday, March 30, 2022 Add Comment Edit

Stages of modify, according to the transtheoretical model.

The transtheoretical model of beliefs change is an integrative theory of therapy that assesses an private's readiness to deed on a new healthier behavior, and provides strategies, or processes of change to guide the individual.[one] The model is composed of constructs such as: stages of change, processes of alter, levels of change, self-efficacy, and decisional balance.[i]

The transtheoretical model is besides known by the abbreviation "TTM"[ii] and sometimes past the term "stages of change",[3] although this latter term is a synecdoche since the stages of change are only i part of the model along with processes of change, levels of change, etc.[one] [4] Several self-help books—Changing for Good (1994),[5] Changeology (2012),[6] and Changing to Thrive (2016)[7]—and articles in the news media[8] take discussed the model. Information technology has been called "arguably the ascendant model of wellness behaviour change, having received unprecedented enquiry attention, yet it has simultaneously attracted criticism".[9]

History and core constructs [edit]

James O. Prochaska of the University of Rhode Island, and Carlo Di Clemente and colleagues adult the transtheoretical model beginning in 1977.[1] It is based on analysis and use of unlike theories of psychotherapy, hence the name "transtheoretical".

Prochaska and colleagues refined the model on the basis of research that they published in peer-reviewed journals and books.[10]

Stages of change [edit]

This construct refers to the temporal dimension of behavioural alter. In the transtheoretical model, change is a "process involving progress through a series of stages":[11] [12]

  • Precontemplation ("not ready") – "People are non intending to accept action in the foreseeable future, and can be unaware that their behaviour is problematic"
  • Contemplation ("getting prepare") – "People are beginning to recognize that their behaviour is problematic, and first to look at the pros and cons of their connected actions"
  • Preparation ("ready") – "People are intending to accept action in the immediate future, and may brainstorm taking small steps toward behaviour change"[nb 1]
  • Action – "People have fabricated specific overt modifications in modifying their problem behaviour or in acquiring new healthy behaviours"
  • Maintenance – "People have been able to sustain action for at to the lowest degree half-dozen months and are working to prevent relapse"
  • Termination – "Individuals accept zero temptation and they are sure they volition not return to their old unhealthy habit equally a mode of coping"[nb ii]

In addition, the researchers conceptualized "Relapse" (recycling) which is not a stage in itself but rather the "return from Activity or Maintenance to an earlier stage".[xi] [nb 3]

The quantitative definition of the stages of change (see beneath) is perhaps the near well-known feature of the model. However it is also one of the most critiqued, even in the field of smoking cessation, where it was originally formulated. It has been said that such quantitative definition (i.e. a person is in grooming if he intends to alter within a calendar month) does not reflect the nature of behaviour change, that it does not accept better predictive power than simpler questions (i.east. "do you have plans to change..."), and that it has problems regarding its nomenclature reliability.[13]

Communication theorist and sociologist Everett Rogers suggested that the stages of change are analogues of the stages of the innovation adoption procedure in Rogers' theory of improvidence of innovations.[14]

Details of each stage [edit]

Stage Precontemplation Contemplation Grooming Action Maintenance Relapse
Standard time more than 6 months in the next half dozen months in the next month at present at to the lowest degree six months any time

Stage 1: Precontemplation (not ready)[5] [11] [xv] [16] [17] [eighteen]

People at this stage do not intend to start the healthy behavior in the near time to come (within 6 months), and may be unaware of the need to change. People hither learn more nigh healthy behavior: they are encouraged to recall most the pros of changing their behavior and to feel emotions about the effects of their negative behavior on others.

Precontemplators typically underestimate the pros of irresolute, overestimate the cons, and oftentimes are non enlightened of making such mistakes.

One of the most effective steps that others tin help with at this phase is to encourage them to get more mindful of their decision making and more conscious of the multiple benefits of changing an unhealthy behavior.

Phase 2: Contemplation (getting ready)

At this stage, participants are intending to beginning the salubrious beliefs within the adjacent six months. While they are usually at present more aware of the pros of changing, their cons are almost equal to their Pros. This ambivalence nearly changing can cause them to go along putting off taking activity.

People here learn about the kind of person they could exist if they changed their behavior and acquire more from people who comport in healthy means.

Others tin influence and assistance effectively at this phase past encouraging them to piece of work at reducing the cons of changing their beliefs.

Stage 3: Preparation (set up)

People at this phase are ready to start taking action within the next thirty days. They have small steps that they believe can help them brand the healthy behavior a part of their lives. For example, they tell their friends and family that they want to modify their beliefs.

People in this stage should be encouraged to seek support from friends they trust, tell people well-nigh their plan to change the way they deed, and think most how they would feel if they behaved in a healthier manner. Their number one concern is: when they act, volition they fail? They learn that the meliorate prepared they are, the more likely they are to go along progressing.

Phase 4: Action (electric current action)

People at this stage take changed their beliefs within the last 6 months and need to work hard to keep moving ahead. These participants need to learn how to strengthen their commitments to modify and to fight urges to skid dorsum.

People in this stage progress past being taught techniques for keeping up their commitments such as substituting activities related to the unhealthy behavior with positive ones, rewarding themselves for taking steps toward irresolute, and avoiding people and situations that tempt them to behave in unhealthy means.

Stage five: Maintenance (monitoring)

People at this stage changed their behavior more than 6 months ago. It is important for people in this stage to be aware of situations that may tempt them to slip back into doing the unhealthy beliefs—especially stressful situations.

It is recommended that people in this phase seek support from and talk with people whom they trust, spend fourth dimension with people who behave in salubrious ways, and think to engage in healthy activities (such as exercise and deep relaxation) to cope with stress instead of relying on unhealthy behavior.

Relapse (recycling)[xix] [xx] [21] [22]

Relapse in the TTM specifically applies to individuals who successfully quit smoking or using drugs or alcohol, only to resume these unhealthy behaviors. Individuals who attempt to quit highly addictive behaviors such as drug, alcohol, and tobacco utilize are at especially high risk of a relapse. Achieving a long-term behavior change often requires ongoing support from family members, a health charabanc, a physician, or another motivational source. Supportive literature and other resources can too be helpful to avoid a relapse from happening.

Processes of alter [edit]

The 10 processes of change are "covert and overt activities that people use to progress through the stages".[11]

To progress through the early on stages, people apply cognitive, affective, and evaluative processes. As people move toward Action and Maintenance, they rely more on commitments, counter conditioning, rewards, environmental controls, and support.[23]

Prochaska and colleagues state that their enquiry related to the transtheoretical model shows that interventions to change beliefs are more constructive if they are "stage-matched", that is, "matched to each individual's stage of modify".[xi] [nb 4]

In general, for people to progress they need:

  • A growing awareness that the advantages (the "pros") of irresolute outweigh the disadvantages (the "cons")—the TTM calls this decisional balance.
  • Conviction that they can make and maintain changes in situations that tempt them to return to their old, unhealthy beliefs—the TTM calls this self-efficacy.
  • Strategies that can help them make and maintain change—the TTM calls these processes of alter.

The x processes of change include:

  1. Consciousness-raising (Go the facts) — increasing awareness via information, teaching, and personal feedback about the salubrious behavior.
  2. Dramatic relief (Pay attention to feelings) — feeling fearfulness, anxiety, or worry because of the unhealthy behavior, or feeling inspiration and hope when hearing nigh how people are able to change to good for you behaviors.
  3. Self-reevaluation (Create a new self-image) — realizing that the salubrious behavior is an important part of who they desire to be.
  4. Ecology reevaluation (Discover your effect on others) — realizing how their unhealthy beliefs affects others and how they could have more than positive furnishings by irresolute.
  5. Social liberation (Notice public back up) — realizing that gild is supportive of the healthy behavior.
  6. Cocky-liberation (Make a commitment) — assertive in 1'due south ability to modify and making commitments and re-commitments to act on that belief.
  7. Helping relationships (Get support) — finding people who are supportive of their alter.
  8. Counterconditioning (Use substitutes) — substituting healthy ways of acting and thinking for unhealthy ways.
  9. Reinforcement management (Utilize rewards) — increasing the rewards that come up from positive behavior and reducing those that come from negative behavior.
  10. Stimulus control (Manage your environment) — using reminders and cues that encourage salubrious behavior and avoiding places that don't.

Wellness researchers have extended Prochaska'southward and DiClemente's 10 original processes of alter past an additional 21 processes. In the first edition of Planning Health Promotion Programs,[24] Bartholomew et al. (2006) summarised the processes that they identified in a number of studies;[24] however, their extended list of processes was removed from afterwards editions of the text, perhaps because the listing mixes techniques with processes. At that place are unlimited ways of applying processes. The additional strategies of Bartholomew et al. were:[24]

  1. Risk comparison (Empathise the risks) – comparing risks with similar dimensional profiles: dread, command, catastrophic potential and novelty
  2. Cumulative risk (Go the overall picture show) – processing cumulative probabilities instead of single incident probabilities
  3. Qualitative and quantitative risks (Consider different factors) – processing different expressions of risk
  4. Positive framing (Think positively) – focusing on success instead of failure framing
  5. Cocky-test relate to risk (Be aware of your risks) – conducting an assessment of risk perception, e.one thousand. personalisation, impact on others
  6. Reevaluation of outcomes (Know the outcomes) – emphasising positive outcomes of alternative behaviours and reevaluating outcome expectancies
  7. Perception of benefits (Focus on benefits) – perceiving advantages of the healthy behaviour and disadvantages of the hazard behaviour
  8. Cocky-efficacy and social back up (Get help) – mobilising social support; skills training on coping with emotional disadvantages of change
  9. Decision making perspective (Determine) – focusing on making the conclusion
  10. Tailoring on fourth dimension horizons (Ready the time frame) – incorporating personal time horizons
  11. Focus on of import factors (Prioritise) – incorporating personal factors of highest importance
  12. Trying out new behaviour (Attempt it) – irresolute something about oneself and gaining experience with that behaviour
  13. Persuasion of positive outcomes (Persuade yourself) – promoting new positive outcome expectations and reinforcing existing ones
  14. Modelling (Build scenarios) – showing models to overcome barriers effectively
  15. Skill improvement (Build a supportive surround) – restructuring environments to contain of import, obvious and socially supported cues for the new behaviour
  16. Coping with barriers (Plan to tackle barriers) – identifying barriers and planning solutions when facing these obstacles
  17. Goal setting (Set goals) – setting specific and incremental goals
  18. Skills enhancement (Conform your strategies) – restructuring cues and social support; anticipating and circumventing obstacles; modifying goals
  19. Dealing with barriers (Have setbacks) – understanding that setbacks are normal and can be overcome
  20. Self-rewards for success (Advantage yourself) – feeling good virtually progress; reiterating positive consequences
  21. Coping skills (Place difficult situations) – identifying high risk situations; selecting solutions; practicing solutions; coping with relapse

While about of these processes and strategies are associated with wellness interventions such as stress direction, do, salubrious eating, smoking cessation and other addictive behaviour,[24] some of them are as well used in other types of interventions such equally travel interventions.[25] Some processes are recommended in a specific stage, while others tin can be used in one or more stages.[1]

Decisional residuum [edit]

This cadre construct "reflects the individual's relative weighing of the pros and cons of irresolute".[11] [nb v] Decision making was conceptualized by Janis and Mann as a "decisional balance sheet" of comparative potential gains and losses.[26] Decisional residuum measures, the pros and the cons, take get critical constructs in the transtheoretical model. The pros and cons combine to class a decisional "residue sail" of comparative potential gains and losses. The balance betwixt the pros and cons varies depending on which phase of change the private is in.

Sound determination making requires the consideration of the potential benefits (pros) and costs (cons) associated with a behavior's consequences. TTM research has found the following relationships between the pros, cons, and the stage of alter across 48 behaviors and over 100 populations studied.

  • The cons of changing outweigh the pros in the Precontemplation stage.
  • The pros surpass the cons in the eye stages.
  • The pros outweigh the cons in the Action stage.[27]

The evaluation of pros and cons is function of the formation of decisional residual. During the alter process, individuals gradually increase the pros and decrease the cons forming a more positive balance towards the target behaviour. Attitudes are one of the core constructs explaining behaviour and behaviour change in various inquiry domains.[28] Other behaviour models, such as the theory of planned behavior (TPB)[29] and the stage model of self-regulated modify,[xxx] besides emphasise attitude as an of import determinant of behaviour. The progression through the unlike stages of change is reflected in a gradual alter in mental attitude before the private acts. About of the processes of change aim at evaluating and reevaluating too equally reinforcing specific elements of the current and target behaviour.

Due to the utilise of decisional balance and attitude, travel behaviour researchers have begun to combine the TTM with the TPB. Frontwards[31] uses the TPB variables to ameliorate differentiate the different stages. Especially all TPB variables (attitude, perceived behaviour control, descriptive and subjective norm) are positively evidence a gradually increasing relationship to stage of change for bike commuting. As expected, intention or willingness to perform the behaviour increases by stage.[31] Similarly, Bamberg[30] uses various behavior models, including the transtheoretical model, theory of planned behavior and norm-activation model, to build the stage model of self-regulated behavior change (SSBC). Bamberg claims that his model is a solution to criticism raised towards the TTM.[30] Some researchers in travel, dietary, and ecology research have conducted empirical studies, showing that the SSBC might be a future path for TTM-based research.[30] [32] [33]

Self-efficacy [edit]

This core construct is "the situation-specific confidence people have that they can cope with loftier-risk situations without relapsing to their unhealthy or high risk-addiction".[11] [nb half dozen] The construct is based on Bandura'south self-efficacy theory and conceptualizes a person's perceived ability to perform on a task as a mediator of performance on future tasks.[34] [35] In his research Bandura already established that greater levels of perceived self-efficacy leads to greater changes in behavior.[35] Similarly, Ajzen mentions the similarity betwixt the concepts of self-efficacy and perceived behavioral control.[36] This underlines the integrative nature of the transtheoretical model which combines various behavior theories. A change in the level of cocky-efficacy tin predict a lasting alter in beliefs if at that place are adequate incentives and skills. The transtheoretical model employs an overall confidence score to assess an individual's self-efficacy. Situational temptations assess how tempted people are to engage in a problem beliefs in a certain situation.

Levels of change [edit]

This core construct identifies the depth or complexity of presenting problems co-ordinate to five levels of increasing complexity.[1] [4] Different therapeutic approaches have been recommended for each level too every bit for each phase of change.[1] [10] The levels are:

  1. Symptom/situational problems: e.g., motivational interviewing, behavior therapy, exposure therapy
  2. Current maladaptive cognitions: due east.g., Adlerian therapy, cerebral therapy, rational emotive therapy
  3. Current interpersonal conflicts: e.g., Sullivanian therapy, interpersonal therapy
  4. Family/systems conflicts: e.g., strategic therapy, Bowenian therapy, structural family therapy
  5. Long-term intrapersonal conflicts: e.g., psychoanalytic therapies, existential therapy, Gestalt therapy

In 1 empirical study of psychotherapy discontinuation published in 1999, measures of levels of change did not predict premature discontinuation of therapy.[37] However, in 2005 the creators of the TTM stated that it is important "that both therapists and clients agree every bit to which level they attribute the problem and at which level or levels they are willing to target as they piece of work to change the problem behavior".[one] : 152

Psychologist Donald Fromme, in his book Systems of Psychotherapy, adopted many ideas from the TTM, but in identify of the levels of change construct, Fromme proposed a construct called contextual focus, a spectrum from physiological microcontext to environmental macrocontext: "The horizontal, contextual focus dimension resembles TTM's Levels of Change, but emphasizes the latitude of an intervention, rather than the latter's focus on intervention depth."[4] : 57

Outcomes of programs [edit]

The outcomes of the TTM computerized tailored interventions administered to participants in pre-Activeness stages are outlined beneath.

Stress direction [edit]

A national sample of pre-Activeness adults was provided a stress management intervention. At the 18-month follow-up, a significantly larger proportion of the handling group (62%) was effectively managing their stress when compared to the control grouping. The intervention too produced statistically significant reductions in stress and low and an increase in the utilize of stress management techniques when compared to the control group.[38] Two additional clinical trials of TTM programs by Prochaska et al. and Jordan et al. too found significantly larger proportions of treatment groups finer managing stress when compared to command groups.[2] [39]

Adherence to antihypertensive medication [edit]

Over one,000 members of a New England grouping exercise who were prescribed antihypertensive medication participated in an adherence to antihypertensive medication intervention. The vast majority (73%) of the intervention group who were previously pre-Action were adhering to their prescribed medication regimen at the 12-month follow-up when compared to the control group.[40]

Adherence to lipid-lowering drugs [edit]

Members of a large New England health programme and various employer groups who were prescribed a cholesterol lowering medication participated in an adherence to lipid-lowering drugs intervention. More than half of the intervention grouping (56%) who were previously pre-Action were adhering to their prescribed medication regimen at the 18-month follow-up. Additionally, merely 15% of those in the intervention group who were already in Action or Maintenance relapsed into poor medication adherence compared to 45% of the controls. Further, participants who were at risk for physical activity and unhealthy diet were given just stage-based guidance. The treatment group doubled the control grouping in the percentage in Action or Maintenance at 18 months for physical activity (43%) and diet (25%).[41]

Depression prevention [edit]

Participants were 350 chief care patients experiencing at to the lowest degree mild depression but not involved in treatment or planning to seek handling for depression in the next 30 days. Patients receiving the TTM intervention experienced significantly greater symptom reduction during the 9-month follow-up menstruum. The intervention's largest effects were observed amid patients with moderate or severe depression, and who were in the Precontemplation or Contemplation stage of change at baseline. For example, among patients in the Precontemplation or Contemplation stage, rates of reliable and clinically significant improvement in depression were 40% for handling and 9% for control. Among patients with mild low, or who were in the Action or Maintenance stage at baseline, the intervention helped preclude disease progression to Major Low during the follow-upward menstruation.[42]

Weight management [edit]

Five-hundred-and-seventy-seven overweight or moderately obese adults (BMI 25-39.9) were recruited nationally, primarily from large employers. Those randomly assigned to the handling group received a stage-matched multiple behavior change guide and a serial of tailored, individualized interventions for 3 health behaviors that are crucial to effective weight management: healthy eating (i.e., reducing calorie and dietary fat intake), moderate exercise, and managing emotional distress without eating. Up to three tailored reports (ane per beliefs) were delivered based on assessments conducted at iv time points: baseline, 3, vi, and 9 months. All participants were followed up at 6, 12, and 24 months. Multiple Imputation was used to guess missing data. Generalized Labor Estimating Equations (GLEE) were so used to examine differences between the treatment and comparing groups. At 24 months, those who were in a pre-Activeness stage for healthy eating at baseline and received handling were significantly more likely to have reached Action or Maintenance than the comparison group (47.five% vs. 34.3%). The intervention also impacted a related, just untreated behavior: fruit and vegetable consumption. Over 48% of those in the treatment grouping in a pre-Action phase at baseline progressed to Action or Maintenance for eating at least 5 servings a day of fruit and vegetables as opposed to 39% of the comparison group. Individuals in the handling group who were in a pre-Activity stage for exercise at baseline were likewise significantly more than likely to reach Action or Maintenance (44.9% vs. 38.1%). The treatment also had a significant result on managing emotional distress without eating, with 49.seven% of those in a pre-Activity stage at baseline moving to Activeness or Maintenance versus 30.3% of the comparison group. The groups differed on weight lost at 24 months amid those in a pre-Action stage for healthy eating and do at baseline. Among those in a pre-Activeness phase for both good for you eating and exercise at baseline, 30% of those randomized to the treatment group lost 5% or more than of their body weight vs. sixteen.half dozen% in the comparison group. Coaction of behavior change occurred and was much more pronounced in the treatment group with the treatment group losing significantly more than the comparison group. This study demonstrates the ability of TTM-based tailored feedback to improve healthy eating, practice, managing emotional distress, and weight on a population ground. The treatment produced the highest population impact to date on multiple health risk behaviors.[43]

The effectiveness of the employ of this model in weight management interventions (including dietary or concrete activity interventions, or both, and also combined with other interventions) for overweight and obese adults was assessed in a 2014 systematic review.[44] The results revealed that in that location is inconclusive evidence regarding the affect of these interventions on sustainable (one yr or longer) weight loss. However, this approach may produce positive effects in concrete activity and dietary habits, such as increased in both exercise duration and frequency, and fruits and vegetables consumption, forth with reduced dietary fatty intake, based on very low quality scientific evidence.[44]

Smoking abeyance [edit]

Multiple studies take found individualized interventions tailored on the 14 TTM variables for smoking cessation to effectively recruit and retain pre-Action participants and produce long-term forbearance rates within the range of 22% – 26%. These interventions take too consistently outperformed alternative interventions including best-in-grade activeness-oriented self-assist programs,[45] non-interactive transmission-based programs, and other common interventions.[46] [47] Furthermore, these interventions continued to move pre-Action participants to abstinence even afterward the program ended.[46] [47] [48] For a summary of smoking abeyance clinical outcomes, come across Velicer, Redding, Sun, & Prochaska, 2007 and Jordan, Evers, Spira, King & Chapeau, 2013.[39] [49]

Example for TTM awarding on smoke control [edit]

In the treatment of smoke command, TTM focuses on each phase to monitor and to reach a progression to the side by side stage.[19] [twenty] [21] [50]

Stage Precontemplation Contemplation Preparation Activeness Maintenance Can Relapse to an
earlier stage
Standard time more than 6 months in the next half-dozen months in the next month now at to the lowest degree 6 months whatever time
Action and intervention not ready to quit or demoralized ambivalent intend to quit take activeness and quit sustained back to smoke
Related source Volume, paper, friend Book, paper, friend doctor, nurse, friend... doctor, nurse, friend... friend, family temptation, stress, distress

In each stage, a patient may have multiple sources that could influence their behavior. These may include: friends, books, and interactions with their healthcare providers. These factors could potentially influence how successful a patient may be in moving through the different stages. This stresses the importance to have continuous monitoring and efforts to maintain progress at each stage. TTM helps guide the treatment process at each stage, and may help the healthcare provider in making an optimal therapeutic determination.

Travel enquiry [edit]

The use of TTM in travel behaviour interventions is rather novel. A number of cross-exclusive studies investigated the individual constructs of TTM, east.g. stage of alter, decisional balance and self-efficacy, with regards to transport mode pick. The cross-sectional studies identified both motivators and barriers at the different stages regarding biking, walking and public transport.[51] [52] [53] [54] The motivators identified were e.g. liking to bike/walk, fugitive congestion and improved fitness. Perceived barriers were e.g. personal fitness, time and the weather condition. This knowledge was used to design interventions that would address attitudes and misconceptions to encourage an increased apply of bikes and walking. These interventions aim at changing people's travel behaviour towards more than sustainable and more active transport modes. In health-related studies, TTM is used to assistance people walk or bike more than instead of using the machine.[51] [55] [56] [57] [58] [59] Most intervention studies aim to reduce auto trips for commute to reach the minimum recommended concrete activity levels of thirty minutes per day.[51] Other intervention studies using TTM aim to encourage sustainable behaviour.[60] [61] [62] By reducing single occupied motor vehicle and replacing them with so called sustainable ship (public send, machine pooling, biking or walking), greenhouse gas emissions can be reduced considerably. A reduction in the number of cars on our roads solves other bug such equally congestion, traffic noise and traffic accidents. By combining health and environment related purposes, the bulletin becomes stronger. Additionally, by emphasising personal health, physical activity or even straight economical impact, people see a straight effect from their inverse behaviour, while saving the environs is a more full general and effects are not straight noticeable.[63] [54] [64]

Different effect measures were used to appraise the effectiveness of the intervention. Health-centred intervention studies measured BMI, weight, waist circumference as well equally general health. However, only i of three plant a significant alter in general health, while BMI and other measures had no effect.[51] Measures that are associated with both health and sustainability were more than mutual. Effects were reported as number of car trips, distance travelled, main mode share etc. Results varied due to greatly differing approaches. In general, machine use could be reduced between 6% and 55%, while utilise of the alternative style (walking, biking and/or public ship) increased betwixt 11% and 150%.[25] These results indicate a shift to activity or maintenance stage, some researchers investigated attitude shifts such as the willingness to change. Attitudes towards using culling modes improved with approximately xx% to 70%.[25] Many of the intervention studies did non clearly differentiate betwixt the five stages, simply categorised participants in pre-activeness and activeness phase. This approach makes it difficult to appraise the effects per stage. Also, interventions included different processes of modify; in many cases these processes are not matched to the recommended stage.[25] Information technology highlights the need to develop a standardised approach for travel intervention design. Identifying and assessing which processes are most effective in the context of travel behaviour change should be a priority in the future in order to secure the function of TTM in travel behaviour enquiry.

Criticisms [edit]

The TTM has been chosen "arguably the dominant model of health behaviour change, having received unprecedented research attending, yet it has simultaneously attracted criticism".[ix] Depending on the field of awarding (e.chiliad. smoking cessation, substance abuse, prophylactic utilize, diabetes treatment, obesity and travel) somewhat dissimilar criticisms have been raised.

In a systematic review, published in 2003, of 23 randomized controlled trials, the authors found that "stage based interventions are no more effective than not-phase based interventions or no intervention in changing smoking behaviour.[65] Nevertheless, it was besides mentioned that phase based interventions are oftentimes used and implemented inadequately in practice. Thus, criticism is directed towards the use rather the effectiveness of the model itself. Looking at interventions targeting smoking cessation in pregnancy constitute that stage-matched interventions were more effective than not-matched interventions. One reason for this was the greater intensity of stage-matched interventions.[66] Also, the use of stage-based interventions for smoking cessation in mental disease proved to exist constructive.[67] Further studies, due east.grand. a randomized controlled trial published in 2009, found no evidence that a TTM based smoking abeyance intervention was more constructive than a control intervention not tailored to stage of change. The study claims that those not wanting to change (i.e. precontemplators) tend to be responsive to neither stage nor non-stage based interventions. Since stage-based interventions tend to be more intensive they appear to be most constructive at targeting contemplators and above rather than pre-contemplators.[68] A 2010 systematic review of smoking abeyance studies nether the auspices of the Cochrane Collaboration found that "stage-based self-assistance interventions (expert systems and/or tailored materials) and individual counselling were neither more nor less effective than their non-stage-based equivalents.[69]

Main criticism is raised regarding the "capricious dividing lines" that are fatigued between the stages. West claimed that a more coherent and distinguishable definition for the stages is needed.[13] Especially the fact that the stages are spring to a specific fourth dimension interval is perceived to be misleading. Additionally, the effectiveness of stage-based interventions differs depending on the behavior. A continuous version of the model has been proposed, where each process is first increasingly used, and and so decreases in importance, every bit smokers brand progress along some latent dimension.[70] This proposal suggests the use of processes without reference to stages of alter.

The model "assumes that individuals typically make coherent and stable plans", when in fact they often do not.[xiii]

Within enquiry on prevention of pregnancy and sexually transmitted diseases, a systematic review from 2003 comes to the conclusion that "no potent conclusions" tin can be drawn virtually the effectiveness of interventions based on the transtheoretical model.[71] Once again this conclusion is reached due to the inconsistency of utilize and implementation of the model.[71] This study too confirms that the better phase-matched the intervention the more event it has to encourage safety utilise.[71]

Within the health enquiry domain, a 2005 systematic review of 37 randomized controlled trials claims that "there was limited evidence for the effectiveness of stage-based interventions equally a footing for beliefs change.[72] Studies with which focused on increasing physical activeness levels through active commute however showed that stage-matched interventions tended to have slightly more effect than not-phase matched interventions.[56] Since many studies practice not utilize all constructs of the TTM, additional research suggested that the effectiveness of interventions increases the ameliorate it is tailored on all core constructs of the TTM in improver to stage of change.[73] In diabetes inquiry the "existing information are bereft for drawing conclusions on the benefits of the transtheoretical model" every bit related to dietary interventions. Once more, studies with slightly different design, east.g. using different processes, proved to be effective in predicting the stage transition of intention to exercise in relation to treating patients with diabetes.[74]

TTM has more often than not found a greater popularity regarding research on concrete activity, due to the increasing problems associated with unhealthy diets and sedentary living, eastward.g. obesity, cardiovascular problems.[75] A 2011 Cochrane Systematic Review found that at that place is picayune evidence to suggest that using the transtheoretical model stages of alter (TTM SOC) method is constructive in helping obese and overweight people lose weight.[ citation needed ] There were only five studies in the review, 2 of which were later on dropped due to non being relevant since they did not measure weight. Before in a 2009 paper, the TTM was considered to be useful in promoting physical activeness.[76] In this study, the algorithms and questionnaires that researchers used to assign people to stages of change lacked standardisation to be compared empirically, or validated.[13]

Like criticism regarding the standardisation also as consistency in the employ of TTM is also raised in a recent review on travel interventions.[25] With regard to travel interventions only stages of change and sometimes decisional remainder constructs are included. The processes used to build the intervention are rarely stage-matched and short cuts are taken by classifying participants in a pre-activity stage, which summarises the precontemplation, contemplation and training stage, and an action/maintenance stage.[25] More than by and large, TTM has been criticised within various domains due to the limitations in the research designs. For case, many studies supporting the model accept been cross-sectional, simply longitudinal study data would let for stronger causal inferences. Another point of criticism is raised in a 2002 review, where the model'due south stages were characterized as "not mutually exclusive".[77] Furthermore, in that location was "scant evidence of sequential movement through discrete stages".[77] While enquiry suggests that movement through the stages of change is not always linear, a study of smoking cessation conducted in 1996 demonstrated that the probability of forward stage motion is greater than the probability of backward phase movement.[78] Due to the variations in employ, implementation and blazon of research designs, information confirming TTM are ambiguous. More care has to exist taken in using a sufficient amount of constructs, trustworthy measures, and longitudinal information.[25]

See also [edit]

  • Change management
  • Decision wheel

Notes [edit]

The following notes summarize major differences betwixt the well-known 1983,[79] 1992,[80] and 1997[11] versions of the model. Other published versions may contain other differences. For example, Prochaska, Prochaska, and Levesque (2001)[17] do not mention the Termination stage, Self-efficacy, or Temptation.

  1. ^ In the 1983 version of the model, the Preparation phase is absent.
  2. ^ In the 1983 version of the model, the Termination stage is absent. In the 1992 version of the model, Prochaska et al. showed Termination as the finish of their "Screw Model of the Stages of Change", not as a separate stage.
  3. ^ In the 1983 version of the model, Relapse is considered one of the five stages of change.
  4. ^ In the 1983 version of the model, the processes of change were said to be emphasized in simply the Contemplation, Action, and Maintenance stages.
  5. ^ In the 1983 version of the model, "decisional rest" is absent. In the 1992 version of the model, Prochaska et al. mention "decisional balance" but in simply ane sentence under the "key transtheoretical concept" of "processes of change".
  6. ^ In the 1983 version of the model, "self-efficacy" is absent-minded. In the 1992 version of the model, Prochaska et al. mention "self-efficacy" merely in only one judgement under the "cardinal transtheoretical concept" of "stages of change".

References [edit]

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Further reading [edit]

  • Prochaska, JO; DiClemente, CC. The transtheoretical arroyo: crossing traditional boundaries of therapy. Homewood, IL: Dow Jones-Irwin; 1984. ISBN 0-87094-438-10.
  • Miller, WR; Heather, N. (eds.). Treating addictive behaviors. second ed. New York: Plenum Press; 1998. ISBN 0-306-45852-seven.
  • Velasquez, MM. Grouping handling for substance abuse: a stages-of-modify therapy manual. New York: Guilford Press; 2001. ISBN 1-57230-625-iv.
  • Burbank, PM; Riebe, D. Promoting exercise and behavior alter in older adults: interventions with the transtheoretical model. New York: Springer; 2002. ISBN 0-8261-1502-0.
  • Prochaska, J. O., & Norcross, J. C. (2002). Stages of change. In J. C. Norcross (Ed.), Psychotherapy relationships that piece of work (303-313). New York: Oxford University Printing.
  • DiClemente, CC. Addiction and modify: how addictions develop and addicted people recover. New York: Guilford Press; 2003. ISBN one-57230-057-4.
  • Glanz, K; Rimer, BK; Viswanath, K. (eds.) Health behavior and health education: theory, enquiry, and practice, fourth ed. San Francisco, CA: Jossey-Bass; 2008. ISBN 978-0-7879-9614-7.
  • Prochaska, J.O.; Wright, J. A.; Velicer, W.F. (2008). "Evaluating Theories of Health Behavior Change: A hierarchy of Criteria Applied to the Transtheoretical Model". Applied Psychology. 57 (iv): 561–588. doi:ten.1111/j.1464-0597.2008.00345.x.
  • Patterson, D. A.; Buckingham, S. L. (2010). "Does motivational interviewing stages of change increase handling memory among persons who are alcohol and other drug dependant and HIV-infected?". Journal of HIV/AIDS and Social Services. nine (1): 45–57. doi:10.1080/15381500903584346. S2CID 57341833.
  • Patterson, D. A.; Nochajski, T.H. (2010). "Using the Stages of alter model to help clients through the 12-steps of Alcoholics Anonymous". Journal of Social Work Practice in the Addictions. ten (2): 224–227. doi:x.1080/15332561003730262. PMC3520431. PMID 23243392.
  • Connors, GJ; Donovan, DM; DiClemente, CC. Substance abuse treatment and the stages of change: selecting and planning interventions. 2d ed. New York: Guilford Press, 2013. ISBN 978-one-4625-0804-four.
  • Prochaska, JO; Norcross, JC. Systems of psychotherapy: a transtheoretical analysis. 9th ed. New York: Oxford University Press, 2018. ISBN 978-0-1908-8041-5.

External links [edit]

  • Pro-Modify Behavior Systems, Inc. Company founded by James O. Prochaska. Mission is to enhance the well-being of individuals and organizations through the scientific development and dissemination of Transtheoretical Model-based alter management programs.

Source: https://en.wikipedia.org/wiki/Transtheoretical_model

Posted by: mcdanielmorly1947.blogspot.com

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