Summary of Transtheoretical Model of Change (TTM)

This article was developed as a part of assignments during my education in 2013. For citation purpose, please use: Gunawan, J. (2013). Summary of Transtheoretical Model of Change (TTM). Retrieved from jokogunawan.com.

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Transtheoretical Model of Change (TTM), a theoretical model of behavior change was originally explained by Prochaska & DiClemente, 1983, and it has been the basis for developing effective interventions to promote health behavior change. This model describes how people modify a problem behavior or acquire a positive behavior. It is also called as a model of intentional change focusing on the decision making of the individual and may help to explain differences in persons’ success during treatment for a range of psychological and physical health problems. The core constructs of the TTM are the processes of change, decisional balance, self-efficacy, and temptation.

Processes of change are the covert and overt activities that people use to progress through the stages. There are ten such processes as explained by Prochaska: Consciousness Raising (Increasing awareness), Dramatic Relief (Emotional arousal), Environmental Reevaluation (Social reappraisal), Social Liberation (Environmental opportunities), Self Reevaluation (Self reappraisal), Stimulus Control (Re-engineering), Helping Relationship (Supporting), Counter Conditioning (Substituting), Reinforcement Management (Rewarding), and Self Liberation (Committing).

Decisional Balance reflects the individual’s relative weighing of the pros and cons of changing. It is included four categories of pros (instrumental gains for self and others and approval for self and others). The four categories of cons were instrumental costs to self and others and disapproval from self and others. However, an empirical test of the model resulted in a much simpler structure. Only two factors, the Pros and Cons, were found. This much simpler structure has always been found. The Decisional Balance scale involves weighting the importance of the Pros and Cons. A predictable pattern has been observed of how the Pros and Cons relate to the stages of change.

Self-efficacy represents the situation specific confidence that people have that they can cope with high-risk situations without relapsing to their unhealthy or high-risk habit. This concept was adapted from Bandura’s self-efficacy theory. This construct is represented either by a Temptation measure or a Self- efficacy construct.

Temptation reflects the intensity of urges to engage in a specific behavior when in the midst of difficult situations.Temptation is the converse of self-efficacy. The most common types of tempting situations are negative affect or emotional distress, positive social situations, and craving.

STAGES OF CHANGE is the key organizing construct of the model. It is important in part because it represents a temporal dimension. Change implies phenomena occurring over time. The Transtheoretical Model construes change as a process involving progress through a series of five stages: precontempation, contemplation, preparation, action, and maintenance.

Precontemplation (Not ready to change) is the stage in which people are not intending to take action in the foreseeable future, usually in the next six months. People may be in this stage because they are uninformed or under-informed about the consequences of their behavior. Or they may have tried to change a number of times and become demoralized about their ability to change. Both groups tend to avoid reading, talking or thinking about their high risk behaviors. They are often characterized in other theories as resistant or unmotivated or as not ready for health promotion programs. The fact is traditional health promotion programs are often not designed for such individuals and are not matched to their needs.

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Contemplation (Thinking of changing) is the stage in which people are ambivalent about change: “Sitting on the fence”. They are not considering change within the next month. They encourage evaluation of pros and cons of behavior change, re- evaluation of group image through group activities, and identify and promote new, positive outcome expectations.

Preparation (Ready to change) is the stage in which people
have some experience with change and are trying to change:
“Testing the waters”. They are intending to take action in the
immediate future, usually measured as the next month. They
have typically taken some significant action in the past year. These individuals have a plan of action, such as joining a health education class, consulting a counselor, talking to their physician, buying a self-help book or relying on a self-change approach. These are the people that should be recruited for action- oriented smoking cessation, weight loss, or exercise programs.

Action (Making change) is the stage in which people have made specific overt modifications in their life-styles within the past six months. Since action is observable, behavior change often has been equated with action. But in this model, Action is only one of five stages. Not all modifications of behavior count as action in this model. People must attain a criterion that scientists and professionals agree is sufficient to reduce risks for disease. In smoking, for example, the field used to count reduction in the number of cigarettes as action, or switching to low tar and nicotine cigarettes. Now the consensus is clear–only total abstinence counts. In the diet area, there is some consensus that less than 30% of calories should be consumed from fat. The Action stage is also the stage where vigilance against relapse is critical.

Maitanance (Staying on track) is the stage in which people are working to prevent relapse but they do not apply change processes as frequently as do people in action. They are less tempted to relapse and increasingly more confident that they can continue their change.

RELAPSE (Fall from grace) is a form of regression to previous stages. It refers to falling back to the old behaviors after going through other stages. Regression occurs when individuals revert to an earlier stage of change. Individual may evaluate trigger for relapse, reassess motivation and barriers, and plan stronger coping strategies

APPLICATION OF THE MODEL . The model has been applied to a wide variety of problem behaviors like smoking cessation, exercise, low fat diet, radon testing, alcohol abuse, weight control, condom use for HIV protection, organizational change, use of sunscreens to prevent skin cancer, drug abuse, medical compliance, mammography screening, and stress management.. Rhode Island Change Assessment Scale (URICA) is a 32-item questionnaire designed to measure the stages of change across diverse problem behaviors, and Motivational Enhancement Therapy (MET) is based on the Prochaska and DiClemente’s stages of change model, which is applicable in smocking cessation and alcohol abuse.

References:
Application of Interpersonal Theory in Nursing Practice. (2011). retrieved at: http://currentnursing.com/nursing_theory/transtheoretical_model.html

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