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The Transtheoretical Model of Health Behavior Change
Abstract
The transtheoretical model posits that health behavior change involves progress through six stages of change: precontemplation, contemplation, preparation, action, maintenance, and termination. Ten processes of change have been identified for producing progress along with decisional balance, self-efficacy, and temptations. Basic research has generated a rule of thumb for at-risk populations: 40% in precontemplation, 40% in contemplation, and 20% in preparation. Across 12 health behaviors, consistent patterns have been found between the pros and cons of changing and the stages of change. Applied research has demonstrated dramatic improvements in recruitment, retention, and progress using stage-matched interventions and proactive recruitment procedures. The most promising outcomes to data have been found with computer-based individualized and interactive interventions. The most promising enhancement to the computer-based programs are personalized counselors. One of the most striking results to date for stage-matched programs is the similarity between participants reactively recruited who reached us for help and those proactively recruited who we reached out to help. If results with stage-matched interventions continue to be replicated, health promotion programs will be able to produce unprecedented impacts on entire at-risk populations.
... In the early stages, temptation tends to be higher than self-confidence; however, in the action stage, both tend to be roughly equal to facilitate behavior change. Hence, the confidence-temptation balance should be maintained as it determines self-efficacy, which is necessary at all stages to prevent relapse [24,25]. ...
... The scores of the con items were reverse-coded (1 = 5, 2 = 4, 3 = 3, 4 = 2, 5 = 1). The total score (6-30)is categorized as positive (23)(24)(25)(26)(27)(28)(29)(30), neutral (15)(16)(17)(18)(19)(20)(21)(22), or negative (≤14) [20]. ...
... It is rated on a five-point Likert scale ranging from not confident (1) to extremely confident (5). The total score (9-45) is categorized as low (≤21), moderate (22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33), or high (34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45) [39]. ...
Background: Smoking is a detrimental health behavior that can be addressed by designing stage-matched interventions with evidence-based behavioral change models such as the transtheoretical model (TTM). This study applied the TTM to predict smoking cessation stages among adults in Saudi Arabia. Methods: This social media-based cross-sectional study in Saudi Arabia used a convenient sample of 491 adult smokers (men and women). A digital questionnaire containing basic and smoking-related data and smoking scales (stages of change, cessation readiness, decisional balance, and self-efficacy) was used for data collection. The data were collected from 1 July to 30 October 2023 and were investigated using an ordinal regression analysis. The results illustrate that among the studied smokers, cigarette smoking was the prevalent method of smoking, especially among men (71.7%) compared to women (27.8%). Regarding stages of smoking, the pre-contemplation (35.8%) and contemplation (30.1%) stages were the highest, where men were more represented in both stages (37.9% and 40.8%, respectively). In comparison, women represented a higher percentage in the action (23.9%) and maintenance (21.1%) stages. The ordinal regression showed that increasing age (adjusted odds ratio; AOR = 1.045, p = 0.044), high quitting readiness (AOR = 1.134, p < 0.001), self-efficacy (AOR = 1.965, p = 0.028), decisional balance (AOR = 1.870, p < 0.001), and absence of psychological problems (AOR = 2.047, p < 0.001) increased the likelihood of being at higher smoking cessation stages. However, increased smoking duration (AOR = 0.756, p = 0.010), male gender (AOR = 0.340, p < 0.001), not working (AOR = 0.364, p = 0.013), adequate income (AOR = 0.535, p = 0.032), no chronic diseases (AOR = 0.430, p < 0.001), regular smoking (AOR = 0.052, p < 0.001), high smoking dependency (AOR = 0.775, p = 0.038), and hookah smoking (AOR = 0.032, p < 0.001) decreased the likelihood of being at higher smoking cessation stages. Conclusion: Cigarette smoking is a prevalent problem among Saudi adults, especially men, with the highest percentage of these being at lower smoking cessation stages. Thus, this study recommends the development of stage-matched interventions to facilitate the move towards higher smoking cessation stages through efforts by, and collaboration between, community sectors to face this rising issue.
... Receptivity to health behavior changes has been extensively investigated. The transtheoretical model (TTM) is a highly used measurement of receptivity to change and may be used to better understand how to intervene [9]. This model relates that there are six stages people fall into when adopting a more healthful lifestyle. ...
... The TTM is often applied to preventive behavioral change. For example, it was reported that current smokers typically fall into a spread of 40% precontemplation, 40% contemplation, and 20% preparation [9]. These researchers suggest that when faced with the potential for serious adverse health outcomes, patients may be able to accelerate through some early stages, such as moving from precontemplation to contemplation, or onto the preparation stage. ...
... Problematically, the community has repeatedly reported mismatches between offline results and real-world utility for more than a decade [66,8,52,47,7,33,69]. It is our belief that the theoretical disparity between commonly used offline evaluation procedures and metrics is at the heart of this: recall and (n)DCG are well-motivated in general machine learning (ML) or information retrieval (IR) settings respectively, but the assumptions required to justify their use are rarely mentioned explicitly in recommendation research. ...
... Psychology has studied extensively the conflict between short-term needs and desires and long-term aspirations and goals and how to help people overcome their short-term desires to focus on the long term. Models of behavioral change talk about different stages in which users go from awareness to motivation to change to action (e.g., the transtheoretical model [69]). Are we able to capture such stages in the data and develop metrics for them? ...
This report documents the program and the outcomes of Dagstuhl Seminar 24211, "Evaluation Perspectives of Recommender Systems: Driving Research and Education", which brought together 41 participants from 16 countries. The seminar brought together distinguished researchers and practitioners from the recom-mender systems community, representing a range of expertise and perspectives. The primary objective was to address current challenges and advance the ongoing discourse on the evaluation of recommender systems. The participants' diverse backgrounds and perspectives on evaluation significantly contributed to the discourse on this subject. The seminar featured eight presentations on current challenges in the evaluation of recom-mender systems. These presentations sparked the general discussion and facilitated the formation of groups around these topics. As a result, five working groups were established, each focusing on the following areas: theory of evaluation, fairness evaluation, best-practices for offline evaluations of recommender systems, multistakeholder and multimethod evaluation, and evaluating the long-term impact of recommender systems. Seminar May 20-24 2024-https://www.dagstuhl.de/24211 2012 ACM Subject Classification Information systems → Recommender systems; Information systems → Evaluation of retrieval results; Human-centered computing → HCI design and evaluation methods License Creative Commons BY 4.0 International license © Christine Bauer, Alan Said, and Eva Zangerle Recommender systems (RS) have become essential tools in everyday life, efficiently helping users discover relevant, useful, and interesting items such as music tracks, movies, or social matches. RS identify the interests and preferences of individual users through explicit input or implicit information inferred from their interactions with the systems and tailor content and recommendations accordingly [13, 16].
... At the benefit perception stage, adolescents are provided with information about the various benefits of preventive measures and proper reproductive health care. Through a participatory and experience-based approach, young people can see how these actions can provide real protection and benefits to their health [43]. ...
Pemerataan kesehatan tidak hanya pada masyarakat umum, tetapi pada masyarakat adat karena mereka seringkali menghadapi tantangan unik yang berkaitan dengan akses terhadap layanan kesehatan, sehingga diperlukan adanya pendampingan. Penelitian ini bertujuan untuk mengembangkan model bantuan literasi kesehatan reproduksi bagi remaja di Kesepuhan Sinar Resmi, Cisolok. Model ini dirancang untuk meningkatkan pengetahuan, sikap dan keterampilan remaja dalam menjaga kesehatan reproduksinya melalui pendekatan berbasis budaya dan partisipatif. Metode penelitian menggunakan pendekatan kualitatif dengan metode Grounded Theory yang memungkinkan teori muncul dari data lapangan. Peserta terdiri atas tokoh adat, anggota adat, remaja, orang tua, perwakilan desa dan tenaga kesehatan, yang dipilih menggunakan purposive sampling. Teknik pengumpulan data meliputi observasi peserta, wawancara mendalam, dan studi dokumentasi. Hasil penelitian menunjukkan bahwa pengetahuan remaja mengenai kesehatan reproduksi masih terbatas dan terdapat hambatan budaya dalam berkomunikasi tentang kesehatan reproduksi. Model pendampingan yang dikembangkan berdasarkan teori pembelajaran partisipatif dan kontekstual, serta integrasi nilai-nilai tradisional dan kearifan lokal, diharapkan dapat meningkatkan literasi kesehatan reproduksi remaja dan memperkuat peran keluarga dan masyarakat adat dalam mendukung kesehatan reproduksi remaja secara berkelanjutan. Model ini mencakup tahapan pendahuluan, hubungan, aplikasi, refleksi, dan perluas, yang disesuaikan dengan prinsip-prinsip model keyakinan kesehatan. Temuan menunjukkan bahwa penerapan model ini dapat meningkatkan pengetahuan, sikap dan keterampilan remaja secara signifikan dalam menjaga kesehatan reproduksinya, serta memperkuat peran keluarga dan masyarakat adat.
... "I take steps to avoid inhaling cleaning products"). We adapted the RtC survey based on the Transtheoretical Model of Health Behavior Change [67] in which we ask about current efforts and interest in limiting exposure to harmful chemicals. EHL and RtC will be assessed to determine their association with EDC levels, as well as the effect of the intervention on EHL and RtC. ...
Background
Exposures to endocrine disrupting chemicals (EDCs) have been linked to chronic diseases including breast cancer, metabolic syndrome, diabetes, and infertility. Exposure during pregnancy may have a lifelong impact on the fetus. Services are needed to allow individuals to learn about their personal EDC exposures and how to reduce them. Million Marker (MM) aims to crowdsource and scale the biomonitoring of environmental chemicals and provide actionable results to empower individuals to proactively assess, track, and reduce their EDC exposures. In previous research, we developed and tested the first mobile EDC intervention service (mail-in urine testing and exposure report-back) for its efficacy in increasing EH literacy (EHL), willingness to reduce exposures (i.e., readiness to change, RtC), and system usability. After intervention, we found increased EHL, increased RtC in women (but not men), and decreased EDC exposure. However, some participants did not increase their RtC and had difficulty carrying out the intervention on their own. The reasons for these less optimal results were the difficulty in the EHL subject matter—participants still felt ill-prepared to apply their knowledge to making healthier lifestyle changes. Therefore, in this study, we will address these perceived limitations.
Methods
We will test a self-directed online interactive curriculum with live counseling sessions and individualized support modeled after the highly effective Diabetes Prevention Program (DPP). Recruiting from the Healthy Nevada Project (HNP), one of the largest population health cohorts in the world, we test the effectiveness of our EDC-specific online intervention curriculum via EHL and RtC surveys and determine changes in EDC exposure before and after intervention in a randomized controlled trial. We will also test for common clinical biomarkers via a commercially available at-home test (Siphox). We will recruit and randomize 300 women and 300 men of reproductive age (total n=600) from HNP. Our target population is men and women of reproductive age (18–44 years old).
Discussion
At the conclusion of this project, we will be well-positioned to scale our services to clinics and the general public, with the eventual aims of FDA approval, insurance coverage, and incorporation into routine clinical care.
... MI techniques are a key part of the intervention, and they are used during checkups to move individuals along the stages of change (e.g., pre-contemplation, contemplation, preparation, action, maintenance) believed necessary to prepare them to take action related to substance misuse (17). Using MI, linkage managers provide feedback, cultivate change talk, develop a sense of partnership between linkage managers and patients, and express empathy. ...
Introduction
Primary care settings present an opportunity for alcohol and substance use disorder (A/SUD) screening and treatment referral. However, there are recognized deficiencies in widely used treatment referral approaches, including acute care connections, vs. those that can support longer-term recovery. Recovery Management Checkups for Primary Care (RMC-PC) is an intervention with an evidence base for improving treatment referral and subsequent recovery for primary care patients; however, the intervention has never been fully implemented outside of a research context. We conducted a feasibility study to inform a future hybrid study of RMC-PC that will test the implementation and effectiveness of the intervention in primary care practice.
Method
We used a convergent mixed method design. The study’s setting was a Federally Qualified Health Center (FQHC) located in a large midwestern city. RMC-PC linkage services were administered by one of two treatment linkage managers: an FQHC linkage manager (F-LM) and a research staff linkage manager (R-LM). Quantitative data included (a) rates of positive A/SUD screening among a group of FQHC patients and (b) linkage manager service data (e.g., rate of successful meeting completion and days to completing of key events). Qualitative data included (c) an assessment of linkage manager’s motivational interviewing performance and (d) a focus group with FQHC staff focused on their perspectives on RMC-PC implementation determinants. Quantitative data were summarized using descriptive statistics, and linkage manager performance was compared. Qualitative data were analyzed using a hybrid deductive-inductive process.
Results
Fifty percent of patients screened met moderate-high A/SUD risk. Eleven of 16 recruited patients completed at least one linkage manager meeting, with 63% completing both meetings. The F-LM delivered RMC-PC services alongside other duties successfully; however, three primary barriers to FQHC implementation were identified (difficulties applying motivational interviewing, incompatibilities of screening with FQHC technology and workflow, and lack of billing mechanism to support services).
Conclusion
RMC-PC is feasible for FQHC staff to deliver, though issues identified must be considered to ensure successful and sustainable implementation. Knowledge gained will inform a packaged implementation strategy that will be used in a future hybrid trial.
Background: Hypertension is a prevalent medical condition associated with cardiovascular and kidney diseases, leading to premature death and disability. Despite medication use, hypertension continues to rise due to unhealthy lifestyles. Self-care strategies play crucial roles in effectively treating hypertension. We aimed to evaluate the effectiveness of interventions based on the transtheoretical model (TTM) in improving self-care, self-efficacy, and health-related quality of life (HRQOL) in hypertensive adults. Methods: A comprehensive search was performed in multiple databases using appropriate search strategies. Two independent reviewers screened articles, and assessed their adherence to the inclusion and exclusion criteria. The risk of bias in randomized controlled trials was assessed by the Cochrane Collaboration tool and quasi-experimental studies using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Quasi-Experimental Studies. Results: The review included 24 studies with a total of 6553 participants. Most interventions aimed to encourage a healthier lifestyle and improve diet and physical activity. The message was delivered through various methods such as slide/tape messages, individual education/counseling sessions, telephone-delivered interventions, and multimedia training software based on the TTM. Control groups received physician visits or attended lifestyle lectures but did not receive specific behavior change programs like the intervention groups. Conclusion: Our results indicated that the TTM and stage of change model can be an appropriate framework for delivering educational messages to patients.
Purpose
This case study aims to review the impact of using the transtheoretical model of behavioural change in the design of a digital pension journey with the intension of increasing engagement by employees at the point of retirement in their pension choices.
Design/methodology/approach
This case study considers the employee engagement with an existing digital pension journey before and after the tool is redesigned using the transtheoretical model of behavioural change.
Findings
This case study highlights the positive impact of using the transtheoretical model of behavioural change in designing a digital pension journey, highlighting the benefit of supporting employees in the pre-contemplation and contemplation stages of their engagement with their pension.
Originality/value
The transtheoretical model of behavioural change has traditionally been used to help people overcome addictions and other problematic behaviours. This case study highlights how it can be used in other settings to support behavioural change.
Background
Healthcare worker (HCW) well-being is essential for safe, high-quality patient care, but clinicians and front-line staff continue to experience alarming rates of burnout. This pilot study evaluated a novel 6-week program of remote wellness coaching supported by daily digital messaging to reduce burnout and increase well-being among HCWs.
Methods
In spring 2023, staff from a large community health center in California were invited to participate in this single-group pretest–posttest study in an academic-practice partnership. Thirty-four participants who were mostly female (91%), Latina (77%), 36 years old on average (range = 20–61), and represented all major job categories provided informed consent and completed the baseline survey. Of these, 17 completed 6 weekly 20-minute coaching sessions; received daily messages about stress management, self-care, workplace well-being, social connections, and lifestyle and health behaviors, and completed follow-up data collection. The Wilcoxon matched pair signed-rank tests assessed changes from baseline to 2-months follow-up.
Results
Self-reported burnout decreased from 59% at baseline to 35% at follow-up. Work exhaustion ( p < .05), stress ( p < .05) and sleep problems ( p < .01) reduced significantly, and wellness practices ( p < .05), moderate physical activity ( p < .01), and healthy daily eating ( p < .05) improved.
Conclusions/Applications to Practice
Our pilot study suggests that a brief digital wellness program may address burnout and increase health and well-being among front-line staff and clinicians. Healthcare settings should consider this type of program for their workers, especially given the added burden of COVID-19 on the healthcare system.
Smokers (N = 756) were randomly assigned by stage of change to (a) standardized self-help manuals (ALA+ condition), (b) individualized manuals matched to stage (TTT condition), (c) interactive expert-system computer reports plus individualized manuals (ITT condition), or (d) a personalized condition with 4 counselor calls, stage manuals, and computer reports (PITT condition). Over 18 months, the ITT group's results more than doubled those of the ALA+ group on abstinence measures. The ALA+ and TTT conditions were equivalent over 12 months, but at 18 months the TTT condition was more effective. The ITT condition was the best or comparable with the best treatment at all follow-ups for smokers at all stages of change. Results suggest that an effective expert system has been developed, and discussion focuses on delivering this system to entire populations of smokers.
Subjects (N= 970) representing five stages of smoking cessation (precontemplation, contemplation, action, maintenance, and relapse) were given a 65-item test measuring 10 basic processes of change. Subjects recorded the last time they quit smoking, their current use, the frequency of occurrence, and the degree of item helpfulness. A 40-item questionnaire provided highly reliable measures of 10 processes of change, labeled (a) consciousness raising, (b) dramatic relief, (c) self-liberation, (d) social liberation, (e) counterconditioning, (f) stimulus control, (g) self-reevaluation, (h) environmental reevaluation, (i) reinforcement management, and (j) helping relationship. In a confirmatory analysis, 770 subjects were assessed 6 months later. The analysis both confirmed the 10-process model and revealed two secondary factors, Experiential and Behavioral, which were composed of 5 processes each and reflected how individuals in particular stages use more than 1 process at a time. The transtheoretical model of change and available external validity evidence are reviewed.
An integrative model of change was applied to the study of 872 Ss (mean age 40 yrs) who were changing their smoking habits on their own. Ss represented the following 5 stages of change: precontemplation, contemplation, action, maintenance, and relapse. 10 processes of change were expected to receive differential emphases during particular stages of change. Results indicate that Ss (a) used the fewest processes of change during precontemplation; (b) emphasized consciousness raising during the contemplation stage; (c) emphasized self-reevaluation in both contemplation and action stages; (d) emphasized self-liberation, a helping relationship, and reinforcement management during the action stage; and (e) used counterconditioning and stimulus control the most in both action and maintenance stages. Relapsers responded as a combination of contemplaters and people in action would. Results are discussed in terms of developing a model of self-change of smoking and enhancing a more integrative general model of change. (14 ref)
Presents an integrative theoretical framework to explain and to predict psychological changes achieved by different modes of treatment. This theory states that psychological procedures, whatever their form, alter the level and strength of self-efficacy. It is hypothesized that expectations of personal efficacy determine whether coping behavior will be initiated, how much effort will be expended, and how long it will be sustained in the face of obstacles and aversive experiences. Persistence in activities that are subjectively threatening but in fact relatively safe produces, through experiences of mastery, further enhancement of self-efficacy and corresponding reductions in defensive behavior. In the proposed model, expectations of personal efficacy are derived from 4 principal sources of information: performance accomplishments, vicarious experience, verbal persuasion, and physiological states. Factors influencing the cognitive processing of efficacy information arise from enactive, vicarious, exhortative, and emotive sources. The differential power of diverse therapeutic procedures is analyzed in terms of the postulated cognitive mechanism of operation. Findings are reported from microanalyses of enactive, vicarious, and emotive modes of treatment that support the hypothesized relationship between perceived self-efficacy and behavioral changes. (21/2 p ref)
Two principles for progressing from the precontemplation stage of change to the action stage were discovered. The strong principle states that progression from precontemplation to action is a function of approximately a 1 standard deviation increase in the pros of a health behavior change. The weak principle states that progression from precontemplation to action is a function of approximately a 1/2 standard deviation decrease in the cons of a health behavior change. In Study 1, these principles were derived from cross-sectional data on 12 problem behaviors relating the pros and cons of changing to the stages of change. In Study 2, these principles were validated on cross-sectional data from an independent sample of 1,466 smokers. Discussion focuses on the implications of these principles for individual psychology and public health policy.
Investigated the generalization of the transtheoretical model across 12 problem behaviors. The cross-sectional comparisons involved relationships between 2 key constructs of the model, the stages of change and decisional balance. The behaviors studied were smoking cessation, quitting cocaine, weight control, high-fat diets, adolescent delinquent behaviors, safer sex, condom use, sunscreen use, radon gas exposure, exercise acquisition, mammography screening, and physicians' preventive practices with smokers. Clear commonalities were observed across the 12 areas, including both the internal structure of the measures and the pattern of changes in decisional balance across stages.
A meta-analysis was conducted of 125 studies on psychotherapy dropout. Mean dropout rate was 46.86%. Dropout rate was unrelated to most of the variables that were examined but differed significantly as a function of definition of dropout. Lower dropout rates occurred when dropout was defined by termination because of failure to attend a scheduled session than by either therapist judgment or number of sessions attended. Significant effect sizes were observed for 3 client demographic variables: racial status, education, and income. Dropout rates increased for African-American (and other minority), less-educated, and lower income groups. Recommendations for future psychotherapy dropout research are presented. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Objectives:
The primary hypothesis of COMMIT (Community Intervention Trial for Smoking Cessation) was that a community-level, multi-channel, 4-year intervention would increase quit rates among cigarette smokers, with heavy smokers (> or = 25 cigarettes per day) of priority.
Methods:
One community within each of 11 matched community pairs (10 in the United States, 1 in Canada) was randomly assigned to intervention. Endpoint cohorts totaling 10,019 heavy smokers and 10,328 light-to-moderate smokers were followed by telephone.
Results:
The mean heavy smoker quit rate (i.e., the fraction of cohort members who had achieved and maintained cessation at the end of the trial) was 0.180 for intervention communities versus 0.187 for comparison communities, a nonsignificant difference (one-sided P = .68 by permutation test; 90% test-based confidence interval (CI) for the difference = -0.031, 0.019). For light-to-moderate smokers, corresponding quit rates were 0.306 and 0.275; this difference was significant (P = .004; 90% CI = 0.014, 0.047). Smokers in intervention communities had greater perceived exposure to smoking control activities, which correlated with outcome only for light-to-moderate smokers.
Conclusions:
The impact of this community-based intervention on light-to-moderate smokers, although modest, has public health importance. This intervention did not increase quit rates of heavy smokers; reaching them may require new clinical programs and policy changes.
Presents a general descriptive theory of decision making under stress, which includes a typology of 5 distinctive patterns of coping behavior, including vigilance, hypervigilance, and defensive avoidance. The theory is illustrated with discussions of laboratory experiments, field studies, autobiographical and biographical material, and analyses of managerial and foreign policy decisions. Two analytical models, a schema for decision-making stages and a decisional "balance sheet," are also presented to clarify the theory. (28 p ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)