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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.
... The Stages of Change Theory proposes that individuals move through a series of stages when changing their behaviour, including precontemplation, contemplation, preparation, action, and maintenance [41]. Men who are in the precontemplation stage may not be considering screening at all, while those in the contemplation stage may be weighing the pros and cons of screening. ...
... Based on these theories, strategies to promote prostate cancer screening could include increasing awareness of the risk of prostate cancer and the benefits of screening, addressing negative attitudes towards drug treatment, providing information and resources to men who are in the contemplation or preparation stages, encouraging men to consult with a physician even if they feel healthy, and providing screening services in convenient and accessible locations [40,41]. ...
Inadequate knowledge and poor attitudes about prostate cancer (PC) negatively affect early screening practices among males. The PC mortality rate is increasing due to late reporting, screening, and treatment. This study explored the awareness, attitudes, and PC screening behaviours among males in the Limpopo, Thulamela municipality. This descriptive cross-sectional study involved 245 males that were randomly selected. A structured questionnaire was used to collect data. Fisher’s exact tests and logistic regression analysis were used to examine the association between sociodemographic variables, awareness, and attitudes towards PC. Our findings revealed that 64.1% demonstrated inadequate awareness about PC. The overall score (84.9%) showed a positive attitude towards PC. However, 87.4% had a negative attitude towards the effectiveness of treatment for PC. The majority (96.7%) of respondents had never undergone a PSA test, although 53.1% were willing to undergo a PSA test. There was a significant positive correlation between awareness of prostate cancer and attitudes toward prostate cancer (r = 0.280, p < 0.001). Health status predicted awareness about PC, while age and health status predicted attitudes towards PC among men. Rural community-based programmes and heightened awareness campaigns are needed to conscientize men about the risk factors, symptoms, diagnosis, and treatment of PC in rural areas of Limpopo.
... After completion of the active intervention, the nutritionists and public health nurses conducted telephone counseling every 4 weeks from July to September (weeks 14-26) to check whether participants were able to maintain the diet and exercise program and confirm that the MMA group was using the application. These healthcare workers provided instruction to participants based on the transtheoretical model of health behavior change [33]. ...
... Participants in our study may not have been aware of the importance of mindfulness. In addition, the healthcare workers who checked MMA adherence were not familiar with mindfulness, which might have made it difficult to follow the transtheoretical model of health behavior change [33]. This study also included ...
Background:
Weight-loss approaches involving mindfulness have been reported to reduce overeating behavior. We conducted a preliminary evaluation of the feasibility and effectiveness of a mindfulness mobile application (MMA) combined with a comprehensive lifestyle intervention (CLI) focused on weight loss and eating behaviors for people with metabolic syndrome based on post-intervention follow-up data.
Method:
Participants were randomly assigned (1:1) to a CLI group or a CLI + MMA group. Participants received weekly CLI for 13 weeks, followed by telephone counseling for 13 weeks. The CLI + MMA group also had access to the MMA. Feasibility was assessed by the number of people who refused to participate, rate of adherence to the MMA, follow-up rate, and participant satisfaction. The preliminary endpoint was weight change (at 26 weeks). Participants completed the Dutch Eating Behavior Questionnaire (DEBQ). A mixed linear model was used for efficacy analysis.
Results:
Eight of the 40 participants declined to participate. The MMA was used 4.4 ± 1.7 days per week, but the rate of adherence declined over time. The follow-up rate was 100%, and there was no difference in participant satisfaction between the groups. There was no significant group-by-time interaction for weight loss (p = 0.924), but there was a significant interaction for the DEBQ restrained eating score (p = 0.033).
Conclusions:
This study found that CLI plus MMA was highly feasible and moderately acceptable. There were no significant differences in weight loss between the groups, but the CLI + MMA group showed an increase in restrained eating. Further large-scale studies are needed.
Trial registration:
Japanese University Hospital Medical Information Network (UMIN-ICDR). Clinical Trial identifier number UMIN000042626.
... Dai reported that people using nontobacco ENDS had lower intent to quit tobacco use than those using tobacco-flavored ENDS, but only the latter was statistically significant. Zavala-Arciniega assessed whether adults who used ENDS who preferred certain ENDS flavors had reached higher stages in the transtheoretical model of behavior change applied to smoking cessation (Prochaska and Velicer, 1997). Their analysis found no significant differences in the intent to quit based on the preferred ENDS flavor. ...
As health communication has emerged as a field of study and continues to advance, the ideologies and theoretical foundations of the discipline require a further appraisal to ensure its effective practice. The environments in which people engage in health behaviours are becoming more dynamic and some theories have converged over time. Hence, constructs from two or more theories could be employed to explain health behaviours. This chapter examines the relationship between communication theories and health communication practice; highlights key communication models and theories about knowledge, attitude, and behaviour regarding health, as well as the case studies and applicability of their assumptions to health communication practice in Africa. Seven health communication theoretical assumptions are presented, along with health promotion interventions that they have been successfully used for and case studies where they can be possibly applied in African contexts. The chapter contributes to existing reviews of health communication models and theories. Hence, it is valuable to students, academics, researchers, and practitioners in health communication.KeywordsExtended parallel processesHealth belief modelHealth communication theoriesDiffusion of innovationsPlanned behaviourTrans-theoretical/Stages of Change
Objective: The aim of this study is to evaluate the effect of hedonic hunger on nutritional change processes and its relationship with BMI in university students. Methods: A questionnaire consisting of sociodemographic characteristics, questions about eating habits, Power of Food Scale (PFS) and Nutrition Change Processes Scale (NPCS) were applied to 1003 undergraduate students. Results: Majority of the students were female and normal weight in terms of BMI. The median PFS and score of the obese students is higher than the normal ones. The median NPCS scores of obese students are higher than other BMI classifications (p< .01). The median scores of food available, food present and food taste sub-factors of PFS are statistically higher in obese students than in normal-weight students (p< .01). The sub-factors of NPCS that consciousness raising, dramatic relief, self-reevaluation, social liberation, contingency management, self-liberation, stimulus control median scores are statistically higher in obese students than in normal-weight students. As hedonic hunger increases, the nutritional change process increases by 13.7%. The increase in hedonic hunger affects the nutritional change processes positively by 46.1% (p< .001). Conclusion: Hedonic hunger and nutrition change processes of obese students are higher than those of normal weight, and as hedonic hunger increases, the process of nutritional change increases, and the increase in hedonic hunger positively affects nutritional change processes.
This study aimed to explore effects of a two-session Educational Person-centered Intervention on Compensatory Strategies (EPICS) designed to increase knowledge of strategies, reduce barriers, and improve accomplishment of meaningful leisure activities (MLA) and well-being in older adults living with frailty. Using a double-blind concurrent mixed-methods design, 36 community-dwelling older adults were assigned to the experimental (EPICS) or control (friendly visits) group through a covariate adaptive randomization. Questionnaires were administered prior to the intervention and ± two months post-intervention. Individual semi-structured interviews conducted at the end of the study furthered the authors’ understanding of the effects of the intervention. Quantitative analysis revealed significant increase in knowledge of compensatory strategies and reduction of barriers for the experimental group only. Qualitative analysis (purposive sample, n = 8) showed enhanced well-being and self-activation. Discussions about barriers to accomplishment may be sufficient to trigger self-activation in someolder adults living with frailty to improve participation in MLA and well-being.
Context: Key populations (KP) in Togo, including men who have sex with men and female sex workers, experience disproportionately high rates of HIV prevalence. In response to this situation, USAID/West Africa and FHI360 established the PACTE–VIH regional HIV/AIDS project, which utilized mobile health (mHealth) to send reminders to enrolled participants on ways to reduce the risk of HIV infection. While mHealth programs are known to be effective in improving HIV–related health behavior outcomes, the role of length of time enrolled in a mHealth program is not well understood. Methods: To assess whether there was a relationship between time enrolled in the PACTE–VIH mHealth program and adoption of HIV prevention behavior, we use data from an operations research study conducted in Lomé, Togo, in 2016 with 1005 KP and employ logistic regression analysis. Results: The odds of adopting prevention behaviors were higher with each additional month enrolled in the program (OR: 1.62; 95% CI 1.19–2.20). Fully adjusted (age and marital status) logistic regression models demonstrated no significant difference in odds of adopting prevention behavior between enrollment times of less than six months and any category greater than six months. Conclusion: Time does matter for adoption of HIV prevention behaviors. However, more studies are needed to better understand what length of time enrolled in a program truly affects behavioral outcomes.
Aim:
To describe demographic, physical and psychological characteristics associated with insomnia in patients with cardiovascular disease (CVD) participating in nurse-led Internet-based cognitive behavioural therapy for insomnia (I-CBTI), and their motives and expectations regarding participation in I-CBTI.
Design:
A mixed method design was applied, including primary care patients with angina pectoris, myocardial infarction, heart failure, atrial fibrillation and atrial flutter or arrhythmia in southern Sweden.
Methods:
Data on demographics, insomnia severity and physical and psychological characteristics were collected through self-rated validated questionnaires (n = 126). Motives and expectations were collected through interviews (n = 19) and analysed using the 'personas' model.
Results:
Physical symptoms and psychological characteristics were associated with insomnia. Three personas were identified: the pragmatist (a curious and optimistic persona), the philosopher (a problem-solving persona) and the philanthropist (an altruistic persona). Expectations were positive among the three personas, but comorbid conditions reduced the perceived ability to make necessary behavioural changes.
Background
Though clinical guidelines for cholesterol-lowering therapies advocate for both a trial of lifestyle modification and the initiation of statin medication when appropriate, the extent to which lifestyle modification may alter a patient’s knowledge-perceptions and receptivity towards statins remains unclear.
Methods
Following completion of a 6-month comprehensive lifestyle modification program, perceived changes in knowledge and receptivity towards statins were examined across prespecified subgroups of age, sex, and statin eligibility using a mixed-methods questionnaire. Quantitative and qualitative analyses incorporated binomial tests, McNemar’s test, and thematic analyses.
Results
Among 192 patients who completed the program and exit questionnaire between December 15, 2020 and July 2, 2021, 88.4% of patients indicated a perceived improvement in cholesterol and/or statin knowledge (P < . 0001). 48.2% of patients acknowledged that their receptivity towards taking statins increased (P = . 61). Changes in receptivity were attributed to several identified program themes including improvements in health knowledge and awareness, motivation and empowerment. Patients who noted improvements in their mental health also reported significantly increased receptivity towards statins (P < . 001).
Conclusions
Patients’ perceived knowledge and receptivity towards statins may improve following participation in a comprehensive therapeutic lifestyle modification program. Future research must evaluate the impact of these programs on statin uptake, compliance and outcomes.
Cigarette smokers who quit on their own (n = 29) were compared with subjects from two commercial therapy programs: A version Group (n = 18) and Behavior Management Group (n = 16). Subjects were administered a Change-Process Questionnaire and a demographic and smoking-history questionnaire within seven weeks of successful cessation, then interviewed again in five months. Using a transtheoretical model of change developed by Prochaska (1979) six verbal and four behavioral processes of change and three stages of change (Decision to Change; Active Change; Maintenance) were analyzed. Subjects in each treatment group were middle class, heavy-smoking adults. The change-process analysis of cessation discriminated between the self-quitters and therapy quitters and between the two groups of therapy subjects on five variables. Stages of change interacted with the processes of change in the cessation of smoking behavior. Verbal processes were seen as important in making the decision to change while action processes were critical for breaking the actual smoking habit. Maintenance of cessation was related to, but not dependent on, how subjects actively changed smoking behavior.
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 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)
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)
Addresses the centrality of the self-efficacy mechanism (SEM) in human agency. SEM precepts influence thought patterns, actions, and emotional arousal. In causal tests, the higher the level of induced self-efficacy, the higher the performance accomplishments and the lower the emotional arousal. The different lines of research reviewed show that the SEM may have wide explanatory power. Perceived self-efficacy helps to account for such diverse phenomena as changes in coping behavior produced by different modes of influence, level of physiological stress reactions, self-regulation of refractory behavior, resignation and despondency to failure experiences, self-debilitating effects of proxy control and illusory inefficaciousness, achievement strivings, growth of intrinsic interest, and career pursuits. The influential role of perceived collective efficacy in social change and the social conditions conducive to development of collective inefficacy are analyzed. (21/2 p ref) (PsycINFO Database Record (c) 2006 APA, all rights reserved). © 1982 American Psychological Association.
How people intentionally change addictive behaviors with and without treatment is not well understood by behavioral scientists. This article summarizes research on self-initiated and professionally facilitated change of addictive behaviors using the key transtheoretical constructs of stages and processes of change. Modification of addictive behaviors involves progression through five stages—pre-contemplation, contemplation, preparation, action, and maintenance—and individuals typically recycle through these stages several times before termination of the addiction. Multiple studies provide strong support for these stages as well as for a finite and common set of change processes used to progress through the stages. Research to date supports a transtheoretical model of change that systematically integrates the stages with processes of change from diverse theories of psychotherapy.