Behaviour change model of health education

This essay will discuss the, “Behaviour Change Model of Health education” or “The Trans-theoretical Model”, (TTM), in relation to smoking cessation. The essay will begin by giving the reader a personal interpretation of what is meant by Theories and Models, followed by Prochaska and Di Clements, Trans-theoretical Model, (TTM), it will discuss some of the key elements of the model and explore how it is used in practice. Drawing on evidence from the current relevant literature the effectiveness of the model, its strengths and weaknesses will be discussed and a conclusion together with any recommendations for its future use will be provided.

Theories, or models according to Redding et al, if used in a metaphor would be explained as road maps, The author of this assignment can understand this metaphor, but in her minds eye her interpretation of it is more of a underground map around London, all the different colours of train lines are there, they are all leading or ending in the same place, most of them stop at the same stations, but take different routes to get there. The same can be said for theories and models, we take a train on a certain route or direction to get us to our destination, some trains get us there easier than others, we may have to disembark and travel on another line because the one we are on does not get us directly to where we want to be, and other trains may give some passengers an express route and they will finish their journey quicker than others.

Redding et al states that, “Theoretical models are fundamentally guides, which guide both our current and future understanding of Health behaviour, which also provides a direction for research and intervention development”, and also “that there are no final or true maps only maps and theory that best match are needs now in the present”.

The author feels that these two quotes, and the metaphor, have helped her understand key concepts and comparisons between Theory and Models, she understands that they are guides that have been tested, challenged and researched by many others in the health promotion field.

Theoretical models of behaviour change are not new, Beckers Health Belief Model 1974, also Fishiens and Ajzens Theory of Reasoned Action 1975, are but a few that were applied over the years to a wide range of disciplines. The theory the author will be looking at for this assignment is; The Stages of Change (SOC) model or, The Transtheoretical Model, (TTM).

A definition of The Transtheoretical Model is “an eclectic theory that combines constructs from different theories into a comprehensive theory of behaviour change”.(Procheska Velicer 1997 as cited inSchumann 2005p12)

According to Redding et al as cited in the International Electronic Journal of Health Education 2003 (special issue 180-193. Dr Procheskas is one of the most influential authors of psychology in the USA, he has published over 100 papers and 3 books on the subject of, The Transtheoretical Model of behaviour change for health promotion, he was also one of the originators of the TTM model, along with Dr Carlo DiClement .

These two American psychologists have made significant contributions to the understanding of behaviour change, but more so their attention to behavioural changes within groups, organisations and whole communities.

. Di Clement and Procheska built on the work of others namely Horn & Waingrow (1996), Cashdan (1973) and Egan (1975) psychologists who’s work identified the four stages of change model in the previous years, what made the difference to Procheska and Di Clement, was the identification and realisation, during their research of the clusters of people who scored highly in both the contemplation and action stage. This lead the way for the psychologists to reveal a fifth stage and according to both men, the very significant stage of, “preparation”. Lawrence (2001) (as cited in Perkins Simnet & Wright 2001 evedence health promotion

These two very influential psychologists carried out further research , and in 1983, suggested, after mounting evidence, that behaviour change occurred in stages and steps, and that any movement throughout these stages where not linear but repeated, involving patterns of adoption, maintenance, relapse, and readopting over time . These patterns were discovered as the two psychologists were carrying out research with smokers attempting to quit on their own and smokers in professional treatment programs, . (Prochaska et al 1993)

The finding led to Procheska, DiClement and their colleagues to identify the dynamics and structure of staged behaviour change, and go on to explain the patterns of behaviour by developing a Transtheoretical Model of Behavioural Change, which proposed that there were five stages in which people move through a cyclical or a spiral pattern; precontemplation, contemplation, preparation, action and maintenance.

The first of the stages is pre-contemplation, this is a stage where the individual has no intention of behaviour change, they don’t see a problem as far as they are concerned there is no risk to them, not until they become aware of a problem in the future would they think of progressing to the next stage.

The second stage is contemplation, at this point the individual is aware of the problem maybe something has changed in their life and they start looking for information to deal with their addiction but have not yet made any steps to do anything about it.

The third stage preparation, this is when the individual is preparing to change, they may see the benefit of giving up their addiction and need support to help them.

The fourth stage, action, this is where the individual has to make a positive decision to quit, he works towards goals that are realistic and achievable, the need for support is very strong at this stage.

The fifth stage, is maintenance, this is the stage of new behaviour for example the individual has quit smoking and moved on to a healthier lifestyle. This is a very difficult time for a lot of people and many fall at this point and revert back to earlier behaviour. Naidoo&Wills foundations for health promotion 3rd edition

Acording to Procheska and Di Cement