Transtheoretical Model (TTM) (Nursing)

by Heide Cygan, DNP, RN

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    00:00 This presentation is all about the Transtheoretical Model.

    00:06 Oftentimes as nurses, our goal is to help our patients change specific behaviors.

    00:10 And we often say things like "We need to meet the patient where they are" or "work with them at their starting point." But what does that really mean? How do we know where they are? How do we know where to start? Well, today I'm going to introduce a model called the Transtheoretical Model.

    00:25 This model can be used by nurses specifically public health nurses to determine where our patients are and their intent to change.

    00:33 It can also help us develop interventions appropriate for their specific stage of change.

    00:40 The Transtheoretical Model is also called the Stages of Change Model.

    00:44 It was developed in the 1970s by researchers who are trying to understand why some people were able to quit smoking on their own while others were not able to.

    00:53 Ultimately, it was determined that people quit smoking when they are ready to quit smoking.

    00:58 As a result, the model focuses on the decision-making of an individual.

    01:03 It's a model of intentional change.

    01:06 The model assumes that people do not change behaviors quickly.

    01:09 Rather, changes in behavior take place continuously and thru a cyclical process.

    01:15 Based on this model, individuals move through 6 stages of change; precontemplation, contemplation, preparation, action, maintenance, and finally termination.

    01:28 So let's take a look at each of these parts of the model specifically each stage of change.

    01:35 Let's start on the far left with a very first stage of change.

    01:38 This is called precontemplation.

    01:41 In this stage, people do not have any intent to change their behaviors.

    01:45 They're often unaware that a specific health behavior is problematic or that their behavior leads to negative health outcomes.

    01:53 When people are in this stage, they typically focus on the downside of changing the behavior and they underestimate the benefits of change.

    02:02 Next, we have contemplation.

    02:04 When in this stage, people are thinking about starting a health behavior change or maybe stopping a behavior that negatively impacts their health.

    02:13 Here, people understand that their behavior may be problematic.

    02:16 They start to think practically about the pros and the cons of behavior change, but here they place equal emphasis on both sides.

    02:25 While they're thinking about change in this stage, most people are still very ambivalent about actually making a change in their lives.

    02:33 Right in the middle, we have a stage called preparation.

    02:36 In this stage, we're ready to take action.

    02:39 This is where people will begin to make small steps towards change and they truly believe in the benefits of making that change.

    02:46 They believe that changing their behavior can lead to a healthier life, a life of higher quality.

    02:53 Next, we have action. This is the stage in which people actually change their behavior.

    02:58 This is where all the fun starts.

    03:00 They make change and then they make plans to keep moving forward with that change.

    03:04 Here, we see people stopping a problem behavior or maybe acquiring a new healthy behavior.

    03:12 And then we have maintenance.

    03:13 This is where people maintain a change going forward.

    03:17 People on this stage actively work to prevent a relapse to earlier stages of the model.

    03:23 And since I mentioned relapse, let's talk about it for a second.

    03:26 With this model, we recognize that the process is not always linear.

    03:30 People often relapse or move backwards on the continuum.

    03:34 It maybe that an individual begins to make a change and then they go back to previous behaviors with no intent to change again.

    03:42 This would mean that they're moving from action back to precontemplation.

    03:46 It's important to recognize that relapse can happen anywhere along the continuum.

    03:51 The final stage is termination.

    03:53 This is the point in which changes made and relapse is no longer possible.

    03:58 Now, many scientists and nurses don't actually believe that termination is possible.

    04:02 Most of us believe that there is always the possibility of relapse.

    04:06 Since the stage is rarely reached, people tend to stay in that maintenance stage.

    04:11 The termination stage is often not considered when we're putting together health promotion programs.

    04:16 So it's likely that when you see this model presented, the final stage of termination won't even be included.

    04:22 So here's another way to look at the stages of change.

    04:26 So again, in precontemplation we're saying "No, I'm not ready for change. I don't even wanna think about it." In contemplation, we say "Well, maybe, I'm considering both sides of this." In preparation, we're preparing to change, we're starting to make those plans.

    04:41 In action, we are doing it, we are making the change, we are doing the new behavior, stopping an old behavior.

    04:48 And then in maintenance, we continue going on with that change.

    04:53 So let's take a look at an example of the Transtheoretical Model in action.

    04:58 We'll use an example that I'm very familiar with, a New Year's resolution to drop those extra holiday pounds.

    05:04 Starting with precontemplation.

    05:06 This is when you're in the middle of the holiday season.

    05:08 You're eating all of the delicious desserts, eating all of the snacks and there is no intent to change.

    05:14 Moving to contemplation, this is when I say "Oh maybe my pants are getting a little tight here" and I begin thinking about how you should probably stop eating cake with every meal, but I'm not actually doing it yet.

    05:27 Then, we move in to the preparation stage.

    05:29 This is when I always say "Okay, I'm going to renew my gym membership, I'm going to go to the grocery store and buy those healthy foods." I'm starting to make a plan to start the change, but I haven't actually done it yet.

    05:41 Then we move to the action phase.

    05:42 This is when I'm making the change.

    05:44 This is going to the gym, eating those healthy foods, really taking care of myself.

    05:50 Next, we have the maintenance phase. This is when we keep going.

    05:54 This is when it's Aprill, it's May and I'm still going to the gym and I'm still eating those healthy foods everyday.

    06:01 And finally, we have termination.

    06:03 Now again, this stage may or may not be possible but in this example this would mean that I would never even think about letting those holiday treats back into my house again.

    06:13 At each stage of change, different intervention strategies are more effective than others.

    06:17 So I want you to do right now is think about a time when you made a change in your health behaviors.

    06:23 What was helpful to you is you started to consider that change.

    06:28 It's probably different than what was helpful to you as you moved in to that maintenance phase.

    06:32 Keep this in mind as you're working with patients who are in different phases of the Transtheoretical Model.

    About the Lecture

    The lecture Transtheoretical Model (TTM) (Nursing) by Heide Cygan, DNP, RN is from the course Health Promotion Frameworks (Nursing).

    Included Quiz Questions

    1. Behavioral change is continuous and cyclical.
    2. Behavioral change occurs unintentionally.
    3. Behavioral change occurs rapidly.
    4. Behavioral change is insignificant.
    1. Contemplation
    2. Pre-contemplation
    3. Preparation
    4. Action
    1. Preparation
    2. Action
    3. Relapse
    4. Contemplation

    Author of lecture Transtheoretical Model (TTM) (Nursing)

     Heide Cygan, DNP, RN

    Heide Cygan, DNP, RN

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