This presentation is all about
the Transtheoretical Model.
Oftentimes as nurses, our goal is to help
our patients change specific behaviors.
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.
This model can be used by nurses
specifically public health nurses
to determine where our patients
are and their intent to change.
It can also help us develop interventions
appropriate for their specific stage of change.
The Transtheoretical Model is also
called the Stages of Change Model.
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.
Ultimately, it was determined that people quit
smoking when they are ready to quit smoking.
As a result, the model focuses on the
decision-making of an individual.
It's a model of
The model assumes that people do
not change behaviors quickly.
Rather, changes in behavior take place
continuously and thru a cyclical process.
Based on this model, individuals
move through 6 stages of change;
precontemplation, contemplation, preparation,
action, maintenance, and finally termination.
So let's take a look at each of these parts of
the model specifically each stage of change.
Let's start on the far left with
a very first stage of change.
This is called precontemplation.
In this stage, people do not have any
intent to change their behaviors.
They're often unaware that a specific health behavior is problematic
or that their behavior leads to negative health outcomes.
When people are in this stage, they typically
focus on the downside of changing the behavior
and they underestimate
the benefits of change.
Next, we have contemplation.
When in this stage, people are thinking
about starting a health behavior change
or maybe stopping a behavior that
negatively impacts their health.
Here, people understand that their
behavior may be problematic.
They start to think practically about the
pros and the cons of behavior change,
but here they place equal
emphasis on both sides.
While they're thinking about
change in this stage,
most people are still very ambivalent about
actually making a change in their lives.
Right in the middle, we have
a stage called preparation.
In this stage, we're
ready to take action.
This is where people will begin to
make small steps towards change
and they truly believe in the
benefits of making that change.
They believe that changing their behavior can lead
to a healthier life, a life of higher quality.
Next, we have action. This is the stage in
which people actually change their behavior.
This is where all
the fun starts.
They make change and then they make plans
to keep moving forward with that change.
Here, we see people stopping a problem behavior
or maybe acquiring a new healthy behavior.
And then we have maintenance.
This is where people maintain
a change going forward.
People on this stage actively work to prevent
a relapse to earlier stages of the model.
And since I mentioned relapse,
let's talk about it for a second.
With this model, we recognize that
the process is not always linear.
People often relapse or move
backwards on the continuum.
It maybe that an individual
begins to make a change
and then they go back to previous
behaviors with no intent to change again.
This would mean that they're moving
from action back to precontemplation.
It's important to recognize that relapse
can happen anywhere along the continuum.
The final stage is termination.
This is the point in which changes made
and relapse is no longer possible.
Now, many scientists and nurses don't actually
believe that termination is possible.
Most of us believe that there is
always the possibility of relapse.
Since the stage is rarely reached, people
tend to stay in that maintenance stage.
The termination stage is often not considered when
we're putting together health promotion programs.
So it's likely that when you
see this model presented,
the final stage of termination
won't even be included.
So here's another way to look
at the stages of change.
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.
In action, we are doing it,
we are making the change,
we are doing the new behavior,
stopping an old behavior.
And then in maintenance, we
continue going on with that change.
So let's take a look at an example of
the Transtheoretical Model in action.
We'll use an example that I'm very familiar with, a New
Year's resolution to drop those extra holiday pounds.
Starting with precontemplation.
This is when you're in the
middle of the holiday season.
You're eating all of the delicious desserts, eating
all of the snacks and there is no intent to change.
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.
Then, we move in to the
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.
Then we move to
the action phase.
This is when I'm
making the change.
This is going to the gym, eating those
healthy foods, really taking care of myself.
Next, we have the maintenance phase.
This is when we keep going.
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.
And finally, we
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.
At each stage of change, different intervention
strategies are more effective than others.
So I want you to do right now is think about a time
when you made a change in your health behaviors.
What was helpful to you is you
started to consider that change.
It's probably different than what was helpful to
you as you moved in to that maintenance phase.
Keep this in mind as you're working with patients who
are in different phases of the Transtheoretical Model.