Jennifer Youngs -Health Belief Theory Paper #2- Transtheoretical Model 1

Your name: Jennifer Youngs

Class: HSC 3208 Health Education Foundations-CRN 10243

Behavior Change Model: Transtheoretical Model (TTM)

Author (s): DiClemente, Carlo C. ; Prochaska, James O.; Fairhurst, Scott K.; Velicer, Wayne F.; Velasquez, Mary M.; Rossi, Joseph S.

Article Date: April, 1991; Accepted date, Sep 1990;  Revised date, Sep 1990;  First submitted date, Apr 1990 ; Release date Aug 1991 (PsycINFO), Jul 2006 PsycARTICLES); Correction dates Jun 2010 (PsycINFO), Jun 2010 (PsycARTICLES).

Date Article summarized: March 14, 2014

Title: The process of smoking cessation: An analysis of precontemplation, contemplation, and preparation stages of change.

Publication: published by the American Psychological Association in the Journal of Consulting and Clinical Psychology; Volume 59; Issue 2, Pages 295-304; Publication date April 1991. Behavior Change Model utilized: Transtheoretical Model/Theory (TTM).

Purpose: The purpose of the TTM is to provide a time-dimension of behavior change. It states that behavior

change occurs over a period of time, and the TTM helps individuals identify which stage they are categorized

in. It is currently the most popular model/theory utilized in research and in practice, related to health education

(Sharma & Romas, 2012). Specifically, the research, being studied in this case, is the “series of stages through

which smokers move as they successfully change the smoking habit” (DiClemente, Prochaska, Fairhurst,

Velicer, Velasquez & Rossi. 1991).

Methodology: This research study tracked 691volunteers (including men and women of all nationalities) in

Texas (TX), and 775 in Rhode Island (RI) using the Transtheoretical Model (TTM); they were all current

smokers and were grouped within four out of the five stages of change (SOC) (DiClemente, Prochaska, et al.,

1991).

The last stage was evaluated six months after the study. The average age of participants in TX was 40, and had

begun smoking at age 17, respectively; those in RI were an average age of 43, and had begun smoking at age

16 (DiClemente, Prochaska, et al., 1991). The TTM follows 5 stages of change; 1) Precontemplation, which

includes those with no thoughts/consideration to change within 6 months; 2) Contemplation, which includes

Jennifer Youngs -Health Belief Theory Paper #2- Transtheoretical Model 2

those who are seriously considering a change within the next 6 months; 3) Preparation, which includes those

who are prepared to change immediately; 4) Action, which include those who have made meaningful change in

the past 6 months and 5) Maintenance, which is the stage in which a person has sustained change for at least 6

months (Sharma & Romas, 2012). After 5 years, maintenance is no longer required because the behavior is

terminated and individuals have no further temptation to revert back to the unhealthy behavior. The

contemplation stage (2nd stage) incorporates 10 constructs also included in the TTM; the constructs are

separated into two sections consisting of experiential, and behavioral processes (Sharma & Romas, 2012). The

experiential processes consist of 1) Conscious raising, in which knowledge and awareness about the concerning

behavior is increased; 2) Dramatic relief, in which emotions are aroused in reference to available treatments or

solutions; 3) Environmental reevaluation requires individuals to consider the impact that their unhealthy

behavior has on their environment and to reassess it; 4) Self-reevaluation requires individuals to consider their

personal emotions, with respect to their issue, and reassess them; 5) Social liberation, the construct in which

attempts are made to decrease the prevalence of the individual’s former unhealthy behavior in society, while

social opportunities and alternatives are increased. The second section, behavioral processes (6-10), consists of:

6) Reinforcement management in which positive behavioral changes are rewarded; 7) Helping relationships

which consists of having trusting and open discussions about the unhealthy behavior with supportive

individuals; 8) Counterconditioning which is the process of learning new healthy alternative behaviors to

substitute the unhealthy one; 9) Stimulus control prepares individuals to cope with stimuli that may have the

potential to trigger a relapse to the unhealthy behavior and 10) Self-liberation is the process of choosing a

course of action to change the unhealthy behavior, and committing to that choice with the belief that they can in

fact change (Sharma & Romas, 2012).

Results/conclusion: There were “no significant demographic differences” found between subjects in each

state. This includes the number of cigarettes smoked per day, age that the unhealthy habit began, the proportion

of people at each stage of change, duration of smoking, and addiction measurements of participants. The

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number of quit attempts varied, with participants in TX averaging 2 times and RI averaging 1.8 times.

Precontemplators were the least active and the prepared subjects were the most active, throughout almost every

process. There were many differences found amongst participant’s smoking patterns and there was also a

difference associated with the value placed on the pros versus the cons, which showed an increasing shift in

decisional balance. Thus, it supports the stages of change paradigm. 80% of those, in the preparation stage

attempted 24-hour quit attempts, contemplators had the least amount of cessation attempts with a rate of 48%

(DiClemente, Prochaska, et al., 1991).

Critique (so what? Importance): The TTM has been assessed in several studies. Indications show that it is

significant because it has the power and foundation blocks to elicit successful behavior transformations. This

study did not focus on treatment effects, and according to researchers, if follow-ups would have also been

conducted over 12-18 months, rather than 6 monthgs, it would be more effective (DiClemente, Prochaska, et

al., 1991). I personally think that the TTM is a sufficient model to use when evaluating smoking cessation, and

I agree that individuals must shift strategies as they move through each stage, to be successful.

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References

DiClemente, Prochaska, Fairhurst, Velicer, Velasquez & Rossi. (1991). The process of smoking cessation: An

analysis of precontemplation, contemplation, and preparation stages of change. Journal of Consulting

and Clinical Psychology, Vol 59 (2), 295-304. doi:10.1037/0022-006X.59.2.295

Sharma, M., & Romas, J. (2012). Theoretical Foundations of Health Education and Health Promotion (2nd

ed.). Sudbury, Ma.: Jones & Bartlett Learning.