Transtheoretical Model and Physical Activity

EPHE 348

Origins

• Basic linear theories were not explaining health behavior completely

• Market segmentation and intervention tailoring?

• Clinical observations of smokers indicated different stages of readiness (Prochaska & DiClemente, 1983)

Stages of Change• The novel concept in the model

• Behavior change unfolds through 5 different stages

• Individuals use different processes or strategies at different times

• Each stage has different needs and requires different strategies (i.e., stage matched interventions)

Maintenance

Preparation

Precontemplation

Action

Contemplation

Stages of Change

Spiral pattern represents the dynamic forwards and backwards movement through the stages.

Termination

Figure 15.1

Constructs of the Transtheoretical Model

• Processes of Change - behavioral (changes in behavior) or cognitive/experiential (changes in thinking)

• Decisional balance

• Self-efficacy

Processes of Change

• 10 Cognitive and behavioural strategies to enact/cause the change

• Research – behavioral processes are correlates of PA, but the transitional nature across the stages is not well established (Plotnikoff et al., 2001)

• Processes are not well-measured/defined and may not be complete

Behavioral Processes of Change• 1) Counter-conditioning: substituting

alternative healthy behaviors for unhealthy ones

• 2) Helping Relationships – seeking/using social support networks for behavior change

• 3) Contingency management – increasing rewards for a positive behavior and decreasing ones for a negative behavior

Behavioral Processes of Change

• 4) Self-liberation – making a firm commitment to change (e.g., written contract)

• 5) Stimulus control – removing reminders or cues for unhealthy behaviors and adding ones for healthy behaviors

Cognitive Processes of Change

• 1) Consciousness raising – learning new facts & tips about healthy behavior change

• 2) Dramatic relief – experiencing negative emotions that go with unhealthy behavioral risks

• 3) Self-reevaluation – realizing the change is part of one’s identity

Cognitive Processes of Change• 4) Environmental-reevaluation –

realizing that the impact of the behavior on one’s social and physical environment

• 5) Social-liberation – realizing the social norms are changing in favor of the healthy behavior

Decisional Balance• Pros vs Cons

• Cons are high in early stages

• Pros become higher in later stages

• Decisional balance less important in later stages

• Research – not really the case (Spencer et al., 2006)

Self-Efficacy

• Confidence to continue the healthy behavior and overcome temptations

• Self-efficacy should increase across the stages of change

• Research – self-efficacy is the most validated across the stages of change

Advantages of the TTM

• The notion of tailoring / market segmentation is actually addressed

• Risk populations can be subdivided

Problems

• No structure among constructs (describe but not explain)

• Stage matched interventions have mixed results (Spencer, 2006)

• 6 studies on the topic• 1/6 shows support for tailoring

Sutton (2000)

• Stages need to be distinct• Clear differences across stage• Order of process across stages

Beyond Stages (Rhodes & Plotnikoff, 2006; Rhodes et al., 2008)

Predicting Physical Activity 27

Table 4 Transtheoretical Model Constructs as Predictors of Action Planning and Control Across Six-Month Measurements. Correlation with Intention-Behavior Profiles F4,1168 Post Hocs discriminant

function NI UA SA UM SM

Pros .11 3.36 (1.01) 3.70 (0.74) 3.85 (0.75) 4.04 (0.78) 4.17 (0.75) 14.44* NI<ALL; UA<UM,SM;

SA<SM

Cons -.23 2.27 (0.58) 2.22 (0.69) 2.08 (0.54) 1.95 (0.65) 1.68 (0.61) 21.46* NI,UA>UM,SM; SA,UM>SM

Behavioral Processes .68 2.01 (0.62) 2.32 (0.66) 2.60 (0.61) 3.13 (0.89) 3.27 (0.86) 61.40* NI<UA<SA<UM,SM Cognitive Processes -.31 2.16 (0.82) 2.84 (0.69) 3.00 (0.68) 3.09 (0.77) 3.11 (0.66) 9.07* NI<All; UA<UM,SM Self-Efficacy .54 2.45 (0.58) 2.54 (0.60) 2.79 (0.72) 3.15 (0.74) 3.67 (0.74) 75.20* NI,UA<SA<UM<SM Note: *=p<.01. Post hoc tests performed at p < .01. NI = nonintenders, UA = unsuccessful adopters, SA = successful adopters, UM = unsuccessful maintainers, SM = successful maintainers.

Application Exercise• Assume that you are a health

professional and a client in the preparation/action stage has come to you for help

• Develop an exercise intervention technique (or series of techniques) for each behavioral process of change (be creative!)