Using the Transtheoretical Model to Motivate and Support Health Behavior Change (This section continues my series on using health behavior models and theories, to promote the adoption of Metarobic exercises in individuals and society).
The Transtheoretical Model was developed by James O. Prochaska and colleagues, to integrate key constructs from popular theories into a comprehensive theory of behavior change, to conceptualize and enhance successful change (1,2). The most used construct in health education and promotion is the Stages of Change, which documents the precursors to change over time, and one’s readiness to change. But since the Ten Processes of Change facilitate progression through the Stages of Change, each of these will be covered briefly as well. The constructs of the Transtheoretical Model can be applied to any desired health behavior change, but since the focus of my posts are on Metarobic exercises for health, it will be applied to enhancing the adoption of Tai Chi in relationship to diabetes, in honor of National Diabetes Month from my last post. The following example will use “Betty” as an example, and a health educator helping her to progress through the Stages and Processes of Change (This case is taken from a personal experience with a person who was diagnosed as pre-diabetic).
Initially Betty is in the Precontemplation Stage, unaware and uninformed about how her diagnosis of pre-diabetes can affect her health. She is told by her doctor to sign up for a diabetes class, which she intends to, but never quite gets around to it. The class is there, but she is not ready for it. A health educator prompts her to learn about pre-diabetes, and how not dealing with it now can lead to severe consequences in the future. In addition to learning more about pre-diabetes, he suggests Tai Chi as a low key exercise which can also help increase awareness of interconnected issues (through the mindfulness component). This begins the Consciousness Raising Process and Dramatic Relief Process (becoming emotionally involved in the personal implications).
Betty enters the Contemplation Stage, realizing that she actually needs to do something about this. The Dramatic Relief Process continues, as she becomes aware of the pros of changing, which will reduce her risk of developing type two diabetes and its severe complications (including nerve damage, glaucoma, cataracts, skin infections, high blood pressure, stroke and kidney disease). However, the cons of changing are also hard. Perhaps the most difficult is that she has to lose a lot weight, eat better, and become more active. She has tried all of these before, with no success. How can she expect to change now? The Environmental Reevaluation and Social Liberation Processes also come into play, as her health educator (as part of the Helping Relationships Process) helps her become aware of how a more positive lifestyle can affect her relationship with others, and the feelings of success which can come from trying to do something about her condition. He encourages her to try Tai Chi, as a first step, and see what happens. He shares Metarobic theory and research with her, and the case stories of others who have used Tai Chi to deal with pre-diabetes and diabetes.
She enters the Preparation Stage, and looks for a health focused and easy to follow Tai Chi program. Within the month, she has started a class, and is in the Action Stage, supported by the Self-Reevaluation Process (creating a new identity for herself) and the Counter Conditioning Process (learning that the relaxation learned in Tai Chi can be used to counter stress in everyday situations). This further stimulates contemplation and preparation in the other areas she need to consider. The mindfulness component of Tai Chi enhances her awareness of how much of her eating is stress or boredom related. The peacefulness aspect also helps reduce her stress, and creates awareness of better opportunities to deal with boredom, including doing Tai Chi with a local group. She likes the social interaction, and they are supportive of her newfound efforts to exercise and eat less and better.
The development of a sense of discipline and accomplishment from Tai Chi (affecting her Self-Efficacy, another Transtheoretical Model construct) helps her to achieve the Maintenance Stage (supported by the Reinforcement Management Process, which can include rewards, (ideally including the enhanced feelings of accomplishment), but can include a trip to the mall, increased social interactions (including the Tai Chi group), a movie, etc., and also by the Stimulus Control Process, by removing negative cues and positive reminders (such as removing junk food from the house, and using a scale to check weight regularly). All of these factors help ensures Betty’s continued practice of Tai Chi, better diet, and adoption of other exercises (swimming and walking), to support her efforts. By the end of the year, she has lost over 60 pounds, is eating healthier, and her blood sugar has returned to healthy levels.
All of the above process and stages can shift between each other, as a lot of factors can come into play. But continued Maintenance develops a sense of self-mastery which is also a goal of many mind/body practices, and makes one less susceptible to relapse. Keith, in the type one diabetes case story from my last post, used a similar but more informal process, which allowed him to beat his type one diabetes. He used the awareness generated from his mindfulness based practices to progress through and use the Stages of Change and the Ten Processes of Change. Awareness, coupled with discipline (which can come from enhanced self-efficacy), and motivation, are key components in all health behavior theories and models.
References
1. Prochaska JO, Redding CA, Evers, KE. The Transtheoretical Model and Stages of Change. In: Glanz K, Rimer B, Viswanath K, eds. Health behavior and health education: Theories, research, and practice, Fifth Edition. San Francisco, CA: Jossey Bass; 2015.
2. Pro-change Behavior Systems: http://www.prochange.com/transtheoretical-model-of-behavior-change
The Transtheoretical Model was developed by James O. Prochaska and colleagues, to integrate key constructs from popular theories into a comprehensive theory of behavior change, to conceptualize and enhance successful change (1,2). The most used construct in health education and promotion is the Stages of Change, which documents the precursors to change over time, and one’s readiness to change. But since the Ten Processes of Change facilitate progression through the Stages of Change, each of these will be covered briefly as well. The constructs of the Transtheoretical Model can be applied to any desired health behavior change, but since the focus of my posts are on Metarobic exercises for health, it will be applied to enhancing the adoption of Tai Chi in relationship to diabetes, in honor of National Diabetes Month from my last post. The following example will use “Betty” as an example, and a health educator helping her to progress through the Stages and Processes of Change (This case is taken from a personal experience with a person who was diagnosed as pre-diabetic).
Initially Betty is in the Precontemplation Stage, unaware and uninformed about how her diagnosis of pre-diabetes can affect her health. She is told by her doctor to sign up for a diabetes class, which she intends to, but never quite gets around to it. The class is there, but she is not ready for it. A health educator prompts her to learn about pre-diabetes, and how not dealing with it now can lead to severe consequences in the future. In addition to learning more about pre-diabetes, he suggests Tai Chi as a low key exercise which can also help increase awareness of interconnected issues (through the mindfulness component). This begins the Consciousness Raising Process and Dramatic Relief Process (becoming emotionally involved in the personal implications).
Betty enters the Contemplation Stage, realizing that she actually needs to do something about this. The Dramatic Relief Process continues, as she becomes aware of the pros of changing, which will reduce her risk of developing type two diabetes and its severe complications (including nerve damage, glaucoma, cataracts, skin infections, high blood pressure, stroke and kidney disease). However, the cons of changing are also hard. Perhaps the most difficult is that she has to lose a lot weight, eat better, and become more active. She has tried all of these before, with no success. How can she expect to change now? The Environmental Reevaluation and Social Liberation Processes also come into play, as her health educator (as part of the Helping Relationships Process) helps her become aware of how a more positive lifestyle can affect her relationship with others, and the feelings of success which can come from trying to do something about her condition. He encourages her to try Tai Chi, as a first step, and see what happens. He shares Metarobic theory and research with her, and the case stories of others who have used Tai Chi to deal with pre-diabetes and diabetes.
She enters the Preparation Stage, and looks for a health focused and easy to follow Tai Chi program. Within the month, she has started a class, and is in the Action Stage, supported by the Self-Reevaluation Process (creating a new identity for herself) and the Counter Conditioning Process (learning that the relaxation learned in Tai Chi can be used to counter stress in everyday situations). This further stimulates contemplation and preparation in the other areas she need to consider. The mindfulness component of Tai Chi enhances her awareness of how much of her eating is stress or boredom related. The peacefulness aspect also helps reduce her stress, and creates awareness of better opportunities to deal with boredom, including doing Tai Chi with a local group. She likes the social interaction, and they are supportive of her newfound efforts to exercise and eat less and better.
The development of a sense of discipline and accomplishment from Tai Chi (affecting her Self-Efficacy, another Transtheoretical Model construct) helps her to achieve the Maintenance Stage (supported by the Reinforcement Management Process, which can include rewards, (ideally including the enhanced feelings of accomplishment), but can include a trip to the mall, increased social interactions (including the Tai Chi group), a movie, etc., and also by the Stimulus Control Process, by removing negative cues and positive reminders (such as removing junk food from the house, and using a scale to check weight regularly). All of these factors help ensures Betty’s continued practice of Tai Chi, better diet, and adoption of other exercises (swimming and walking), to support her efforts. By the end of the year, she has lost over 60 pounds, is eating healthier, and her blood sugar has returned to healthy levels.
All of the above process and stages can shift between each other, as a lot of factors can come into play. But continued Maintenance develops a sense of self-mastery which is also a goal of many mind/body practices, and makes one less susceptible to relapse. Keith, in the type one diabetes case story from my last post, used a similar but more informal process, which allowed him to beat his type one diabetes. He used the awareness generated from his mindfulness based practices to progress through and use the Stages of Change and the Ten Processes of Change. Awareness, coupled with discipline (which can come from enhanced self-efficacy), and motivation, are key components in all health behavior theories and models.
References
1. Prochaska JO, Redding CA, Evers, KE. The Transtheoretical Model and Stages of Change. In: Glanz K, Rimer B, Viswanath K, eds. Health behavior and health education: Theories, research, and practice, Fifth Edition. San Francisco, CA: Jossey Bass; 2015.
2. Pro-change Behavior Systems: http://www.prochange.com/transtheoretical-model-of-behavior-change
RSS Feed