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TTM(Transtheoretical Model

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Behavior modicationBehavior change

NCD (non communicable disease


1979Healthy People

50% 5
107
(US Dept. of Health, 1979
418
173.5Mokdad. 2004)

TTM (Transtheoretical Model)


ProchaskaDiClemente(1982)
transtheoretical)
Prochaska

1. stage of change)

Tadao Okada, MD, MPH @ Primary Care Institute Japan

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precontemplation

contemplation

preparation

action

maintainance

termination

100%

relapse


(Prochaska 1997)
2.
(process of change)

3. decisional balance)
I. L. Janis & L. Mann
4. (self-ecacy)
A. Bandura
condence vstemptation

Outcome Expectancy ()

Ecacy Expectancy ()

Prochaska, DiClemente, Velicer, & Rossi1993, Rossi1994


0.74(Noar. 54, 2007)
TTM

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experiential

consciousness raising

XX

dramatic relief

environmental revaluation

self-revaluation

social liberation

behavioral

self-liberation

counterconditioning

helping relationship

contingency/reinforcement
management

stimulus control

1
2
3
4

Conviction-condence model, Keller & White, 1997)


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Tadao Okada, MD, MPH @ Primary Care Institute Japan

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!
5A, 5R, 2008)
5AR
Ask about tobacco use.

Relevance

Advise to quit.

Risks

Assess willingness to make


a quit attempt.

Rewards

Assist in quit attempt.

Roadblocks

Arrange followup.

Repetition

, 2002)

LEARN (Berlin, 1983)


Listen with sympathy and understanding to the patient's perception of the problem / Explain
your perceptions of the problem / Acknowledge and discuss the dierences and similarities /
Recommend treatment / Negotiate agreement

(motivational interviewing)

US Department of Health, Education, and Welfare. Healthy people: the surgeon general s report on health promotion and disease prevention. Washington DC:
US Government Printing Oce; 1979.
Mokdad. et al. Actual causes of death in the United States, 2000.JAMA. 2004;291:1238-1245.
Prochaska, J. O., & DiClemente, C. C (1982). Transtheoretical therapy: Toward a more integrative model of change. Psychotherapy: Theory, Research and
Practice, 20, 161-173.
Prochaska JO, Velicer WF. The transtheoretical model of health behavior change. Am. J Health Promot 1997;12(1):38-48
. . J. Natl. Inst. Public Health. 58(1), 2009
Patricia M. Burbank, Deborah Riebe. ed. Promoting Exercise and Behavior Change in Older Adults: Interventions With the Transtheoretical Model. Springer
Publish Company, Inc, NY, 2002 . Book House HD,Ltd.,Tokyo

Y http://blogs.yahoo.co.jp/uechihiroaki/13312460.html
. (TTM) . . 9 2010, 77-88
: ,,82(2),135-141,2000.
Bandura A. Self-ecacy: toward a unifying theory of behavior change. Psychol Rev 1977;84:191-215.
Janis lL, Mann L. Decision Making: A Psychological Analysis of Conict, Choice and Commitment. New York: Free Press, 1977
Noar, S.M., Benac, C.N., and Harris, M.S. Does tailoring matter? Meta-analytic review of tailored print health behavior change interventions. Psychological Bulletin,
4, 673-693, 2007
. [] http://www.igaku-shoin.co.jp/
paperDetail.do?id=PA02874_07
. 2002
e-[]http://www.e-healthnet.mhlw.go.jp/information/

Keller VF, et al. Choices and changes : a new model for inuencing patient health behavior. J Clin Outcomes Manag. 1997 ; 46 : 33-6.
U.S. Dept. of Health and Human Services Public Health Service. Treating Tobacco Use and Dependence: 2008 Update. Clinical Practice Guideline. May, 2008
Berlin EA, Fowkes WC. A teaching framework for cross- cultural health care. The Western journal of medicine. 1983;139(6):934-8.
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health. Theory at a Glance A Guide For Health Promotion Practice (Second
Edition) . 2005.

Tadao Okada, MD, MPH @ Primary Care Institute Japan

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