MODELS OF HEALTH BEHAVIOR

STAGES OF CHANGE MODEL

PSY – 375

Adapted from Ogden (2012) Open University Press, and Sanderson, Health Psychology, 3e. © SAGE Publications, 2019.
THE TRANSTHEORETICAL MODEL
(TTM)

• The Transtheoretical Model (TTM) of Behavioral Change,

developed by James O. Prochaska and Carlo C.
DiClemente in the late 1970s, is a theoretical framework
that describes the process individuals go through when
making intentional changes to behavior. The model is also
known as the Stages of Change model.
 • is an integrative model of behavior change,
combining key constructs from other theories
THE TRANSTHEORETICAL (as a synthesis of 18 therapies describing the
M O D E L ( T T M ) O F B E H AV I O R A L processes involved in eliciting and
CHANGE
maintaining change)
(PROCHASKA AND
DICLEMENTE,1982) • describes how people modify a problematic
behavior or acquire a positive behavior.
• the central organizing construct of the model
is the Stages of Change.
 • is used to identify a number of stages that
individuals experience as they progress
through lifestyle modifications.
THE TRANSTHEORETICAL
M O D E L ( T T M ) O F B E H AV I O R A L • Identifying which stage each individual is in
CHANGE

(PROCHASKA AND
• helps to better understand how individuals:
DICLEMENTE,1982) • are feeling about adopting positive lifestyle
changes, and
• how we can help them progress through the
stages of change.

THE TRANSTHEORETICAL MODEL
( S TA G E S O F C H A N G E - S O C )
PROCHASKA AND DICLEMENTE
(1982)
• - based upon 5 stages
• 1 - pre-contemplation: not intending to do any
changes
• 2 – contemplation: considering a change
• 3 – preparation: making small changes
• 4 – action: actively engaging in a new behavior
• 5 – maintenance: sustaining the change over time
 Images retrieved from https://amactraining.co.uk/

T H E T R A N S T H E O R E T I C A L M O D E L ( S TA G E S O F C H A N G E - S O C )
PROCHASKA AND DICLEMENTE (1982)
 •In this stage, people do not intend to take action in the
foreseeable future (defined as within the next 6 months)
1 –
P R E CO N T EMP LAT I O N •People are often unaware that their behavior is problematic
or produces negative consequences
( I W O N ’ T)
•People in this stage often underestimate the pros of
changing behavior and place too much emphasis on the cons
of changing behavior.
 •In this stage, people are intending to start the healthy
behavior in the foreseeable future (defined as within the next
6 months).

2 – CONTEMPLATION
•People recognize that their behavior may be problematic,
and a more thoughtful and practical consideration of the pros
(I MIGHT) and cons of changing the behavior takes place, with equal
emphasis placed on both.

•Even with this recognition, people may still feel ambivalent

toward changing their behavior.
 •In this stage, people are ready to take action within the next
3 – PREPARATION 30 days.

(I WILL) •People start to take small steps toward the behavior change,
and they believe changing their behavior can lead to a
healthier life.
 •In this stage, people have recently changed their behavior
4 – ACTION (defined as within the last 6 months) and intend to keep
moving forward with that behavior change.

(I AM)
•People may exhibit this by modifying their problem
behavior or acquiring new healthy behaviors.
5 – MAINTENANCE •In this stage, people have sustained their behavior change
for a while (defined as more than 6 months) and intend to
maintain the behavior change going forward.
(I HAVE)
•People in this stage work to prevent relapse to earlier stages.
 • One of the main objectives of this model is to get
individuals to engage in beneficial decision making by
implementing decisional balance.

• - weigh the pros and cons of making the changes they

are contemplating.
DECISIONAL BALANCE
• As individuals progress through the TTM, decisional
balance shifts in critical ways.

• Precontemplation stage - PROS outweighed by the

CONS
• Contemplation stage - CONS equal to the PROS
• Preparation/Actions stages - decisional balance begins
to shift in favor of the PROS
• Maintenance stage - PROS now outweigh the CONS
Examples
 THE • - examines how the individual weighs up the costs
TRANSTHEORETI and benefits of a particular behavior
CAL MODEL
( S TA G E S O F
CHANGE - SOC) • - stages do not occur in a linear fashion ( e.g.
PROCHASKA moving from 1 to 5)
AND • - behavior change is considered as dynamic (e.g.
D I C L E ME N T E preparation back to contemplation several times,
(1982) before progressing to the action stage)
 THE TRANSTHEORETICAL
M O D E L ( S TA G E S O F C H A N G E -
SOC)
PROCHASKA AND DICLEMENTE
(1982)

Images retrieved from https://amactraining.co.uk/

 Summary – example of stages of change
Precontemplation Individual is unaware, under-informed, or unconvinced of the need for change, or the
possibility of change, and has no plans to undertake change in the foreseeable future

Contemplation Individual expresses desire or intent to change without any concrete action toward
change and may also express ambivalence or worry over costs of making the change.

Preparation Individual has concrete plans to initiate behavior change in the near future (e.g. 1 month)
and has taken some steps toward the behavior or has practiced it for a brief time.

Action Individual is practicing the behavior successfully. The new behavior is not yet habitual
(practiced for less than 6 months) and adjustments are made to integrate the behavior
into daily life.

Maintenance Individual practices the behavior habitually (for at least 6 months) and has integrated it
into daily life.

Termination For life-long behavior changes, the individual has practiced the behavior for 5 years or
(where applicable) more. Relapse is nearly impossible because the behavior is so deeply integrated into
daily routines and significant social activities.
©John and Bartlett Publishers
As a spiral staircase model reflects change is neither
an all or -nothing phenomenon nor linear process.

Revert at any time or fall back. Forwards again

Utilization of different strategies and interventions

depend upon an individual’s stage of change.

https://youtu.be/oO80XyBDrl0
•The Transtheoretical Model recognizes relapses
as a normal part of the behavior change process
and emphasizes the importance of learning from
setbacks. Addressing relapses involves
reevaluating goals, adjusting strategies,
providing ongoing support, and viewing relapses
as opportunities for growth and refinement in the
pursuit of positive behavior change.
 • Useful health-related theories should:
• (1) generate significant research
• (2) organize and explain observations, and
• (3) help the practitioner predict and change
behaviors.

CRITIQUE OF
HEALTH- • The older models (such as the health belief model)
have produced a great deal of research,
RELATED • the newer models have produced more supporting
THEORIES evidence

• However..
• None of the models explain all of the
complexities of health-related behavior
 • Several factors not included in these theories may lessen
the theories effectiveness.
CRITIQUE OF • These include poverty, public policy, ethnic
HEALTH- background, legislation, and lack of medical and
health information, institutional factors, and
RELATED community factors.

THEORIES • The variety of these circumstances poses a substantial

problem for any such theory
 • Much illness now relates to behavior
• Health behavior can be understood in terms of
health beliefs
• Models of health beliefs have been developed:
TO • Individual beliefs / theories
CONCLUDE • Stage models
• Social cognition models
• Vary in their use of emotion, past behavior
and social context
• Have costs and benefits
CLASS ACTIVITIES
 CLASS ACTIVITY - SHORT
WRITTEN REPORT

•Choose one unhealthy behavior in your life or of someone you might know (e.g., not
getting enough exercise sleep or the proper nutrition, smoking, etc.).

•Think about that behavior

•What stage do you feel you /or someone you know are in and explain why.

•Please go to

https://docs.google.com/presentation/d/1GDJtKWU9854bkdUPMf8
8_C2a0refuYIy/edit?usp=sharing&ouid=102164638277120860359
&rtpof=true&sd=true
 •Lisa works in a big manufacturing company and
has come in to see you because her supervisor asked
her to talk to someone about her smoking. She has
been smoking for 15 years. She states she has been
sent to you because she is spending too much time
for smoke breaks. The manager recently moved the
tobacco use area outside of the gate; it now takes her
SCENARIO #1 over 15 minutes in travel time to get there and back.
She feels that her productivity is being affected by
the new “smoke-free base” rules and not by her
smoking.

•What stage of change is Lisa experiencing and how

can we address this scenario?
 • Steve has been diagnosed with and treated for
PTSD. Initially he refused to take medication
because he felt it was a sign of weakness. Over the
past five months he has been consistently taking
his medication as scheduled. He does not attend
SCENARIO #2 his support group any longer but sees his doctor
regularly.

• What stage of change is Steve experiencing and

how can we address this scenario?
 • Glenn had a sedentary lifestyle and understood he
needed to increase his physical fitness level in order to
qualify for active-duty service. He significantly
increased his physical activity by participating in
strength training and aerobic activity six days a week
with good success. He was hurt while playing
basketball; subsequently his time now consists of
SCENARIO #3 watching TV or he’s on the computer. He is
disappointed that he was injured and feels the only way
to avoid re-injury is to refrain from going to the gym.

• What stage of change is Glenn experiencing and how

can we address this scenario?
 • David, an army officer, previously went to treatment for
drinking behavior. He has been sober for 18 years. He
goes to meetings regularly and shares how he did not allow
his past alcohol problem to affect his current life. He uses
his own situation to encourage junior enlisted members on
SCENARIO #4 how to deal with alcohol related problems they may be
experiencing.

• What stage of change is David experiencing and how can

we address this scenario?