Transtheoretical Model and Physical Activity
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Transcript of Transtheoretical Model and Physical Activity
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Transtheoretical Model and Physical Activity
EPHE 348
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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)
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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)
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Maintenance
Preparation
Precontemplation
Action
Contemplation
Stages of Change
Spiral pattern represents the dynamic forwards and backwards movement through the stages.
Termination
Figure 15.1
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Constructs of the Transtheoretical Model
• Processes of Change - behavioral (changes in behavior) or cognitive/experiential (changes in thinking)
• Decisional balance
• Self-efficacy
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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
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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
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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
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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
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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
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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)
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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
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Advantages of the TTM
• The notion of tailoring / market segmentation is actually addressed
• Risk populations can be subdivided
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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
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Sutton (2000)
• Stages need to be distinct• Clear differences across stage• Order of process across stages
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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.
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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!)