The TTM posits that individuals move through six stages of change: precontemplation, contemplation, preparation, action, maintenance, and termination.
The TTM operates on the assumption that people do not change behaviors quickly and decisively. Rather, change in behavior, especially habitual behavior, occurs continuously through a cyclical process. The TTM is not a theory but a model; different behavioral theories and constructs can be applied to various stages of the model where they may be ...
There are several limitations of TTM, which should be considered when using this theory in public health. Limitations of the model include the following: 1 The theory ignores the social context in which change occurs, such as SES and income. 2 The lines between the stages can be arbitrary with no set criteria of how to determine a person's stage of change. The questionnaires that have been developed to assign a person to a stage of change are not always standardized or validated. 3 There is no clear sense for how much time is needed for each stage, or how long a person can remain in a stage. 4 The model assumes that individuals make coherent and logical plans in their decision-making process when this is not always true.
Ten processes of change have been identified with some processes being more relevant to a specific stage of change than other processes. These processes result in strategies that help people make and maintain change. Consciousness Raising - Increasing awareness about the healthy behavior.
Social Liberation - Environmental opportunities that exist to show society is supportive of the healthy behavior. Self-Liberation - Commitment to change behavior based on the belief that achievement of the healthy behavior is possible. Helping Relationships - Finding supportive relationships that encourage the desired change.
Reinforcement Management - Rewarding the positive behavior and reducing the rewards that come from negative behavior.
Dramatic Relief - Emotional arousal about the health behavior, whether positive or negative arousal. Self-Reevaluation - Self reappraisal to realize the healthy behavior is part of who they want to be. Environmental Reevaluation - Social reappraisal to realize how their unhealthy behavior affects others.
Stage-based theories contend that people learn, develop, and change their behavior according to discrete steps. Cognitive and stage-based models can be effectively used together; cognitive theories provide insights on why people change their behavior, and stage-based perspectives generate insight on how the change is implemented.
The TTM is one of the most widely used health behavior models and has been shown to have a positive impact on various behaviors including treatment adherence.
The TTM is a widely used tool and can supplement other health models such as the TPB and the Health Behavior Model by facilitating behavior changes and tracking progress through the stages. It may be particularly useful in informing the way that adherence information is provided to the patient and influence the design of adherence interventions 5, 7; studies demonstrate that patients respond well to the individualized feedback informed by the TTM. 4 However, TTM-based interventions are not always more effective than other reasonably designed approaches, 5 and health behavior research increasingly prioritizes more recent behavioral models, such as COM-B, and other developments in behavioral theory that will be discussed in other articles. These models are complimentary and provide important insights into the patient journey.
The first version of the TTM was proposed in the 1980s by James Prochaska and Carlo DiClemente, who focused on nicotine addiction; since then, it has been applied to a number of different health behaviors. 4, 6. The TTM consists of two major components: stages of change and processes of change. The stages of change are at the core ...
Behavioral processes are used primarily in later stages. These include stimuluscontrol, e.g. resolving stimuli that provoke undesirable behavior, and helpingrelationships, i.e. seeking out people who are important to the patient and will help him with adherence. 4.
Experiential processes are useful primarily in early stages of change, such as Contemplation. These processes may include, for example, raising consciousness, i.e. the patient’s growing recognition that he benefits from his treatment as it controls his vertigo symptoms. Behavioral processes are used primarily in later stages.
The Transtheoretical Model (TTM) is an integrative, biopsychosocial model used to conceptualize the process of intentional behavior change — that is, an individual’s readiness to act on new, healthier behavior. Whereas other models of behavior change focus on just one dimension of change (for example, they focus mainly on social factors, ...
Processes of Change — strategies to help individuals make and maintain change — the “how” of change. Decisional Balance — a growing awareness that the advantages (the “pros”) of changing outweigh the disadvantages (the “cons”)
Its name spells out what it is: the prefix trans means across, and theoretical means concerned with the theory of a subject or area of study — hence, the term transtheoretical. The TTM has been applied successfully in a variety of behaviors, populations, and settings.
Behavior change is a process that unfolds over time through a sequence of stages. Stages are both stable and open to change, just as chronic behavior risk factors are both stable and open to change. Interventions can motivate change by enhancing the understanding of the pros and diminishing the value of the cons.
While progression through the stages of change can occur in a linear fashion, a nonlinear progression is common. Often, individuals recycle through the stages or regress to earlier stages from later ones. Although the time a person stays in each stage is variable, the tasks required to move to the next stage are not.