Transtheoretical Model of Health Behaviour Change

Have you ever started working on a New Year Health Resolution with full zeal only to bring it to a halt at the end of month 1? I am sure you have, and you are not alone in this! But have you wondered why this cycle keeps repeating itself? Well, change can be a difficult process and can be affected by various elements such as readiness, barriers, and likelihood of relapse. Researchers Prochaska & DiClemente address this question in their Transtheoretical Model of Health Behaviour Change.

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What is the Transtheoretical Model of Health Behaviour Change?

The Transtheoretical Model of Health Behaviour Change puts forth the idea that health behaviour change involves going through six stages:

• Pre-contemplation
• Contemplation
• Preparation
• Action
• Maintenance
• Termination

We will look at what these stages mean and also understand the typical behaviours shown by individuals in each of these stages. Further directions to move through the cycle of change are provided.

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Stage 1: Precontemplation

“I haven’t been thinking about making changes in the area and I don’t intend to shortly.” Is this your thought now, despite people asking you to make significant changes in a specific health behaviour you show? Provided, you also know that integrating those changes would enhance your quality of life and overall health. If yes, you’re at the pre-contemplation stage.

In this stage, typical behaviours include:

• Resistance to change
• Denying that certain behaviour is problematic
• Unaware of the harms and damages caused by the problem behaviour
• Under-informed and unaware of the consequences of that particular health behaviour

In this stage, the first step is to be aware. It is suggested that you rethink your actions, analyze your perceptions of the same and perform a risk-benefit analysis concerning the behaviour.

Stage 2: Contemplation

“I have thought about making changes in this area of my life, but haven’t done anything about it yet?” In this stage, you are aware that you are engaging in a certain problem behaviour and have thought about making changes, but you haven’t yet integrated those changes or put them into action.

Typical behaviours in this stage include :

• As a result, you experience ambivalence about changing, due to the conflict between costs and benefits.
• You become increasingly aware of the potential benefits of making the change.
• You are also worried about the costs of the change.
• Delays in change due to this uncertainty.

If you feel you are at this change, then it is suggested that you perform a cost-benefit analysis and see if one outweighs the other. Check your level of readiness and your determination and ability to change. Identification of barriers to change would also help you to smoothly manoeuvre through the process of change.

Stage 3: Preparation

“I am going to make a change but I’m not quite sure if it’s the right thing to do.” At this stage, you are all ready and set to take action and integrate the change into your lifestyle.

Typical behaviours you might show at this stage include :

• Beginning to make small changes to prepare for a larger life change
• Your action moves towards a certain decided direction

In this stage, you can write down your goals. Make sure they are SMART (Specific, Measurable, Achievable, Relevant and Time-oriented). You could also prepare an action plan with motivating statements to keep you going on the journey of change. As you embark on this journey, try and gather as much information as you can about the ways to change your behaviour. Additionally, you can also choose to receive support, encouragement and advice from counsellors, therapists, friends, family and support groups.

Stage 4: Action

“I have been actively making real changes in this area of my life for at least the last month.” As the name suggests, this is the stage where you act upon your goals by engaging in goal-directed behaviour. In this stage, you might see some resolutions falling apart in case you haven’t worked as much on the previous stages of change.

In this case, the following tips are recommended:

• Reward your successes, big and small!
• Reinforcement and support are extremely important in maintaining positive changes.
• Take time to review your motivations, resources and progress so that you replenish your commitment and belief in your ability to change.

Stage 5: Maintenance

“I have been actively making successful changes in this area of my for about six months.” As the name suggests, this is the stage where action (the previous stage) is maintained.

Typical behaviours in this stage include:

• Being successful in avoiding former undesirable health behaviours
• Successfully replacing old habits with more positive actions
• Higher assurance of being able to continue the change

Continue to hold on to the changes that you have integrated. However, in times when you falter, remember not to be hard on yourself. Minor setbacks do happen on the road to change. But it is important to review those setbacks and get back on track! If you have successfully integrated the change despite occasional setbacks for years now, the process of change is terminated.

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Stage 6: Relapse

However, in cases where you find yourself going back to your old ways, you are at the relapse stage. You might experience feelings of failure, disappointment, frustration and the tendency to give up.

In this case, here are some steps you could take:

• Reassess your resources and strategies
• If needed, devise a new action plan
• Review the setbacks and analyse why they happened
• Make plans for dealing with temptations in the future
• Reaffirm your motivation, plan of action, and commitment to your goals

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Limitations of the Transtheoretical Model

While this model looks promising in helping people change, there are some limitations this model fails to consider:

• Not focusing on contextual factors such as socioeconomic status, occupation, ethnicity, culture, class, etc.
• The assumption is that all individuals are capable of decision-making and acting logically and rationally.
• The transition between stages and their definition itself is vague.

Nevertheless, this theory is extensively used in health psychology and behavioural medicine today. Using this theory, psychologists recognize that change is difficult, but motivate their clients along the process, proving that the change is not impossible.