HxRefactored - Pro Change Behavior Systems Inc - Kerry Evers
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The document summarizes the Transtheoretical Model (TTM), which is a leading theory of behavior change. The TTM proposes that behavior change involves progress through six stages: precontemplation, contemplation, preparation, action, maintenance, and termination. It also identifies processes of change - techniques and strategies - that are most effective for facilitating movement between the stages. The TTM has been widely researched and applied to interventions for health behaviors like smoking cessation and weight management. It provides a framework for tailoring interventions to individuals' readiness to change.
HxRefactored - Pro Change Behavior Systems Inc - Kerry Evers
- 1. Behavior Change Tailoring: The Transtheoretical Model Kerry E. Evers, Ph.D. Pro-Change Behavior Systems, Inc.
- 3. Behavior Change “Up to 40 percent of annual deaths from each of five leading US causes are preventable” CDC, Morbidity and Mortality Weekly Report, May 2014
- 4. • Health behavior change is a science • Health behavior change interventions should be grounded in a leading theoretical model Theore.cal Base “Programs to influence health behavior, including health promo8on and educa8on programs and interven8ons, are most likely to benefit par8cipants and communi8es when the program or interven8on is guided by a theory of health behavior.” Glanz, et al., 2008 -‐ There is nothing as prac8cal as a good theory. Lewin, 1935 Glanz, K, et al (Eds.) (2008). Health Behavior and Health Educa4on: Theory, Research, and Prac4ce, 4th Edi4on. San Francisco, CA: Jossey-‐Bass Lewin, K. (1935) A dynamic theory of personality. New York: McGraw-‐Hill.
- 5. “The transtheore.cal model has been around since the late 1970s but is no less powerful now and even has special u.lity when two-‐thirds of Americans are overweight or obese and 600,000 of us are killed by cardiovascular disease per year." Dr. Oz, Time Magazine, October 2012
- 6. Google Search conducted 3/17/2014 184,000 results for “Transtheore.cal Model” 442,000 results for “Stages of Change” TTM in the Public Eye
- 7. • Search of PubMed Journal Articles • Pubmed 1983-Present: 14,617 • 2013 Alone: 1,129 • Search of Google Scholar • Stage of Change Model: 1,270 • Transtheoretical Model: 21,400 TTM in the Academic Literature
- 9. History of the TTM
- 10. • Smoking cessa.on • Stress management • Depression preven.on • Weight management • Exercise acquisi.on • Healthy diet • Responsible drinking • Medica.on adherence • Sun exposure • Mammography screening • Obesity preven.on • Debt Reduc.on Transtheore.cal Model Applica.ons § Collabora.on in health care § Organ dona.on § Returning to work § Bullying preven.on § Juvenile delinquency § Da.ng violence § Domes.c violence § Advancing women scien.sts § Adop.on readiness § Professional prac.ces § Mastering change in the workplace § Pain Self Management § Informed decision making 10
- 11. • Integrates ideas from several different theories and therapies • Involves progression through five stages of change: § Precontempla.on – Not yet ready § Contempla.on – Geing ready § Prepara.on -‐ Ready § Ac.on -‐ Doing the healthy behavior § Maintenance -‐ Keeping up the healthy behavior • Certain principles and processes of change work best at each stage to reduce resistance and facilitate progress Overview of the TTM
- 12. • is based on principles developed from over 35 years of scientific research, intervention development, and scores of empirical studies; • applies the results of research funded by over $80 million worth of grants and conducted with over 150,000 research participants; and • is currently in use by professionals around the world. Transtheore.cal Model:
- 13. 13 "Most theories are about behavior, not about behavior change." – James O. Prochaska
- 14. • Index of readiness • Tells WHEN people change • Predicts who will change successfully • A dynamic, not static, client characteristic • Inclusive, empathic, optimistic • Guides member-treatment matching Stage of Change
- 15. Not Ready Have no inten4on to start taking ac4on in next 6 months Precontempla.on
- 16. Geing Ready Intend to start in next 6 months Contempla.on
- 17. Ready Prac4cing the behavior Intend to start in next 30 days Prepara.on
- 18. Recently Started to Change Overt Behavior Consistently for less than 6 months Ac.on
- 19. Has Overtly Changed Behavior Consistently for 6 months or more Maintenance
- 20. Pros = Advantages Of Changing Cons = Disadvantages Of Changing Decisional Balance: A growing awareness that the advantages (Pros) of changing outweigh the disadvantages (Cons) How do people move from one stage to another?
- 21. Confidence Degree to which individuals believe they can achieve a healthy goal even under temp.ng situa.ons DiClemente CC, Prochaska JO, Fairhurst SK, Velicer WF. The Process of Smoking Cessa.on: An Analysis of Precontempla.on, Contempla.on, and Prepara.on Stages of Change. J Consult Clin Psychol. 1991; 59:295-‐304. Self-‐Efficacy
- 22. • HOW people change • Experiential and behavioral strategies and techniques used to change behavior • Facilitate transitions between stages • Used as basis of intervention design Processes of Change
- 23. Prochaska, J.O., DiClemente, C.C., & Norcross, J.C. (1992). In search of how people change: Applica.ons to addic.ve behaviors. American Psychologist, 47(9), 1102-‐1114. Precontempla?on Contempla?on Prepara?on Ac?on Maintenance Self-‐Reevalua?on Self-‐Libera?on Helping Rela?onships Counter Condi?oning Reinforcement Management S?mulus Control Social Libera?on Drama?c Relief Consciousness Raising Environmental Reevalua?on Processes of Change: The “How” of Change GeNng the Facts Use Subs?tutes Make a Commitment Get Support Use Rewards Manage your Environment No?ce your Effects on Others Pay AVen?on to Feelings Create a New Self-‐Image No?ce Social Trends Experiential Behavioral
- 24. One Size Fits All Targeted Stage Matched Ac?on Oriented Levels of Tailoring
- 25. Precontempla?on Contempla?on Prepara?on Ac?on Maintenance Environmental Reevalua?on No?ce your Effects on Others
- 26. Precontempla?on Contempla?on Prepara?on Ac?on Maintenance Drama?c Relief Pay AVen?on to Feelings
- 27. Precontempla?on Contempla?on Prepara?on Ac?on Maintenance Helping Rela?onships Get Support
- 28. Prepara?on Ac?on Maintenance Reinforcement Management Use Rewards
- 29. Contempla?on Prepara?on Ac?on Maintenance S?mulus Control Manage your Environment A-CHESS (Addiction – Comprehensive Health Enhancement Support System)
- 31. Personal Ac.vity Center (PAC)
- 33. One Size Fits All Targeted Tailored Stage Matched Stage + Pros + Cons + Self-‐Efficacy + 10 Processes Ac?on Oriented Depth of Tailoring
- 34. Hall, K. L. & Rossi, J. S. (2008). Meta-‐analy.c examina.on of the strong and weak principles across 48 health behaviors. Preven4ve Medicine, 46, 266-‐274. The Pros & Cons of Changing Across Stage of Change: 48 Behaviors
- 35. Confidence Degree to which individuals believe they can achieve a healthy goal even under temp.ng situa.ons DiClemente CC, Prochaska JO, Fairhurst SK, Velicer WF. The Process of Smoking Cessa.on: An Analysis of Precontempla.on, Contempla.on, and Prepara.on Stages of Change. J Consult Clin Psychol. 1991; 59:295-‐304. Self-‐Efficacy
- 36. Computer-‐Tailored Interven.ons (CTI) Reliable, valid assessments of most important behavior change constructs Evidence-‐based, sta.s.cally-‐derived decision-‐making rules Individualized, tailored behavior change guidance Feedback dynamically updated based on new assessment data
- 37. Questions Internet-based expert system Data collection/analysis/feedback/assessment Responses Tailored Feedback Individuals
- 39. 0 5 10 15 20 25 30 35 Precontemplation Contemplation Preparation Action Maintenance Rate of Change
- 40. Rate of Change
- 41. Rate of Change
- 42. Norma.ve & Ipsa.ve Clinical Guidance
- 43. Norma.ve & Ipsa.ve Tailored Feedback
- 44. Processes Feedback: Sample Screen
- 45. • Fred Pennic Outlined findings from Mobiuity Report • Create an individualized solu.on • Analy.c models that trigger the appropriate interven.ons and outcomes for each user • Personalized communica.ons to increase engagement • Low-‐effort data collec.on 4 Best Prac.ces for Crea.ng Behavior Changing Mobile Health Apps hop://www.hitconsultant.net/2013/07/26/4-‐best-‐prac.ces-‐for-‐crea.ng-‐behavior-‐changing-‐mobile-‐health-‐apps/
- 46. • Theore.cal variables that produce large effect sizes when included in tailored communica.ons compared to tailored communica.ons that exclude these variables: § Stages of Change § Pros and Cons of Changing § Self-‐Efficacy § Processes of Change § Aitudes § Social Support Tailored Communica.ons that Tailor Each of the Following Variables
- 47. Theore.cal Variables that Produce Smaller Effect Sizes Perceived Suscep.bility Noar, S. M., Benac, C. N., & Harris, M. S. (2007). Does tailoring maoer? Meta-‐analy.c review of tailored print health behavior change interven.ons. Psychological Bulle4n, 133, 673-‐693.
- 48. Theore.cal Variables that DO NOT Make a Difference Behavior Inten.ons Social Norms Noar, S. M., Benac, C. N., & Harris, M. S. (2007). Does tailoring maoer? Meta-‐analy.c review of tailored print health behavior change interven.ons. Psychological Bulle4n, 133, 673-‐693.
- 49. Number of Tailoring Variables that make a difference 0-‐2 < 3-‐5 > 6-‐9
- 50. Compara.ve Outcomes of Interven.ons Johnson, J.L., Prochaska, J.O., Paiva, A.L., Fernandez, A.C., DeWees, S.L., and Prochaska, J.M. (2013) Advancing Bodies of Evidence for Popula.on-‐ based Health Promo.on Programs: Randomized Controlled Trials and Case Studies. Popula4on Health Management, 16(6), 373-‐380.
- 51. Well-‐Being: Change Over Time Prochaska, J.O., Evers, K.E., Castle, P.H., Johnson, J.L., Prochaska, J.M., Rula, E.Y., Coberley, C., & Pope, J.E. (2012). Enhancing Mul.ple Domains of Well-‐being by Decreasing Mul.ple Health Risk Behaviors: A Randomized Clinical Trial. Popula4on Health Management, 15 (5), 276-‐286.
- 52. Improvements in Well-‐Being Overall Individual Domains Prochaska, J.O., Evers, K.E., Castle, P.H., Johnson, J.L., Prochaska, J.M., Rula, E.Y., Coberley, C., & Pope, J.E. (2012). Enhancing Mul.ple Domains of Well-‐being by Decreasing Mul.ple Health Risk Behaviors: A Randomized Clinical Trial. Popula4on Health Management, 15 (5), 276-‐286.
- 53. Contacts Pro-‐Change Behavior Systems, Inc. • www.prochange.com Online Basic Transtheore?cal Model Training • www.prochange.com/e-learning Demo of Domes?c Violence Program • www.prochange.com/domesticviolencedemo Demo of Healthy Pregnancy Program • www.prochange.com/pregnancydemo Coaches Guide for Using TTM with Clients • www.prochange.com Online MyHealth Behavior Change Programs • www.prochange.com/myhealth Mastering Change in the Workplace • www.prochange.com/products Janice M. Prochaska • jmprochaska@prochange.com