Transtheoretical Model of Behavior (TTM)

Transtheoretical Model of Behavior (TTM)

Definition

Transtheoretical model of behavior is a model of intentional change that targets decision making abilities of a person rather than the biological and social influences of health related behavior (Hales, 2008). According to TTM, change occurs over time, and a person progresses through five stages of change involving behavioral modification.

Pre contemplation Stage: At this stage people are unaware of the consequences of their behavior, or discouraged, or may have experience of unsuccessful attempts; they are unwilling to take action in the foreseeable future (often defined as six months).

Contemplation stage: Individuals are intending to make a change within the next six month period. At this stage, a person is deciding if they need to change their behavior. The person weighs the pros and cons of maintaining his current behavior.

Preparation stage: this refers to the stage in which a person is planning of making a change within the next month. The person may not know how to make the change and may be nervous. When they establish a plan that they think will work they will move on to the next stage.

Action stage: at this stage, persons will have made a decision to modify the behaviors and or environments in the past six months. It requires a commitment of energy and time. The person moves to the next stage when he sees evidence of improvement.

Maintenance: At this stage individuals are working to prevent relapse and maintain the gains acquired during the action stage. Persons in this stage are more reluctant to relapse.

The stages of change are often evaluated with a five item algorithm in which the questions asked require a yes or no answer to determine the stage in which a person falls.

Smoking Cessation

Stage of Change	Characteristics	Techniques
Pre contemplation	The person is currently ignoring change (do not consider quitting smoking).	Confirm their lack of readiness. Clarify to them that the decision is entirely theirs. Encourage the person to re-evaluate current behavior. Encourage self-assessment, and not action. Explain and personalize risk.
Contemplation	The individual not sure about change. He is not considering a change of behavior within the next month.	Enquire and confirm the person’s lack of readiness. Clarify decision is theirs. Enhance personal evaluation of cons and pros of behavior. Identify and explain new positive outcome expectation.
Preparation	The person has some experience about change and is trying to change. The Person is planning to change within the next month.	Obstacles: Help the person identify and solve problems. Help the person identify social support. Evaluate and confirm that the person has underlying ability for behavioral change. Encourage the person through small initial steps.
Actions	The person is practicing the new behavior (nonsmoking) for three –six months.	Focus on restructuring cues and social support. Foster self-capacity for dealing with problems. Discourage feelings of loss and focus on long- term benefits.
Maintenance	The person shows continued commitment to maintaining new behavior after six months to five years.	Plan for follow-up support. Reinforce internal rewards. Discuss coping with relapse.
Relapse	Resumption of old habits.	Assess trigger for relapse. Reevaluate barriers and motivation. Plan longer coping strategies.