Transtheoretical Health Promotion Model for Patient Essay
Transtheoretical Health Promotion Model for Patient Essay
This assignment will look at the health promotion of a patient who is required to lose weight before surgery can take place using the Transtheoretical Health Promotion Model (Prochaska and Diclemente 1983) to follow the patient through the journey of weight loss. It will discuss the healthcare professional’s role in helping a patient to change their behavior and the steps the patient will need to take to achieve weight loss. It will then analyse if the Transtheoretical Model is a suitable for this kind of health promotion and identify any shortcomings.
Mrs Smith is a 52 year old female, is 5’4″, weighs 20 stone, and has a Body Mass (BMI) in excess of 40. Her name has changed to protect patient confidentiality (Nursing and Midwifery Council (NMC) 2008. Mrs Smith needs to lose 3 stone before she can undergo surgery. She is married, works shifts in a call centre and generally leads a sedentary life. Transtheoretical Health Promotion Model for Patient Essay.
McArdle (2002) describes obesity as”A biological response to an individual’s environment that can have a profound impact on patients Health”. Obesity is identified by an increase in body weight and a BMI of >30 which leads to excess adipose tissue (Rollo 2004, World Health Organisation (WHO) 2003). In England obesity levels have dramatically increased over the last 30 years and are a growing concern. In 2008 61.4% of adults were obese and if the trend continues 60% of men and 50% of women will be classed obese by 2050 (Department of Health (DOH) 2009). Public Health is a key issue for the Government who are committed to reversing the increasing trend of obesity (Scriven and Orme 2001). Strategies have been such as healthy weight; healthy lives (DOH 2008) to provide practical support and improve care for adults with obesity focusing on health not illness.
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Obesity increases risks during and after surgery. All surgery carries a risk of stroke and even death which will increase with obesity (reference).The thick adipose tissue around Mrs Smith’s abdomen will mean the incision will be longer and access to her womb will be restricted causing difficulties during surgery and increases the risk of infections post operatively (Baxter 2003). She may also experience more unpleasant side effects of anesthetic than a patient with a healthy BMI. Generally being obese will increase the risk of many other illnesses such as Diabetes Type 2, heart disease, cancer, high blood pressure, osteoarthritis and respiratory problems (Jebb 2005)
Mrs Smith needs to be as healthy as possible for surgery. WHO (2003) define health as:
“A state of complete physical, mental and social well being and not merely the absence of disease or infirmity”.
It is clear that Mrs Smith is not in the best physical health and it could be argued the consequences of which may have an effect on her mental and social well being (reference).
Health promotion will help her achieve optimum health and is defined as:
“Enabling people to exert control over the determinant of health and thereby improve their health.” (The Public Health Agency (PHA) 2010)
Healthcare professionals are required to promote health and wellbeing (NMC 2008). Combing health education with healthy public policy the National Institute for Clinical Excellence (NICE) (2006) recommend the implementation of structured programmes to promote individual tailored health advice to patients in collaboration with others agencies such as, local authorities, social services, voluntary sectors and workplaces.
The Transtheoretical/Stages of Change Model (Prochoska et al 1992) is based on people changing their behavior, it is used in a variety of settings including well known campaigns associated with addictive behaviors such as smoking and alcohol. (WW website). It works on the basis that most people have tried to give up an addictive habit at some point but have given up due to a number of factors including support, no motivation, time and knowledge. (Naidoo and Wills YEAR). Changing the health related behavior of patients is challenging for nurses due to the complex mix of psychological, social and environmental factors and this model helps nurses to help patients focus and move forward to the next stage. Transtheoretical Health Promotion Model for Patient Essay. It is an ongoing cycle, of stages in which people move forwards as well as backwards. (Naidoo and Wills YEAR).
The first stage of Pre-Contemplation assumes Mrs Smith is unaware of any potential risks to her health (Naidoo and Wills YEAR). However it is hard to imagine that she is not aware of the detriment to her health considering national media campaigns such as the NHS Change 4 Life progamme (2010) aimed at improving the nation’s health. It is more likely that she is in denial and does not want to change. Her views on health may differ to the healthcare professional’s view, which might be related to age, experiences or cultural beliefs (Helman 2007). It is therefore important to try to understand her believes. She may have tried to diet before and failed. Education and advice will raise awareness the effects of her lifestyle before she progresses to the next stage of the model (Benbow and Jordan 2007).
At the Contemplation stage Mrs Smith will not be ready to make changes but seeking advice and information to help her weigh up whether making changes are worth the effort. The healthcare professional will have an opportunity to tailor information specifically to help her understand that weight loss means eating less and increasing physical activity (NMC 2008). The advice and information communicated to her should be clear, precise, evidence based and at the right level to help her make an informed choice regarding weight loss (Naidoo and Wills YEAR). Time should be spent to build Mrs Smiths confidence and motivation by explaining the many benefits she can expect to see from weight loss, such as in addition to undergoing surgery, improvements to her health will include amongst others reduced breathlessness, increased mobility (Jebb 2005). Regular exercise will reduce her medical problems including improving gylcaemic control, cholesterol level, cardiac fitness, and physical well being. The healthcare professional’s priority will be to focus on empowering Mrs Smith to want to make the behavioral changes and move towards the next stage in the cycle which they could do by identifying what prevented Mrs Smith from losing weight before or asking her to visualize a forthcoming event and how she might look and what she might wear if she lost some weight (Rollo 2004).
At the third stage of the model, Preparing to Change, Mrs Smith will be serious about her decision to change and will be ready to take action (Rollo 2004). Healthcare professionals will need work together with her to assess her current lifestyle and help her understand what she needs to do to achieve weight loss (Naidoo and Wills). Clinical assessments will be taken for baseline purposes and will include past weigh loss/gain history, medical and psychiatric history, weight, BMI, waist measurement, blood glucose levels, thyroid function and lipid profile (Cook 2009). With support she will need to be prepared to make a change for life and any myths she may have will need to be dispelled if she is to be successful (Jebb 2005). A plan should be formulated to help Mrs Smith succeed, outlining what activities are required for her achieve weight loss. This list is exhaustive but might include keeping a food and exercise diary, controlling portion sizes, introducing regular mealtimes, changing to healthier food types and aiming to use healthy cooking methods (Jebb 2005). Transtheoretical Health Promotion Model for Patient Essay. As Mrs Smith does very little physical activity at the moment recommendations might include introducing a something new like a low impact exercise such as swimming or walking more often. Her expectations should be discussed, and any difficulties identified and coping strategies implemented. For example, Mrs Smith is works shifts so she will need to plan healthy meals in advance (Jebb 2005). It is proven that people who spend more time in the planning stage achieve a higher weight loss than those who don’t (reference). The plan should also include, the rewards she will get for losing weight and what support will be available, and when monitoring and review will take place (Cook 2009).
The fourth stage is Making the Change. During this stage healthcare professionals can help Mrs Smith to make positive decisions to modify her diet and physical activity by agreeing clear realistic goals and how they are going to be achieved, taking into account cultural and individual preferences. These can be broken down into small steps to give her greater sense of achievement (McArdle 2002). For example, to achieve weight loss she will need to reduce food intake byaround 600 kcal/day, concentrating on losing 1-2lbs per week will seem more achievable than focusing on losing several stone and maintaining a food and exercise diary will enable her see the positive changes she has made (Jebb 2005). As she leads a sedentary life it would be totally unrealistic to suggest high impact aerobic exercise, instead she could perhaps walk for ten minutes each day increasing the time as she increases her physical fitness. To maintain momentum ongoing practical support, information and advice should be available at continuous sessions and support groups (Rollo 2004).
The fifth stage of the model is Maintenance. Mrs Smith should be encouraged to make changes she can sustain indefinitely. Managing obesity is a long-term commitment and she will need to be educated with new skills to enable her to maintain her new habits. She will need to identify when she is likely to fail and have a coping strategy in place, such as choosing a healthy option when eating out. Mrs Smith may require additional support at particular stressful times in her life to prevent her gaining weight again (Jebb 2005).
The last stage is Relapse. Maintaining new habits can be difficult and Mrs Smith is likely to regain weight at some point. She may relax once her target weight has been achieved and slip back into bad habits or she may be disappointed if she doesn’t achieve the weight loss as quickly as she anticipated. She will then revert to previous stages of the model. Transtheoretical Health Promotion Model for Patient Essay. Additional support and encouragement will be needed to help her understand that she is not a failure, that it is human nature to relapse and to help her get back on track. It is likely that she will go back and forth many times through the different stages (Naidoo and Wills).
In conclusion obesity is a major concern today and it would appear this model is successful in helping people to achieve weight loss. Both commercial and government organisations use the model for major health campaigns (NHS 2010, ww 2010). This model aims to help people make lifestyle changes that are permanent. However it is very much dependent on people changing their behavior and as people are individuals it cannot be applied in a set manner, what works for one person will not necessarily work for another (Benbow and Jordan 2007). The model involves therapeutic intervention and the outcomes can be significantly affected by the healthcare professional. The patient/healthcare professional relationship is based on trust and understanding and will only work if the patient is ready to change. Success of this model cannot be measured short term as managing obesity is a life-long commitment (REFERENCE)
Students will write a 5 page academic paper in APA format that addresses one of the health behavior issues that was identified while interviewing their “volunteer patient”. For example, while obtaining your patient’s health history you may have discovered that they are a smoker, do not get enough sleep, have poor eating habits, are a diabetic who does not monitor their blood sugar, or perhaps they have a sedentary lifestyle. These are all behaviors that may affect your patient’s health and well-being. In order to affect a healthy change you will apply Prochaska & DiClemente’s Transtheoretical Model of Behavior Change (TTM) to your “volunteer patient” as a health promotion activity. The goal is to identify the stage of the TTM the patient is in, and design an evidence-based nursing intervention to assist the patient in changing this behavior, which will allow them to the next stage of the Transtheoretical Model.
For additional information regarding how the Model can be applied to your patient and how to write the paper please you may wish to listen to the lecture in the course Module. Transtheoretical Health Promotion Model for Patient Essay.
NOTE: The maximum paper length is 5 pages; any text over 5 pages will not be considered for grading.
An APA paper includes the proper setup, a title page, an abstract, the body of 5 pages of writing, and a reference list. Please use APA headings to separate the different topics in the body of the paper will help to organize your data (see APA manual or Purdue Owl website for use of headings, PERRLA software will help you do these automatically).
Be prepared to submit the assignment to Turnitin (the anti-plagiarism tool described previously in NU360. PLEASE NOTE: DO NOT SUBMIT YOUR PAPER WITH YOUR NAME ANYWHERE ON THE ACTUAL PAPER INCLUDING THE TITLE PAGE WHEN YOU POST IT TO TURNITIN.
PLEASE NOTE: This paper cannot be rewritten after grading/submission. Papers with multiple grammatical errors or structural/flow issues will not be read/graded (these papers will be returned without corrections with a grade of zero and will not be allowed a second opportunity for submission). ***If you have difficulty, writing papers you are highly encouraged to consult with the Writing House Online Tutors (they can assist with set-up, grammar, sentence flow, and APA formatting. They will not assist with content). The corrected paper should be saved for your WPE portfolio with your WPE certificate (should you receive one). Please be sure to save the paper and certificate in 3 different, safe places as these cannot be reproduced once the course closes.
PLEASE SEE NEXT 2 PAGES FOR PAPER OUTLINE/FORMAT
Please follow the outline below when constructing your paper:
Paper outline:
1. Introduction:
Please do not use the word “Introduction” as a Level 1 APA heading it is assumed that the first paragraph is the introduction in an APA paper):
Describe the intent (or purpose) of the paper, identifying the focus of the behavior to be changed and introduce the TTM to your reader. Remember to identify a behavior and not a symptom or condition. (For example, with the condition of obesity, the related behavior might be eating large portions, poor food choices, lack of planning, lack of exercise, etc.Transtheoretical Health Promotion Model for Patient Essay. However, “weight loss” is not a behavior; it is a symptom. Select ONE behavior to focus on –though you may need to identify that other, related behaviors exist that contribute to the condition). Introduce the patient (according to HIPAA—do not use the “patient’s” full name or relation to you. Use the initials or the first name only). The expected outcome (thesis statement) should be clearly stated as a measurable objective. This section should be one paragraph.
2. Health History:
Summarize the “patient’s” health history. You should not repeat the
entire patient history, rather analyze the history, discuss only the relevant facts from the patient and family histories that pertain to the behavior you are addressing, and identify at least two actual or potential health risks. This should only take one paragraph.
3. Rationale:
Provide the rationale for the chosen behavioral health risk factor your “patient” needs to change to promote health in his/her life (be sure to link this to your thesis statement). Provide current, scientific evidence from the peer-reviewed literature as to why the risk factor is important to address in relation to health promotion (you should use a minimum of 3 peer-reviewed references for this section that should be no more than 3-5 years old). This is similar to a literature review, use citations to back up your rationales. You must use references other than the course textbook (this shows strength of research effort). Also, do not use “lay person” websites such as Mayoclinic.com or WebMD. Please use only professional websites such as CDC.gov, NIH.gov or other peer-reviewed websites if you intend to use web-based references. This section should be one-to-two paragraphs.
4. Overview of the TTM:
a. Review the stages of TTM. Articles included in the course sessions may be used to write this portion of the paper. However, you may not use the textbooks from the course in this section of the paper. This is a brief discussion of the 5 stages based on their temporal dimensions.
b. Describe how the TTM works. Briefly discuss motivation and readiness for change (discuss the three outcome measures), identify the ten processes of change and state how the patient looks at the pros and cons of changing their behavior (combining the processes with the outcome measures). Remember, this is still a discussion about the theory behind the model, not as it relates specifically to your patient.
c. Describe how TTM is used in practice. Relate the stages, processes of change, and decision-making aspects of TTM (decisional balance/temptation/self-efficacy) to your patient. Identify which stage your patient is in and which of the processes and outcomes are operating in your patient’s health belief system. Next, identify one appropriate nursing intervention that may assist your patient to progress to the next stage of the Transtheoretical Model while improving their health outcomes. State what nurse’s role would be in guiding/coaching the patient through this intervention (remember, in the TTM the patient who makes the change, not the nurse). Be sure to consider culturally competent care when designing your interventions. Identify at least one barrier that may be affecting your patient’s progress. Support your intervention with evidence with at least 2 articles from the peer-reviewed literature (e.g., identify how applying one of the processes of change may motivate the patient to move to the next stage, or, identify at least one barrier that may prevent this progression). Transtheoretical Health Promotion Model for Patient Essay.
5. Conclusion:
Please do not use the word “Conclusion” as a Level 1 APA heading it is assumed that the last paragraph is the conclusion in an APA paper):
This should be a conclusion of your paper, not a conclusion of your patient (the conclusion about the patient should be in the previous section). The conclusion of the paper re-iterates what was discussed in the paper and its relevance to nursing practice. This should also tie-in the items discussed in the introduction.
The patient is a 39 year old Hispanic male. He is lives with his wife and three children. He owns 2 business of auto tinting and works Monday to Saturday 8am to 6pm. He reports frequent migraine headaches, fatigue and stress. He has moderate seasonal allergies which are well control with Allegra and Flonase. He also takes Excedrin for migraines with good relieve. Patient has almost daily difficulty sleeping due to bilateral lower legs pain, restless leg syndrome. Patient has a family history of aneurism, his maternal aunts has multiple surgeries to remove them and his maternal grandmother die of aneurism. Patient mother has hypertension. His sister has hypothyroidism, his paternal grandfather is diabetic, and his father is pre diabetic and has high cholesterol. Patient is not aware of other family history. He did mention his maternal grandfather had some type of gastrointestinal disease and had surgery where he had an ostomy for a few months but he can’t recall what it is. Patient reports he used to very active and to exercise about 5 -6 times a week. Patient notice he has lost weight, he states “muscle weight” and has a belly now and feels sluggish. He has been contemplating to on starting to go to the gym but does not have the motivation. He states he knows he needs to go but just feel very tired every day to go. Patient is overall healthy, reports he has a good nutrition but could eat healthier.
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The Transtheoretical Model for Behavior Change
Author’s Name
Institutional Affiliation
The Transtheoretical model for behavior change is proposed by Prochaska and DiClemente (1970) to examine the antecedents maintaining a behavior and stages through which change occurs. It amalgamates three major fields that may contribute towards intentional change i.e. all biological, psychological and social elements.Transtheoretical Health Promotion Model for Patient Essay. The strength of Prochaska’s model is how it inculcates these diverse fields together in explaining a single phenomenon instead of focusing on one dimension i.e. only biological or social. The model also allows individuals to identify the stage of change they are at. The following paper will discuss and relate TTM to the patient R.M. with relevance to change in exercise habits.
Summary
Studies of patient adherence to health behavior programs, such as physical exercise, smoking cessation, and diet, have resulted in the formulation and validation of the Transtheoretical Model (TTM) of behavior change. Although widely accepted as a guide for the development of health behavior interventions, this model has not been applied to vocal rehabilitation. Because resolution of vocal difficulties frequently depends on a patient’s ability to make changes in vocal and health behaviors, the TTM may be a useful way to conceptualize voice behavior change processes, including the patient’s readiness for change. The purpose of this paper is to apply the TTM to the voice therapy process to: (1) provide an organizing framework for understanding of behavior change in voice therapy, (2) explain how treatment adherence problems can arise, and (3) provide broad strategies to improve treatment adherence. Given the significant role of treatment adherence in treatment outcome, considering readiness for behavior change should be taken into account when planning treatment. Principles of health behavior change can aid speech pathologists in such understanding and estimating readiness for voice therapy. Transtheoretical Health Promotion Model for Patient Essay.
INTRODUCTION
Why do some voice patients diligently practice their daily voice exercises, whereas others return only to provide reasons for not doing so? Why do some overcome struggles in changing vocal health behaviors, whereas others give up at the first sign of difficulty? The relationship between learning how to rehabilitate one’s voice, and taking action to do so, appears neither transparent nor direct. As voice therapy is a behavioral intervention that primarily aims to resolve the behavioral component of a voice disorder, it depends inherently on active patient involvement. Any behavioral approach can only be as effective as a patient’s adherence to it. Moreover, there is evidence suggesting that for some voice disorders, patient adherence to treatment, rather than any specific treatment approach, determines outcome, or is suspected to play a substantial role.1–5
Although factors underlying treatment adherence have not been investigated in voice research, they have received considerable attention in other areas of health behavior research. Study of treatment adherence has led to the development of various conceptualizations of health behavior change, including the Transtheoretical Model (TTM),6,7 the Theory of Reasoned Action,8,9 the Health Belief Model,10–12 and health applications of Social Cognitive Theory.13 This current knowledge of intentional health behavior change can inform our understanding of behavior change in voice therapy and therefore our understanding of voice therapy adherence. Given its clinically operational constructs, the TTM appears particularly well suited to the voice clinic, and may explain some of the adherence and behavior challenges we observe in our voice patients. Transtheoretical Health Promotion Model for Patient Essay.
PURPOSE
The purpose of this paper is to apply the TTM to the voice therapy process to: (1) provide an organizing framework for understanding of behavior change in voice therapy, (2) explain how treatment adherence problems can arise, and (3) provide strategies to informally assess patient readiness and facilitate behavior change. Core constructs of the TTM will be discussed first, including stages of change, decisional balance, processes of change, and self-efficacy. Next, treatment adherence problems will be discussed from a TTM perspective of strategy-to-stage mismatch, unresolved ambivalence, and poor self-efficacy. Last, the role of assessing stages, importance, and confidence in clinical voice practice are discussed. Examples and quotations are derived from the authors’ clinical experience.
BACKGROUND OF THE TRANSTHEORETICAL MODEL
The TTM has become one of the most widely accepted model of health behavior change.14 The model was developed inductively, through study of the change strategies used by individuals who independently quit tobacco use. Initially describing only smoking cessation, further studies have shaped the model to represent how individuals succeed or fail in changing various health behaviors, including quitting addictive behaviors and initiating new health regimens. For instance, the TTM has been extensively applied across a variety of health behaviors including physical exercise, nutrition and diet, and HIV prevention.14–22
One of the primary contributions of the TTM is the finding that successful self-changers draw upon strategies across psychotherapeutic approaches to achieve their goals.20,23–29The TTM does not recommend any particular approach, but rather, provides a “Transtheoretical” organizing framework for understanding and facilitating the process of health behavior change. Transtheoretical Health Promotion Model for Patient Essay.
At this time, the TTM provides the foundation for health intervention programs and research guided by the Centers for Disease Control & Prevention, including the study of HIV prevention,30 and cancer prevention (www.cancer.gov) and is applied internationally.31,32
TRANSTHEORETICAL MODEL CONSTRUCTS
The TTM postulates that behavior change is accomplished through a series of stages, rather than a single or sudden event. These five stages of change are precontemplation, contemplation, action, preparation, and maintenance. Time spent in each stage can vary, and “recycling” through a prior stage can occur. The first three stages describe the development of intention to take action, whereas the last two stages describe the process of fully actualizing the intent to change. Thus the initial stages concern introspective cognitions about change, whereas the latter stages are characterized by observable behavior change.6,22 Different experiences and self-regulatory strategies (termed “processes of change”) aid the individual in moving from one stage to the next.33 Self-efficacy influences the entire course of changing.
Stages of change
Precontemplation
In the stage of precontemplation, individuals are not seriously considering behavioral change. Two distinct groups of precontemplators exist: those who are not aware that behavior change is possible or beneficial and those who are aware but choose not to pursue it. In the voice clinic, examples of the former group may include individuals with hyper-functional voice disorders who, on initial examination, are not aware of the behavioral component of their dysphonia. When these individuals, after examination and education, do not accept the diagnosis of a functional component or etiology, they remain in this unaware type of precontemplation. The latter (aware) group consists of individuals who, for a variety of reasons, are not interested in changing vocal- or voice-related behaviors. Some examples include patients who are “happy as long as it isn’t cancer”; have other more pressing priorities than vocal (re)habilitation, and those who are retaining their dysphonia for financial or psychosocial reward. Transtheoretical Health Promotion Model for Patient Essay
When speaking with a precontemplative patient, strong antichange statements may be observed, such as “Smoking is my best friend,” “I’ve talked this way all my life: that can’t be the cause,” or “My husband makes me yell!” Such antichange statements suggest these patients are not yet considering change, and thus residing in the stage of precontemplation.
Stage 2: Contemplation
In this stage, individuals actively consider making a change in behavior, weighing the advantages and disadvantages, or “pros and cons” of changing. Ambivalence, defined as feeling two ways about change, is the primary characteristic of contemplation.34 This ambivalence must be resolved before any action-oriented therapy can successfully commence.
Ambivalent patients voice opinions both for and against change, such as “I love going to the bar with my friends even though it really makes my throat hurt. I do miss singing.” For those who enroll in voice therapy at the urging of the voice team, as distinct from their own desire to enroll, ambivalence during sessions and poor adherence outside of therapy are likely (“I tried to do my homework but my in-laws were in from out of town”). Other signs of contemplation include the need for repeated discussion of possible causes of the problem rather than the solution (“Do you think this all started when the horse bit my ear?”35), continued requests for evidence supporting the efficacy of voice therapy when this information has already been provided, and requests to explain voice exercises/mechanics when this material has been covered repeatedly. Prochaska et al speculate that a subgroup of contemplators may hope that, while contemplating, the problem will resolve without further action, or that contemplation will provide a solution that does not necessitate action.34
Stage 3: Preparation
As patients become more resolved about pursuing change, and less ambivalent, they enter the stage of preparation. In preparation, the commitment to change is made. Verbal commitment statements (eg, “I want to work on this” or “I have to do this now”; “I’m really excited about learning better technique”) are indicative of the preparation stage. According to the TTM, collaborative goal setting for a treatment plan is now possible, because the patient is ready to take action. Small steps toward change can also be initiated: patients may wish to clear their schedule of vocally demanding activities, identify practice times, or purchase an amplifier. Transtheoretical Health Promotion Model for Patient Essay.
Stage 4: Action
In this stage, patients are actively engaged in modifying their voice-related behavior. The voice patient in action uses therapy sessions to discuss accomplishments and difficulties of adopting new behaviors and to review relevant voice exercises and techniques. With mastery experiences in and outside the clinic, a patient’s skill and confidence grows (“I noticed my throat getting tense so I started to talk softer. And that’s when people started listening to me.”), but the possibility for failure also exists, putting the patient at risk for recycling to a previous stage of change: “I’m working on staying in my resonant voice but it’s just so hard to do.”
Stage 5: Maintenance
Maintenance is defined as integration of the newly developed behavior. In voice therapy, patients enter this stage when they are effectively and independently maintaining healthy voice use and vocal health-related behaviors on an ongoing basis. This typically signals the end of regular voice therapy sessions. The patient may state that “I think I’m done with therapy,” “I know what to do when I lose my tone-focus,” or “I don’t have to think about it that much anymore.”
Part of successful maintenance is mastering the ability to return to healthy voice use in case of relapse/recycling. Therefore, as the patient moves into the maintenance stage, discussion of relapse prevention is important.18,21,36
Decisional balance
In the TTM, the process of resolving ambivalence in contemplation is referred to as decisional balance. Transtheoretical Health Promotion Model for Patient Essay. A significant increase in the perceived pros of change as compared with the perceived cons of change is seen in patients who resolve ambivalence and commit to action.37,38 This shift comes about if the patient finds that the behavior change is vital to an important goal in his or her life. For instance, a patient who sings in church may resolve her ambivalence when realizing that singing is a vital part of worship for her, and that worship is fundamental to her values.
Processes of change
The TTM identifies 10 self-regulation strategies that successful self-changers use to move from stage to stage.7,39 These function as independent variables between the dependent variables of stages.40,41 TTM proposes that these “processes of change” can be elicited or applied in therapeutic interventions. Table 1 describes each process of change and provides voice-related examples. The strategies should be considered broad categories of therapeutic interventions, rather than specific techniques. For example, the process of “consciousness raising” is a broad strategy that can be accomplished through very different techniques from oppositional schools of psychotherapy or counseling. Transtheoretical Health Promotion Model for Patient Essay.
