1. Transtheoretical Model and Physical Activity EPHE 348

2. Origins Basic linear theories were not explaining health behavior completely Market segmentation and intervention tailoring? Clinical observations of smokers indicated different stages of readiness (Prochaska & DiClemente, 1983)

3. Stages of Change The novel concept in the model Behavior change unfolds through 5 different stages Individuals use different processes or strategies at different times Each stage has different needs and requires different strategies (i.e., stage matched interventions)

4. Stages of Change Spiral pattern represents the dynamic forwards and backwards movement through the stages. Termination Figure 15.1

5. Constructs of the Transtheoretical Model Processes of Change - behavioral (changes in behavior) or cognitive/experiential (changes in thinking) Decisional balance Self-efficacy

6. Processes of Change 10 Cognitive and behavioural strategies to enact/cause the change Research – behavioral processes are correlates of PA, but the transitional nature across the stages is not well established (Plotnikoff et al., 2001) Processes are not well-measured/defined and may not be complete

7. Behavioral Processes of Change 1) Counter-conditioning: substituting alternative healthy behaviors for unhealthy ones 2) Helping Relationships – seeking/using social support networks for behavior change 3) Contingency management – increasing rewards for a positive behavior and decreasing ones for a negative behavior

8. Behavioral Processes of Change 4) Self-liberation – making a firm commitment to change (e.g., written contract) 5) Stimulus control – removing reminders or cues for unhealthy behaviors and adding ones for healthy behaviors

9. Cognitive Processes of Change 1) Consciousness raising – learning new facts & tips about healthy behavior change 2) Dramatic relief – experiencing negative emotions that go with unhealthy behavioral risks 3) Self-reevaluation – realizing the change is part of one’s identity

10. Cognitive Processes of Change 4) Environmental-reevaluation – realizing that the impact of the behavior on one’s social and physical environment 5) Social-liberation – realizing the social norms are changing in favor of the healthy behavior

11. Decisional Balance Pros vs Cons Cons are high in early stages Pros become higher in later stages Decisional balance less important in later stages Research – not really the case (Spencer et al., 2006)

12. Self-Efficacy Confidence to continue the healthy behavior and overcome temptations Self-efficacy should increase across the stages of change Research – self-efficacy is the most validated across the stages of change

13. Advantages of the TTM The notion of tailoring / market segmentation is actually addressed Risk populations can be subdivided

14. Problems No structure among constructs (describe but not explain) Stage matched interventions have mixed results (Spencer, 2006) 6 studies on the topic 1/6 shows support for tailoring

15. Sutton (2000) Stages need to be distinct Clear differences across stage Order of process across stages

16. Beyond Stages (Rhodes & Plotnikoff, 2006; Rhodes et al., 2008)

17. Application Exercise Assume that you are a health professional and a client in the preparation/action stage has come to you for help Develop an exercise intervention technique (or series of techniques) for each behavioral process of change (be creative!)