Have you ever heard of the transtheoretical model? It’s a bit of a mouthful which is why it’s sometimes shortened to just TTM.
If you've come across it before then great, you’re already a few steps further along than most when it comes to understanding health related behaviour change. If you haven’t heard of it before that’s also ok, I’ll try to unpack the concept a little…
The transtheoretical model - also known as the ‘stages of change model’ - relates to the readiness of an individual to change their health related behaviour. It was designed in 1977 and incorporates five distinct stages of change plus a termination phase at the end.
Stages Of The TTM
Pre-contemplation
This is the ‘no’ phase whereby individuals have no intention of taking any action to achieve a particular health related objective at some future point. Although they may intuitively know that their health is not as it could or should be they are often unaware that their behaviour is causing a problem.
Contemplation
This is the ‘maybe’ phase whereby individuals are starting to realise that either their current state of behaviour is detrimental to their health or that they should aim to improve their health in general. During this phase people start to mentally assess the positives and negatives of changing their specific situation.
Preparation
This is the ‘prepare/plan’ phase whereby individuals have a clear intention of taking some form of action in the immediate future. At this point they may already be engaging in some incremental positive behaviour changes or mapping out what they intend to do.
Action
This is the ‘do’ phase. Individuals in this phase have made very clear behavioural modifications and are actively engaged in improving their health. They are open to learning and acquiring new healthy behaviours and have become disciplined enough to be involved in the new behaviour consistently.
Maintenance
This is the ‘keep going’ phase. Individuals in this phase are engaged in sustained healthy activities multiple times per week. They have adhered to these activities for at least six months and consciously try to prevent relapse to previous unhealthy behaviours.
Termination
This is the ‘end’ phase. Individuals have little, if any, temptation to relapse and have become adept at making healthier decisions for themselves.
It's possible, actually it's quite probable, for a relapse to occur at one of the various stages within the model and when this happens it's recommended to re-enter back in at the point of relapse. This could mean going back one step, a few steps or even back to the very beginning.
Positive health related behaviour change is not limited to only going to the gym or only eating healthy food, it's much, much broader than this and encapsulates many aspects. It’s herein that a conflict arises.
What The Science Says
A systematic review was conducted by Robert Paul Riemsma (a Dutch behavioural psychologist) et al in 2003 on the effectiveness of the transtheoretical model with regards to stopping smoking.
The results of the review concluded that:
“[Of] 23 randomised controlled trials [that] were reviewed; two reported details of an economic evaluation. Eight trials reported effects in favour of stage based interventions, three trials showed mixed results, and 12 trials found no statistically significant differences between a stage based intervention and a non-stage based intervention or no intervention. Eleven trials compared a stage based intervention with a non-stage based intervention, and one reported statistically significant effects in favour of the stage based intervention. Two studies reported mixed effects, and eight trials reported no statistically significant differences between groups. The methodological quality of the trials was mixed, and few reported any validation of the instrument used to assess participants’ stage of change. Overall, the evidence suggests that stage based interventions are no more effective than non-stage based interventions or no intervention in changing smoking behaviour.”
Essentially, this points to the fact that specifically in the case of smoking cessation the transtheoretical model was not effective. The study stated that further systematic reviews are required to be able to accurately evaluate the effectiveness of interventions based on other theoretical models.
Is The TTM Good Or Bad?
I personally don’t believe it’s as binary as this. Perhaps what this particular systematic review fails to consider is that a positive health related behaviour change such as smoking cessation sits on the higher end of the spectrum when it comes to difficultly. Although the model did not prove successful for this particular outcome it does not necessarily mean that the model doesn’t work at all.
Irrespective of the scientific arguments and counter arguments the transtheoretical model remains arguably the most dominant health behaviour change model at this time. It should therefore at the very least be considered by individuals thinking about changing their own health related behaviour.
Whatever stage you are at on your own health journey it does pay to give some thought to this model and others like it. Thinking logically and in a structured fashion will help you to shape your own thought processes around what it is you need or want to do to improve your health.
I hope you enjoyed the content. Please leave your thoughts below in the comments section and let me know what other health and well-being topics you'd like me to cover.
If you’re interested in improving your health then please do get in touch!
Michael East
ME LIFE
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