The Transtheoretical Model (also known as the Stages of Change Model) was established as a result of studies comparing the experiences of smokers who were able to quit on their own versus those who needed more help to understand why some people were able to quit on their own. The Transtheoretical Model (TTM) in health coaching focuses on individual decision-making and is a model of deliberate change (Hashemzadeh et al., 2019). The TTM is based on the premise that people do not alter their behavior fast or decisively. Rather, change in health related behavior, is a cyclical process that occurs continuously. The TTM is a model, not a theory, and other behavioral theories and constructs can be applied to different stages of the model depending on their effectiveness.
The TTM’s core organizational component is the stage of change, which refers to a person’s readiness to modify a health behavior. According to the TTM, there are five stages of transition. They are precontemplation, contemplation, preparation, action, and maintenance stages (Hashemzadeh et al., 2019). Each of the stages corresponds to the distinct behavior within a certain period of time. Precontemptation is the first six months period when a person does not will to change behavior, contemplations are the next six months when they plan to change behavior, and preparation refers to the period when one decides to change behavior in the next thirty days. Finally, action is a period corresponding to the behavior change, and the maintenance stage is a period of sustained new behavior within six or more months.
Furthermore, the TTM model is based on the idea that people’s behavior evolves as they consider and assess the benefits and drawbacks of their actions for their health. The goal of the pre-contemplation stage is to raise awareness of the need for change and to increase the benefits of changing one’s behavior (e.g., stop smoking). The contemplation stage is used to dig deeper into one’s motive and reduce the drawbacks of changing one’s behavior (e.g., giving up smoking). Setting clear goals and establishing action plans are part of the preparation stage, which may include fears of failure. The action stage entails taking the first little actions toward achieving goals, as well as beginning to exercise and practice desired behaviors. Individuals must work hard at this stage to avoid regressing to prior stages. Preventing relapse and consolidating improvement are the goals of the maintenance stage.
People do not go through the change stages in a strictly sequential manner. Rather, the TTM suggested a cyclical, nonlinear, and dynamic transformation process, and research shows that people can progress through the backslide stages and cycle (Hashemzadeh et al., 2019). In fact, reverting to unhealthy behaviors is seen as a natural part of the change process rather than a failure. The phases of change are descriptive stages that describe a person’s willingness to modify their behavior.
The basic change principles underlying the TTM suit the techniques of health coaching, which is also focused on changing behaviors, even though the TTM was established in the context of unhealthy behaviors and emphasizes individuals’ readiness to change behavior. Individuals who seek coaching may be at various phases of change, and transformation is characterized by a gradual progression via particular changes (Hashemzadeh et al., 2019). Many methods are available in health coaching to help uncover the root cause of health problems and encourage lifestyle changes. Some of the methods are covered in the motivational interviewing.
Motivational Interviewing (MI) is a set of client-centered coaching methods that focuses on supporting, behaving, and communicating as a coach to encourage the client to engage in self-reflection, self-discovery, and solution exploration. It arose from the experience treating problem drinkers, is a patient-centered method that has been gaining popularity in health settings. Motivation, rather than being a personality feature, might be thought of as a condition of preparedness for change (Frost et al., 2018). Motivation as a state can change over time or from one scenario to the next, and it can be influenced to move in a certain way. As a result, a lack of drive (or reluctance to change) is perceived as something that can be changed rather than something that is inherent in the patient.
MI’s major goal is to aid behavior change by assisting patients in exploring and resolving their ambivalence about the change. This perspective of motivation as a state that is open to change contrasts sharply with traditional approaches, which see motivation as a personality trait and denial or resistance as a problem that must be confronted aggressively. Indeed, adopting an assertive and/or confrontational style (as in traditional treatments) is likely to elicit responses from the patient (such as disputing), which the practitioner may misinterpret as denial or resistance (Frost et al., 2018). MI differs from other patient-centered approaches in that it is directive. That is, the purpose of MI is to explore the patient’s ambivalence in such a manner that the patient is more likely to choose to change his or her behavior in the desired direction, and systematic procedures are employed to do so.
Motivational interviewing is used for different health-related issues in health coaching, which include alcohol reduction, exercise, dietary management, smoking, sexual health, medication adherence, and substance misuse. The health coach may choose to employ MI to assist the client in examining the concerns at their own pace. The coach works with the client’s resistance and does not challenge them; instead, the coach works to increase the client’s self-efficacy or their belief that they can change their behavior (Frost et al., 2018). During the conversation, the coach listens for and elicits this change-talk. MI is addressed in a number of courses offered by the Centre for Health Coaching and is an important aspect of health and wellness coaching.
MI is founded on the clinical principles of expressing empathy, developing discrepancy, avoiding debate, rolling with resistance, and supporting self-efficacy. MI considers empathic communication to be essential. Acceptance and the conviction that ambivalence is natural must be the underlying attitude. The practitioner’s job in this empathic method is to establish and exaggerate any disparity between the patient’s current behavior and significant goals so that the patient may make a case for change. Argumentation or direct persuasion is counterproductive and should be avoided since they are likely to result in defensiveness or resistance. On the other side, resistance is interpreted as a signal to alter tactics (Frost et al., 2018). It is acknowledged and investigated, rather than being opposed, with the goal of changing the patient’s perceptions (Frost et al., 2018). The patient is considered a vital resource in discovering answers to difficulties when self-efficacy is supported. The patient is held accountable for choosing and implementing personal change, but he or she must also believe in his or her own potential to change.
Motivational interviewing has a lot of potential for changing people’s health habits. It echoes the desire of patients and practitioners for patient-centered approaches in health coaching, where the health practitioner-patient interaction is viewed as a partnership. MI also allows health coaches to customize their interventions to the patient’s level of preparedness for change. It gives health coaches a better way to engage with patients who are hesitant to change or are not ready for it.
References
Frost, H., Campbell, P., Maxwell, M., O’Carroll, R. E., Dombrowski, S. U., Williams, B., Cheyne, H., Coles, E. & Pollock, A. (2018). Effectiveness of motivational interviewing on adult behaviour change in health and social care settings: A systematic review of reviews. PloS one, 13(10), e0204890. Web.
Hashemzadeh, M., Rahimi, A., Zare-Farashbandi, F., Alavi-Naeini, A. M., & Daei, A. (2019). Transtheoretical model of health behavioral change: A systematic review. Iranian journal of nursing and midwifery research, 24(2), 83. Web.