This document discusses several studies that applied the Transtheoretical Model (TTM) to understand behavior change. The TTM proposes that behavior change occurs through five stages: precontemplation, contemplation, preparation, action, and maintenance. One study applied the TTM to understand physical activity and sedentary behaviors in college students. It found associations between TTM stage and physical activity levels. Another study examined how the TTM's processes of change can be culturally adapted to promote physical activity in Hispanic women. A third study reviewed applications of the TTM to eating behavior change and identified ways to improve stage classification and validate the model for dietary interventions.

1. APPLICATION OF TRANSTHEORITICAL
MODEL IN RESEARCH DESIGN
 SHANKAR DEVKOTA- BPH, MPA, MPH-1ST YEAR, IOM
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2. INTRODUCTION
The Transtheoretical Model (also called the Stages of Change Model), developed by Prochaska
and DiClemente in the late 1970s.
Research was being conducted on the experience of smokers, some who quit on their own with
those requiring further treatment to understand why some people were capable of quitting on
their own.
Research concluded that quit smoking when they were ready, thus giving birth to the
transtheoretical Model. (TTM).
There are five stages in the TTM.
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3. STAGES
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4. INTRODUCTION
 It is an integrative, biopsychosocial model to conceptualize the process of intentional behavior
change. Whereas other models of behavior change focus exclusively on certain dimensions of
change (e.g. theories focusing mainly on social or biological influences),
The TTM seeks to include and integrate key constructs from other theories into a
comprehensive theory of change that can be applied to a variety of behaviors, populations, and
settings—hence, the name Transtheoretical.
TTM recognizes change as a process that unfolds over time, involving progress through a series
of stages. While progression through the Stages of Change can occur in a linear fashion, a
nonlinear progression is common. Often, individuals recycle through the stages or regress to
earlier stages from later ones.
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5. PRECONTEMPLATION (Not Ready)
In this stage, people do not intend to take action in the foreseeable future (defined as within the
next 6 months).
People are often unaware that their behavior is problematic or produces negative
consequences.
People in this stage often underestimate the pros of changing behavior and place too much
emphasis on the cons of changing behavior.
The fact is, traditional programs were not ready for such individuals and were not designed to
meet their needs.
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6. CONTEMPLATION (Getting Ready)
 In this stage, people are intending to start the healthy behavior in the foreseeable future (defined as within the
next 6 months).
 People recognize that their behavior may be problematic, and
 A more thoughtful and practical consideration of the pros and cons of changing the behavior takes place, with
equal emphasis placed on both. Even with this recognition, people may still feel ambivalent toward changing their
behavior.
In a meta-analysis across 48 health risk behaviours, the pros and cons of changing were equal (Hall & Rossi, 2008).
This weighting between the costs and benefits of changing can produce profound ambivalence that can cause
people to remain in this stage for long periods of time. This phenomenon is often characterized as chronic
contemplation or behavioural procrastination. Individuals in the Contemplation stage are not ready for traditional
action-oriented programs that expect participants to act immediately.
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7. PREPARATION (DETERMINATION) (Ready)
In this stage, people are ready to take action within the next 30 days.
People start to take small steps toward the behavior change, and they believe changing their
behavior can lead to a healthier life.
These individuals have a plan of action, such as joining a gym, consulting a counselor, talking to
their physician, or relying on a self-change approach. These are the people who should be
recruited for action-oriented programs
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8. ACTION
In this stage, people have recently changed their behavior (defined as within the last 6 months)
and intend to keep moving forward with that behavior change.
 People may exhibit this by modifying their problem behavior or acquiring new healthy
behaviors.
 Because action is observable, the overall process of behavior change often has been equated
with action. But in the TTM, Action is only one of five stages.
 Typically, not all modifications of behavior count as Action in this Model. In most applications,
people have to attain a criterion that scientists and professionals agree is sufficient to reduce
risk of disease. For example, reduction in the number of cigarettes or switching to low-tar and
low-nicotine cigarettes were formerly considered acceptable actions. Now the consensus is
clear—only total abstinence counts.
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9. MAINTENANCE
In this stage, people have sustained their behavior change for a while (defined as more than 6
months) and intend to maintain the behavior change going forward.
Maintenance stage, people are less tempted to relapse and grow increasingly more confident
that they can continue their changes.
Based on self-efficacy data, researchers have estimated that Maintenance lasts from six months
to about five years. While this estimate may seem somewhat pessimistic, longitudinal data in
the 1990 Surgeon General’s report support this temporal estimate. After 12 months of
continuous abstinence, 43% of individuals returned to regular smoking. It was not until 5 years
of continuous abstinence that the risk for relapse dropped to 7% (USDHHS).
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10. APPLICATION OF TRANSTHEORITICAL MODEL IN RESEARCH DESIGN
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11. Application of the transtheoretical model to sedentary behaviors and its association
with physical activity status
Purpose:-to identify the association between current physical activity and
sedentary behaviors based on TTM constructs.
Methodology:-Participants (225 college students) completed a package of
questionnaires including validated TTM, physical activity and sitting time
questionnaires and MANOVAs were conducted to determine mean
differences in psychological constructs across the TTM stages to evaluate
the associations between current physical activity and sedentary behavior.
 study was described college students’ sedentary behaviors based on the
TTM and the association between the TTM outcomes and physical
activity levels.
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12. Application of Transtheoritical model in activity promotion
Indroduction
Hispanic women in the U.S. have disproportionately high rates of obesity and health
disparities related to insufficient physical activity (PA). While the Transtheoretical Model
(TTM) is one of the most commonly used behavioral theories in interventions promoting PA,
there is a lack of evidence to support the cultural relevance of theoretical constructs for
increasing PA in Hispanic women
Methodology
To learn about Hispanic women’s use and interpretation of the construct Processes of
Change (POC) for increasing PA, we conducted focus groups with overweight/obese
Mexican/Mexican-American females (N=13) ages 27-40 years
Conclusion
This study examined culture-specific factors used by Mexican-American women for
becoming more physically active as they correspond to the theoretical constructs of the
TTM. We showed that the POC examined in our study are culturally relevant and enacted by
Mexican- American women for increasing PA, and are poised to be deployed in culturally
appropriate PA promotion and weight loss interventions.
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13. Application of transtheoritical model in eating behavior change
Abstract: This review provides a rigorous investigation of the question of
whether the transtheoretical model (TTM) (or stages of change model) is
applicable to eating behaviour change. The TTM is currently the most
popular of a number of stage theories being used to examine health
behaviour change. Stage theories specify an ordered set of `stages of
readiness to change' into which people can be classifed and identify the
factors that can facilitate movement from one stage to the next. If eating
behaviour change follows a stage process, then nutritionists could identify
the predominant stage or stages in a population and focus resources on
those issues most likely to move people to the next stage (e.g. from no
intention of changing, to thinking about changing).
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14. Application of transtheoritical model in eating behavior change
In addressing this question, the review draws on the defining characteristics of stage theories as clarified by
Weinstein et al. (1998), provides an in-depth coverage of methodological considerations, and a detailed summary
table of dietary studies applying the TTM. Specific recommendations are made for improving the accuracy of
dietary stage classifications. Among the key conclusions are: (1) dietary studies using the TTM have been
hampered by a focus on nutritional outcomes such as dietary fat reduction, rather than clearly understood food
behaviours (e.g. servings of fruit and vegetables per day); (2) accurate stage classification systems are possible for
food-based goals, but major misclassification problems occur with nutrient-based goals;
(3) observation of an association between stage and dietary intake is not suffficient to demonstrate the validity of
the model for dietary behaviour;4) there is a need for valid questionnaires to measure all aspects of the TTM, and
more research on the whole model, particularly the `processes of change', rather than on single constructs such as
`stage'; (5) cross-sectional studies generally support the predicted patterns of between-stage differences in
decisional balance, self-effficacy, and processes of change; (6) studies which test the key hypothesis that different
factors are important in distinguishing different stages are rare, as are prospective studies and stage-matched
interventions test of the TTM will be the effectiveness of stage-matched dietary interventions,the review ends by
exploring the requirements for such studies.
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15. The study described in this paper develop a measure that focused on
the ‘qualitative’ difference between stages to classify individuals into
different stages of dietary change for three dietary behaviours i.e
eating a healthy diet, eating a low-fat diet and eating five portion of
fruit and vegetables.
Methods
Sample: Volunteers were recruited on two separate occasions as part
of a larger study using advertisement placed in regional newspaper.
(n=541)
Materials: questionnaires were developed for each behaviour. Each
questionnaire included some questions to assess the demographic
characteristics of the sample together with a measure to categorize
respondents into the different stages of change.
Measures:
•Precontemplaters
•Contemplaters
•Preparators
•Actors
•Maintainers
Application of Transtheoritical model ‘s stages of changes to dietary behaviors
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16. whether the respondent was `thinking about' or had decided to' eat a healthy
diet/low-fat diet in the future
they had decided to engaged in dietary
behaviours.
YES PrecontemplatorsNO
Preparators Contemplators
NO
Respondents were asked whether they were `currently trying to eat a healthy
diet
Actors
YES
asked about the length of time they had been making this change with possible
responses:
Less than 1 month 1-3 months 4-6 months 7-9 months More than 10months
Maintainers
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17. The respondents were classified into one of the five different stages of change for each dietary behaviour using the categorization method
described above. The percentage distribution of respondents across the different stages is displayed in Figure.
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18. CONCLUSION
The Transtheoretical Model (TTM) is a successful framework for guiding behavior change
programs for several health behaviors.
In summary, the TTM is a practical theory for health education programs. We have found the
TTM to be useful and appropriate for application to health education with older adults for
program planning, curriculum development, and program evaluation.
The TTM specifically provided a framework to (a) identify stage of change in behaviors, (b)
monitor the dynamic movement through these stages, and (c) explain how this movement
occurs through the constructs of decisional balance, self-efficacy, and processes of change.
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19. References
 Prochaska, James O.; DiClemente, Carlo C. (2005). "The transtheoretical approach". In Norcross, John C.; Goldfried, Marvin R.
(eds.). Handbook of psychotherapy integration. Oxford series in clinical psychology (2nd ed.). Oxford; New York: Oxford University Press.
pp. 147–171.
Jump up to:a b Prochaska, James O.; Butterworth, Susan; Redding, Colleen A.; Burden, Verna; Perrin, Nancy; Leo, Michael; Flaherty-Robb,
Marna; Prochaska, Janice M. (March 2008). "Initial efficacy of MI, TTM tailoring and HRI's with multiple behaviors for employee health
promotion". Preventive Medicine. 46 (3): 226–231.
Greene, GW; Rossi, SR; Rossi, JS; Velicer, WF; Fava, JL; Prochaska, JO (June 1999). "Dietary applications of the stages of change
model". Journal of the American Dietetic Association. 99 (6): 673–8.
Pro-Change Behavior Systems. About us. Transtheoretical model. 2008 Mar. Accessed 2009 Mar 21.
Jump up to:a b Fromme, Donald K. (2011). Systems of psychotherapy: dialectical tensions and integration. New York: Springer-Verlag.
pp. 34–36.
Jump up to:a b Prochaska, James O.; Norcross, John C.; DiClemente, Carlo C. (1994). Changing for good: the revolutionary program that
explains the six stages of change and teaches you how to free yourself from bad habits (1st ed.). New York: William Morrow and Company. I
Norcross, John C.; Loberg, Kristin; Norcross, Jonathon (2012). Changeology: 5 steps to realizing your goals and resolutions. New
York: Simon & Schuster. ISBN.
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