Case Study on Alistair: Applying Transtheoretical Model and Motivational Interviewing for Health Behavior Change

This case study focuses on Alistair, a patient with osteoarthritis who needs to undergo total knee replacement. The assignment applies the transtheoretical model of change and motivational interviewing to change certain health behaviors that would help him to live better and safe life, free from any health risks.

Running head: CASE STUDY ON ALISTAIR
CASE STUDY ON ALISTAIR
Name of the student:
Name of the university:
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CASE STUDY ON ALISTAIR
The assignment would be mainly based on the patient Alistair, who is suffering from
osteoarthritis and has to undergo total knee replacement. The assignment would apply the trans-
theoretical model of change and motivational interviewing to change certain health behaviors
that would help him to live better and safe life, free from any health risks.
The trans-theoretical model is a health-behavior change model that helps in assessing the
readiness of the individuals in adopting new healthy behaviors for maintaining better quality of
life. This model usually helps in explaining the procedure of alteration in behavior by the
integration of the leading principles as well as the theories of behavior changes. A number of
core-constructs mainly form the foundation base of this health-behavior change model. These are
the “the Stages of Change, Processes of Change, Decisional Balance, Self-Efficacy, and
Temptation” (Lipschitz et al., 2015). Another important counseling strategy for initiating
behavior changes in individuals are motivational interviewing procedures. It is a direct as well as
client-centered counseling style. It helps to elicit behavior changes by providing help to the
clients in various ways. It helps the patient in exploring and resolving ambivalence (Middelkamp
et al., 2015).
The patient named Alistair is suffering from osteoarthritis and is undergoing a total knee
replacement. He weighs about 160 kgs and can be considered as an obese individual. He is quite
concerned about his health and believes that his weight might have been one of the contributing
factors to the development of this chronic disorder. He wants to live a healthy life and is quite
anxious about the fate of his present condition. From the close analysis of his condition, obesity
can be considered to be one of the risk factors that had made him develop osteoarthritis. Obesity
results when an individual gains excess weight, due to the accumulation of a huge amount of
calories that are not burned out, but gets stored in the body of the individuals, especially in the

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abdominal segments (Lipschitz et al., 2015). Often obesity results in the development of a large
number of chronic disorders like osteoarthritis, cardiovascular disorders, diabetes, hypertension
and many others (Rimer & Brewer, 20150. Gain of excess weight results in excess pressure on
the knees and the hips of individuals, making such individuals develop osteoarthritic disorder.
Such pressure results in gradual wear and tear of the cartilage present in the region of the joints.
In course of time, the cartilages are seen to get degenerated, which makes mobility difficult (De
Vries, 2017). The joints are found to rub against each other resulting in swelling and
inflammation of the cartilages (Middelkamp et al., 2018). Hence, patients suffer a lot due to pain
and loss of mobility, thereby affecting their activities of daily living. This results in a
deterioration of the quality of lives.
Therefore, it can be accepted that the patient named Alistair does not maintain proper
healthy behaviors like diet and proper physical activities. These might be the contributing factors
for gaining a high number of calories and being overweight (O”Halloran et al., 2014). These
healthy behaviors need to be changed and for this, the nursing professionals can apply the trans-
theoretical model of care and motivation interviewing. These models would help in ensuring
healthy behavior changes that would help people to maintain a healthy weight and live a life free
from any disorders (Gorczynski, Hill & Rathod, 2017).
The first stage is called the pre-contemplation stage. In the stage, the patients are seen
not to understand the importance of the adopting a physical activity program. Therefore, while
working with clients who are present in this stage, professionals need to encourage them in ways
by which they start thinking about the change and the benefits that accompany with this change
(O”Halloran et al., 2014). The next stage is called the contemplation stage. In this stage, the
patient is seen to consider the idea of adopting the healthy behavior and recognizes the benefits

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that come with this step. The patients are not entirely ready to make the change but they start
thinking about the healthy behavior change as the option. In this case, the patient named Alistair
is not seen to be present in the pre-contemplation stage but is present in the contemplation stage.
He is already concerned that his heavy weight might be one of the reasons that had made him to
develop osteoarthritis, for which he is suffering so much (Madson et al., 2018). Therefore, he has
been able to understand it and he might consider changing the behaviors that contribute to his
gaining weight.
The next stage is called the preparation stage. In this stage, the client is seen to be both
mentally and physically preparing to adopt the new healthy behavior changes like that of the
physical activity session and intake of calorie-free organic diet (VanBuskirk et al., 2014).
Researchers suggest that in this step, the patients are seen to show intentions for change and
small steps are taken towards the changing of the behaviors. They start believing that behavior
change can help them to lead fitter and safe lives (Madson et al., 2018). This is the best stage
where the nursing professionals might implement the motivational interviewing sessions with
Alistair, helping him to realize the strategies that he can adapt to maintain a healthy weight and
how to adhere with the interventions.
The next stage is called the action stage. In this stage, the patients engage in a plethora of
health behaviors that help them to develop an enhanced quality of life. Patients in this stage are
seen to have already adopted to the modifications in the behaviors, with which they intend to
align. They want to stick with these changes (VanBuskirk et al., 2014). They might try to
complete this stage successfully by either adapting to new behaviors or modifying the present
behaviors (Copeland et al., 2015). The next stage is called the maintenance stage, where people
are found to sustain their behavioral alterations successfully and put in their best efforts for

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prevention of relapse to their earlier stages. They intend to maintain the behaviors throughout the
upcoming years in their lives. In such stage, the nursing professionals should try to act as support
to constantly encourage the Alistair and motivate him to align with the stages. Motivation would
help him to feel good and he would be applying for his achievement.
The next stage is called the termination stage. Here, the people have no desire to return
to any form of unhealthy behaviors and become confident that they would not relapse.
Researchers are of the opinion that this strategies hardly reached and patient them to stay in the
maintenance stage. However, in this stage, professionals can make sure that Alistair had
overcome his negative habits and had modified them into good behaviors that will ensure him
quality life and prevent chronic ailments.
Motivational interviewing procedures can be defined as the collaborative counseling
strategy that encourages the healthcare professionals to engage in the patient centered
communication (Miller et al., 2015 . The professionals are seen to ask open-ended questions and
probe along with affirmation of the patient when sharing information. The professionals then
reflect on what the patient had said, thereby providing statements that help in summarizing the
nature of the discussion (VanBuskirk et al., 2014). This process would encourage Alistair to
discuss different behaviors that associate with self-management of osteoarthritis, as well as help
in assisting patients in their motivation and confidence for making changes (Rimer & Brewer,
2015). Such changes will help in reduction of his present weight and will help to maintain a
healthy weight. The professionals while undertaking such counseling session with Alistair would
follow five important steps (Madson et al., 2018). They would establish rapport with him,
assessing his readiness; assess motivation and confidence of Alistair. The fourth step would be

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the identification of the problems and solution by Alistair with the fifth step being the
identification of the next actions and following up.
Four important spirits need to be remembered by the professionals while conducting the
steps of motivational interviewing. The professionals should maintain the spirits like
collaboration, evocation, autonomy and compassion (Gorczynski et al., 2017). The professionals
should collaborate with Alistair, elicit the desires and reasons for a change in him, respect, honor
his autonomy, and allow him to be in control of his own decisions and compassionately promote
the welfare of Alistair. The principles of motivational interviewing follow the pattern of
“R.U.L.E” (Miller et al., 2015). The professionals who would be caring for the patient should
resist the righting reflex and understand the motivation of the patient. The professionals should
listen to the patient and empower the patients. This would help Alistair to successfully change
his behaviors and live fitter life.
From the above discussion, it becomes clear that patients might harbor many negative
health habits that affect the quality of lives. The patient might become vulnerable to many
disorders and suggest due to this disorder. Hence, professionals can incorporate the six steps of
the trans-theoretical model and help the patients to develop such negative health habits and adopt
new health behaviors. Motivational interviewing is another collaborative counseling strategy that
also helps in eliciting and strengthening motivation among patients for behavior change, these
models can help to overcome negative habits and develop positive health behaviors that ensure
safe and diseases free lives.

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References:
Copeland, L., McNamara, R., Kelson, M., & Simpson, S. (2015). Mechanisms of change within
motivational interviewing in relation to health behaviors outcomes: a systematic
review. Patient education and counseling, 98(4), 401-411.
https://doi.org/10.1016/j.pec.2014.11.022
De Vries, H. (2017). An integrated approach for understanding health behavior; the I-change
model as an example. Psychol Behav Sci Int J, 2(2), 10-19080.
https://pdfs.semanticscholar.org/6213/b2de06427a28cc4bd2b88b36c93e061d51e5.pdf
Gorczynski, P., Hill, D., & Rathod, S. (2017). Examining the construct validity of the
transtheoretical model to structure workplace physical activity interventions to improve
mental health in academic staff. EMS Community Medicine Journal, 1(1).
https://researchportal.port.ac.uk/portal/files/8438799/Examining_the_Construct_Validity.
pdf
Lipschitz, J. M., Yusufov, M., Paiva, A., Redding, C. A., Rossi, J. S., Johnson, S., ... &
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nonchangers. Journal of Sport and Exercise Psychology, 37(6), 592-606.
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Madson, M. B., Villarosa-Hurlocker, M. C., Schumacher, J. A., Williams, D. C., & Gauthier, J.
M. (2018). Motivational Interviewing Training of Substance Use Treatment
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strategies of European fitness professionals to support clients in changing health-related
behaviour: A survey study. https://repository.ubn.ru.nl//handle/2066/158381
Miller, W. R., & Rose, G. S. (2015). Motivational interviewing and decisional balance:
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psychotherapy, 43(2), 129-141. https://www.cambridge.org/core/journals/behavioural-
and-cognitive-psychotherapy/article/motivational-interviewing-and-decisional-balance-
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N. F. (2014). Motivational interviewing to increase physical activity in people with
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Rimer, B. K., & Brewer, N. T. (2015). Introduction to health behavior theories that focus on
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