Transtheoretical Stages of Change Model for Lifestyle Modification Programs

This essay applies the Transtheoretical Stages of Change (TTM SOC) model to assess unhealthy behavior in the case study of Harry, a 58 year old client with obesity. It demonstrates the utility of motivational interviewing techniques in overcoming conflict during the change process and motivating client to adapt new and desired behavior.

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The transtheoretical stages of change (TTM SOC) model are a useful intervention
approach in lifestyle modification programs and changing unhealthy behavior of patients. It is a
theoretical framework that describes the five stages of change that an individual go through when
shifting from an unhealthy or negative behavior to that of a healthy or positive behavior
(Mastellos et al., 2014). The main purpose of this essay is to apply the TTM model to assess
unhealthy behavior in the case study of Harry, a 58 year old client with obesity and understand
the significance of using the model to support the client to achieve weight loss, improve dietary
habit and achieve healthy behavioral change. The essay demonstrates the utility of motivational
interviewing techniques in overcoming conflict during the change process and motivating client
to adapt new and desired behavior.
The essay deals with the case scenario of Harry, who has been admitted to the surgical
ward for a hip replacement surgery. He is due to have a hip replacement and his current weight is
165 kg. Obesity is a significant contributing factor that has deteriorated bone health of Harry and
made it necessary for him to have a hip replacement. Barrett et al. (2018) supports that obesity is
a condition that is greatly associated with the need for hip replacement or total hip arthroplasties.
Hence, achieving weight loss is crucial for long-term health and recovery of such patients.
Considering his current condition, it is important for Harry to focus on weight loss and change
his current dietary habits. However, review of Harry’s statement reveals that he has been
overweight for years and he expresses ‘That’s just how I am. I love food … I am all around food
all day long. His statement suggests that despite knowing that obesity is influencing his health,
Harry has no intention to change his behavior. To change perception of Harry regarding risk of
weight on his health and prepare him to change his eating habits, use of TTM model is important
to motivate him towards the change process. This will be combined with motivational

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interviewing technique to predict client’s readiness to change and develop his intrinsic
motivation to help him to make difficult changes in his life (Flinn & Jones, 2011). Considering
he is a chef, it is evident that this change will be very difficult for him.
The key assumption of TMM model is that behavior change is a gradual and sequential
process and people transition through defines stages in the process of altering their problemativ
behavioral patterns. The key stages involved in TMM model of change includes the stages of
pre-contemplation, contemplation, preparation, action, maintenance and termination. For this
essay, the stages of change cycle to maintenance will be covered to understand how to support
Harry in adapting healthy behaviors. The first stage of the model (pre-contemplation stage) is the
phase in which no problem is acknowledge by the client and they do not give any thought
towards change (Prochaska, Redding & Evers, 2015). Harry is currently in pre-contemplation
stage of change because he has acknowledged no problem with his obesity and regards it as
normal. Similar to the change process in contemplation stage, Harry has no plans to change his
behavior (eating habits) too.
The key risk identified for Harry is that unless he changes his eating habits and reduce his
weight, he cannot achieve full recovery post surgery. His weight issues may interfere with
surgical outcomes and increase risk of other ailments for him too. Hence, the first goal in the
process of behavioral change is to support Harry to move to the contemplation stage.
Contemplation is the second stage of the TMM model where a problem is acknowledged and
serious thought is give to change in the future (Tseng et al., 2017). While proceeding with this
process, the first challenge that can be encountered is that client may not agree to move from his
status quo and may find the change unnecessary. Hence, to ensure that client develops the
motivation to change his behavior without developing feelings of resistance and negative thought

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pattern, MI techniques will be applied during the second stage of change. The key advantage of
MI is that it is a valuable tool for assisting individuals through the initial stage of change which
is most difficult for them (Magill et al., 2018). By using the MI interviewing skills of asking
open-ended question, use of empathy, reflective listening, negotiation and non-judgmental
attitude, Harry will be prepared to change his dietary habits and lifestyle (Resnicow et al., 2015).
Harry is classified as a contemplator as currently he has no motivation to change his
eating habits and he does not understand the impact of his dietary habits on his health outcome.
As he is a chef with strong love for food, he may display defensive behaviors such as resistance
when told about changing his diet habit. Hence, to overcome this challenge during interaction
with Harry, there is a need to establish good communication skills with Harry using MI skills.
Before directly instructing Harry to perform a prescribed activity for change in his diet, it is
necessary to develop rapport with him, explore the need for change and then increase his
confidence and motivation to change. This will help to maintain people’s capabilities for
exercising their free choice during the process of change (Apodaca et al., 2016). The use of
empathy at this stage is important too because it ensures that authoritarian style is not adapted
and a safe and open environment is provided to understand client’s unique perspective regarding
current behavior. Empathy can be exercised through the use of reflective listening skills where
question is asked in a way that respects client’s feeling, compliments their values and gradually
motivate them to understand the need for change. Having a non-judgmental approach during
interaction with client is also crucial at this stage (Lord et al., 2015). By using these strategies,
Harry can be introduced to the harmful effect of his weight and dietary habits and the importance
of changing his diet. He can then transition to the contemplation stage.

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By the use of above MI strategies, Harry can develop the motivation to change his current
eating habits. He will enter the contemplation stage after fulfillment of the above actions. The
key hallmarks of people in the contemplation stage are that they acknowledge and reflect that
serious problem exists. However, they are still ambivalent about the change process (Tseng et al.,
2017). To move to the next stage of action, a lot of time is needed to be spend with Harry to help
him understand the problems, its causes and its consequences. The health care professional can
then work with Harry to discuss about various options to resolve the problem. As per MI
approach, at this stage it is important to consult client regarding their preferences and cross-
check whether the new plan is attainable for them or not. All cultural and individual adaptation
to change must be reviewed at this stage (DiClemente & Wiprovnick, 2017). Completing this
step will help to establish a documented plan of change. According to Miller and Rose (2015),
after building the motivation for change, the second priority for a therapist is to address
ambivalence about enacting the change and strengthen commitment towards change. Once
commitment to change is promoted, client can easily progress to the action stage.
During the action stage of TTM, various behavioral actions are implemented to alter
previous behavioral pattern in client. In case of Harry, the action stage can be accomplished
when Harry follows his established dietary plan in collaboration with dieticians and adheres with
changes in lifestyle as negotiated during the contemplation stage. This can be followed by
maintenance stage where efforts will be employed to ensure that Harry sustains new behavior for
long-term period. This can be achieved by using patient-centered care approach to take feedback
from regarding the experience of following new change plan and experiences of continuing with
the new behavior (Denison‐Day et al., 2018). At this point, adherence to the change plan and
barriers to the change process can be explored. To prevent relapse to earlier stages, changes in

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the plan can be made to support Harry to overcome additional barriers too. Therefore, by
integration of TTM model along with MI concepts, Harry can be supported to control his weight
and adhere with healthy diets to achieve optimal health in the future.
The overall conclusion from the essay is that different people have different perception
towards accepting a new behavior. To help client prepare and accept the need for change, having
good understanding about the stages of TTM model is important. By using TTM and MI
techniques to facilitate behavioral change for Harry, the essay demonstrated that TTM is an
important theoretical framework to support clients to adapt positive health behavior. It also
revealed the utility of MI in increasing intrinsic motivation of clients towards change process and
addressing ambivalence and resistance towards achieving desired behavioral goals. It suggests
how use of empathy, respect, reflective listening, non-judgmental attitude and gentle persuasion
helps to establish trustful relationship with client.

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