Trans-Theoretical Model for Health Behavior Change with Motivational Interviewing

This article discusses the Trans-Theoretical Model for Health Behavior Change with Motivational Interviewing. It explains the six stages of change and how motivational interviewing can help patients adopt healthier behaviors. The article uses a case study of a patient with obesity and osteoarthritis to illustrate the application of the model. The nursing professional can use the model to help the patient move from the contemplation stage to the maintenance stage. The article also discusses the principles and spirits of motivational interviewing that nursing professionals should keep in mind while caring for patients.

Running head: TRANS-THEORETICAL MODEL
TRANS-THEORETICAL MODEL
Name of the student:
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Author note:

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The trans-theoretical model is an integrative health-behavior change theory. This theory
mainly helps in describing the procedures by which people can change their behaviors
successfully. Researchers are of the opinion that the central organizing construct of this theory is
the stages of the change that are composed of five distinct changes of readiness for changing
behaviors (Archer et al., 2018). Studies have shown that movement through the stages may be
non-linear. Cycling and recycling through the different changes are considered as the natural part
of the change procedures. This assignment will show how this model of health behavior change
with motivation interviewing would help a patient change his behavior successfully.
Obesity is considered one of the important risk factors that contribute to the occurrence of
osteoarthritis. Researchers are of the opinion that carrying an extra amount of weight creates
stress and pressure on the joints (Lingman et al., 2016). This factor tends to accelerate the onset
of the disorder of osteoarthritis. Patients are seen to suffer from excessive pain and inflammation
resulting from degeneration of the cartilage that affects mobility. Therefore, surgeries are often
required for such patients where doctors need to replace the affected joints with the artificial
joints. It ensures the development of the walking ability of the patient.
The patient in the case study is seen to be suffering from obesity for a large number of years. In
the case of the patient named Alistair, it was seen that he was overweight and this had affected
his knees due to osteoarthritis. Therefore, he had to go through surgeries. It is important for him
to develop health literacy and understand how his overweight condition had contributed to the
present situation of osteoarthritis. He should be motivated to make positive lifestyle and diet
changes are that he can reduce his weight and thereby maintain a healthy lifestyle. This would
prevent his weight creating extra pressure on his knees and would prevent him from developing

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other threatening chronic conditions. The nursing professional should apply the trans-theoretical
model helping to change the health behaviors of Alistair enabling him to develop fitter lifestyles.
The first step would be the pre-contemplation stage. In this stage, the patients are seen
not to possess any intention of taking actions in the near future. Patients mainly remain unaware
that their behavior is a problem or that their behavior is creating any negative consciences. The
next stage is called the contemplation stage (Romian et al., 2018). In this stage, patients are
seen to recognize that their behavior may be problematic and they start intending to adopt
healthy behaviors in the near future. They start accepting the pros and cons of the modifying the
behavior with equal emphasis given on both options. Researchers suggest that many clients are
seen to feel ambivalent towards changing their behaviors in the stage. In the case study, the
patient is seen to be present in the contemplation stage (Mastellos et al., 2014). He is not in the
pre-contemplation stage, as he does not deny the fact that his health behaviors are causing any
suffering to him. In place, he is in the contemplation stage where he is seen to believe that he has
remained overweight for many years and this aspect might be creating more health issues for
him.
The next stage is called the preparation stage. In this stage, people are seen to take
actions within the next 30 days. People are seen to take small steps towards the behavior changes
and they start accepting the fact that exchanging their own behaviors can help them to lead
healthier lives. The next stage is called the action stage. In this step, the people are seen to have
changed their behaviors recently. They intend to keep moving forward with their health behavior
change. People may exhibit this aspect by either modification of their existing problem behavior
and acquiring new healthy behaviors (Seagall et al., 2017). With the effective intervention f
motivational interviewing, the nursing professionals can help Alistair to understand the

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importance of the change of the behavior. She can provide him of the strategies to change the
behaviors. Thereby, this intervention in the preparation stage would develop the grounds for
success in the action stage. In the action stage, Alistair would be successful in altering the
present behaviors like his sedentary lifestyles and high-calorie food-intake behaviors. He would
take up new healthy behaviors like undertaking exercise sessions of 30 minutes every day, eating
organic foods and many others, that would help in reduction of his weight.
The next stage is the maintenance stage. In this stage, people have sustained their
behavior for a while. They intend to maintain the health behavior change. Patients in this stage
are seen to prevent relapse to their earlier stages (Friman et al., 2017). In this stage, the nursing
professionals need to encourage the patient constantly about their positive health behavior
change. The nursing professionals would help the patient to identify how his changed behavior is
helping him to move towards a fitter life. This constant encouragement from the professional
would help Alistair to stick to his behavior and will prevent him from getting back into the old
habits.
The next stage is called the termination stage. In this stage, people are seen to have no
desire of returning to their unhealthy behaviors and they become sure that they will not relapse
into the old habits. However, researchers are of the opinion that people reach this stage rarely
and they tend to stay in the maintenance stage (Lindsay et al., 2015). Therefore, this stage is not
considered in the health promotion programs. Once Alistair completely adapts to the new
positive changes and maintains them, he would never fall back to his old habits and would tend
to live fitter quality lives.

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In the preparation stage, the nursing professionals can take up a motivational
interviewing approach to counsel the patient named Alistair. Motivational interviewing can be
defined as the collaborative counseling strategy that helps in elicitation and strengthening
motivation and willpower for the behavior changes among patients. Researchers are of the
opinion that motivational interviewing can be incorporated into the routine care of the patients
and encourage the patient to discuss behaviors that are associated with self-management
(Mantler et al., 2015). This procedure helps individuals in assisting with their motivation and
confidence for effectively making changes that help in the improvement of their healthcare habit
and behaviors. This form of the counseling strategy would encourage the healthcare
professionals for engaging in patient-centered communication by the asking of open-minded
questions and probes. This procedure also includes affirming patients when they share the
information, reflecting on what the patient had shared and thereby providing the statement that
summarizes the nature of the discussion. Motivational interviewing also recommends assessment
of the confidence of the patient, ability and commitment in the achieving of the agreed upon
goals, which are the key components of the successful behavior change (Maggill et al., 2018).
Four important spirits of motivational interviewing should be kept in mind while caring
for the patients. The first one is collaboration. The nursing professional who would be caring for
the patient named Alistair should be collaborating with the patient effectively and try to develop
a bond and effective relationship with him to make him feel comfortable in the discussion
process. The next spirit is called the evocation (Resnicow et al., 2015). The nursing
professionals should elicit the desires and reasons for the change to Alistair. They should discuss
with him the negative outcomes of the improper health behaviors and the ways they might lead
to negative consequences on the health of the patient. The third spirit is called the autonomy.

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The researchers are of the opinion that it is important to respect and honor the autonomy of the
patient as this enhances the bonding with the patient and helps the patient to develop trust on the
professionals. The nursing professionals caring for Alistair should allow him to be in control of
his own decisions and give him total freedom to take decisions for him. This aspect prevents the
creation of any stress in the patient making them feel comfortable and allow them to make the
correct decisions that have positive impacts on their health. The fourth spirit is the compassion.
The nursing professionals need to promote the welfare of the patient actively. The nursing
professionals treating Alistair needs to develop a therapeutic relationship with the patient that
would comprise of compassion and empathy. This would make the patient feel that the
professionals are genuinely interested in helping him change his health behaviors for making his
life better. This would ensure better compliance of the patient with the trans-theoretical model of
care.
A number of principles of motivational intervening needs to be kept in mind by the
professionals who are caring for the patient named Alistair. The main principles follow the
process of R.U.L.E that include resisting the Righting reflex, Understanding the patient’s
motivation, Listening to the patient and Empowering the patient (Elwyn et al., 2014). The
nursing professionals who would be caring for Alistair should incorporate the principles to
ensure the success of the motivational interviewing procedure and result in the best health-
behavior-change experience for the patient.
From the above discussion, it becomes clear that patients often might need to change
certain health-behaviors which are harmful to them and exposé them to health risks. In such
cases, nursing professionals might use the Trans-theoretical model of care. This model of health-
behavior change follows the bio-psycho-social approach of care and makes the patients go

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through six important stages ensuring the complete change of the health behavior making them
adopt behaviors that yield a positive outcome for them. Motivational interviewing is one of the
most effective counseling strategies for the patients. It is mainly a talk therapy. It ensures
effective communication with the patient, helping the patient to identify the wrong behaviors. It
helps to gain confidence in them and advise them with strategies by which they can develop their
health. These approaches ensure patients with health behaviors and habits that would help in
living better quality lives.

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