Trans-theoretical Model of Change: A Case Study on Motivating Behavioural Change

This study focuses on the trans-theoretical model of change and motivational interviewing approach to motivate Harry, a 58-year-old obese patient, to change his behaviour and manage his obesity condition. The study discusses the six stages of the model and how the nurse can help Harry to reach the termination stage.

Running head: TRANSTHEORETICAL MODEL OF CHANGE
TRANSTHEORETICAL MODEL OF CHANGE
Name of the Student:
Name of the University:
Author note:

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Introduction:
Trans-theoretical model of change is considered as the behavioural change model that
consists of integrative therapy theory which evaluates the readiness of an individual to
perform onto a novel healthier behaviour by providing process or strategies of change that will
eventually guide and motivate the individual. This model consists of six different stages that
will assist the individual in altering their attitude and behaviour which can result in any
adverse health outcome (Prochaska, Redding & Evers, 2015). This study will focus on a
patient, named, Harry, a 58 years old man, who was admitted to the surgical ward for
undergoing hip replacement surgery. Harry was aware of his obese condition and was still not
motivated to change his behaviour and manage his obesity. He was warned by his doctor that
his overweight condition might have a negative impact on his health condition, and even after
knowing this he was negligent towards his health. Hence, the primary purpose of this study is
to encourage harry to effectively involve in trans-theoretical model of change that will assist
him in changing his attitude and behaviour. The role of motivational interviewing is also
explained in this study that will aim to motivate the patient to alter his health behaviour
(Macdonald & Treasure, 2015).
Discussion:
Trans-theoretical model of change was designed and developed by Prochaska and
Carlo Di Clemente at the beginning of 1977 after critically evaluating an individual who was
flexible to alter their behaviour and lifestyle (Krebs et al., 2019). This theory was developed
by using other associated psychotherapy theories and hence was given the name of “Trans-
theoretical model of change”. According to Doherty (2016), the trans-theoretical model of
change is based on the process that includes different progression phase through the series of
stages. There are six stages of trans-theoretical model of change namely Precontemplation

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(not-ready), Contemplation (getting ready), Preparation (ready), Action, Maintenance and
Termination phase. Hence, in this case scenario, the nurse will execute this model to develop
a behavioural change in the patient and motivate him to lead a healthy lifestyle and also
maintain his obesity condition.
After evaluating the case scenario of Harry, it was evident that he was aware that his
behaviour was problematic for his health in future but was not motivated to perform any
activity that could help him to overcome from his bad health. After conducting an interview
with the patient it was observed that since he was a chef by profession and weight 165 kgs
and used to love food. Harry was not ready to change his attitude or behaviour due to his food
liking and was aware that his negligent behaviour could lead to adverse health consequences.
The six stages of trans-theoretical model of change and the case study if Harry were compared
and it was identified that harry was in the contemplation or second stage of the model. The
individual belonging to the second stage of model can recognise that their attitude or
behaviour is problematic for their health and might have am adverse effect on their overall
health. In this stage, the individual can get motivated and influenced to change their behaviour
and reduce the adverse effect of their behaviour (Grimolizzi, 2018).
Motivational interviewing is defined as the psychotherapeutic approach which
attempts to motivate the individual to shift away from the uncertainty state and develop the
motivation to make positive changes in their behaviour and accordingly accomplish the
established goal which will help them to yield an enhanced health outcome (Van et al., 2019).
The different counselling session is conducted for motivating the individual to adapt the
required behavioural change by using the principles and standards of motivational
interviewing. In the provided case scenario, Harry was motivated by the registered nurse
using motivational interviewing approach, where the nurse looked into every aspect of the
approach and thus aimed to modify the behaviour of Harry to manage his obesity condition.

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As Harry was in the second stage of trans-theoretical model, he was aware that his obesity
condition was harmful but was unaware of the adverse health consequence that might be
faced by him in his later phase of life (Copeland et al., 2015). Hence, the nurse will educate
harry to increase his awareness regarding the adverse health complication of obesity by
asking question such as “open-ended question” where the nurse can understand the
perspective of the patient.
Harry had already crossed the first stage or Precontemplation stage of the model
because he was aware that his overweight condition was harmful to his health as his doctor
had already warned him before. He stated that his doctor had explained him that his increasing
weight is affecting his health and if not controlled can be extremely harmful to his overall
well-being. Hence, the nurse should only focus on motivating harry to change his behaviour
and lifestyle and effectively manage his obese condition (Hardcastle et al., 2015). The nurse
will communicate with harry by using the motivational interviewing approach and will exhibit
the empathic behaviour towards Harry. The nurse will assist harry to reach the next stage of
the model which is Preparation stage by applying the “change talk”, where the patient will
understand if the change is necessary for him or not (Johnstone 2018).
The preparation stage is also known as the determination stage, where an individual is
ready to adapt the behavioural change by altering their lifestyle and attitude in succeeding 30
days. The individual will believe that the change is necessary for them to maintain their mental
and physical wellbeing as the nurse will generate “resistance “in the patient by asking “if he
believes that he should not change his behaviour?” (Atkinson & Woods, 2017). Hence, the
nurse will help harry to reach this stage and will establish few short-term goals that must be
achieved by him to bring the change he requires in is life. Rendering to the short-term goals,
Harry can reduce his weight approximately 6 pounds in a weak and also have a positive
impact on his wellbeing.

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The nurse will further help Harry to reach in the fourth stage by motivating him to
“change his plan “and exercise effectively that will help him to reduce his weight. The nurse
will motivate harry to adapt to physical exercising or yoga through which he can change his
behaviour and also manage his overweight condition. Hence, in the fourth stage, harry will
develop the action stage, where he will aim to achieve enhanced health outcome and will be
motivated by the nurse to follow the diet plan and aim towards achieving the long-term goals
(Morton et al., 2015). The nurse will formulate the long-term goals for Harry that will help
him to reduce approximately 70 kgs and to keep him motivate the nurse effectively
communicate with him. By using the approach of motivational interview, the nurse will,
therefore, help harry to reach the fifth stage of the model.
The fifth stage of the trans-theoretical model is known as the maintenance stage, where
an individual is motivated and are working towards the required change in their behaviour. In
this stage, the individual intends to sustain their behavioural change and also maintain their
health behaviour for a better future that will further assist them in avoiding any adverse health
complication (Franco & Pease, 2019). The nurse will motivate harry to “consolidate” his
behavioural change by enrolling in gym or by maintaining a strict diet to prevent any relapse
in his routine. The nurse will, therefore, compare the previous and current health condition of
harry and achieve a successful transition of harry from contemplation stage to action stage.
The nurse will therefore adapt therapeutic communication strategy where the nurse will
communicate with the patient and understand his perspective and the change that he building
in his lifestyle (Thompson, 2019).
The nurse has successfully adapted the different aspect of motivational interviewing
by developing short-term and long-term goal for Harry and motivating him to adapt the
required behavioural change that will assist him in yielding enhanced health outcome (Wrona
& Burke, 2019). The nurse will also educate harry to increase his knowledge and

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understanding of the adverse health complication due to obesity and how this may impact his
future life. The nurse will provide harry with a complete analysis of the factors that must be
eliminated by harry to adapt the termination stage of the model and lead a healthy life (Boff
et al., 2018).
Conclusion:
It can be concluded that the trans-theoretical model is an appropriate model for
achieving behavioural change in an individual for better health and wellbeing. This study
focused on the patient harry who was in the second stage or contemplation stage of the trans-
theoretical model and required immediate attention and support from the nurse to manage his
health. The nurse has adopted the motivational interviewing approach to motivate harry
regarding his health condition and aimed to increase his awareness regarding management of
his overweight condition. The nurse had developed the short-term and long-term goal for
Harry using which he can reach the termination stage or the final stage of the model form his
present stage of health behaviour.

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