Transtheoretical Model of Change and Motivational Interviewing

This paper provides an overview of how to support Harry through the five stages of change cycle based on transtheoretical model of change and motivational interviewing. It discusses how to assist Harry through the stages of change cycle and the role of motivational interviewing in children and adolescents in pediatric care.

Running head: TRANSTHEORETICAL MODEL OF CHANGE 1
Nursing – Transtheoretical Model of Change and Motivational Interviewing
Student’s Name
Institutional Affiliation

TRANSTHEORETICAL MODEL OF CHANGE 2
Nursing – Transtheoretical Model of Change and Motivational Interviewing
Introduction
The problem of weight gain and lack of proper exercise is among the major health
concern across the country. The use of lifestyle interventions has been linked to positive
outcomes for those facing this issue. In fact, changing the diet and enhancing physical activity
are the key interventions recommended to inspire a change in behavior. Simmonds et al. (2016)
argued that there is a five-fold increase in the rate of obesity among adults and adolescents,
which implies that there is a corresponding increase in cases related to excessive weight gain.
Harry is just one example of several patients who are regularly diagnosed with complications
emanating from increased weight gain. It is possible to assist such patients using the
transtheoretical model of change and motivational interviewing (Desai, 2019). This paper
provides an overview of how to support Harry through the five stages of change cycle based on
transtheoretical model of change and motivational interviewing.
How to Support Harry through the Stages of Change Cycle
Precontemplation
A significant number of patients go through a pre-contemplation stage where they are not
willing or considering to start the journey of a behavioral change process. The reason for the lack
of will is usually emanating from their inability to understand or conceptualize the value and
benefits that will come with the change. Harry states that he is always around food and he loves
it, which has been the reason why he has remained overweight for many years. The statement
that Harry made is a clear indicator of being sedentary and he is not yet familiar with the benefits
that will come with a change in his eating behavior. It is normal for patients to fail to understand

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and figure out the need for a change in lifestyle or behavior (DiClemente, 2015). The first thing
to consider at this level is awareness and education. Already the doctor has pointed out to him
that his weight is significantly impacting his health, which implies that his recovery depends on
his willingness to check on his weight. Therefore, Harry needs a therapeutic session focusing on
the benefits of controlling his diet and engaging in physical activity to reduce his weight. Based
on clinical evidence motivational interviewing, the conversation should both be encouraging and
sympathetic (Resnicow et al., 2016). Such considerations will enable Harry to develop the desire
to make a positive lifestyle behavioral change.
Contemplation
Successful educational sessions with the patient could lead to a change in perception and
the client could start considering the need to embrace the change. Harry has received a
confirmation from the doctor regarding the effect of his weight on his wellbeing and indeed,
clinical evidence ascertains the implication of excess weight on one’s health (Boff et al., 2016;
Daly et al., 2016). Already he is scheduled for a hip replacement. During the contemplation
stage, Harry will start to think about how a change could lead to positive results by comparing
the possible outcomes to the present situation. At this moment, Harry needs encouragement but
this time, it is not about education. That is, the focus of the motivation is to clearly present to him
the two sides of the scenario: his life without the change and during as well as after a change in
eating and physical activity behavior. During the contemplation stage, the patient needs a
comprehensive picture of what will happen if he/she accepts to change. At this level, Harry
needs to understand clearly that his situation is going to exacerbate with his current weight (Boff
et al., 2016; Daly et al., 2016). As a caregiver, I will continue to encourage Harry but at the same
time emphasize on essence of accepting to undertake the proposed interventions.

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Preparation
The third stage of behavioral change is where the individual is ready physically and
mentally to adopt the intended program. In this case, the patient is no longer sedentary. However,
at this level, there is no significant commitment or consistency. Overweight individuals at the
preparation stage are willing to work with the practitioner to develop a comprehensive long-term
plan that will be used to encourage weight reduction and proper eating habit (Sousa et al., 2016).
For Harry, the main concern will be how to fit physical activity in his daily schedule as a chef.
At the same time, the concern will be how to assist him to make healthy food choices while
working in an environment where food is readily available. Therefore, it will be essential at this
level to set a plan or program that fits into Harry’s life without creating inconveniences. França
et al. (2013) argue that the success of a change in behavior among obese individuals depends on
the extent to which they are willing to adhere to specific diet. A study by Sousa et al. (2016) also
ascertained the same evidence among adolescents.
Action
The action stage is where the plan initially created is now implemented. During the action
stage, consistency and commitment play a key role in determining the long-term outcomes. In
most cases, individuals who fail to get enough support in terms of encouragement and motivation
at this level could be unable to reach the desired goals (Han et al., 2015). During the action stage,
Harry needs regular support because he is a chef; therefore, as a practitioner, it will be essential
to recognize each milestone that he achieves or effort made. At the same time, it is prudent to set
SMART goals. It is also clinically professional to inform and prepare Harry on possible
anticipations and obstacles that could emerge and how he could overcome. For the first six
months, Harry should focus on a healthy meal plan and regular physical activity in line with the

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recovery program after hip replacement. According to Queiroz et al. (2016), food craving is one
of the major challenges that Harry will face; however, developing a strategy to suppress triggers
of extreme appetite could help him overcome. The role of motivational interviewing at this level
is to ensure that Harry is aware of and experiencing the instantaneous changes that will
eventually culminate into the ultimate desired progress.
Maintenance
The last level of the five stages of change cycle based on the transtheoretical model of
change is the maintenance phase. Relapse is also common among people facing the issue of
increased weight (Bianchi-Hayes et al., 2018). The case of Harry is critical because his job
involves access to food of different kinds. However, the role of the practitioner who is
supporting such a client is to ensure that as part of the maintenance stage interventions, is to
work collaboratively to list things that could entice the individual to go back to previous form of
lifestyle. When these factors have been identified, it is important to set up a strategy to avoid or
prevent being susceptible to triggers. For example, Harry should avoid tasting any meals to
determine their quality; therefore, the restaurant should appoint another person to be in charge of
certifying the taste of prepared meals. When it comes to weight management and eating behavior
regulation, it is possible for the patient to encounter oscillatory transitions where he/she can
experience one stage repeatedly. Through regular interviews that emphasize on the objective of
achieving the ultimate goal, the practitioner should be able to encourage the client to consistently
foster a positive attitude and commitment towards the desired change (Ribeiro et al., 2016).
Conclusion
In conclusion, it is possible to assist Harry through the five stages of change cycle based
on the transtheoretical model of change to solve his overweight problem. However, it depends on

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the ability of the practitioner or caregiver to show empathy while at the same time encouraging
behavioral change through awareness and collaboration. Harry could go through some stages
more than once; however, the focus should be on the benefits that he will get by achieving the
lifestyle change goals.

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References
Bianchi-Hayes, J., Schoenfeld, E., Cataldo, R., Hou, W., Messina, C., & Pati, S. (2018).
Combining Activity Trackers with Motivational Interviewing and Mutual Support to
Increase Physical Activity in Parent-Adolescent Dyads: Longitudinal Observational
Feasibility Study. JMIR Pediatr Parent., 12(1); e3. Doi: 10.2196/pediatrics.8878.
Boff, R. M., Liboni, R. P., Batista, I. P., de Souza, L. H., & Oliveira, M. D. (2016). Weight loss
interventions for overweight and obese adolescents: A systematic review. Eating Weight
Disorders Journal, 22(2), 211-219. Doi: 10.1007/s40519- 016-0309-1.
Desai, N. (2019). The Role of Motivational Interviewing in Children and Adolescents in
Pediatric Care. Pediatr Ann., 48(9), e376-e379. Doi: 10.3928/19382359-20190816-01.
Daly, P., Pace, T., Berg, J., Menon, U., & Szalacha, L. A. (2016). A mindful eating intervention:
A theory-guided randomized anti-obesity feasibility study with adolescent Latino
females. Complementar Therapies in Medicine, 28, 22-28. Doi:
10.1016/j.ctim.2016.07.006.
DiClemente, C. C. (2015). Change is a process not a product: Reflections on pieces to the puzzle.
Substance Use & Misuse, 50(8-9), 1225-1228. Doi: 10.3109/10826084.1042338.
França, S. L., Sahade, V., Nunes, M., & Adan, L. F. (2013). Adherence to nutritional therapy in
obese adolescents; a review. Nutrition Hospital, 28(4), 988-998. Doi:
10.3305/nh.2013.28.4.6481.
Han, H., Gabriel, K. P., & Kohl, H. W. (2015). Evaluations of validity and reliability of a
transtheoretical model for sedentary behavior among college students. American Journal
of Health Behavior, 39(5), 601-609. Doi: 10.5993/AJHB.39.5.2.
Queiroz, M. A. C., Pedrosa, L. F., & Yamamoto, M. E. (2016). Food cravings among

TRANSTHEORETICAL MODEL OF CHANGE 8
Brazilian population. Appetite, 108, 212-218. Doi: 10.1016/j.appet.2016.10.009.
Resnicow, K., Harris, D., Wasserman, R., Schwartz, R. P., Perez-Rosas, V., Mihalcea, R., &
Snetselaar, L. (2016). Advances in Motivational Interviewing for Pediatric Obesity:
Results of the Brief Motivational Interviewing to Reduce Body Mass Index Trial and
Future Directions. Pediatr Clin North Am., 63(3), 539-62. Doi:
10.1016/j.pcl.2016.02.008.
Ribeiro, F. A., Boff, R. M., Feoli, A, M. P., Gustavo, A. S., Donadio, M. V., & Oliveira, M. S.
(2016). Randomized clinical trial of a motivational interdisciplinary intervention based
on the transtheoretical model of change for lifestyle modification in overweight/obese
adolescents: MERC study protocol. International Journal of Clinical Trials, 3(4), 225-
232. Doi: 10.18203/2349-3259. ijct20163961.
Simmonds, M., Llewellyn, A., Owen, C. G., & Woolacott, N. (2016). Predicting adult obesity
from childhood obesity: A systematic review and meta-analysis. Obesity Review, 17(2),
95- 107. DOI: 10.1111/obr.12334.
Sousa, P., Gaspar, P., Fonseca, H., & Gaspar, F. (2016). Lifestyle and treatment adherence
among overweight adolescents. Journal of Health Psychology, 21(4), 562-572. Doi:
10.1177/1359105314531469.