Reflection on Healthcare: Harry's Case and Behavior Change Models

This report presents a case study of a 58-year-old male patient named Harry, hospitalized for a hip replacement, who is significantly overweight. The assignment aims to demonstrate understanding of the Trans-theoretical Model (TTM) of change and motivational interviewing (MI) techniques to assist Harry in modifying his behaviors for weight loss. The report explores the stages of the TTM, from pre-contemplation to maintenance, and discusses how this model, along with MI, can be applied to develop diet and exercise plans. It references research studies that support the effectiveness of both TTM-based interventions and MI in promoting weight loss, improved eating habits, and increased physical activity. The report concludes that a combined approach of TTM and MI can be beneficial, and the evaluation of behavior change is essential for effective weight management.

Running head: REFLECTION
Reflection
Name of the student
Name of the university
Author’s name

1REFLECTION
This is a case study about a patient named Harry, who is a 58-year-old male. He has been
hospitalized for the hip replacement. I have gone through different research papers and found out
that, the average weight of a male between the age group of 40-59 should be around 90 kg
(Marcin, 2019). However, Harry is weighing 165 kg; according to the Doctor’s his weight is
impacting on his health. The purpose of this essay is to make students demonstrate their
understanding of the trans-theoretical model of change within the evidence-based framework.
Along with this, the students are allowed to use the motivational interviewing techniques in
assisting the patient in changing their behaviours.
The Trans-theoretical Model (TTM), also known as stages of change (SOC), was
established by Prochaska and Di Clemente in the late 1970s. The Trans-theoretical Model
enables people to move through different phases of change (Prochaska, Redding & Evers, 2015).
The initial stage is pre-contemplation, where people are unaware of their actions, and they do not
mean to take necessary steps for the probable future. In the second step, people start to recognize
their actions, and they initiate taking healthy and meaningful actions for the likely future. The
third step is the preparation stage, where individuals start taking small steps toward behaviour
change. In the fourth step, people get motivated and keep moving forward, where they intend to
continue the selected steps for the improvement of their behaviours. In the fifth step, people take
actions to resist in the relapse towards the earlier phases. The final stage is often considered as
negligible as some people start getting back to their old habits; however, this phase is rarely
reached, and individuals intend to continue the maintenance phase (Prochaska, Redding & Evers,
2015).
Nowadays, overweight and obesity have become a significant worldwide health problem
which comprises of various health conditions, such as type 2 diabetes, hypertension,

2REFLECTION
cardiovascular disease and osteoporosis (Williams et al., 2015). Due to this issue, different
researchers have discussed the motivational approaches that can motivate people in promoting
weight loss by bringing the audience at the weight loss programmes (Schelling et al., 2011).
Through the weight management perspective, the TTM provides a theoretical context that helps
in evaluating the willingness to improve and change and, helps in forming mediations conferring
to the patient’s desire and inhibiting failure from the perspective of weight management (Neil,
Addicks & Randall, 2017). The TTM model enables an intentional change in the individual,
which predicts the probable results during the adaptation of the different developed behavioural
change. The TTM model has been successful as an approach to the reduction of smoking
amongst adults (Brick et al., 2017). According to the TTM model, two critical things are to be
kept in mind. Firstly, many people do not change their behaviour at the first moment, and thus
they cannot be assisted with customary action-oriented prevention programs. Secondly changing
the behaviour of a person is a complicated procedure, and it will progress through several stages.
Thus to implement the TTM model during the treatment of Harry, it would be necessary for him
to be aware of his condition (Mastellos et al., 2014).
I would suggest a change in the diet by planning a diet related strategy which will be based on
the TTM model. As a result, there will be change in the eating habits of Harry, like daily
consumption of calories and fatty food consumption can be reduced which will lead to
sustainable weight loss. Similarly, physical activity plans can be formed on the basis of the
model which will help in increasing the amount of exercises and the physical activities. This will
help Harry reach the targeted health outcome. The outcome of this model will be that there will
be change in the behaviour of Harry which will occur voluntarily and will be self-driven,
contributing to a maintainable need for the behaviour change (Mastellos et al., 2014).

3REFLECTION
I have gone through different literature reviews to check the effectiveness of the TTM model.
There was a paper which conducted a study to see the effectiveness of the TTM model among
overweight or obese people. The study included 1277 participants who had a BMI in between 25
to 39.9. The researchers of the study claimed that TTM model can improve the eating habits,
physical activity, administration of emotion, and manage the weight of the study population. The
outcome of the study showed a major rise in the intake of fruit and vegetable; and people
intended to improve their behavior and maintained it for 24 months (Johnson et al., 2008).A
systematic review was chosen from the Cochrane database. In this review there were 41
randomized controlled trials which included 3476 participants. The systematic review evaluated
physical activity and exercises as a way of to reduce weight and proved that physical activities
and exercise had an affirmative influence on the weight of patients who were overweight or
obese. It was seen that physical activity and exercise led to a significant weight loss without any
other treatment. Though, when physical activity and exercise were integrated with diet, it
resulted in more significant reduction of weight than diet alone (Shaw et al., 2006).
Thus, when TTM based intervention is to be applied on Harry, it is mandatory that the whole
procedure is delivered by health-care professionals. The initial outcomes from the TTM
intervention will be sustained weight loss and the second outcome would be a change in self-
reported change in SOC progression.
There is a second approach through which I can help Harry in reducing his weight. The second
approach is Motivational interviewing. It is a method in which I have to assist Harry in the
change process and express acceptance of your client. Motivational interviewing (MI) is an
effective counseling approach that helps in motivation through the resolve of uncertainty. The
model of Motivational interviewing was made on the basis of Miller and Roll nick’s work in the

4REFLECTION
field of addiction medicine and on the basis of TTM model, which developed the expression
ready, willing and able that shapes three significant factors of motivation which are willingness,
ability and readiness (Ceccarini et al., 2015) (Neil, Addicks & Randall, 2017). Using the MI
methods, the healthcare professional can create motivational interventions for Harry’s stage of
change according to the TTM model (Draxten, Flattum& Fulkerson, 2016). MI technique is
based on patient- centered approach of psychoanalysis that tries to draw internal, deep-down
inspiration to change their existing behavior and inspires people to appreciate and resolve their
ambivalence to such change. I would suggest Motivational Interviewing as a better approach
compared to any surgery or medications as MI is cost-effective approach. The MI approach will
help Harry to explore his own health opinions. Mediations which are based on the MI approach
are effective in changing an individual’s behavior and also reduce the risk factors regarding the
coronary artery disease (Morton et al., 2015).
To confirm the effectiveness of the MI technique I have reviewed various literatures. There was
a study which demonstrated the effectiveness of the MI technique on physical exercises,
significant reduction in weight, hypertension control and cholesterol management (Hardcastle et
al., 2008). Another research was conducted on overweight and obese workers by Navidian et al.
which demonstrated a significant reduction in weight and BMI after the implementation of MI
approach (Navidian et al., 2010). Another study was conducted in patients who were diagnosed
with hypertension due to obesity. The study resulted that there was a significant change in the
regular intake of vegetables, polyunsaturated oils, salt, meat, dairy products, and increase in the
physical exercise levels and there was a significant reduction in the body weight after MI (Abedi
et al., 2010).

5REFLECTION
I think there is a benefit in implementing MI over the TTM model. The MI approach allows in
the reduction of resistance, strengthens the attributions, elevates in the internal motivation,
allows an increase in the capacity and proneness to change their behavior and finally enhances
the treatment outcomes (Zeidi & Hajiagha, 2013).
I think that by implementing the TTM model, it will be able to improve the motivational
interviewing method which will encourage Harry to reduce his weight and strictly follow the
weight management programs to get positive outcomes. Thus with the help of Harry’s
motivational level and information delivered by Harry’s will to change I will be able to construct
proper weight-management interventions. During the weight management program, the
evaluation of phases of the stages of change is generally carried out through the evaluation of
dietary fat reduction and physical activities, individually. Using targeted interventions of dietary
fat decrease behaviours and physical activity at once can help to provide a credible and effective
weight-management motivation evaluation.

6REFLECTION
REFERENCES
Brick, L. A., Redding, C. A., Paiva, A. L., &Velicer, W. F. (2017). Intervention effects on stage
transitions for adolescent smoking and alcohol use acquisition. Psychology of addictive
behaviors, 31(5), 614. doi: https://psycnet.apa.org/doi/10.1037/adb0000302
Ceccarini, M., Borrello, M., Pietrabissa, G., Manzoni, G. M., & Castelnuovo, G. (2015).
Assessing motivation and readiness to change for weight management and control: an in-
depth evaluation of three sets of instruments. Frontiers in Psychology, 6, 511. doi:
https://dx.doi.org/10.3389%2Ffpsyg.2015.00511
Draxten, M., Flattum, C., & Fulkerson, J. (2016).An example of how to supplement goal setting
to promote behavior change for families using motivational interviewing.Health
communication, 31(10), 1276-1283. doi: https://doi.org/10.1080/10410236.2015.1062975
Hardcastle, S., Taylor, A., Bailey, M., & Castle, R. (2008). A randomised controlled trial on the
effectiveness of a primary health care based counselling intervention on physical activity,
diet and CHD risk factors. Patient education and counseling, 70(1), 31-39. doi:
https://doi.org/10.1016/j.pec.2007.09.014
Johnson, S. S., Paiva, A. L., Cummins, C. O., Johnson, J. L., Dyment, S. J., Wright, J. A., ... &
Sherman, K. (2008). Transtheoretical model-based multiple behavior intervention for
weight management: effectiveness on a population basis. Preventive medicine, 46(3),
238-246. doi: https://doi.org/10.1016/j.ypmed.2007.09.010
Marcin, J. (2019). What is the average weight for men?. Retrieved 10 September 2019, from
https://www.medicalnewstoday.com/articles/320917.php

7REFLECTION
Mastellos, N., Gunn, L. H., Felix, L. M., Car, J., &Majeed, A. (2014).Transtheoretical model
stages of change for dietary and physical exercise modification in weight loss
management for overweight and obese adults. Cochrane Database of Systematic Reviews,
(2). doi: https://doi.org/10.1002/14651858.CD008066.pub3
McNeil, D. W., Addicks, S. H., & Randall, C. L. (2017). Motivational interviewing and
motivational interactions for health behavior change and maintenance. doi:
10.1093/oxfordhb/9780199935291.013.21
Morton, K., Beauchamp, M., Prothero, A., Joyce, L., Saunders, L., Spencer-Bowdage,
S., ...&Pedlar, C. (2015). The effectiveness of motivational interviewing for health
behaviour change in primary care settings: a systematic review. Health Psychology
Review, 9(2), 205-223. doi: https://doi.org/10.1080/17437199.2014.882006
Navidian, A., Abedi, M. R., Baghban, I., Fatehizadeh, M. A. R. Y. A. M., &Poorsharifi, H.
(2010).The effects of motivational interviewing on lifestyle modifications of clients
suffering from hypertension. Razi Journal of Medical Sciences, 17(71), 79-94.
Navidian, A., Abedi, M. R., Baghban, I., Fatehizadeh, M., Poursharifi, H., &Dehkordi, M. H.
(2010).Effects of motivational interviewing on weight loss of individuals suffering.
Iranian Journal of Nutrition Sciences & Food Technology, 5(2), 45-52.
Prochaska, J. O., Redding, C. A., & Evers, K. E. (2015).The transtheoretical model and stages of
change. Health behavior: Theory, research, and practice, 125-148.
Schelling, S., Munsch, S., Meyer, A. H., &Margraf, J. (2011).Relationship between motivation
for weight loss and dieting and binge eating in a representative population

8REFLECTION
survey. International Journal of Eating Disorders, 44(1), 39-43. doi:
https://doi.org/10.1002/eat.20748
Shaw, K. A., Gennat, H. C., O'Rourke, P., & Del Mar, C. (2006). Exercise for overweight or
obesity. Cochrane database of systematic reviews, (4). doi:
https://doi.org/10.1002/14651858.CD003817.pub3
Williams, E. P., Mesidor, M., Winters, K., Dubbert, P. M., & Wyatt, S. B. (2015). Overweight
and obesity: prevalence, consequences, and causes of a growing public health
problem. Current obesity reports, 4(3), 363-370. doi: https://doi.org/10.1007/s13679-
015-0169-4
Zeidi, I. M., & Hajiagha, A. P. (2013). Effect of motivational interviewing on eating habits and
weight losing among obese and overweight women. J Obes Weight Loss Ther, 3, 172.
doi: 10.4172/2165-7904.1000172