Behaviour Change and Motivational Interviewing: An Essay

This essay explores the application of the Transtheoretical Model of Change (TMM) to a case study of a 58-year-old obese male, Harry, who is scheduled for hip replacement surgery. It examines how the TMM, encompassing stages like pre-contemplation, contemplation, action, maintenance, and termination, can be used to assess Harry's readiness for change and develop a plan to improve his health behaviors. The essay highlights the importance of motivational interviewing (MI) skills in facilitating behavior change, particularly in the context of Harry's profession as a chef, which presents challenges to dietary changes. It discusses specific MI techniques, such as open questions, reflective listening, and empathy, to build rapport and encourage Harry to adopt a healthier lifestyle, including adhering to a diet plan. The essay emphasizes the need for healthcare professionals to acquire MI skills to effectively guide patients through the stages of change, ultimately improving their health and well-being.

Running head: BEHAVIOUR CHANGE
Behaviour change
Name of the student:
Name of the University:
Author’s note

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Behavioural modification is a major part of lifestyle intervention which targets
changing negative health behaviour of clients and encouraging them to adapt healthy
behaviour. This form of change in harmful behaviour of patient is critical to reduce risk of
chronic disease and promote health and well being (Williamson, 2017). The transtheoretical
model of change (TMM) or stages of change is a popular model that is applied during the
process of increasing people’s readiness to change and adapt new behaviour. This essay
focuses on the application of the transtheoretical model to the case study of Harry who is
engaged in harmful behaviour. It illustrates the utilization of motivational interviewing (MI)
skills to enable patient to change their health behaviour too.
The case study is related to Harry, a 58 year old male who is due to have hip
replacement surgery tomorrow. He is obese with weight of 165kg indicating severe obesity.
Despite being so heavy, Harry’s statement suggests that he regards his weight gain as a
normal issue as he is living with it for years. He loves food and since he is a chef by
profession, he is involved in preparing and eating different types of food all day long. The
review of the case study shows that Harry’s obesity is a major risk factor that has increased
the risk for hip replacement surgery. In addition, his eating habit is a negative and harmful
health behaviour that can further deteriorate his health and affect post surgical outcomes too
(Barrett et al., 2018).
Considering the risk to Harry based on his current health behaviour, the TMM model
of change needs to be applied to first assess his readiness to act on the new health behaviour
and then implement appropriate action plan to guide the client. The significance of using this
model of change is that by systematically going through the process of change, this model
provides a theoretical framework to facilitate movement between different stages and analyze
pros and cons of moving with the desired change process (Hashemzadeh et al., 2019). In the

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context of Harry, using this model will assist in developing self efficacy of Harry towards
weight control and adhering to healthy diet plan.
The TMM model consists of five stages of change namely pre-contemplation,
contemplation, action, maintenance, and termination. Pre-contemplation is the stage at which
an individual does not have the awareness that any problem exist in their behaviour and they
pay major attention to the cons of changing behaviour instead of the pros of the same (Krebs
et al., 2018). Harry is currently in the pre-contemplation stage as he does not regard his
obesity to be a significant health issue and he is continuing with his normal food habits. The
first goal is to support Harry to move to the second stage of contemplation, a stage during
which people acknowledge their problematic behaviour and they pay attention to both pros
and cons of changing the behaviour (Friman, Huck & Olsson, 2017). As Harry is a chef,
many challenges may be encountered in motivating him to change his current eating habits.
This is because of his preference and value for foods. However, to overcome challenge in the
process of change, the concept of motivational interviewing needs to be applied during
interaction with the client. MI is a client centred approach to communication which pays
emphasis towards developing motivation of client towards new behaviour by the use of good
communication skills (Balán et al., 2016). This will be discussed in more detail to understand
how MI can be used to assist client in adapting new behaviour during different stages of
change.
To help Harry move to the contemplation stage, it is necessary to develop his intrinsic
motivation for change. This can be done using MI skills which believe in the use of approach
to adjust client resistance instead of opposing them directly. This form of conversation is
necessary to create a safe environment for disclosure of harmful effects to patient (Edwards et
al., 2015). Therefore, to make Harry aware about the harms of continuing with his current
behaviour, good communication practice needs to be employed. This involves use of

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techniques like rapport building, open questions, affirmation and reflective listening to
introduce client to new behaviour (Hartlieb et al., 2016). For example, while inquiring about
Harry’s knowledge about harmful effect of obesity, the question that can be asked is ‘What
do you know about the health benefits of maintaining appropriate weight and controlling
weight?’. This form of questions is thought provoking and do not put client on the defensive
side too. Furthermore, reflective listening skills can be exercised during the process by
avoiding interruption and using non judgmental attitude throughout the conversation
(Prochaska, Redding & Evers, 2015). Another communication technique is the use of
empathy by acceptance of feelings of Harry and using statements that convince client to
change their current behaviour instead of disrespecting their feelings (Zoffmann et al., 2016).
Hence, through the use of above MI technique, trustful alliance can be created with Harry and
he can be made aware regarding the harmful effects of his current behaviour. Once he is
convinced, this will facilitate him to prepare and go to the next stage of action.
The third stage of change is the action stage where people plan to take small steps
towards behavioural change. However, they are still ambivalent about it. At this stage, the
main goal is to make client aware about different options for change and interpret their
readiness to engage with the new change plan (Vancampfort et al., 2016)). In the case
scenario of Harry, the key action that is needed is to restrict sugar and excess fat in his diet
and help him adhere to a new diet plan as prepared by expert dietician. At this stage, it is very
likely that the client may not accept specific elements of the diet chart. Hence, to avoid non
acceptance of the plan, the MI technique of reflective listening and respecting client’s value
related to food eating habits need to applied. For instance, health staffs can ask Harry about
any food preference or habits that he can never leave. Based on such preference, the diet plan
can be revised so that Harry never gets the feeling that his personal values have been
violated. Active discussion with client with use open questions and affirmation technique can

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ensure that the change implemented is in agreement with client’s values and preference
(Raynor & Champagne, 2016). In this way, Harry can get ready to follow the new diet plan
very soon and proceed to the next stage of change.
The next stage that follows after the action stage is the maintenance stage during
which people have taken steps towards modifying their past behaviour and adapting new
lifestyle (Vancampfort et al., 2016). They become confident in continuing with their changes
and they are tempted to relapse. To successful achieve this goal in the maintenance stage,
feedback should be taken from Harry regarding his experience of processing with change in
his diet. The questions that can be asked to provoke his feelings includes ‘Did you faced any
challenges in going with the new diet plan?’ or ‘How far has the new diet plan worked for
you?’ This type of questioning technique can invite Harry to give his feedback and express
his views regarding proceeding further with the new change. Continuous discussion and
change in plan at this stage can finally make Harry confident regarding the way to control his
weight (Schoo et al., 2015). This technique will help him to adhere to the behaviour for long
term period too. Once this is achieved, patient will proceed to the final stage which is the
termination stage. At this stage, the motivation and interest to continue with new change is so
strong that people do not have any desire to return back to previous behavior. Harry is likely
to achieve the same once he is confident in overcoming challenges during adhering with his
new diet plan.
To summarize, it can be said that the review of TTM stages of change is useful
framework to support people to prepare for a new change and develop their intent to leave
harmful behaviour. The essay revealed the utility of MI technique in assisting Harry to
develop his motivation and understand the necessity of changing his current behaviour for
overall health and well being. Nurses and other staffs must acquire MI skills to ensure that
clients are encouraged to adapt desired health behaviour without any resistance.

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