Essay: Applying Transtheoretical Model and Motivational Interviewing

This essay delves into the application of the Transtheoretical Model (TTM) of behaviour change and the Motivational Interviewing (MI) technique within a healthcare context. The essay begins by highlighting the importance of behaviour change in achieving optimal patient health outcomes, particularly in relation to adherence to treatment and recovery. It then introduces a case study of a 58-year-old male, Harry, who is scheduled for hip replacement surgery but is resistant to weight loss despite his obesity. The essay proceeds to apply the TTM, which comprises pre-contemplation, contemplation, preparation, action, and maintenance stages, to Harry's situation. It emphasizes the role of MI in guiding Harry through the stages of change, focusing on techniques such as open-ended questions, empathy, and reflective listening to address his ambivalence and foster self-efficacy. The essay details how MI can be used to identify barriers to change, develop a personalized change plan, and support Harry through the action and maintenance phases. The conclusion underscores the significance of healthcare professionals developing skills in both MI and TTM to facilitate patient-centered behaviour change, ultimately improving health outcomes. The essay also includes references to relevant research supporting the use of these models.

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

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In the health care setting, health promotion goals for patient focus on behavioural
changes too apart from resolution of physical symptoms of patient. This is important because
engaging in many negative health behaviours predispose patients to adverse health outcomes.
Hence, to promote optimal health outcome, focussing on healthy behavioural change in patient is
crucial to promote adherence to treatment and support patient to achieve recovery from illness
(Young, 2014). There are many health behavioural change theories that support health care
professionals to guide patient towards positive behavioural change. The main aim of this essay is
to apply the transtheoretical model of change to case study of Harry and discuss about
motivational interviewing technique to enable Harry to adapt new health behaviour.
The case study is about Harry, a 58 year old male who is due to have a hip replacement
surgery. The patient is 165 kg and despite being scheduled for surgery, he has no intention to
reduce his weight. As per Harry’s statement, he loves food as he is a chef and that is the way he
is. Harry also confided that his doctors have informed him that that his weight is having impact
on his health. The case study scenario clearly demonstrates that Harry’s food eating habits and
his weight gain is a concern that is detrimental to his health. Pellegrini et al. (2017) gives the
evidence that majority of knee replacement patients are overweight or obese. Obesity is the
contributing factor that results in progression of knee osteoarthritis and the need for total knee
replacement for patient. Harry is in need of knee replacement surgery because of his weight gain
issues. However, as Harry is due to have a hip replacement surgery, management of his weight is
important to reduce surgical complications and promote recovery of patient.
Currently, losing weight is important for Harry to reduce his surgical complication and
achieve full recovery after hip replacement surgery. However, unless Harry understands the risk
associated with weight gain, his intention to control his diet will never change. Although diet

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plan can be prepared, he will never adhere to it unless he has positive intention to change his
behaviour. According to Hashemzadeh et al. (2019) obesity is a risk factor for various health
issues such as heart disease, backpain and osteoporosis. To prevent development of chronic
disease due to obesity, targeting lifestyle improvement is important. This is dependent on
changing behavioural patterns of patient and transtheoretical model (TMM) of behavioural
change is the best model to achieve this goal. Therefore, to help Harry change his thoughts and
behaviours related to food eating and diet, the application of transtheoretical model (TMM) of
behavioural change will be necessary to gradually support Harry to change his eating habits and
achieve positive attitude towards weight management. The TMM model is based on the
assumption that changing behaviour of patient is not sudden. Instead, it requires transition
through five stages of change namely recontemplation, contemplation, preparation, action, and
maintenance (Prochaska, Redding & Evers, 2015). Different people may be at different stages of
change and understanding their readiness for change is crucial to provide appropriate education.
The transtheoretical model of change can be applied to support Harry to change his
behaviour related to eating and food intake. The first stage of change according to the TMM
includes the pre-contemplation stage during which people make no intention to change their
behaviour in the future and they are not aware that their behaviour can be harmful for their health
(Friman, Huck & Olsson, 2017). Harry is currently in the pre-contemplation stage too as does not
have any plans to lose his weight. Pre-contemplation stage is followed by contemplation stage
where people recognize that their health behaviour is problematic and they give thoughtful
considerations to change their behaviour (Prochaska, Redding & Evers, 2015). However, at this
stage, they are not aware how to do this. To help Harry move to the contemplation stage, it is
necessary to use motivational interviewing (MI) technique so that he develops the motivation to

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move from his status-quo. MI is a type of client-centred and directive counselling where people
elicit behaviour change by supporting client to explore and resolve ambivalence. The main goal
of using MI for Harry is to help him move through stage of readiness for change and avoid risky
behaviour that can further deteriorate his health.
The main utility of MI technique in promoting behaviour change is that it helps to
identify thoughts and feelings of patient that cause them to continue with unhealthy behaviours
and support the patient to develop new thought pattern for behavioural change (Copeland et al.,
2015). This can start with the use of open-ended question where Harry can be asked if he knows
about the impact of his weight on his current health. This will help to determine Harry is in
which stage of change. After this, perceived barriers to change can be evaluated by the use of
empathy, reflective listening and validating question. The advantage of empathy during patient
interaction is that it helps to establish a safe and open environment to elicit personal reasons for
continuing with a behaviour in patient (Flinn & Jones, 2011). Harry’s perspective related to diet
can be explored by statements like ‘I understand it is difficult for you to change your food
preference as you are a chef and have love for food. However, based on your current health, it is
still important to work on this. What do you think you can do to lose weight and control your
food intake?’. The significance of using such statement is that it allows interviewers to gently
persuade client to change his behaviour and also understand whether patient is ambivalence
about change or not (Zoffmann et al., 2016). After collecting details on Harry’s perscpective and
values related to his current eating habits, he can be made aware regarding the consequences of
obesity and not changing diet on his health. At this point, supporting self-efficacy and self-
motivation in client will be important by introducing him to pathways by which he can reduce
weight.

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After interacting with Harry using the above MI technique, one can move to the third
stage of preparation of TMM model. The stage of preparation is the stage in which clients take
small steps towards behaviour change. The MI process that can be adapted at this stage can
include use of different coping strategies and empowering techniques to prepare Harry towards
diet change and weight control (Miller & Rose, 2015). Client commitment for change can be
strengthened by giving Harry a copy of daily diet plans and physical activity routine that he can
use to maintain his weight. At this point, patient’s concern and priorities must be discussed to so
that appropriate agendas can be made and Harry is ready to adapt healthy behaviour within few
days. The advantage of this strategy is that it is a patient-centred approach to change and it will
help to respect client autonomy and negotiate with patient to develop appropriate change plan for
them (Hardcastle, Fortier, Blake & Hagger, 2017).
This can be followed by the fourth stage of action where people have changed their
behaviour and they are complying with positive behaviour introduced by therapist or counsellors
(Prochaska, Redding & Evers, 2015). This stage is followed by maintenance phase which reflects
successful long-term continuation of the acquired behaviour by regularly engaging with client
and working to prevent relapse of undesired behaviour. To ensure that Harry continues with his
diet chart and schedule for physical activity, it is necessary to interact with Harry regularly and
inquire if he has faced any challenges while adhering to the new change plan. At this point,
barriers can be explored and plans can be revised based on client’s concern. The significance of
using this tactic during the process of behavioural change is that self-efficacy of Harry related to
weight loss and controlling obesity can be developed for a longer period of time. Nezami et al.
(2016) supports that increase in self-efficacy in the areas of eating and physical activity is crucial
to during the active phase of intervention to ensure that weight loss and diet intake is managed

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by clients at later points too. Finally, the success of the overall behavioural change can be
evaluated in the termination stage. The process is completed after people express no desire to
return to unhealthy behaviours (Prochaska, Redding & Evers, 2015).
From the discussion regarding the use of TMM model and MI technique to assist Harry
in making appropriate changes in his health behaviour, it can be concluded that individuals vary
in their degree to make changes in their daily life and acquire new behaviour for health. In such
scenario, the TMM is an appropriate model of change to predict preparedness of client and shift
them towards stage of preparedness and change. As conflict avoidance is common during the
initial stages of change, the utility of MI technique in changing client’s perspective and achieve
self-efficacy to continue with desired behaviour has been identified from the essay. It is essential
that health care staffs develop skills in appropriate application of MI and TMM model to engage
in client-centred behavioural change process.

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