Using TTM and MI to Improve Health Outcomes: A Case Study Essay

This essay presents a case study of a 58-year-old obese man, Harry, admitted for hip replacement surgery, and explores the application of the Transtheoretical Model of change (TTM) and Motivational Interviewing (MI) techniques to promote health behavior change. The essay examines how Harry's negative health behavior, particularly his diet, can complicate surgical outcomes. It then details the five stages of TTM – precontemplation, contemplation, preparation, action, and maintenance – and how MI skills can be employed at each stage to address Harry's ambivalence, build rapport, and encourage a shift towards healthier behaviors. The essay emphasizes the importance of reflective listening, empathetic communication, and tailored action plans to support Harry in adopting and maintaining positive dietary habits, ultimately improving his surgical outcomes and overall health. The essay also highlights the significance of addressing relapse prevention and developing Harry’s self-efficacy to ensure long-term adherence to the new health behavior.

Running head: HEALTH CARE
Health care
Name of the student:
Name of the University:
Author’s note

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The essay deals with the case study of Harry, who is 58 year old man admitted to the
surgical ward for a hip replacement surgery. He is an obese client weighing 165 kg and due to
have a hip replacement the next day. Harry states that he is overweight. He is surrounded by food
all day as he is a chef. His doctor has informed him that his weight is having an impact on his
health. By reviewing this case scenario, the main purpose of the essay is to demonstrate how the
transtheoretical model of change (TTM) can be applied to promote change in health behaviour of
Harry and discuss the utility of motivational interviewing techniques while assisting Harry to
move through the process of change.
Considering the case scenario of Harry, obesity and no change in his diet is a negative
health behaviour that can complicate his surgical outcomes as well as create future health risk.
This is said because evidence shows that obesity is a predictor of surgical outcomes in terms of
pain, disability and quality of life and complications post hip replacement arthroplasty too
(Pozzobon et al., 2018). Hence, changing his behaviour related to food intake and diet is crucial
to promote health. The main rational for using TTM model of change in the context of Harry is
that it is a common behavioural change model which assumes that changing a behaviour is not a
coincidence. Instead it depends on a step wide process of change. This theory clarifies that
during the process of change, people pass through five stages of precontemplation,
contemplation, preparation, action, and maintenance (Hashemzadeh et al., 2019). The theory
states that different people are in different stage of change and assessing readiness of client to
move to next level is important. This can be followed by the use of motivational interviewing
technique to convince client to change their behaviour and gradually move through different
stages of change process by evoking their thoughts and empowering them to achieve the new

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behaviour (Schoo et al., 2015). The following paragraphs discuss each stage of TTM and the way
to use MI technique to change behaviour of Harry during each stage of TTM.
The first stage of the TTM model is the pre-contemplation stage when people are not
aware that there is any problem in their current behaviour. They have no intention or interest to
take any action in the foreseeable future to change their current behaviour (Brannon, Feist &
Updegraff, 2014). Harry is found to have the characteristics of pre-contemplators too as currently
he is unready for help and has no knowledge that his dietary habits can be detrimental to his
health. Developing Harry’s interest in changing the behaviour is important because any health
education tactics cannot work unless client has the interest to change his behaviour. The MI
skills that can be used to assess the current awareness of Harry regarding his problematic
behaviour includes use of rapport building skills and use open-ended question to assess Harry’s
current view about obesity (Stein-Parbury, 2017). For example, after greeting Harry and making
the client comfortable with general conversation, open-ended question can be used to assess his
knowledge regarding harmful effect of current behaviour. The question that can be asked
includes ‘Do you know about the benefits of reducing your weight?’. Reply to this question help
to assess the extent to which Harry lacks knowledge about negative effects of his current
behaviour. According to Apodaca et al. (2016), the advantage of using open ended question
during MI is that it encourages the client to develop trust with the interviewer and do most of the
talking.
The second stage of TTM includes the contemplation stage or the getting ready stage
where people intend to change their behaviour in the future. However, the major dilemma for
people at this stage is that they are more aware about the disadvantages of changing instead of
the benefits of changing (Prochaska, Redding & Evers, 2015). Hence, due to this conflict, people

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at this stage are ambivalent towards adapting new behaviour. In the context of Harry, making
him ready can be difficult too because he is a chef and it will be difficult to convince him that he
need to control his dietary habits. Even he is told about the need to change his dietary habit for
his future health, he may have ambivalent attitude too. Utilization of MI skills is most important
at this stage as this interviewing technique uses person-centered counselling skills to address
ambivalence about change. In the context of Harry, ambivalence about change can be addressed
by the use of reflective listening and empathetic style of communication (Rollnick, Miller &
Butler, 2012). Reflective listening can be practiced with Harry by attentively listening to Harry’s
point of viewing regarding changing his dietary habits and avoiding any interruptions in
between. This can be followed by affirmation and summarization to restate the patient’s view.
After this, client views can be challenged by the use of empathetic style of communication such
as showing respecting, complimenting client’s feelings, providing support and gently persuading
client to change the behaviour (Hartlieb et al., 2016). Gentle persuasion can be done by
statements like ‘Would you like to know how maintaining healthy diet has helped people to
control their weight?’. This form of conversation will support Harry to move to the next stage of
change.
The third stage of change according to the TTM model is the action stage where people
develop the commitment or motivation to make overt changes in their lifestyle. At this stage,
continuous collaboration with health care professional is important to ensure that new behaviour
is aligned to current guidelines and practice (Krebs et al., 2019). In case of Harry, he can be
ready to take action once he negotiates with health care professionals regarding different
behavioural change options and his cultural preferences related to new diets. To effectively
negotiate with Harry regarding new action plan for change, it will be necessary to use MI skills

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of respect and open communication to understand what actions will be negotiable for Harry
(Webb, 2011). For example, if Harry states that he can never avoid eating sweets, then decisional
balance can be achieved by giving the option to reduce sugar consumption instead of completing
avoding it. According to Rollnick, Miller and Butler (2012), during the process of change, re-
exploring values and establishing its connection with positive change is crucial to ensure that
client’s preference are respected and they do not feel that they are being forced to take on a new
behaviour. By using the above tactics, appropriate diet chart can be planned and Harry is likely
to adhere with the same to achieve positive surgical outcome and overall health benefits too.
The fourth stage of change is the maintenance stage and it is the time when people have
made specific overt modifications in their lifestyles. However, they still do not have the intention
to continue with the new change for long-term period (Prochaska, Redding & Evers, 2015). This
implies that there might be barriers or challenges in adhering to the new change due to which the
client may be having the feeling that they will not continue the new positive health behaviour for
long-term period (Apodaca et al., 2016). Similar challenged can be encountered by Harry too
when he proceeds with new diet chart and certain diet restrictions to control his weight. To
ensure that the client continues with the same behaviour, working with client to prevent relapse
to earlier stage is important. This is also a part of MI process as Reims and Ernst (2016) states
that providing support to the client throughout the recovery process is important. The focus
should be to develop self-efficacy of Harry in adhering to positive dietary habits (Sigelman,
Rider & De George-Walker, 2015). This will also dependent on reflective listening skills and
intently listening to the problem that Harry faced in going with the new change. After listening,
summarization can be used to reaffirm client’s statement and then suggesting new tactics for
overcoming challenges.

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The final stage of change is the termination stage during which people have developed
self-confidence and self-efficacy in continuing with the new behaviour and they have no desire
to return to unhealthy behaviours (Brannon, Feist & Updegraff, 2014). Achieving this is the
ultimate goal of lifestyle modification intervention as this ensures that the client at no more risk
of chronic health risk because of negative health behaviour. Harry will reach this stage once he is
comfortable with the new change plan and face no discomfort in continuing with health diet. At
this stage, the process of developing motivation to change is completed and no more application
of MI technique is needed.
The essay summarized the method of applying MI techniques to help Harry move
through the five stages of change according to the TMM model. The analysis of the stages of
change shows that initially any client is very ambivalent in adapting new behaviour and they
give more preference to pros rather than cons of behaviour change. However, MI is an important
client-centred communication technique that can assist interviewers or health care professionals
to address resistance to change and gradually develop the motivation to adapt new and desired
health behaviour.

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