The transtheoretical model and substance dependence: theoretical and practical aspects

OBJECTIVE: This paper aims to present and discuss the Transtheoretical Model and its importance for the treatment of substance abuse disorders. METHOD: A literature review was made based on articles from the last 10 years in substance use with human subjects found in PubMed (Medline) and the Scientific Electronic Library Online, as well as on the main books written by the creators of the model. From the initial collection of articles related to the Transtheoretical Model, the University of Rhode Island Assessment and substance abuse, those related to other health conditions were excluded. Although articles related to hospitalization were also excluded, as were those related to the Minnesota Model, treatment proposals were included. RESULTS: Although the TTM has been studied for over 20 years, new concerns regarding the initial idea continue to arise. Such concerns include the cross-sectional design of studies employing the model, as well as the prescriptive versus descriptive point of view. DISCUSSION: The review of the Transtheoretical Model brought intentional behavior change to light, which could broaden the understanding of addictive behaviors. Together with its concepts of processes and stages of change, the Transtheoretical Model provides professionals with the idea that the effectiveness of therapy is dependent upon the capability of the therapist to match the technique to the current motivational stage of the patient in the process of change. This demonstrates the importance of identifying the stage of change of the patient when they present for treatment. Here, we describe the principal elements of the Transtheoretical Model, as well as the instruments currently used to identify the stage of change. Finally, criticisms and limitations of the model are discussed.

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Stages of Change in Batterers and Their Response to Treatment

Violence and Victims ◽

10.1891/0886-6708.23.4.476 ◽

2008 ◽

Vol 23 (4) ◽

pp. 476-492 ◽

Cited By ~ 22

Author(s):

Pamela C. Alexander ◽

Eugene Morris

Keyword(s):

Rhode Island ◽

Stages Of Change ◽

Transtheoretical Model ◽

Partner Violence ◽

Readiness To Change ◽

Violent Behavior ◽

Stage Of Change ◽

Response To Treatment ◽

Future Research ◽

Cluster 2

One important dimension of individual differences among batterers is their readiness to change. According to the transtheoretical model (Prochaska & DiClemente, 1984), all individuals go through precontemplation, contemplation, preparation, action, and maintenance before a change in behavior is accomplished. The applicability of this model to intimate partner violence was assessed by administering the University of Rhode Island Change Assessment (URICA) scales (with reference to their domestic violent behavior) to 210 court-ordered male batterers. Their responses were clustered, and two clusters were derived and then compared on other measures. As hypothesized, cluster 2 individuals (characterized by a profile of URICA scale scores suggesting an earlier stage of change) self-reported less initial distress (depression, anxiety, and alcohol abuse), less violence, and fewer problems with anger than cluster 1 individuals (characterized by URICA scale sores suggesting a later stage of change), although partners reported no difference in violence perpetrated by the two clusters. Cluster 1 individuals evidenced greater improvement in self-reported depression, anxiety, and anger control. Strategies to engage the more resistant cluster 2 individuals as well as suggestions for future research are considered.

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Stages of change and factors associated with misperceived eating behavior in obese individuals

Revista de Nutrição ◽

10.1590/1678-98652016000100004 ◽

2016 ◽

Vol 29 (1) ◽

pp. 33-42 ◽

Cited By ~ 2

Author(s):

Lydiane Bragunci BEDESCHI ◽

Aline Cristine Souza LOPES ◽

Luana Caroline dos SANTOS

Keyword(s):

Food Intake ◽

Behavior Change ◽

Eating Behavior ◽

Stages Of Change ◽

Transtheoretical Model ◽

Vegetable Intake ◽

Saturated Fatty Acids ◽

Cross Sectional ◽

Factors Associated ◽

Maintenance Stage

ABSTRACT Objective: To evaluate the stages of behavior change related to fat and fruit/vegetable intakes and the factors associated with misperceived eating behavior (pseudo-maintenance). Methods: This cross-sectional study collected sociodemographic, socioeconomic, health, and food intake data from obese individuals (n=103) aged ≥20 years. Stages of behavior change according to the Transtheoretical Model were measured for fat and fruit/vegetable intakes. The pseudo-maintenance stage was reclassified in subjects in the action/maintenance stage who had inappropriate food habits. Multiple logistic regression models were proposed to assess the factors associated with misperceptions. Results: The prevalences of pseudo-maintenance for fat and fruit/vegetable intakes were 23.3 and 19.4%, respectively. The factors associated with misperceived fat intake were overconsumption of saturated fatty acids (OR=3.84; 1.18-12.56) and age (OR=1.06; 1.02-1.11), and with fruit and vegetable intake, income (OR=0.99; 0.98-0.99). Conclusion: The results reveal that perceived eating behavior and actual food intake diverge from anthropometric and health data, signaling the need of different intervention strategies to raise awareness in this group for the need of modifications.

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Single-Item vs Multiple-Item Measures of Stage of Change in Compliance with Prescribed Medications

Psychological Reports ◽

10.2466/pr0.94.1.115-124 ◽

2004 ◽

Vol 94 (1) ◽

pp. 115-124 ◽

Cited By ~ 10

Author(s):

Christopher L. Cook ◽

Matthew Perri

Keyword(s):

Health Behaviors ◽

Stages Of Change ◽

Transtheoretical Model ◽

Behavioral Change ◽

Stage Of Change ◽

Multiple Choice ◽

Single Item ◽

Multiple Item ◽

Change Measure

The Stage of Change construct from the Transtheoretical Model of behavioral change has been widely utilized in the assessment of various health behaviors. The majority of these tests measure the Stage of Change construct using the single-item, multiple-choice format. This study validated the use of a single-item measure in measuring readiness to comply with taking a prescribed medication. A sample of 161 subjects tested the multiple-item Stage of Change measure, then a refined multiple-item survey was tested with 59 subjects. With the latter survey, discriminating subjects at the differing stages of change dimensions was difficult. A correlation of .91 was found for stage classifications between ratings on the single-item and multiple-item scales. The use of the single-item measure seems reasonable when assessing stage of change in compliance with prescribed medication.

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A systematic review of the transtheoretical model of behaviour change and alcohol use

Psychologica ◽

10.14195/1647-8606_57-1_1 ◽

2014 ◽

Vol 57 (1) ◽

pp. 7-22

Author(s):

Flaviane Bevilaqua Felicíssimo ◽

Víviam Vargas Barros ◽

Sabrina Maura Pereira ◽

Natália Quintela Rocha ◽

Lélio Moura Lourenço

Keyword(s):

Systematic Review ◽

Alcohol Use ◽

Rhode Island ◽

Behaviour Change ◽

Stages Of Change ◽

Transtheoretical Model ◽

Readiness To Change ◽

Change Processes ◽

Processes Of Change ◽

Change Assessment

Introdução: O estudo sobre o álcool tem aumentado em todo o mundo devido ao seu impacto social e econômico, e as doenças relacionadas ao uso de álcool estarem entre os distúrbios mais comuns de abuso de substâncias. Desta forma, faz-se necessário investigar os métodos mais eficazes e adequados de tratamento para diferentes populações. Método: Este trabalho analisou a literatura científica sobre o Modelo Transteórico de Mudança de Comportamento relacionados ao consumo de álcool. Foram consultadas as bases de dados Scopus, PubMed, PsycINFO, PepsiCo e Lilacs, utilizando os descritores transtheoretical model, transtheoretical approach, stages of change, processes of change e cycle of change cruzado com o descritor alcoholism, no período de dez anos (2001 a 2011). Principais resultados: A maioria das pesquisas encontradas utilizavam métodos longitudinais e quantitativos, além de uma prevalência no uso dos questionários Readiness to Change Questionnaire e University of Rhode Island Change Assessment utilizados na mensuração do ModeloTransteórico. Os resultados indicaram que outras variáveis podem influenciar o comportamento do indivíduo em relação à sua fase de mudança de comportamento e identificou problemas relacionados ao uso de álcool em pacientes que procuravam tratamento para outras condições de saúde. Esta constatação reforça a necessidade de práticas de triagens para a prevenção dos agravos relacionados ao uso de álcool.Implicações: O modelo Transteórico é importante no processo de mudança de comportamento, uma vez que permite a identificação dos estágios e a escolha de intervenções mais adequadas ao estágio do paciente, além de evitar que esforços sejam feitos na direção contrária à necessidade do usuário. Conclusão: Ressalta-se a necessidade de mais estudos na área, especialmente em relação às práticas de profissionais de saúde.

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Validation of an Awareness and Preparedness on a Hearing Conservation Program Questionnaire: A Cross Sectional Study in Thailand

Journal of Health Science and Medical Research ◽

10.31584/jhsmr.2018.36.2.6 ◽

2018 ◽

Vol 36 (2) ◽

pp. 127

Author(s):

Kittisakdi Choomalee ◽

Supeecha Rungruang ◽

Chutarat Sathiraphanya ◽

Thitiworn Choosong

Keyword(s):

Stages Of Change ◽

Transtheoretical Model ◽

Role Model ◽

Health Belief ◽

Model Material ◽

Cronbach’S Alpha ◽

Cross Sectional ◽

Hearing Conservation ◽

Conservation Program ◽

Cronbach's Alpha

Objective: To validate a hearing conservation program (HCP) questionnaire based on the health belief model and stages of change model (or transtheoretical model).Material and Methods: The perception levels of 145 workers who voluntarily participated at 2 companies were determined using this HCP questionnaire from April 2014 to September 2015. Exploratory factor analysis was performed to justify the final questionnaire.Results: The final questionnaire had 24 items with 5 components: risk acceptance (8 items), perceived barriers (3 items), perceived benefits (5 items), role model (4 items), and the stages of change (4 items). Cronbach’s alpha coefficients of each component were 0.75, 0.64, 0.84, 0.85, 0.71, and the total Cronbach’s alpha coefficient of this questionnaire was 0.78. Workers in the factory who promoted continuous safety activities of HCP had a better score in all dimensions than those workers in the factory who did not.Conclusion: This questionnaire of 5 components was a well validated, predictable, and positive instrument for the HCP situation in manufacturing.

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Interrelationships of Health Related Behaviors among Young Adults

Californian Journal of Health Promotion ◽

10.32398/cjhp.v7isi.1996 ◽

2009 ◽

Vol 7 (SI) ◽

pp. 07-22

Author(s):

Erica R. Scioli ◽

Henry Biller ◽

Joseph Rossi ◽

Deborah Riebe ◽

Anthony Scioli

Keyword(s):

Stages Of Change ◽

Transtheoretical Model ◽

Smoking Status ◽

Adult Population ◽

Stage Of Change ◽

Smoking Behavior ◽

Psychology Students ◽

Internet Survey ◽

Smoking Behaviors ◽

Health Related

Obesity and smoking continue to be some of the nation’s top health concerns. This study explored the interrelationships among exercise, nutrition and smoking behaviors among young college adults. Undergraduate psychology students (N=612) completed an internet survey that included measures of exercise, nutrition and smoking behaviors. Analyses revealed that more males were exercising while more females were eating nutritiously. The Transtheoretical Model constructs stage of change for exercise and eating nutritiously were significantly related. There were no significant differences found for smoking behavior across the stages of change for exercise or nutrition. Health professionals and researchers should not assume that regular exercise is associated with a non-smoking status or that a non-smoking status is associated with consuming a more nutritious diet. Further research and intervention is strongly urged targeted towards both men and women among the young college adult population.

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Investigating Smoking Behavior in Iranian Smokers Based on Transtheoretical Model

Global Journal of Health Science ◽

10.5539/gjhs.v9n2p55 ◽

2016 ◽

Vol 9 (2) ◽

pp. 55 ◽

Cited By ~ 1

Author(s):

Morteza Mansourian ◽

Mostafa Qorbani ◽

Babak Rastgari Mehr ◽

Zahra Shafieyan ◽

Aziz Rezapoor ◽

...

Keyword(s):

Rhode Island ◽

Level Set ◽

Transtheoretical Model ◽

Effect Size ◽

Smoking Behavior ◽

Higher Order ◽

Large Effect Size ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Alpha Level

BACKGROUND: Smoking causes more than 4 million deaths annually in the globe. This study aimed to understand the behavior of smoking in smokers, Ilam, Iran according to the Transtheoretical model.METHODS: In a cross-sectional survey, 400 smokers and ex-smokers who were enrolled via convenient sampling in 2015 completed a questionnaire based on TTM variables according to Rhode Island University. Gathered data were analyzed using SPSS 18.Alpha level set at 0.05.RESULTS: According to multiple analyses of variance with the standardized effect size, smoking temptation revealed large effect size (0.14).In General, two higher order processes of changes, cognitive and behavioral processes had significant effect size with 0.17 and 0.13, respectively. Conversely, other Most TTM variables showed low effect size.CONCLUSIONS: This study showed that except smoking temptation other TTM constructs demonstrated low effect size in Iranian smokers. The findings of the current study are inconsistent with TTM nature.

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0476 Readiness and Stages of Change in a Behavioral Sleep Medicine Clinical Sample: From Pre-Contemplation to Struggling to Maintain Change

SLEEP ◽

10.1093/sleep/zsaa056.473 ◽

2020 ◽

Vol 43 (Supplement_1) ◽

pp. A182-A183

Author(s):

G Amatrudo ◽

K Puzino ◽

E Bourchtein ◽

S L Calhoun ◽

J Fernandez-Mendoza

Keyword(s):

Rhode Island ◽

Stages Of Change ◽

Transtheoretical Model ◽

Behavioral Treatment ◽

Readiness To Change ◽

Clinical Sample ◽

Significant Proportion ◽

Sleep Medicine ◽

Treatment Center ◽

Penn State

Abstract Introduction Stages of change in the transtheoretical model are used to assess a patient’s readiness to change, which may help providers tailor behavioral treatment (BT). As research has focused on substance abuse, there is a significant lack of data in individuals presenting for behavioral sleep medicine (BSM) treatment. Methods 146 consecutive patients (46.1±16.0 years, 61.6% female, 19.9% minority) who were evaluated at the BSM program of Penn State Hershey Sleep Research & Treatment Center completed the University of Rhode Island Change Assessment Scale (URICA) assessing readiness to change (RtC) and pre-contemplation (P), contemplation (C), preparation/action (A) and struggling to maintain (M) stages of change. Subjects also completed the Insomnia Treatment Acceptability Scale (ITAS) and Dysfunctional Beliefs and Attitudes about Sleep Scale (DBAS). Results The average RtC score was 9.4, with 21.9% of the sample in stage P, 56.2% in C and 21.9% in A. The average P (53.2±7.6), C (49.1±10.1), A (48.8±12.3) and M (37.7±9.1) scores suggested an overall “contemplation cluster profile”. Higher RtC (r=0.37), C (r=0.31) and A (r=0.24) scores were associated with greater acceptability of BT, while higher P scores were associated with lower acceptability of BT (r=-0.22). In contrast, higher M scores were associated with greater acceptability of pharmacological treatment (r=0.21) as well as higher DBAS scores, including sleep medication expectations (r=0.23). Conclusion Patients attending a BSM program typically present at a contemplation stage, which indicates intention to start changing sleep behaviors within the next few months with some ambivalence in regards to pros/cons of such change. A significant proportion of patients struggle to maintain change and present with higher acceptability for pharmacological interventions, which may hinder the effectiveness of BT and may require specific therapeutic approaches. Support Department of Psychiatry, Penn State College of Medicine

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Perception versus intake of fruit and vegetables

Revista de Nutrição ◽

10.1590/1678-98652018000200008 ◽

2018 ◽

Vol 31 (2) ◽

pp. 221-233 ◽

Cited By ~ 2

Author(s):

Maria Cecília Ramos de CARVALHO ◽

Mariana Carvalho de MENEZES ◽

Aline Cristine Souza LOPES

Keyword(s):

Stages Of Change ◽

Transtheoretical Model ◽

Vegetable Intake ◽

Multinomial Logistic Regression ◽

Cross Sectional Study ◽

Fruit And Vegetables ◽

Nutrition Interventions ◽

Cross Sectional ◽

Weight Satisfaction ◽

Belo Horizonte

ABSTRACT Objective To compare perception and intake of fruit and vegetables, and to identify the factors associated with misperception of intake. Methods Cross-sectional study with 3,414 participants of the Health Academy Program from Belo Horizonte (MG), Brazil. Stages of change from Transtheoretical Model were used to evaluate perception of intake, and questions adapted from national surveys were used to assess intake of fruit and vegetables as separate groups. Individuals whose intake and perception were discordant were reclassified in pseudo-maintenance (wrongly believe their intake is adequate) or non-reflective action (wrongly believe their intake is inadequate). Results Insufficient intake of fruit and vegetables and misperception of intake were observed. Pseudo-maintenance was more prevalent, given that 45.1% of individuals were reclassified in this stage regarding their vegetable intake and 22.9% regarding fruit. According to multinomial logistic regression, pseudo-maintenance of fruit intake was associated with sex, schooling, food and nutrition security, weight satisfaction, and participation in nutrition interventions; pseudo-maintenance of vegetable intake was associated with schooling and weight satisfaction. Non-reflective action was associated with age. Conclusion An important discordance between perception and intake was found, with emphasis on pseudo-maintenance of vegetable intake. Misperception was associated with different factors regarding fruit and vegetables, including sociodemographic variables, participation in nutrition interventions, and weight satisfaction. These results can contribute to the design of interventions aligned with eating behavior, aimed to empower individuals for their food choices.

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Determinants of Forward Stage Transition from Precontemplation and Contemplation for Fruit Consumption

American Journal of Health Promotion ◽

10.4278/0890-1171-19.4.278 ◽

2005 ◽

Vol 19 (4) ◽

pp. 278-285 ◽

Cited By ~ 26

Author(s):

Emely de Vet ◽

Jascha de Nooijer ◽

Nanne K. de Vries ◽

Johannes Brug

Keyword(s):

Transtheoretical Model ◽

Self Efficacy ◽

Response Rate ◽

Early Stage ◽

Stage Of Change ◽

Decisional Balance ◽

Fruit Intake ◽

Sampling Frame ◽

Cross Sectional ◽

Stage Transition

Purpose. To examine associations between decisional balance, self-efficacy, fruit intake, and stage of change transition from precontemplation and contemplation with cross-sectional and longitudinal methods. Design. A longitudinal cohort study with the use of electronic questionnaires was conducted. Three measurements were analyzed cross-sectionally, and the two intervals between the measurements were analyzed longitudinally. Setting. A random sample of 1500 individuals from an existing Dutch Internet panel resulted in a cohort of 735 individuals. Of the cohort, 648 (response rate 88%), 592 (response rate 81%), and 570 (response rate 78%) respondents completed questionnaires at the start of the present study (T1), 53 days after T1 (T2), and 106 days after T1 (T3), respectively. Subjects. Mean age was 37.5 years, 51% were women, and 57% ate less than the recommended intake of 250 g of fruit per day. Measures. Questionnaires included items measuring stage of change, factors favoring (pros) or working against (cons) behavior change, and self-efficacy. A food frequency questionnaire was used to assess fruit intake. Results. Logistic regression analyses showed that pros, fruit intake, and self-efficacy predicted forward stage transition from precontemplation. Self-efficacy predicted forward stage transition from contemplation. Cons did not predict stage transitions. Results from longitudinal analyses were similar to cross-sectional results, except for self-efficacy: no differences between early stages in self-efficacy were found, whereas self-efficacy predicted these early stage transitions. Conclusions. Within the limitations posed by the sampling frame, results provided support for the Transtheoretical Model, although determinants might not always be stage specific.

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