Transtheoretical Model, Case Study Example

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Case Study

DESCRIPTION OF PROBLEM

A sedentary lifestyle is a problem. A person living a sedentary lifestyle is more exposed to chronic diseases than those living an active lifestyle (U.S. Department of Health and Human Services, 2003; Messerli et al., 2007).

A sedentary lifestyle is a problem not only the lifestyle of a few people. It is the dominant lifestyle of a large number of people in the corporate world. These people are working day in and day out behind a desk. All they do all day; they do with personal computers and other gadgets.  The result is that people are too tired to their schedule too tight to engage in some form of physical exercises. In addition to this, the people are so tired that they think that engaging in unhealthy decadent lifestyle is a form of reward for their hard work. However, it is a common knowledge that the consequences of such a lifestyle will appear in the long run. Take the case of hypertension as an example. People living a sedentary lifestyle is more exposed to risk of hypertension than people who are not. Diagnosing and treating hypertensive patients are still subjects of discussion (Bersamin et al., 2009; Hyman & Pavlik, 2001). Another important thing is that it can somehow be prevented. This is through engaging in physical activities that can in turn then help lower blood pressure (Hajjar & Kotchen, 2003).

One of the main aims in this intervention program is to make the client engage in regular exercises. The traditional notion, a regular exercise is at least 20 minutes of continuous physical activity that a person does at least three times a week (Rodgers et al., 2001). This is how the term “regular exercise” is used in the intervention program and in this paper.

DESIRED BEHAVIOR

The ultimate goal of the intervention program is to make the client’s lifestyle healthier. Lifestyle covers a wide range of things. This includes everything that a person does daily, from the time one wakes up, the food one eats, to the time one sleeps.

There are three central goals to influence the client’s lifestyle (i.e., to make it healthier). These are to encourage the client to perform routine physical exercises. In relation to this, the intervention aims to teach him how to make this a lifestyle rather than a chore. Another goal is to discover the difficulties which prevent him from engaging in such behavior.

The intervention aims to encourage the client to perform routine physical exercises for good reasons. The first reason is that the client needs this because of the high risk of developing diseases due to his sedentary lifestyle. Researches show that people who lead sedentary lifestyles are exposed to high risk of chronic diseases (U.S. Department of Health and Human Services, 2003). There are also reasons why the intervention aims to teach him to make the programs a lifestyle rather than a chore. Making it a habit is more effective than seeing it as a chore because of the associated ideas that are attached to the term “chore”. If the client sees it as a chore, it is most likely that he will treat it as a task. In this case, the client might be de-motivated by thinking that his job is a heavy task itself, and he does not need any more tasks; he’d rather rest than accomplish another “task” (i.e., exercising). The reason for identifying the difficulties preventing him from engaging in such behavior is that these difficulties are the target of the intervention program.

DESCRIPTION OF THE CLIENT

The client is a 25-year old male. He moved to Miami where he plans to pursue a career. His name is Rashid and is currently taking a master’s degree. He is the stereotypical picture of a young man who is optimistic of a future full of promises and is ready to chase after the opportunities up for grabs. His focus on personal and professional development will play a critical role in pursuing the desired changes that the intervention program aims at.

The client has a BMI of 28.1. His BMI falls within the range of what is considered by as overweight. This means that he needs to make adjustments in his routine to achieve normal weight. In other words, making some changes in his daily routine is the key if he wants to lead a healthy lifestyle.

He is living a sedentary lifestyle. He doesn’t engage in any regular exercises. This is because he spends most of his time behind a desk, doing his paperwork. Since he moved to Miami, he considered many times to join a health club. This shows that he has the will to lead an active and healthy lifestyle. One can imply from this that he is aware that his current and sedentary lifestyle is not doing him any favor in the health department.

However, it appears that although he has plans to engage in healthy activities, there is one thing that keeps him from doing so. He lacks motivation. Motivation is crucial because motivation is the force that is supposed to drive the client to change his lifestyle. Therefore, the intervention aims to provide or assist the client in developing enough motivation for him to lead a healthier lifestyle. This means that the intervention program aims to influence the behavior of the client.

METHOD OF APPROACH

The Framework

The intervention program utilizes the transtheoretical model of intentional behavioral change. This model was introduced in the 80s to help in smoking cessation (Prochaska & DiClemente, 1984). The transtheoretical model is applied in attempts to reduce people’s consumption of cigarettes (Spencer et al., 2002), and unhealthy food and beverages (Snelling and Adams as cited in Spencer et al., 2006). The advantage of using this model is that the model/framework can be “personalized” in order to make it as suitable as possible for the person that will undergo a change process. The effectiveness of using the model to promote physical activities is also widely practiced (Adams & White, 2002).

This model prescribes five major stages. These are (1) pre-contemplation, (2) contemplation, (3) preparation, (4) action, and (5) maintenance. The process of change occurs in two modes: cognitive/experiential and behavioral modes. Also, the change happens in a context. A change can happen in current life situation, beliefs and attitudes, etc. The markers of change are decisional balance, and self-efficacy/temptations.

Before proceeding, one can notice that the healthy diet is also discussed although it is not described as one of the main goals of the intervention program. This is because adopting a healthy diet should always come with regularly exercising to maximize the effects.

Application

In the pre-contemplation change, the client is not seriously considering to change his lifestyle. He may have plans to join the health club, but it seems like he is not taking it seriously. As mentioned, he lacks the motivation to push him to join the club. Providing the client with enough motivation involves raising the client’s awareness of the consequences if he will not pursue the desired changes. In other words, it is during the contemplation change that the drivers of change are introduced to the client’s consciousness. This involves influencing the cognitive and behavioral aspects of the client through introducing personal concerns and environmental pressure. Personal concerns include the health risks the client is exposed to. Environmental pressures include the rather superficial fact that society treats people who are “physically fit” and look it better than those who are not. Personal concerns and environmental pressures overlap in this manner; this is in the sense that such environmental pressure affects the personal concern in terms of how the former affect the self-esteem. The client was able to recognize the health risks of continuing his current lifestyle. However, he shows this attitude of not caring much about what other people’s opinion (the environmental pressures).

This is worked out through appealing to the client’s values, aspirations, and expectations regarding his own life. The client, being a 25 year-old, is full hope towards creating his future where he will be personally and professionally satisfied. The situation is then assessed within the context of the workplace. It is then suggested that the changes is good for the client’s personal and professional development. The reasoning is that a healthier lifestyle will make the client be more productive in the workplace and thereby increases the chance of his superiors to notice his improved performance. He will be more productive because an active and healthy lifestyle means more energy to do physical and mental tasks. The client will be physically fit to perform and handle the pressures of the workplace. The client will also be mentally healthy to assess situation better than before and hence respond to these situations appropriately.

In the contemplation stage, the client starts thinking seriously about the desired changes in his lifestyle. During this stage, the client was provided with good reasons why he should start taking his health seriously through making his life more active. By more active, this means engaging in physical exercises. Note that, at this stage, the client is already aware of the consequences of continuing the lifestyle he currently has. However, the motivation is not enough. This is because the client still lacks the confidence to do so. The contemplation stage is all about convincing the client that “he can” make the change, or that he has all the capacity to do so. To fuel this drive, the client assesses his current lifestyle and the potential for change within a risk-reward analysis. This creates a decisional balance. In the client’s case, the pros were developing better immunity against chronic disease, better sleeping pattern, and better physical and mental health condition. All of this contributes to improving the overall performance of the client in his workplace. The cons were low immunity resistance to chronic illness, easily being exhausted, negative effect of workplace pressures to his health. At the end of this stage, the client was able to make the decision to pursue the change. The high value the client puts to personal and professional development is the decisive force that pushes him to participate in achieving the desired changes; the client is ready to prepare for the change.

PROGRESSION THROUGH TWO WEEKS

First Week

The first week was quite difficult. However, this is naturally so because what the intervention ultimately aims at is influencing a habit. The client’s habits are something that he has been practicing for a long period of time. This means that it is already deeply rooted in his life that it is hard to bend it. The following are the activities done during the first week:

  • Day 1 – The idea [the intervention program] is introduced to the client
  • Day 2 – Still on the convincing process…
  • Day 3 – Casual talk with the client about the pros and cons of regular exercises
  • Day 4 – Took the client to observe an activity by health club members
  • Day 5 – Skipped talking about the program to avoid giving off the impression that I am nagging about it
  • Day 6 and 7 – I went to the gym and casually asked the client to join… he said no.

The first week is difficult. This is because the client appears indifferent to the main goals of the intervention program. When the program is introduced to him, he appears to be not into those kinds of things. This is because he does not see the relevance of it with regards to how he lives and values his time. However, upon seeing the activities in the gym, it is noticeable that the client was amused of the activities. This is a positive sign that his interest over physical exercises increased. But the client still lacked motivation. This is evident from his refusal to come with me to the gym.

Second Week

During the second week, the goal is to give the client enough good reasons for him to join the health club. The following are the activities done in the second week of the program:

  • Day 1 – casual talk with the client about the pros and cons of regular exercising
  • Day 2 – did not broach the topic [i.e. the intervention program]
  • Day 3 – client still refused to join the health club
  • Day 4 – no progress
  • Day 5 – second casual discussion of the pros and cons
  • Day 6 and 7 – client realized that there are more pros than cons

In the first few days of the week, client is still indifferent toward the idea. This is why there is no progress until the 6th and 7th day. He eventually realized the advantages and disadvantages of regularly exercising. He also finds more advantages than disadvantages. This is a good progress since it gives him more reason to join the health club.

CRITIQUE OF THE EXPERIENCE

Overall, the experiment is going well because of how the model of change is appropriate for the kind of change that the client needs. The client also plays a decisive role in the experiment. The client himself can be a force that can resist the change. During the first couple of weeks, it is very hard to convince the client. This is because he lacks good reasons to do so. He also lacks motivation. These are worked out in the days that followed.

The client was eventually able to see into himself and changed the forces within his own self that will make him resist the change. The client changed his perspective on a healthy lifestyle, which in turn made him reconsider his view of adopting a healthy lifestyle. The experience will most likely go well because the client is cooperative enough to make it happen. The desired change also, hopefully, is achieved because of the model used: the transtheoretical model. As mentioned, the advantage of using the model is that the model can be tailor-fitted for specific purposes.

What the experience tells is that, first, change is possible. All it takes is the cooperation of the client. The client shows cooperation and enough willingness for the change. At first, the client finds the change process quite challenging. Then again, all change process is a challenge. The client is my roommate, and I am familiar with the health club conveniently located in our building. I asked him to join me every time I went to work out. At first, he came with me at least three times per week, after which he became less and less compliant, until we finally reached an agreement: Every time he joins me at the gym, I will wash the dishes. This is something that is not mentioned in the previous sections, but this means something important.

The agreement in the previous paragraph is important in a broader implication of pursuing a change. It has a factor of sacrifice. This means that the people who are sincere at making a change for the good sometimes needs to make sacrifices. In the experiment, the sacrifice is through doing something the other person a favor in exchange of cooperating. In other words, people will most likely cooperate if the instigator of change is willing to do others a favor as an exchange. This has implication for organizations that promote pro-health changes or any kind of changes for that matter. The question that an organization can ask is, “what kind of favors can the organization do to make people cooperate with the change process?” This favor is doing something that the other people needs to do but sort of hate doing. In the case of this experiment, it’s dishwashing. Organizations can then identify the things that other people have to do and then determine if the organization has the capacity to do those things for them.

One more important thing that the experience tells is on how change can be efficiently implemented. This is through associating the change to the things that an individual upholds to a high degree. In the case of the client, this is his high regard to personal and professional development. Personal and professional development is the ends, but the means to reach this ends is not yet clear. The change process influences the means of how such an end can be achieved. This is through promoting physical activities for the client. The experiment was able to convince the client that pursuing the change can be beneficial for achieving personal and professional development.

VII. ADENDUM AND FOLLOW-UP ASSESSMENT

During the follow-up assessment, the client is already in the action stage. Before the client proceeds to the action stage, the client went through the preparation stage. During the preparation stage, the client commits to the change and develops a course of action to fulfill the desired changes. The plan is through joining the health club. The plan should be acceptable, accessible, and effective. It should be acceptable in such a way that joining the health club will not intervene in the client’s job. It should be accessible in terms of the proximity of attending the health club’s activities to where the client lives and works. It should be effective in terms of appropriateness of the health club’s program to help the client achieve the desired change. Joining the health club is acceptable because it does not have strict schedules of meetings with the members; this means that it will not be an obstacle to whatever path the client is taking to “chase his dreams”. Joining the health club is accessible in because it is conveniently located in the building the client lives in. It is also effective because the club is guided or advised by people expert in the field of maintaining a healthy lifestyle. They also have the facilities that the client can use for regular exercising. The client is then provided with good reasons (pros) that outnumber the bad reasons (cons) of committing and participating to the plan. The client is ready to realize the change through acting on the plan.

In the action stage, the client implements the plan and takes the course of action to change his current lifestyle and to make way for pro-health activities. The strategy for change is joining the health club that will provide the guidelines and facilities to create the changes. The client enlists as a member of the health club and began exercising, eating healthy diets, etc. It is important to revise the plan when needed. The client should not be deprived of the rather unhealthy food that he likes to eat. Therefore, cheat days are scheduled where the client can indulge in just lounge around, indulge in fatty food, high-calorie beverages (e.g. beer) and the likes. It is also important to sustain the commitment in the face of difficulties. The difficulties include the anticipation of immediate results of joining the health club. The commitment can be sustained through reminding the client that the noticeable results of leading a healthy lifestyle will take a considerable length of time to appear. However, it is all worth the effort because of the long-term effects of a healthy lifetime in the client’s pursuit for personal and professional development. The client was able to act according to the plan establish the desired changes in his lifestyle. He started performing routine physical exercises. He also started to treat the activities as part of his lifestyle, and not a chore. In addition to this, the client discovered the difficulties which prevent him from engaging in such behavior. These difficulties include his way of viewing a healthy lifestyle. He used to view regular exercises, avoidance of unhealthy food and lifestyle as obstacles to the kind of lifestyle that “young, and wild, and free” individuals like him should make the most of. The client was able to change this view and realized that he can still enjoy the perks of being “young and restless” while leading a healthy lifestyle. This change in perspective influenced the client’s behavior. This, in turn, affected the way he lives his life. The new lifestyle the client was able to adopt needs to be sustained for a long period of time. This is for the client to reap the long-term benefits.

In the maintenance stage, the lifestyle will be sustained through avoiding possibilities of relapse to the previous lifestyle of the client. At this stage, the client will be motivated through complimenting his efforts for doing regular exercises. This will also be done through encouraging him that, once he gets the hang of it, the client would be more than capable to do all that it takes to pursue the changes. This is because once leading a healthier lifestyle is integrated to his life, being healthy will become a normal thing to do. This means that being healthy will be the “normal” thing to do, and indulging in unhealthy lifestyle will be such a stressful thing to do.

In sum, it is fair to say that the experiment is a success. The transtheoretical model was adequately used to achieve the objective of the experiment. It is adequately used in terms of tailor-fitting the framework to suit the situation. The client lacked motivation. This motivation is heightened in pre-contemplation and contemplation stages. In the pre-contemplation stage, personal concerns and environmental pressures are used to drive the desired change. The contemplation stage, a decisional balance is struck. This serves as the final push to the client, for him cooperate. Striking a decisional balance continues in the preparation stage where the commitment of the client to pursue the change. Cognitive experiential processes are active in this stage. These processes are active in terms of heightening the awareness of the client in the need for the change, and the client’s capability, actively, to realize such changes. Self-efficacy plays an important role in action and maintenance stages. This is in terms of sustaining the belief of the participant, voluntarily, to embrace the change. Behavioral processes are also at work during this stage. Through developing a positive behavior towards the desired changes, the change in behavior will reflect on the actions of an individual (Harper, 2008).

There will always be a possibility of relapse to the old lifestyle. As they say, habit is something that is hard to break. In the follow-up assessment, the client was able to continue what he has begun. The change of diet to a healthier than before is the client’s own initiative and not included in the original plan. However, he has continued to eat a balanced meal. He also became used to the schedule of going to the gym right after work to “wind down”. It seems like physical exercise became his way of relaxing instead of engaging in booze fest. The client, however, said that he skips the gym whenever he feels that he is too tired from the work place. This is also good because he is beginning to recognize the limits of his body. The client is showing a positive attitude. He is, slowly but surely, treating regular exercises in the gym a natural part of his routine. In other words, it is so far so good.

References

Adams, J. & White, M., 2002. Are activity promotion interventions based on the transtheoretical model effective? A critical review. British Journal of Sports Medicine, 37, pp.106-14.

Bersamin, A., Stafford, R. & Winkleby, M., 2009. Predictors of Hypertension Awareness, Treatment, and Control Among Mexican American Women and Men. J Gen Intern Med, 23(3), pp.521-27.

Hajjar, I. & Kotchen, T., 2003. Trends in Prevalence, Awareness, Treatment, and Control of Hypertension in the United States, 1988-2000. JAMA, 290(2), pp.199-206.

Harper, C., 2008. Environment and society: human perspectives on environmental issues. 4th ed. New Jersey: Pearson Prentice Hall.

Hyman, D. & Pavlik, V., 2001. Characteristics of patients with uncontrolled hypertension in the United States. The New England Journal of Medicine, 345(7), pp.479-86.

Messerli, F., Williams, B. & Ritz, E., 2007. Essential Hypertension. The Lancet, 370(9587), pp.591-603.

Prochaska, J.O. & DiClemente, C.C., 1984. Self-change processes, self-efficacy and decisional balance across five stages of smoking cessation. Advances in Cancer Control: Epidemiological Research, pp.131-40.

Rodgers, W.M., Courneya, K.S. & Bayduza, A.L., 2001. Utility of the transtheoretical model for understanding lifestyle versus tra. Avante, 7(3), pp.28-40.

Spencer, L. et al., 2006. Applyng the transtheoretical model to exercise: A systematic and comprehensive review of the literature. Health Promotion Practice, 7(4), pp.428-43.

Spencer, L.S., Pagell, F., Hallion, M.E. & Adams, T.B., 2002. Applying the transtheoretical model to tobacco cessation: A review of literature. American Journal of Health Promotion, 17(1), pp.7-71.

S. Department of Health and Human Services, 2003. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. NIH Publication.

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