Transtheoretical Model: A Quantitative Study
Smoking is a major modifiable risk factor for diseases and premature death, and can be prevented with health promotion and disease prevention strategies. This paper will focus on the clinical issue regarding tobacco use among the female adolescent population. Since female adolescents are at the beginning stage of their reproductive years, introduction of smoking cessation early will help alleviate foreseeable health problems. The purpose of this paper is to examine how the application of the Transtheoretical model (TTM) will increase the utilization of Internet based smoking cessation intervention among the female adolescent smokers. Four research studies utilizing the TTM core constructs were reviewed for effectiveness and applicability to the clinical problem regarding tobacco use. Two of the studies were specific to the female adolescent population, while the other two included the male and female population. After reviewing the four studies, the TTM was identified as a useful tool that can guide the advanced practice nurse (APN) in implementing intervention strategies, such as Internet based smoking cessation, based on the person’s level of readiness. Keywords: Transtheoretical,
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smoking cessation, adolescent
The 2014 National Youth Tobacco Survey estimated over 13 million tobacco users in high school and close to 2.9 million tobacco users in middle school (Arrazola, 2015).
All forms of tobacco, such as electronic cigarettes, hookah, cigarettes, cigars, smokeless tobacco, snus, pipes, bidis, and dissolvable tobacco were included in the survey. According to Centers for Disease Control and Prevention (CDC, 2015), “If smoking continues at the current rate among youth in this country, 5.6 million of today’s Americans younger than 18 will die early from a smoking-related illness” (Discussion section, para. 3). This paper will focus on the application of a non-nursing theory, the Transtheoretical Model of Health Behavior Change (TTM), to affect change specifically in smoking adolescent
females.
Transtheoretical Model of Health Behavior Change TTM derived its concepts from various “psychotherapy and behavior change” theories such as the Freudian, Skinnerian and Rogerian traditions, the Janis and Mann’s model, and Bandura’s self-efficacy theory (Prochaska & Velicer, 1997, p. 38). TTM core constructs include the six stages of change, processes of change, decisional balance, self-efficacy and temptation. The stage construct represents a time-based element that involves progression of behavior change through six stages. Precontemplation is the stage wherein people do not have plans of taking action in the next 6 months. In this change, the people may be unwilling or have no motivation to participate in any health promotion programs. Contemplation is the stage wherein people have intentions of changing in the next 6 months (Prochaska & Velicer, 1997). In this stage, people may be aware of the pros and cons of changing but are still indecisive and are not ready to make that move. Preparation is the stage wherein people expect to act in the next month. In this stage, people have a definite plan such as seeking a counselor or conferring with their doctor. People in this stage are the ones that should be offered to participate in “action-oriented programs” such as smoking cessation (Prochaska & Velicer, 1997, p. 39). Action is the stage wherein people have made lifestyle changes within the last 6 months. In smoking cessation, action is measured by the decrease in the number of cigarettes smoked, or changing to low nicotine cigarettes (Prochaska & Velicer, 1997). Maintenance is the stage wherein people stay focused on continuous abstinence and prevention from relapse. This stage lasts from 6 months to 5 years (Prochaska & Velicer, 1997). The author explained that relapse was a “form of regression” to a former stage and was not considered a separate stage (Prochaska & Velicer, 1997, p. 39). Termination is the final stage wherein the people have achieved 100% self-efficacy and zero temptations even during difficult or stressful situations (Prochaska & Velicer, 1997). “Processes of change are the covert and overt activities that people use to progress through the stages” (Prochaska & Velicer, 1997, p. 39). Decisional balance pertains to the person’s evaluation of the pros and cons of changing behavior. Self-efficacy is the state wherein the people have the confidence to cope without relapsing to their previous habit. Finally, temptation refers to the power of urges to go back to the old habit when faced with difficult situations. By identifying the person’s stage of change and utilizing the TTM core constructs, the APN can modify interventions based on the person’s level of readiness and thereby achieve better patient outcomes.
smoking cessation, adolescent
The 2014 National Youth Tobacco Survey estimated over 13 million tobacco users in high school and close to 2.9 million tobacco users in middle school (Arrazola, 2015).
All forms of tobacco, such as electronic cigarettes, hookah, cigarettes, cigars, smokeless tobacco, snus, pipes, bidis, and dissolvable tobacco were included in the survey. According to Centers for Disease Control and Prevention (CDC, 2015), “If smoking continues at the current rate among youth in this country, 5.6 million of today’s Americans younger than 18 will die early from a smoking-related illness” (Discussion section, para. 3). This paper will focus on the application of a non-nursing theory, the Transtheoretical Model of Health Behavior Change (TTM), to affect change specifically in smoking adolescent
females.
Transtheoretical Model of Health Behavior Change TTM derived its concepts from various “psychotherapy and behavior change” theories such as the Freudian, Skinnerian and Rogerian traditions, the Janis and Mann’s model, and Bandura’s self-efficacy theory (Prochaska & Velicer, 1997, p. 38). TTM core constructs include the six stages of change, processes of change, decisional balance, self-efficacy and temptation. The stage construct represents a time-based element that involves progression of behavior change through six stages. Precontemplation is the stage wherein people do not have plans of taking action in the next 6 months. In this change, the people may be unwilling or have no motivation to participate in any health promotion programs. Contemplation is the stage wherein people have intentions of changing in the next 6 months (Prochaska & Velicer, 1997). In this stage, people may be aware of the pros and cons of changing but are still indecisive and are not ready to make that move. Preparation is the stage wherein people expect to act in the next month. In this stage, people have a definite plan such as seeking a counselor or conferring with their doctor. People in this stage are the ones that should be offered to participate in “action-oriented programs” such as smoking cessation (Prochaska & Velicer, 1997, p. 39). Action is the stage wherein people have made lifestyle changes within the last 6 months. In smoking cessation, action is measured by the decrease in the number of cigarettes smoked, or changing to low nicotine cigarettes (Prochaska & Velicer, 1997). Maintenance is the stage wherein people stay focused on continuous abstinence and prevention from relapse. This stage lasts from 6 months to 5 years (Prochaska & Velicer, 1997). The author explained that relapse was a “form of regression” to a former stage and was not considered a separate stage (Prochaska & Velicer, 1997, p. 39). Termination is the final stage wherein the people have achieved 100% self-efficacy and zero temptations even during difficult or stressful situations (Prochaska & Velicer, 1997). “Processes of change are the covert and overt activities that people use to progress through the stages” (Prochaska & Velicer, 1997, p. 39). Decisional balance pertains to the person’s evaluation of the pros and cons of changing behavior. Self-efficacy is the state wherein the people have the confidence to cope without relapsing to their previous habit. Finally, temptation refers to the power of urges to go back to the old habit when faced with difficult situations. By identifying the person’s stage of change and utilizing the TTM core constructs, the APN can modify interventions based on the person’s level of readiness and thereby achieve better patient outcomes.