5. Transtheoretical model and Health Action Process Approach Flashcards
what do TTM and HAPA stand for?
TTM by who? in what year?
TTM = transtheoretical model
- by prochaska & diclemente, 1983
HAPA: Health action process approach
describe the stage model of TTM
- PRECONTEMPLATION:
- no intention of willingness to act or engage in behaviour - CONTEMPLATION
- having some intention or willingness to act or engage in a behaviour soon
- still ambivalent to change
- have not started or engaged in intended behaviour
- ie: am i gonna start exercising? - PREPARATION
- taken small steps towards acting or engaging in a behaviour
- ready to take action in next 30 days
- ie look for gyms around your house, plan running routes - ACTION
- engaging in intended behaviour
- engaged in it for less than 6 months
- still a volatile stage (can easily regress back) - MAINTENANCE
- engaged in intended behaviour for more than 6 months <3
from 1 to 5 –> progress
from 5 to 1 –> relapse!
*can fast track through stages or regress
TTM includes stages of change and what else?
processes of change! describes how people progress through the stages!
stage movement involves changing
- how people think about exercise
- how people think about themselves
- environmental influences on exercise behaviour
a) 5 experimental processes:
- increase people’s awareness to change thoughts and feelings about themselves and PA
- typically in earlier stages (precont, cont, and prep)
b) 5 behavioural processes:
- behaviours that person undertakes in order to change aspects of the environment that may affect exercise participation
- typically in later stages (prep, action and maintenance
name the 5 experimental processes of change and the 5 behavioural processes of change
EXPERIMENTAL PROCESSES
a) consciousness raising!!!!!!
- seeking new info and better understanding of exercise
b) self-reevaluation:
- assessing how one thinks and feels about oneself as an inactive person
c) environmental reevaluation!!!!!!!
- considering how inactivity affects physical and social environment –> impact of inactivity on your life? impact of PA on climate change
d) dramatic relief:
- expressing feelings about becomes more active or remaining inactive through exercise
e) social liberation:
- increasing awareness of social and environmental factors that support PA
BEHAVIOURAL PROCESSES
a) self-liberation:
- engaging in activities that strengthen one’s commitment to change and the belief that one can change
b) counter-conditioning!!!!!!!
- substituting sedentary activities by physical activities
c) stimulus control:
- controlling situations and cues that trigger inactivity and skipped workouts
d) reinforcement management:
- rewarding oneself for being active
e) helping relationships!!!!!!
- using support from others during attempts to change –> in your social surroundings
apart from stages of change and processes of change, what are 3 other constructs in TTM?
- self-efficacy! –> more confident in your ability to engage in PA
- temptations –> important construct but rarely studied!
increase in self efficacy + decrease in temptation (to skip exercise) as you progress through each stage
- decisional balance: shift in pros over cons as per people move stages
a) precontemplation: high levels of cons, low number of pros
b) contemplation: cons stay same but pros increase a lot! –> equal pros and cons = ambivalence
c) preparation: pros increase a bit, cons decrease a bit –> a bit more pros than cons –> volatile situation
d) action: decrease in cons, pros stay high
e) maintenance: even more decrease in cons, pros stay same
what are limitations of TTM (2)?
- how is if useful?
- where should we go next?
LIMITATIONS:
- arbitrary lines are drawn in time (for each stage)
- previous reviews; support for TTM in PA is weak!
USEFULNESS: intuitive framework that seems practical –> provides a tool where you can place people in boxes
NEXT?
- more complex picture of motivation –> seems like stages are just “no motivation” –> low mot –> some mot …
- not to limit and put people in boxes, especially based on time
Meta-analysis of TTM:
- what are the 5 constructs
- what where the results on PA when low number of theoretical constructs used (1-2) vs high (3-5)?
- problem with past TTM interventions? (2)
- stage-matched interventions
- selected by stage interventions
- decisional balance
- temptation (only 3/33 included it…)
- self-efficacy
- process of change
- low: 0.16 –> small effect
- high: 0.49 –> medium effect size!
- not truly grounded in TTM -
- only used stages of changes and not the other theoretical constructs!
*not that TTM is not good, but researchers didn’t use it correctly
what is the HAPA stage model? describe
health action process approach
NON-INTENDERS
- little motivation or intention to adopt a behaviour (ie precont)
INTENDERS
- willing to start and/or have tried to adopt (cont/prep)
ACTORS
- are engaging in the behaviour
- no time domain
HAPA:
- at least 2 processes in behaviour change –> describe
- identifies critical factors to address what?
- motivational –> ends with intention
- volitional –> ends with successful performance (increase in PA behaviour)
- address the intention-behaviour gap!
describe the schéma that explains HAPA
NON-INTENDERS:
- focus on action self-efficacy + outcome expectancies + risk perception
*these 3 lead to A)intention!
*action self-efficacy also leads to B)maintenance self efficacy
- A) and B) leads to action and coping planning!
INTENDERS:
- focus on intention, maintenance self-efficacy and action/coping planning
*maintenance self-efficacy leads to recovery self efficacy
*maintenance SE and action/coping planning lead to ACTION/PA (where there’s a loop between initiative, maintenance and recovery)
ACTORS:
- focus on recovery self-efficacy
DEFINE the main constructs of HAPA
ACTION SE
RISK PERCEPTION
OUTCOME EXPECTATIONS
MAINTENANCE SE
ACTION PLANNING
COPING PLANNING
RECOVERY SE
ACTION SE:
- belief in capability to perform a new behaviour
RISK PERCEPTION
- belief in chance of a negative health outcome will occur (ie developing diabetes, cancer, CVD if no PA)
OUTCOME EXPECTATIONS
- a person’s estimate that a given behaviour will lead to certain outcomes
MAINTENANCE SE
- belief in capability to continue to perform a behaviour when faced with barriers –> overcome barriesr
ACTION PLANNING
- detailed plan of what, where, when and how to engage in a behaviour
COPING PLANNING
- plan to overcome or address anticipated barriers
RECOVERY SE
- belief in capability to resume a behaviour after a lapse (ie took 2-3 wks off)
- avoid or come back into action after lapse or relapse
how to increase action, maintenance, recovery self-efficacy?
- vs outcome expectations and risk perceptions?
Self-efficacy:
- 4 sources of self-efficacy, specific to type of SE
- increase past performances, vicarious experiences, verbal persuasion, affective/cognitive sources
OE and RP: similar to building attitudes in TPB: information provision!
- build awareness!
- increase awareness of benefits
- high evaluation of PA –> being a good thing in both belief and feelings
HOW? media, booklet, listing BENEFITS, informing, listing joyful activities, presentation, research
how to create and action plan for PA? 4 components
give examples!
- why do that?
- HOW often? or HOW long?
- WHAT type of PA?
- WHERE will you participate?
- WHEN will you do PA
WHAT: jog outside
WHERE: from home to canal pedestrian bridge and back
WHEN: noon
HOW: 35min
WHAT: stationary bike
WHERE: at gym
WHEN: 9am
HOW: 45min
*can add how often: ie 3x /week
- the more specific you are, the better the action plan!
- allows you to offload the demand of exercising!
how to create a coping plan?
- think of possible barriers
- write how you will cope with the barrier (overcome it)
ie: if ….. then……
- offloads mental energy!
ie: if it’s too icy to run outside, I will do a workout video inside
HAPA research:
- Meta-analysis of observational studies –> results? –> explain using the other meta-analysis that the prof presented
- what did the 3rd meta-analysis show?
all relationships were mostly moderate (some lower, some were strong)
- BUT risk perception –> intentions; was low –> maybe not that big of a construct, especially for PA
- AND low correlations between recovery SE and behaviour + action planning and behaviour (0.9)
BUT when looking at experimental studies (meta-analysis) –>
- only planning intervention vs neutral only control –> 0.37 (med-large effect)
- all types (planning + multicomponent) vs neutral control only –> 0.38
- all types intervention vs all types control –> 0.24
- all types planning vs active only control (crossword) –> 0.13!!
*shows that intervention with planning still changes PA above other techniques (is decisional balance) –> planning has unique properties! and brings something to PA more than other strategies
3rd meta- analysis: similar effect sizes: small to moderate (0.41, 0.30, 0.35)
