Quiz 2 (TTM and PAPM) Flashcards
TTM
Why was the Transtheoretical Model developed?
lecture 4 / ch.6
way to understand how people change behaviors
in particular: addictive behavior
TTM
What type of theory is the Transtheoretical Model?
lecture 2
Intrapersonal theory because it focuses on factors within the person that influence behavior
TTM
What does the Transtheoretical Model propose?
behavior change is a process that occurs in stages
as people attempt to change their behavior, they move through different stages using a variety of processes to help them get from one stage to the next until the desired behavior is attained
theory is also known as Stages of Change
TTM
What are the principles of TTM?
lecture 4 / ch.6
- behavior change is a process
- the process is characterized by a series of stages
- the stages correspond to the persons readiness to change
- readiness to change varies over time
- intervention must target the stage of readiness
- success is not limited to change of behavior
- relapse is common
- relapse serves as an opportunity to learn how to sustain change
- a person’s resistance can be seen as a measure to which the provider jumped ahead of the person’s stage of readiness (provider is pushing too much too quick)
TTM
How is analyzing behavior change using the TTM model helpful?
lecture 4 / ch.6
helps understand why some people are successful at changing behavior and other are not
TTM
How can TTM be used?
lecture 4 / ch.6
it can be used during any behavior change intervention, such as:
- smoking cessation
- substance use
- HIV risk reduction
- weight loss
- stress management
TTM
What are the stages of change in the TTM?
lecture 4 / ch.6
- pre-contemplation
- contemplation
- preparation
- action
- maintenance
- relapse
- termination
TTM: Precontemplation (stage 1)
Define the precontemplation stage
lecture 4 / ch.6
no recognition of need for or interest in change (not ready)
TTM: Precontemplation (stage 1)
What are the characteristics of a person in this stage?
lecture 4 / ch.6
- the person has no intention of changing behavior
- blaming external factors
- had an unsuccessful past attempt - the person has not yet contemplated change
- person may be unaware of the consequences of their behavior
- may be uninformed or underinformed
TTM: Precontemplation (stage 1)
What would a person in this stage say?
lecture 4 / ch.6
- “it doesn’t negatively impact me”
- “I don’t have a problem”
- “I can still do…”
- “quitting is easy, I’ve done it a million time before”
Stage Based Counseling Strategies: Pre-Contemplation
What are some counseling strategies that can be done in this stage?
lecture 4 / ch.6
consciousness-raising/education, based on assessment of clients current knowledge and understanding
- exploring beliefs about health/illness, substance use, etc.
- introducing the concept of a “client-provider partnership” in decision-making and the importance of open communication
What can you do?
- story telling: present a similar scenario to the client with their outcomes
- discuss impact of behavior on others (family friends etc.)
TTM: Contemplation (stage 2)
Define the contemplation stage
lecture 4 / ch.6
thinking about change (getting ready)
TTM: Contemplation (stage 2)
What are the characteristics of a person in this stage?
lecture 4 / ch.6
- acknowledges need for change / recognizes there is a problem
- may or may not have specific plans to change in the near future
- better understanding of the consequences of the behavior
- not ready to change (cons outweigh pros)
TTM: Contemplation (stage 2)
What would a person in this stage say?
lecture 4 / ch.6
- “I’m not ready to change”
- “Maybe someday”
- weighing pros/cons (decisional balance)
Stage Based Counseling Strategies: Contemplation
What are some counseling strategies that can be done in this stage?
lecture 4 / ch.6
explore ambivalence - focus on pros/cons and increase perceived benefit
What can you do?
- make a pros/cons list
- add to the pros; link benefits of not doing the behavior to clients long term goals
- identify barriers to changing behavior
- ask client to keep a diary of daily activities
TTM: Preparation (stage 3)
Define the preparation stage
lecture 4 / ch.6
planning for change (ready)
TTM: Preparation (stage 3)
What are the characteristics of a person in this stage?
lecture 4 / ch.6
- getting ready to take action soon
- may have developed a plan
- may have even attempted change
in this stage, you may be able to increase individual’s confidence
TTM: Preparation (stage 3)
What would a person in this stage say?
lecture 4 / ch.6
- “I’m looking for information on how to change”
- “I started looking into __”
- “I have set small goals for myself”
Stage Based Counseling Strategies: Preparation
What are some counseling strategies that can be done in this stage?
lecture 4 / ch.6
develop a plan!
What can you do?
- develop and practice skills required for new behavior
- develop a detailed schedule and plan for anticipated barriers
- find community
- review available resources and support systems
- bring up stories of success that you have encountered
TTM: Action (stage 4)
Define the action stage
lecture 4 / ch.6
adopting new habits (ready)
- behavior change is the goal of action
TTM: Action (stage 4)
What are the characteristics of a person in this stage?
lecture 4 / ch.6
- has put plan into action / actively participating in the behavior
- concrete steps toward change have occurred
- is practicing the new behavior change
- change has occurred in less than 6 months
- not consistent… yet
TTM: Action (stage 4)
What would a person in this stage say?
lecture 4 / ch.6
- “I see progress in my behavior”
- “I did ___ last week”
Stage Based Counseling Strategies: Action
What are some counseling strategies that can be done in this stage?
lecture 4 / ch.6
activities at this stage are behavioral
What can you do?
- continue to assess and build skills to maintain behaviors (focus on positive behaviors to help)
- tracking progress
- reward and recognize success (incentives, events, attention)
- using helping relationships (peers, provider, family, friends)
- making/maintain changes in the environment to maintain the new behavior
TTM: Maintenance (stage 5)
Define the maintenance stage
lecture 4 / ch.6
ongoing practive of new healthier behavior (sticking to it)
- begins after 6 months of being in the active stage of changing
TTM: Maintenance (stage 5)
What are the characteristics of a person in this stage?
lecture 4 / ch.6
- behavior is incororated into daily life (6 months of doing the new behavior)
- behavior has been consistent over a long period of time
- can acknowledge problem + the triggers and how to manage them
TTM: Maintenance (stage 5)
What would a person in this stage say?
lecture 4 / ch.6
- “I’m working to prevent relapses”
- “I feel confidence managing triggers”
- it is apart of daily routine
Stage Based Counseling Strategies: Maintenance
What are some counseling strategies that can be done in this stage?
lecture 4 / ch.4
- activities at this stage are behavioral
- introduce the idea that life events/stressors may interfere with progress
What can you do?
- develop a contingency plan to prevent relapse
- continue rewards/recognition of milestones
- tracking improvements in health
- train the client to be a peer mentor; empowering the client to see themselves as an expert
TTM: Relapse (stage 6)
What are the characteristics of the relapse stage?
lecture 4 / ch.6
should be seen as an opportunity to learn from unsuccessful attempts to change behavior
- don’t shame the individual
- individual might be having negative self talks + shame/guilt
normalised and is used as an opportunity to learn
TTM: Relapse (stage 6)
What would a person in this stage say?
lecture 4 / ch.6
- “I deserve this, I’ve been working so hard”
- “I’m so weak, I can’t seem to stick to this”
- “I made the change once before I can do it again”
- “Once won’t hurt”
TTM: Termination (stage 7)
What are the characteristics of the termination stage?
lecture 4 / ch.6
- behavior change complete
- zero tempation
- 100% self-efficacy
- desire
- complete integration of behavior in their life
TTM: Termination (stage 7)
What would a person in this stage say?
lecture 4 / ch.6
- “I can’t imagine going back to”
- “I’m embarassed about that time in my life”
- “I can handle my triggers”
- ” I don’t think about the habits anymore, I don’t want to go back to that”
Staging Tool
What is the Staging Tool?
lecture 4 / ch.6
- used to determine the stage of readiness for change
- consists of questions that guage clients
- reflects what client is being staged for
Staging Tool
What questions are included in this tool?
lecture 4 / ch.6
- How clients feel about the behavior
- is the behavior a problem?
- has the client thought abouth changing their behavior?
- what gets in the way of changing the behavior? - has the client attempted to change in the past?
- has the client ever been able to sustain the change behavior?
- for what period of time?
Change
How does change occur?
lecture 4 / ch.6
- consciousness raising
- dramatic relief
- environmental - reevaluation
- social liberation
- self-reevaluation
- stimulus control
- helping relationships
- counter conditioning
- reinforcement management
- self - liberation
TTM
What is self-efficacy
lecture 4 / ch.6
the belief that one can be successful in an attempt to change behavior
- vital at each stage of behavior change
- provider’s job to increase self-efficacy at any point
PAPM
What is the Precaution Adoption Process Model?
lecture 5
stage theory but its different than TTM!!
stage theory: as people attempt to change their behavior, they move through different stages using a variety of processes to help them get from one stage to the next until the desired behavior is attained
PAPM
What does PAPM identify a stage for?
lecture 5
- there is a stage for when people may be unaware of risk or precaution
- there is a stage for when people choose not to engage in target behavior
PAPM
What type of application is the PAPM used for?
lecture 5
- osteoporosis prevention
- mammography
- colorectal cancer screening
- hep b vaccination
- home testing to detect radioactive radon gas
PAPM
What are the stages of change in the PAPM?
lecture 5
- stage 1: unaware of issue
- stage 2: unengaged by issue
- stage 3: deciding about acting
- stage 4: decided not to act
- stage 5: decided to act
- stage 6: acting
- stage 7: maintenance
PAPM: Unaware (Stage 1)
Define the unaware stage
lecture 5
an individual is completely unaware of a health hazard
- if people have never heard of a hazard or its potential precaution, they cannot have formed opinions about it
link between unprotected sex and
EXAMPLE: radon exposure from cigarettes
PAPM: Unaware (Stage 1)
What would a person in this stage say?
lecture 5
“I have never heard of this”
“I didn’t know this was a problem”
PAPM: Unaware (Stage 1)
What are some counseling strategies that can be done in this stage?
lecture 5
- media messages/PSA may influence
- have infographs on common conditions
- ask open ended questions
PAPM: Unengaged (Stage 2)
Define the unengaged stage
lecture 5
once people have heard about a hazard, they begin to form opinions about it (they are therefore no longer unaware)
- people can know a moderate amount of information about a hazard without ever having considered whether they need to do anything about it (never thought about an action)
the condition of awareness without personal engagement is quite common
PAPM: Unengaged (Stage 2)
What would a person in this stage say?
lecture 5
“Other people worry about it, but I’m not concerned”
PAPM: Unengaged (Stage 2)
What are some counseling strategies that can be done in this stage?
lecture 5
increase awareness that other are making up their mind and you must have some opinion of the current issue
- get a significant other involved (emotional conection)
- talking about personal experiences
- challenge their thoughts
PAPM: Deciding About Action (Stage 3)
Define the deciding about action stage
lecture 5
the person faces a decision about acting
- people who have thought about acting may be more knowledgeable
- attitudes based on experience with an issue are more predictive of future behavior than attitudes generated on the spot without such experience
PAPM: Deciding About Action (Stage 3)
What would a person in this stage say?
lecture 5
“Maybe I should think more about quitting ___”
“I’m not sure if I should start using sunscreen everyday”
PAPM: Deciding About Action (Stage 3)
What are some counseling strategies that can be done in this stage?
lecture 5
- use the health belief model
- discuss perceived social norms
- create a plan
PAPM: Decided Not to Act (Stage 4)
Define the decided not to act stage
lecture 5
PAPM may end with decision not to act…for time being…
- people who have come to a definite position on an issue have different responses to information and can be more resistant to persuasion than people who have not formed opinion
confirmation bias, perserverance of beliefs, hypothesis preservation
PAPM: Decided Not to Act (Stage 4)
What would a person in this stage say?
lecture 5
“It’s not a big deal for me right now”
“I’ve tried this before and it didn’t work”
“It’s too late to change”
PAPM: Decided Not to Act (Stage 4)
What are some counseling strategies that can be done in this stage?
lecture 5
- use the health belief model
- discuss perceived social norms
- reframe the issue
- have a nonjudgemental approach
PAPM: Decided to Act (Stage 5)
Define the decided to act stage
lecture 5
decision to act does not mean there will definitely be action
you may make a plan and the action may still fall through due to additional variables
this stage represents intention to act
PAPM: Decided to Act (Stage 5)
What would a person in this stage say?
lecture 5
“I’ve decided to quit smoking, I’ll start next week”
“I know I need to use sunscreen, I’m just waiting for the right time”
PAPM: Decided to Act (Stage 5)
What are some counseling strategies that can be done in this stage?
lecture 5
- create a schedule/plan
- find support
- start with small steps
PAPM: Action (Stage 6)
Define the action stage
lecture 5
actively engage in behavior change
- contention with variables specific to early or one-time action
PAPM: Action (Stage 6)
What would a person in this stage say?
lecture 5
“I’ve been using sunscreen everyday”
“I’ve stopped smoking for 2 weeks now”
PAPM: Action (Stage 6)
What are some counseling strategies that can be done in this stage?
lecture 5
- reinforce positive behavior
- discuss potential triggers/barriers
- celebrate milestones
PAPM: Maintenance (Stage 7)
Define the maintenance
lecture 5
continued behavior change
- not always applicable (screening)
- contention with variable specific and applicable to maintenance
PAPM: Maintenance (Stage 7)
What would a person in this stage say?
lecture 5
“I’ve been smoke free for 6 months”
“I make sure to wear sunscreen every day now”
PAPM: Maintenance (Stage 7)
What are some counseling strategies that can be done in this stage?
lecture 5
- continue to discuss potential triggers for relapse
- reinforce self-efficacy
- continue encouragement
PAPM Progression
When it comes to progression, what are some things about PAPM to keep in mind?
lecture 5
- PAPM identifies seven stages along the path from lack of awareness to action
- people usually pass through the stages in sequence, without skipping any
- movement back to an earlier stage can occur without having to go back through all intermediate stages
- once stages 1 and 2 are completed, people do not return
