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The Transtheoretical Model (TTM) speaks on suggested strategies for public health interventions to address people at various stages of the decision-making process. Acknowledgements of this and other behavioural change models will resulting in social marketing campaigns being implemented as they're tailored to suit the target audience.
(Stages of Change Model)
Developed by Prochaska and DiClemente in the late 1970s.
Research was being conducted on the experiences of smokers,
some who quit smoking on their own and some who had to
seek treatment. They wanted to understand why people quit
on their own.
Research concluded that people quit smoking when they were
ready, thus giving birth to the Transtheoretical Model (TTM).
There are five stages on the TTM:
People do not intend to take action in the near future.
Completely unaware that their lifestyle is problematic and may
produce negative consequences.
Places more emphasis on the cons than the pros of changing
The intention is there to start living a healthy behaviour in the
foreseeable future (in the next 6 months).
People are now made aware that their behaviour is unhealthy
and can lead to serious consequences.
A more thoughtful and equal approach is taken to the pros and
cons however, the person may be a bit reluctant to change their
People are ready to take action within the next 30 days.
Small efforts are being made as they believe that it will lead to
a healthier life.
People have changed their behaviour over the past six months
and intends to continue to maintain those changes.
Changes can be seen when people modify their problematic
behaviour or adapt to healthier behaviours.
People have changed and stuck to their new or modified
behavioural practices for the past six months and intend to
They make every effort not to relapse into earlier stages.
People have no desire to return to their previous behaviour
and are sure they will not relapse.
Process of Change
To progress through the stages of change, people apply cognitive,
affective, and evaluative processes.
These processes result in strategies that help people make and
1. Consciousness Raising - Increasing awareness about the healthy behavior.
2. Dramatic Relief - Emotional arousal about the health behavior, whether positive or negative
3. Self-Reevaluation - Self reappraisal to realize the healthy behavior is part of who they want
4. Environmental Reevaluation - Social reappraisal to realize how their unhealthy behavior
5. Social Liberation - Environmental opportunities that exist to show society is supportive of
the healthy behavior.
6. Self-Liberation - Commitment to change behavior based on the belief that achievement of
the healthy behavior is possible.
7. Helping Relationships - Finding supportive relationships that encourage the desired change.
8. Counter-Conditioning - Substituting healthy behaviors and thoughts for unhealthy behaviors
9. Reinforcement Management - Rewarding the positive behavior and reducing the rewards
that come from negative behavior.
10. Stimulus Control - Re-engineering the environment to have reminders and cues that support
and encourage the healthy behavior and remove those that encourage the unhealthy
The limitations of the TTM should be considered especially when
using the theory in public health:
Ignores the social context in which change occurs such as the
socioeconomic status (SES) and income.
The lines between the stages can be arbitrary with no set
criteria of how to determine a person's stage of change. The
questionnaires that have been developed to assign a person to
a stage of change are not always standardized or validated.
There is no clear sense for how much time is needed for each
stage, or how long a person can remain in a stage.
The model assumes that individuals make coherent and logical
plans in their decision-making process when this is not always
The Transtheoretical Model provides suggested strategies for
public health interventions to address people at various stages
of the decision-making process. This can result in interventions
that are tailored (i.e., a message or program component has
been specifically created for a target population's level of
knowledge and motivation) and effective. The TTM encourages
an assessment of an individual's current stage of change and
accounts for relapse in people's decision-making process.