Implementing a Health Behavior Theory – Opinion and Personal Experience

Implementing a Health Behavior Theory – Opinion and Personal Experience

Lyn Riebel and Garvita Thareja

As a student enrolled in the Health Behavior Theory course with Dr. Garvita Thareja, through the Public Health program at Metropolitan State University of Denver, we were offered an engaging assignment to expose us to real-world experience in the area of behavior change. As part of this assignment, students must utilize theories of health to change their own selected behavior. I chose to focus on increasing my cardio activity level from generally relying on long walks each day to adding more vigorous activities such as an at-home spin class and high-intensity interval training as the focus of my behavior change, and the Transtheoretical Model of Change (1) (TTM) as the theory to utilize for the practice of enacting this behavior change.

The Transtheoretical Model of Change, often referred to as “TTM'' or the “Stages of Change”, was introduced in 1983 by Prochaska & DiClemente to describe how most individuals progress through a process of identifiable stages (sometimes repeating the stage cycle) to move through or towards a behavior change (1). Through my research of TTM, I came across a book called Changing to Thrive (1) (2016) which was written by a founder of TTM (Prochaska) and his wife. This book helped me dig deeper into the processes within the individual stages, which are:

Precontemplation – where the individual is not ready or does not see a need for change Contemplation – where the individual is starting to see the benefits for change Preparation – where the individual is ready to work towards the change Action – where the individual is actively engaging in new behaviors of change Maintenance – where the individual is keeping up with the action of behavior change for at least six months

Once I identified the behavior I wanted to change, increasing my physical activity, specifically cardio—which has been challenging over the last couple of years due to nerve damage—then I began to identify which stage I was currently in. To do this, I used TTM which was studied through coursework and the Changing to Thrive1 book. This helped me get a baseline for what stage I was currently in (Preparation) and where I wanted to be in the stages of change (Maintenance). I identified my initial stage as Preparation because I saw the benefits of increasing my cardio activity, however I had not yet actively begun engaging in new habits that would lead to increased cardio. My goal throughout this activity was to progress to the Maintenance stage, where I would be enacting habits that would increase my cardio activity for many years to come.

An image by LaMorte (2019) depicts the stages of change cycle.

Another aspect of this assignment was to keep a daily journal of my progression throughout this behavior change. This is where I was able to identify different barriers, strategies, motivators for achieving the change, and a plan for action. This allowed me to set the stage to increase my internal belief, or self-efficacy, that I was capable of sustaining my desired change. Throughout this 4-week exercise, I was able to identify that scheduling and setting a plan for the entire week for what cardio activities I was going to do and at what times were the most helpful for progressing my behavior change. I also found that having a backup plan, one that allowed for an easy pivot, was also a key factor in keeping movement towards the progress of my change rather than falling back into an earlier stage in TTM. The other thing I found helpful was discussing my behavior change progress with others in situations where they were participating with me or encouraging me in other ways. For me, this primarily included my spouse, but for others this could be friends, family, or anyone who could provide similar encouragement.

Throughout this assignment, I also found other research articles that used TTM to increase the level of physical activity in individuals (3,4,5). Within both articles, it was identified that the TTM approach was effective in promoting self-efficacy, which then promoted an increase in level of physical activity. In seeing the effects of using TTM in my own behavior change, I agree with these authors that this model was effective in increasing my own self-efficacy, which in turn increased my engagement in enacting the change and ultimately increased my cardio activity in my life (2,3,5).

I thoroughly enjoyed this assignment particularly because I got so much more out of it than just a grade. It truly has been a rewarding way to implement not only a behavior change, but what feels like a lifestyle change. For me, that means getting more of my life back. I also found this assignment rewarding because I have been working as a health and wellness coach for over 5 years and utilize this behavior change model in my professional setting. While I was previously familiar with TTM, this was the first time that I focused on my own behavior change while using this model for this length of time. One of the main reasons I like this model is that it doesn’t feel demoralizing and allows an individual to progress at their own pace and choose how they want their path to look.

Putting this assignment into real-world action for my own personal behavior change now allows me to apply this model more effectively as an option when working with others. The TTM provides an individual with a good way to identify their various stages of change from the beginning to the end of a behavior change journey. In addition to learning more about TTM during this assignment, I found it an effective method for behavior change in my personal life as well. While TTM was originally used to understand how people change behaviors, particularly in smoking sensation and addiction settings, it is being used more and more in other areas of health and wellness and can ultimately be an effective way for an individual to enact any behavior change they are seeking (1,3,4,5).