Health behaviour is an accomplishment that enhances, continue or intimidate an individual’s health (Barkway 2009, p. 126).The desire to change personal behaviour to enhance future health outcomes is usually overrated. It is inner personalities of the person that born or been nurtured the way they were. Health behaviour influences a lot of aspects in life and it is an ongoing process throughout lifespan. Experience and environmental factors influenced a person’s behaviour. To transform one’s health behaviours include prevention, management of treatment, right attitudes and awareness which are also the base to individual’s perspectives.
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Variance between behaviour and knowledge might be within Tamara who professes to value health yet still smokes. Cognitive dissonance revealed that she recognized and understand the smoking effect in her heath, but her behaviour doesn’t link with her knowledge and principles. With few attempts to change her smoking behaviour without success, it’s not just a matter on understanding and making it simple, therefore it’s important to identify what is involved in the process of behaviour change and turn it to psychology (Candlin 2008, p. 192). According to (Barkway 2009, p. 138) transtheoretical model of behaviour change, accommodate both behaviour and cognitive strategies. Cognitive based therapy help people to go further towards the perpetuation stage of positive health behaviour such as smoking cessation.
In Australia, smoking is the third disease that causes most death: it is liable for about 80% of all lung cancer death and 20% of all other cancer deaths. Australian spent about 21 billion dollars in a year for tobacco in health care, social cost and business and passive smoking took life over 200 people a year; half of which are children. The healthcare setting is engaging and making a lot of awareness to the public; such as stop smoking campaign, going cold turkey, quit smoking month in working environment, Australia Better Health Initiative and Tags-program are aimed at children in primary schools. All these are to motivate and encourage all the young dynamic generation to quit smoking and to save the environment.
Base on Tamara’s case study, personal behaviours such as smoking, financial, fit in social and standard of living needs and do not need to be conventional to a health-focused model of behaviour change. Transtheorectical Model (TTM) of behaviour change analyses both behaviour and cognitive strategies. TTM also states clearly that the person can maintain the stages of positive health as maintenance and it’s also not uncommon for a person from maintenance stages to relapse before achieving to the stable stage. In this case study shows that Tamara has the determination to change and reached to the maintenance stage but her social circle influences are greater than her strong abilities, which makes her to reverse on the different stages in TTM. As a health professional to obtain successful outcomes of nursing care, the nurse must adopt the role as patient educator to start and facilitate the process of health behaviour change. The purpose to change a person’s behaviour completely is impossible but with effort, educations and reasoning can make the most changed in an individual’s behaviour.
TTM model was developed by Procaska and DiClemente (1984) from addiction research studies and was further expand by Prochaska et al (1992) as stated in (Barkway 2009 p. 138). Stages in TTM encourage a person to analyses as a cycle of change but not a failure. A precontemplation stage is where Tamara is not aware that smoking is bad to health and she does not feel as a treat because her parents are smokers and she has been broad up in such an environment that is acceptable. She might have the perception that if my parents smoke and they are healthy and so am I. Tamara’s self esteem and pride that pulled her through when she is out with her friends and she feel herself been left out if she does not smoke as all her friends smoke. In the other hand she also used smoking as to maintain her body weight.
In contemplation stage it is an effective stage where Tamara is aware that smoking is bad for health and in result there is a need to change after her father was diagnosed with early stage of emphysema. Her father’s state triggered Tamara’s awareness and realized smoking is harmful for health.
Preparation stage is where Tamara became aware the potential harm caused by smoking and makes an attempt to stop smoking by reducing it to only smoke on weekends. Action is the most crucial stage where autonomy and willpower plays an important role in decision making for an individual to choose the best for them (Leddy 2006, p. 165). For Tamara she decided to quit smoking for good due to her father’s illness. Maintenance or termination stage is whereby a person has to self control, belief on what the person need to achieve and has the resistance to temptation to surrounding environments and influences by social activities. In Tamara’s situation she lacks of determination and willpower on her goals to cease smoking where the state that she relapsed and resume to daily smoking. Tamara has only short term achievement. Due to relapse, the whole process of TTM stages starts to recycle again.
According to (West 2006, p. 774) argued that TTM are no ‘stages’ in any significant sense and there is no ‘cycle of change’. TTM also mention that if a person’s desire and if that condition is right, stimulates an attempt at change whose success depends on their background and personal factors. According to Prochaska, TTM model was the first model to tackle the subject at a population level.
According to Prochaska, TTM is a progressive approach whereby individuals have to progress through stages but (West 2006, p. 775) argued that TTM should be a stage free whereby people who are at a given moment where more or less, than those who are in the process of trying to change and others who are more or less ascertain in their new behaviour styles. And yet another journal also reviewed that the effectiveness of interventions in TTM, regardless whether it is stage progression, behaviour change and with either no or with other type of intervention, or usual care control have limited evidence to be proven (Bridle et al. 2005, p. 295). According to (West 2006, p. 775) criticized TTM is a model whereby it overlooked the essential motivation process of an individual but Prochaska mentioned that TTM does include operant learning principles and not simply the positive and negative type of analysis.
According to (West 2006, p. 775) that human being’s inspiration is much livelier and influenced by the instant context. According to Prochaska, action stage needs a significant commitment of time and energy. This is the stage where an individual gets most recognition from others because of their visible efforts (West 2006, p. 775). Research caution not to oversight this visible action of trying to change naturally because that the individual only change when there is a must to change as when there is a need to reached the definite goal; a decisive factor which scientist and experts agree is enough to reduce risk to the problem behaviour.
TTM stages function outside conscious awareness and did not follow the decision making rules where it weigh up the costs and benefits. There is modest or no consideration of the notion of addiction which is obviously a crucial consideration when it comes to smoking behaviour.
Prochaska described that temptation as the strength of urges to fit in a precise habit while in complex situation. Proschaska further mention that situations of negative effect or emotional distress, positive social situations, and cravings are the most common types of temptation to acknowledge.
Temptation and self-efficacy have an inverse relationship with each other across the stages of change as it’s proven in studies (Guo 2009, p. 834).
In an article it was shown that argument about the TTM was not against the existence or measurement of discrete entities that would be nonsensical, but (West 2006, p. 774) mentioned that TTM was actually criticized on the stages. There isn’t any evidence to prove that TTM measures were superior to predicting the desire or intention of health behaviour change.
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In order for TTM to be generalized to the population, more studies should be carried out (Bridle et al. 2005, p. 299). It is important to analyse the process of hypothesis for each stages of transition in TTM (Guo 2009, p. 834). However, with the best evidence available it is limited not only in terms of methodological quality, but also the effectiveness of TTM interventions in health behaviour change in relation to either facilitate or promote progress stage (Bridle et al. 2005, p. 299).
As a health professional has traditionally been apprehension with individual’s risk factors for disease, economic, social and political causes for health issues. It’s a challenge for a nurse to assist a person to change his/her lifestyle and there is no ‘miracle’ to make a person to change their behaviour overnight.
As a first step, Tamara should prepare herself on her action and planned on what she needs to help herself. Tamara also needs to be actively taking part in her action on developing and monitor herself on her progress.
The healthcare professional has to set goals for Tamara and counselling is the first step of her improvement. During this stage of behaviour change, consciousnesses should be raised and assess the knowledge, barriers and how the family members can help Tamara; also check on the degree of the readiness of Tamara in change of herself. Tamara should prepare herself emotionally to face the physical, environment and her personal values.
Tamara’s counselling should include on how to handle her smoking influences when attend social activity, weight loss program-exercise and the harm of smoking effect for herself and people surrounding her. Evidence shows that women who are active in exercise initiated a quit attempt, which embrace promise and motivated to quit smoking (Vidrine et al. 2006, p. 101).
Also set a quitting date, teach her coping skills. Build a good healthcare professional and patient relationship. Compassionate, empathy and concern from healthcare professional, that numerous smokers have effectively quit smoking (Vidrine et al. 2006, p. 101).
As a healthcare professional, encourage or engage Tamara to speak to people who have successfully changed their lifestyle habits. In the early phase of change, the immediate positive verbal feedback of her desire should be re-assessed and re-evaluated by healthcare professional. That would help the healthcare professional to evaluate on how far Tamara has achieved her target. Arrange a support group, and telephone counselling, therefore whenever she feels she need a listening ear to reduce her stress, she can get help directly. That action would help to prevent her from relapse.
As a healthcare professional, motivations, support and follow up on the progress of her health behaviour changes should be reviewed every 2 to 3 week for the initial period with telephone calls review, and 1to 3months of follow ups to check on her progress. There’s a lot of other ways of interventions and different types of healthcare professionals approaches in their own unique way for smoking cessation. More healthcare professionals training is needed in cessation of smoking and further behaviour researches in general have to establish.
In conclusion, even there are pros and cons in TTM stages, it should be taken the measures of the attitudes as an individual towards quit smoking. All the result supports the concept that attitudes influences both intention and behaviour. TTM stages is a useful evaluation method, it can be use as a guide and valuable psycho-educational tools.
TTM also facilitate and educate candidates about the change process in nature and dynamic of change. Feedbacks on performance are accurate and timely as the progress is crucial part of the self-regulatory cycle. Usage of Transtheorectical Model is base on the type of research as different research design offers different rank of evidence about the efficiency. TTM stages help a person to know where, when, how and at which stage change of behaviour affected, such as relapse and also help the person to improve or recover from the stage of relapse. Without stages it’s difficult for a healthcare professional to determine at what level or degree an individual is experiencing. Currently there are a lot of evidences supporting TTM and criticizing the model therefore it will be appealing to see what future will find.
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