2- transtheorical model.pdf

Theory Driven Approach: Diving Deep into the Transtheoretical Model of Behavior Change Matt Mara DMD, EdD Learning Objectives 1. Identify common challenges and barriers to patient behavior change. 2. Recognize the importance of tailoring interventions to individual patients including considering the...

Theory Driven Approach: Diving Deep into the Transtheoretical Model of Behavior Change Matt Mara DMD, EdD Learning Objectives 1. Identify common challenges and barriers to patient behavior change. 2. Recognize the importance of tailoring interventions to individual patients including considering the patient's unique life context and readiness to change as a means of achieving better health outcomes. 3. Describe the basic principles of social cognitive theory, the health belief model, theory of planned behavior, self-determination theory and the transtheoritical model of behavior change. 4. Apply the transtheoritical model of behavior change to a clinical scenario. Behavior Change CHANGE HAPPENS NATURALLY IN EVERYDAY LIFE. ONE'S INTRINSIC MOTIVATION AFFECTS BEHAVIOR. CHANGE HAPPENS WHEN ONE IS READY TO CHANGE. BEING ABIVIILANT IS PART OF THE PROCESS. REAL CHANGE OCCURS OUTSIDE OF THE DENTAL PRACTICE AND WITHIN THE CONTEXT OF OUR PATIENTS' LIVES. Behavior change is complex. What does research suggest? Behavior change can be a struggle for both patient and dentist. Advice alone is not enough. Providing advice in a conversational envioronment makes a significant difference on how advice is received by a patient. Good communication is essential. Expression of empathy may be the most important factor to supporting behavior change. Involve patients in the process of decision making and goal setting. The Role of Interpers onal Skills & Behavior Change A dentists "way of being" can influence a patient's behavior and willingness to change. A one-size fits all approach will not work with every patient. A dentist should be flexible in their approach as they consult with patients. Research suggests matching consulting style with the behavioral style of the patient may lead to the best outcomes (Rollnick et. Al., 2007). It is the patient's task to say how and why they may change their behavior. It is the provider's role to help the patient elicit arguments for change and agree on priority areas. Considering Our Patients' Unique Life Context Fear Appeals A "do this or else" message where non-compliance to a recommended behavior has the intention of creating fear Work until a moderate amount of fear is conveyed and then there is no added benefit. Theoretical Frameworks Provide a particular perspective, or lens, through which to examine a topic. Often used to define concepts and explain phenomena. Theoretic al Models of Behavior Change Social Cognitive Theory Health Belief Model Theory of Planned Behavior Self-determination Theory Transtheoretical Model of Behavior Change Social Cognitive Theory Social Cognitive Theory Includes the concept that environmental factors (such as socio-economic status and familial status) influence self-efficacy, motivation and beliefs. An individual is 1) a product of and 2) can influence their environment. Health Belief Model Health Belief Mo del An individual's likelihood to change a health behavior is influenced by two factors: o The perception of the threat o How likely the proposed intervention or treatment will be successful Theory of Planned Behavior Theory of Planned Behavior The best predictor of a behavior is an individual's intention. One's intention is influenced by: o Attitudes o Subjective norms o Perceived behavioral control Self-determination Theory SelfDetermina tion Theory One's behavior is influenced by: o Competence o Autonomy o Relatedness Transtheoretical Model of Behavior Change Precontemplat ion Persons in this stage do not consider their behavior to be affecting their health negatively in any way. Persons do not see any reason why they should consider changing their behavior despite evidence that suggests otherwise. Contemplat ion At this stage, persons have become aware that a problem exists and begin to think about change. Persons may flip between focusing on change and no change as they decide what they want to do. Persons can weigh pros and cons of change in this phase. Preparati on Persons move out of contemplation phase when they have clear intention to change their behavior. Persons have not yet integrated this change fully into their lives; however, they are exploring ways to follow through on their plan to change. Action Persons are actively engaged in their changed behavior. A time of high motivation as persons may start to feel the benefits of the change and feel successful. Persons are highly vulnerable to relapse and old patterns. Maintenan ce The new behavior is fully integrated into their lifestyle and routines. Relapse Maintenance fails and cycle restarts. Sample Provider to Patient Probing Questions PreWhat do you think it would take for you to even contemplati consider that this is a behavior you may want to on change? Contemplati What do you feel are the factors that are on motivating you and deterring you from changing your behavior? Preparation What systems can you put in place to help you reach this goal? Action How do you feel? Is this change something you feel like you can maintain? Maintenace How as this new behavior integrated into your routine? Relapse New habits are hard to maintain. Looking back, what factors made it a challenging behavior to maintain? What could you consider doing differently next time? "I'm still having the jaw pain we talked about at my last visit. I know you gave me a referral to a specialist, but I haven’t called them yet to make an appointment. I'm still determining if it's necessary." Based on what you know, what stage of the transtheoretical model do you believe your patient is currently in? Pre-contemplation Contemplation Preparation Action Maintenace Relapse Announcements Overall, nice work on Discussion Board #1. Make sure to submit posts and reply posts as assignments and copied and pasted on your discussion board. Discussion Board #2 Initial Post due by 11:59pm on 3/26. Response posts due by 11:59pm on 3/28.