Seite - 150 - in Applied Interdisciplinary Theory in Health Informatics - Knowledge Base for Practitioners

1.4. Transtheoretical model In 1982, shortly before the publication of Ajzen’s Theory of Planned Behaviour, another highly influential model was introduced: the Transtheoretical or "stages of change" model. As the name implies, the model was developed through the integration of several behavioural and psychological models, and proposed that behavioural change occurs in five stages [11] (Box 1). A final stage, termination, was added later. The authors also recognized 10 processes of change, and noted that particular cognitive processes tend to be used at different stages of change (Box 1). The verbal processes tend to play a large role in the early states of change. Self-reevaluation and self-liberation tend to come into the action phase, and counterconditioning and stimulus control bridge the action and maintenance phases. Social liberation plays a role in all phases. Self-efficacy and temptation (the strength of the desire to engage in the old behaviour) were added in later revisions of the model. The transtheoretical model has also been applied to and influenced research on organizational change – the study of preparing individuals and organizations for changes in the workplace [12]. "Resistance to change" is modelled as a mismatch between the readiness of the leadership for change and the stage of change of the employees. Studies across a range of behaviours show that before an action is taken, about 40% of people are in the pre-contemplation stage, and thus will likely resist change if the organization leadership proposes it. This can be addressed by assessing the employees' readiness to change, and taking action (individualized or collectively) according to their stage of change, for example by activities which raise awareness of the need for change for employees in the pre- contemplation phase. Like the Health Belief Model, the Transtheoretical model portrays behaviour as mainly individual, with social influences playing only a minor role. It also assumes that people plan changes before making them. Armitage has suggested that the "five stages" can be better modelled as only two: a motivational phase (where a person prepares to change) and a volitional phase (where a person executes the change) [13] (Figure ). Figure . Armitage’s two-stage model of change [13]. Stages of change Precontemplation: Not yet thinking about change, may not be aware that change is needed Contemplation: Thinking about the change Preparation: Becoming determined to change Action: Taking action to change Maintenance: Maintaining the new habit Termination: The new behaviour no longer requires active maintenance Processes of change Consciousness-raising: Seeking information about the behaviour Self-liberation: Belief in the ability to change Social liberation: Seeking and recognizing social support for the new behaviour Self-reevaluation: Changing one’s self-image in line with the new behaviour Environmental reevaluation: Seeking and recognizing the effect of the old and new behaviour on others Counter-conditioning: Substituting new, healthier behaviours for old habits Stimulus control: Removing cues that trigger the old behaviour Reinforcement management: Recognizing rewards from others and creating rewards for the new behaviour Helping relationships: Seeking and recognizing support from others for the new behaviour 3 3 S.MedlockandJ.C.Wyatt /HealthBehaviourTheory inHealth Informatics150