Helping Patients Change Their Behavior

Understanding how people change their behavior is crucial for medical professionals, especially pharmacists, who play a key role in supporting patients in managing chronic conditions.

The transtheoretical model of change (TTM) is a widely used model that describes the stages of change that individuals go through as they consider and make changes in their behavior.

The Stages of Change

The TTM identifies five stages of change that individuals progress through as they contemplate and make a behavior change:

Precontemplation: At this stage, individuals are unaware of or unwilling to change their behavior. They may not believe they have a problem or may not see the need to change.
Contemplation: Individuals in this stage are thinking about changing their behavior but are still undecided. They may be weighing the pros and cons of change or feeling ambivalent.
Preparation: Individuals in this stage are planning to take action to change their behavior within the next month. They may be setting goals, identifying resources, and making other preparations.
Action: Individuals in this stage have begun to take steps to change their behavior. They are actively engaged in the change process but may still be experiencing some challenges.
Maintenance: Individuals in this stage have been successfully maintaining their behavior change for at least six months. They are working to prevent relapse.

How Pharmacists Can Use the TTM

Pharmacists can use the TTM to tailor their interventions to the specific needs of each patient. Here are some tips for using the TTM in a pharmacy setting:

Assess the patient's stage of change. There are a number of tools available to help pharmacists assess a patient's stage of change, such as the University of Rhode Island Change Assessment Scale (URICA).
Use stage-specific interventions. Once you know the patient's stage of change, you can use interventions that are most likely to be effective at that stage. For example, for patients in the precontemplation stage, you may focus on providing education about the benefits of behavior change. For patients in the action stage, you may help them develop a plan for overcoming challenges.
Focus on motivation. The TTM emphasizes the importance of motivation for change. Pharmacists can use a variety of techniques to help patients increase their motivation, such as motivational interviewing.
Build self-efficacy. Self-efficacy is the belief that one can successfully change one's behavior. Pharmacists can help patients build self-efficacy by focusing on their past successes and by providing them with skills and resources to cope with challenges.

Additional Tips for Behavior Change

Here are some additional tips that pharmacists can use to help patients change their behavior:

Set SMART goals. Goals should be Specific, Measurable, Achievable, Relevant, and Time-bound.
Focus on small changes. It is often easier to make small changes that can be gradually built upon over time.
Develop a support system. Social support can be a powerful motivator for change. Pharmacists can help patients identify sources of social support, such as family, friends, or support groups.
Address barriers to change. Patients may face a number of barriers to change, such as lack of access to resources or lack of time. Pharmacists can help patients identify and address these barriers.
Celebrate successes. It is important to celebrate patients' successes, no matter how small. This will help to keep them motivated on their journey to change.

By understanding and using the TTM, pharmacists can play a vital role in helping patients make positive changes in their behavior and improve their health outcomes.

Conclusion

The transtheoretical model of change is a valuable tool that can help medical professionals understand and support patients as they make changes in their behavior. By tailoring interventions to the specific needs of each patient, pharmacists can play a key role in promoting positive health outcomes.

Stages of Change and Pharmacist Support

Stage	Characteristics	Skills/Interventions by Pharmacist
Precontemplation	Unaware, unwilling, too discouraged, have not tried anything, cons outweigh pros, not ready to try anything within next 6 months	Listening and empathic responding, effective questioning, identifying barriers to change, nonjudgmental approach; persuasive strategies are generally ineffective; avoid argumentation in all stages
Contemplation	Open to information, education; thinking about trying something within 6 months; low self-efficacy; high perceived temptations to stay the same	Listening and empathic responding, educational interventions, emotional support, social support, effective questioning, discussion of strategies to remove barriers, developing discrepancies
Preparation	Ready to engage in behavior(s) in the next month, have made at least one prior attempt in the past year, beginning to set goals and "psych" self-up	Listening and empathy, praise for readiness to manage illness, assistance in setting goals, discussion of plan of action, identification of pitfalls, asking about support of others
Action	Taking steps; fighting "coercive forces"; engaging willpower, developing a sense of autonomy; improved self- efficacy, but may also experience guilt, failure, limits of personal freedom; very stressful stage	Listening and empathy; reinforcement of self- efficacious behavior; encouragement; continued emotional support, especially if relapse occurs; identification of reasons for relapse; confrontation may be necessary; avoid argumentation
Maintenance	Engaged in new behaviors for at least 6 months; senses that "I am becoming more like the person I want to be"; is able to more clearly identify situations and self-defeating behaviors that encourage relapse	Listening and empathy, open assessment of situations likely to produce relapse, continued use of counterconditioning and stimulus control, continued support and positive reinforcement

Process of Change and Most Prominent Stages

Process	Peak Stage
Social liberation: noticing that others with a similar condition in their environment are changing behaviors	Contemplation, preparation
Dramatic relief: becoming upset or emotional in response to information about the hazards of not changing	Precontemplation, contemplation
Helping relationships: the existence of meaningful or salient others who provide support for one's change efforts	Preparation, action, and maintenance
Consciousness-raising: gaining and thinking about information that is relevant to one's health maintenance behaviors	Precontemplation, contemplation
Environmental re-evaluation: recognizing the harmful effects of not taking care of oneself on the physical and social environments	Contemplation
Reinforcement management: rewarding oneself or being rewarded by others for healthy behaviors	Action, maintenance
Self-re-evaluation: cognitively evaluating one's attitudes toward healthy and unhealthy behaviors	Contemplation
Stimulus control: altering or manipulating the environment to remove cues that trigger relapses in behaviors and introducing cues to facilitate healthy behaviors	Action, maintenance
Counterconditioning: developing and engaging in new behaviors Action, to take the place of a behavior such as overeating	Action, maintenance
Self-liberation: realizing that one is capable of successfully engaging in healthy behaviors if one chooses	Preparation

Traditional versus Empowerment Model of Care

Biomedical Model (Paternalistic)	Socio-behavioral Model
Practitioner-centered	Patient-centered
Information giving	Information exchange (a meeting of experts)
Practitioner must "save" the patient	Patients must save themselves
Dictate behavior	Negotiate behavior
Compliance	Adherence
Authoritarian (parent-child) relationship	Servant
Motivate the patient	Assess the patient's motivation
Persuade, manipulate	Understand, accept
Resistance is bad	Resistance is information
Argue	Confront
Respect is expected	Mutual respect is assumed

Important Contrasts

Foreign	Þ	Internalized
Ambivalence	Þ	Dissonance
Coercion	Þ	Decision-making
Paternalism	Þ	Helping relationship

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Helping Patients Change Their Behavior