How to Use the Transtheoretical Model to Help Clients Make Healthy Behavioral Changes
The Transtheoretical Model (TTM) of Behavioral Change is used to identify a number of stages that clients experience as they progress through lifestyle modifications. Identifying which stage each of your clients is in will help you better understand how your clients are feeling about adopting positive lifestyle changes, and how you can help them progress through the stages of change. The TTM is made up of five stages of change—precontemplation, contemplation, preparation, action and maintenance.
Let’s take a closer look at these five stages of change:
Stage 1: Precontemplation
Precontemplation is the stage in which a client is not even considering adopting a physical activity program. This client is sedentary and does not see or understand the value of introducing physical activity into his or her daily routine. When working with clients in the precontemplation stage, encourage them to start thinking about change and the benefits that come with it. This is a time to educate your clients about the health risks of inactivity and the value of being physically active. As the fitness professional, it is important for you to validate the fact that the client is not ready to make a change, while still offering encouragement and information about the benefits of making positive lifestyle-behavior changes.
Stage 2: Contemplation
Contemplation is the stage where a client begins to consider the idea of adopting a physical activity program. A client in this stage is still sedentary, but has started to think about how a sedentary lifestyle is negatively affecting his or her health. This client is not ready to make a change, but is starting to think about physical activity as an option. As the fitness professional, it is important to encourage the client to weigh the pros and cons of a healthy behavioral change, so he or she can start to better understand the benefits of adopting a physical-activity program and making other positive lifestyle modifications.
Stage 3: Preparation
Preparation is the stage where a client is both mentally and physically preparing to adopt a physical activity program. By definition, this client is no longer sedentary. This client as begun to engage in some form of physical activity (e.g., walking, occasional visit to the gym), but there is no consistency or commitment in this stage. As the fitness professional, it is important to work with the client to create a plan for adopting healthy lifestyle changes and overcoming challenges. This plan may include how to fit physical activity into a busy work schedule, making healthy food choices when eating out and identifying and creating a social support system. The preparation stage is all about establishing a plan for adopting healthy behavior changes that are specific to the client.
Stage 4: Action
Action is the stage where a client has been engaging in regular physical activity for less than six months. This client is carrying out the plan created during the preparation stage. As the fitness professional, it is important to offer continuous support and encouragement, while helping the client focus on the long-term advantages of making positive behavior changes. In this stage, goal setting (using SMART goals) is particularly useful. It is also important to teach the client how to anticipate and overcome obstacles that might deter his or her motivation or adherence.
Stage 5: Maintenance
Maintenance is the stage where a client has been engaged in a regular physical-activity program for more than six months. This client has progressed from the action stage into the maintenance stage, where he or she is maintaining new healthy behavior changes. As the fitness professional, it is important to offer continued encouragement to the client so he or she maintains the changed behavior, and to identify those things that might cause a relapse. Take time to work with the client to identify things that might tempt or undermine the positive changes he or she has made. In addition, help the client to strategize how to prevent these newly identified triggers for relapse. As the fitness professional, it is essentially your goal to provide your client with the tools necessary for maintaining positive behavior changes.
Keep in mind that your clients may oscillate back and forth between stages throughout their time working with you and throughout their lifetime. The shift back and forth between stages may be caused by internal (e.g., changes in self-efficacy) and external (e.g., commitments to family, work) factors. Be aware that such oscillations may occur and work with your clients to help them progress through each of the stages as needed.