Fall Prevention through Behavior Change: Exercise

							 Fall Prevention through
 Behavior Change:
 Exercise Interventions with the
 Transtheoretical Model

Patricia Burbank, DNSc, RN
Professor
URI College of Nursing
RI Geriatric Education Center
Objectives
   Describe the Transtheoretical Model of
    Behavior Change as it applies to exercise
    and fall prevention.
   Assess the stages of change for exercise
    behavior.
   Discuss processes and strategies for
    exercise behavior change among older
    adults.
   Identify strategies for exercise behavior
    change to identified stages of change.
Transtheoretical Model of
Behavior Change (TTM)

   Prochaska & DiClemente, 1984
    Dimensions of TTM


 Stages of change
 Processes of change

 Decisional balance

 Self efficacy
Stages of change (5)
   Precontemplation - no intention to
    change behavior in foreseeable future
   Contemplation - seriously considering
    changing behavior within 6 months
   Preparation - Intending to take action
    within next month
Stages of change (cont’d)


   Action - successfully altered behavior
    for one day to 6 months

   Maintenance - a continuation of
    changed behavior from 6 months to
    indefinite
Processes of change (10)

Cognitive:
 Consciousness raising

 Dramatic relief

 Environmental reevaluation

 Self-reevaluation

 Social liberation
Processes of change
(cont’d)

Behavioral:
 Counter-conditioning

 Helping relationships

 Reinforcement management

 Self-liberation

 Stimulus control
Description of Processes

   Consciousness raising - seek new
      information about the behavior
   Dramatic relief - Express feelings
      about problem or behavior
   Environmental reevaluation -
      Assess how problem affects
      physical and social environment
    Description of Processes
     (cont’d)


   Self re-evaluation - Re-appraise
        values regarding the behavior
   Social liberation - Develop
        awareness and acceptance of
        changed lifestyle
   Counter-conditioning - Substitute
    alternative for problem behavior
Description of Processes
(cont’d)
   Helping relationships - Use support
    from others
   Reinforcement management -
       Reward changed behavior
   Self-liberation - Commit to action;
       belief that change is possible
   Stimulus control - Control situations
    and cues that support problem
    behavior
Decisional Balance

   Precontemplation - cons of changing
    outweigh pros
   Contemplation - pros stronger but still may
    not outweigh cons, crossover may occur
   Preparation - crossover (pros stronger than
    cons)
   Action -            cons
                                              pros
Self efficacy


   Self efficacy increases across stages
   Temptation scores decrease across
    stages
   Maximum self efficacy and minimal
    temptation occurs in maintenance
Moving through
      Stages of Change
        Precontemplation

            Contemplation

  Relapse                   Preparation

Maintenance                   Action

    Termination
Precontemplation:
Goals and Strategies

Increase awareness of need to
  change.

   Give personalized information and
    feedback
   Encourage thinking about change
Contemplation:
Goals and Strategies
Motivate and increase confidence in
 ability to change.
   Emphasize benefits of change
   Express empathy and provide support
   Explore concerns and fears
   Clarify misconceptions
Preparation:
Goals and Strategies
Negotiate a plan.

   Set realistic goals.
   Recommend a plan; provide options
   Individualize plan
   Reinforce small change
Action :
Goals and Strategies
Reaffirm commitment and follow-
 up.
   Reaffirm agreed-upon plan
   Teach behavioral skills
   Provide educational materials
   Enhance social support
   Arrange follow-up date
Maintenance:
Goals and Strategies
Encourage active problem-solving.

   Encourage planning for potential
    difficulties
   Enhance support network
Relapse:
Goals and Strategies
Assist in coping.

   Help overcome shame and guilt
   Reframe as learning opportunity
   Analyze stumbling blocks
Assessing Stage of Change
  Identify behavior first, then:
   Yes, I have been for more than 6
    months
   Yes, I have been, but for less than 6
    months
   No, but I intend to in the next 30 days

   No, but I intend to in the next 6
    months
   No, and I do not intend to in the next
    6 months
Tailor interventions
to stage of change
Summary

   Behavior change occurs in stages
   TTM: 4 main components
   Behavior change works better if
    interventions are tailored to stage of
    change
   Design stage-tailored strategies for
    population group and setting