Transtheoretical Model (TTM): Guiding Physical Exercise Intervention to Reduce Obesity Prevalence in Alabama

Introduction

One of the approaches that will be used to implement physical exercise intervention to reduce the prevalence of obesity in the State of Alabama is the Transtheoretical Model (TTM) of Behavioural Change. The TTM is useful in the implementation of the intervention because it is useful in helping to understand people's behavioural changes and in explaining how they move gradually via five stages of behavioural changes. The TTM is also crucial in guiding the intervention because it has been empirically validated to clarify how people adopt and maintain physical activity. According to Han, Pettee Gabriel, and Kohl (2017), TTM is a successful framework for reducing sedentary behaviour.

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The TTM posits that a person will decide to adopt a healthy behaviour when he or she sees the adoption of the practice to have more benefits than demerits (Han, Gabriel, & Kohl, 2015). When the advantages attributed to a health behaviour change outweighs the disadvantages, an individual decides to change their behaviour. Such a decision takes place at the preparation (determination) stage of the TTM. According to LaMorte (2019), this stage is characterized by one's readiness to change his or her behaviour within the next thirty days. The need for behavioural change is attributable to the belief that modification of behaviour will lead to a healthier life (Hardy, White, & Gray, 2015; Russell et al., 2016).

The Stage Theory of Organizational Change

The second theory that will be used to guide physical exercise intervention is the Stage Theory of Organizational Change. The model is comprised of four stages. In the first stage, members of an organization become aware of the existence of the problem and possible solutions (The University of Pennsylvania, n.d.). In the second stage, members make a pronouncement to adopt an innovation aimed at solving the problems. The third stage is characterized by the implementation of the change. This takes place through modification of the structures of the organization to accommodate the solutions.

In the last stage, the institutionalization of innovation occurs, which implies that innovation is made part of the organization's daily activities (The University of Pennsylvania, n.d.). The Stage Theory of Organizational Change was chosen because it focuses on actions that take place in each of the four stages rather than focusing on the factors that affect how an organization transit from one step to the next. Because of this, this model can allow for stage-tailored interventions.

The Key Objectives of the Intervention and Linkage to the Theories

The proposed physical exercise intervention is aimed at achieving three key objectives. The first objective is to increase efforts towards ensuring that the participants accomplish mastery experiences in physical activity. Secondly, the intervention provides that physical exercise teachers implement strength-focused exercises. Third, the intervention is aimed at ensuring that every participant engaged in at least a 30-minute daily activity and a total of 150 minutes per week.

The physical exercise intervention can be linked to the TTM through its various stages and constructs. For instance, before the implementation of physical exercise, the ideal stage of the participants regarding the intervention will be determined. The pros and cons attributable to exercise will be explained to the participants to enable them embrace physical activity. The benefits associated with the intervention will be disclosed to the teachers and parents to help persuade the children to engage in exercise. When the participants understand that the benefits of the intervention outweigh the demerits, they will move to the preparation and action stages of the TTM. Consequently, they will embrace the physical exercise intervention.

In the TTM, the elements of the theory that work well with the intervention are the stages of change. It is vital to determine a person's stage of change in order to provide the most appropriate intervention. However, some constructs of the TMM (e.g., maintenance and termination) may not apply to the intervention because it will not last for six months.

The Stage Theory of Organizational Change is also linked to the intervention because it allows for different change agents to assume leading roles at various stages of the model. For example, at the school level, the senior administrators play a crucial role in the problem awareness and definition stages (Butterfoss, Kegler, & Francisco, 2008). On the other hand, the adoption of new behaviour and its implementation are carried out by the curriculum coordinators and the principals. Teachers are also crucial in the implementation stage as they ensure that the children adhere to the intervention. Lastly, senior administrators have been found to play a critical role in the institutionalization of the intervention (Butterfoss et al., 2008). Not all elements of the Stage Theory of Organizational Change will work with physical exercise intervention. For instance, the institutionalization of the intervention may not be accomplished because of the limited amount of time for the program.

Comparison of the Chosen Theories With Two Other Theories

The TTM and the Stage Theory of Organizational Change will be compared with two other theories (the Health Belief Model (HBM) and the Diffusion of Innovation Theory) that could be used in the implementation of the intervention. Unlike the TTM and the Stage Theory of Organizational Change which explains the behavioural change as a process that takes place through definite stages, the HBM non-stage (Fisher et al., 2018). However, in both TTM and HBM, an individual's participation in health behaviour is based on the benefits attributable to the adoption of the behaviour (Gehlert & Browne, 2019; Hinote & Wasserman, 2019).

The Diffusion of Innovation Theory differs from the TTM and the Stage Theory of Organizational Change in many ways. First, in the Diffusion of Innovation Theory, individuals are placed in different categories based on their readiness and willingness to adopt a new behaviour or idea (Jallouli et al., 2019; Stair & Reynolds, 2016). However, the HBM does not place people in categories, but the likelihood of adopting a new behaviour is based on perceived benefits (Brannon, Feist, & Updegraff, 2017; Rieger, 2017). Lastly, unlike the Stage Theory of Organizational Change, the Diffusion of Innovation Theory is non-stage.

Strengths and Weaknesses of the Theories

The TTM has been reported to have critical strengths that make it a robust model for behaviour change. First, the TTM is beneficial because it matches the stage of a person with appropriate intervention strategies (Lacey & Street, 2017). Second, it is useful in various health-related interventions such as vegetable and fruit consumption, condom use, and smoking cessation. Third, the TTM has been linked to greater participation than other theoretical interventions.

The TTM model has been reported to have some limitations which must be taken into consideration when being used to change behaviours. One of the limitations of this theory is that it does not take into account the social context in which behaviour change takes place, e.g., a person's income level and socioeconomic status (LaMorte, 2019). For instance, even if an individual has found out engaging in at least 30 minutes of physical exercise a day could help prevent obesity, he or she may not implement the behaviour if there is no money for a gym membership.

Another demerit linked to the TTM is that there is no guideline on how a person's stage of change can be determined (LaMorte, 2019). Because of this, it may prove challenging to provide stage-appropriate behavioural interventions. Third, the TTM does not state the amount of time needed for each stage or the duration an individual can remain in each of its five steps (LaMorte, 2019). Consequently, it is difficult for a researcher to determine the amount of time needed for a behaviour change to be accomplished.

References

Brannon, L., Feist, J., & Updegraff, J. A. (2017). Health psychology: An introduction to behaviour and health. San Francisco, CA: Cengage Learning.

Fisher, E. B., Cameron, L. D., Christensen, A. J., Ehlert, U., Guo, Y., Oldenburg, B., & Snoek, F. J. (2018). Principles and concepts of behavioural medicine: A global handbook. New York, NY: Springer.

Gehlert, S., & Browne, T. (2019). Handbook of health social work. Burlington, MA: John Wiley & Sons.

Han, H., Gabriel, K. P., & Kohl, H. W. (2015). Evaluations of validity and reliability of a transtheoretical model for sedentary behaviour among college students. American Journal of Health Behaviour, 39(5), 601-609. https://doi.org/10.5993/AJHB.39.5.2

Han, H., Pettee Gabriel, K., & Kohl, H. W. (2017). Application of the transtheoretical model to sedentary behaviours and its association with physical activity status. PloS One, 12(4), e0176330. https://doi.org/10.1371/journal.pone.0176330

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Lacey, S. J., & Street, T. D. (2017). Measuring healthy behaviours using the stages of change model: An investigation into the physical activity and nutrition behaviours of Australian miners. Biopsychosocial Medicine, 11. https://doi.org/10.1186/s13030-017-0115-7

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The University of Pennsylvania. (n.d.). Health behaviour and health education | part four, chapter fifteen: Stage theory of organizational change. Retrieved from https://www.med.upenn.edu/hbhe4/part4-ch15-stage-theory-of-organizational-change.shtml