Application to Health
Transtheoretical Model (TTM) for HIV Prevention in a Facility-Based and a Community-Level Behavioral/Intervention Research Study
-The main objective was to use the TTM to increase condom and contraceptive use for woman at risk for contracting HIV.
-To reach women with high-risk behaviors in the diverse settings they frequent, investigators developed the following two types of interventions: one that was facility based (in Baltimore and Philadelphia) and one that intervened at the community level (in Pittsburgh,Portland, and Philadelphia). The goals of these projects were to reduce sexual behaviors that increase risk for HIV, increase the use of effective contraception, and strengthen reproductive decision-making skills.
-The TM was selected as the foundation for these projects because they felt that the description of behavior change was gradual, incremental, and dynamic and was appropriate and useful for characterizing the process of adopting condom and contraceptive use.
-Researchers conducted cross-sectional stage assessments of women in the community settings where the interventions would occur. These measurements deter-mined the distribution of the women’s stages for implementation of these interventions.
-surveys indicated that many women were in precontemplation for condom use by their main partners (51%), with 10% in contemplation, 18% in preparation, and only 20% in action or maintenance. For condom use by non–main partners, 12% were in precontemplation, none in contemplation, and 16% in preparation; there were more women in action and maintenance (56%).
-The TM was applied to (a) the production of print materials for at-risk women and (b) in dividua loutreach encounters conducted by trained community members in public housing developments and other residential areas, businesses, and public areas where women with risk behaviors congregate.
-Applying the TM to the production of print material derived in part from the groundbreaking work in HIV prevention by the AIDS community demonstration projects.
- Stage tailored messages were spread throughout the participating communities by having community volunteers distribute HIV prevention materials (e.g., flyers, brochures, and newsletters) containing role-model stories.
-The proportion of stories developed for each of the five stages,that is, precontemplation, contemplation, preparation,action, and maintenance, was determined by the pro-portion of women from the community who were in that stage at baseline.
-The activity of the peer networkers was complemented by a second strategy that integrated the TM: the stage-based outreach encounter.The stage-based outreach encounter was delivered by paraprofessionals called out-reach specialists who were most often community members who had been trained to apply the TM model. With standardized training on reflective listening skills and application of the Transtheoretical Model to real-life situations, the outreach specialists were skillful in approaching,engaging, and developing rapport with women.
-Repeated cross-sectional surveys were conducted annually.
-Results showed that women in the treatment communities who reported exposure to the intervention were more likely than those in the comparison communities to have attempted to get their main partner to use condoms (an increase of 37%) and were less likely to report never talking to their partner about and never using condoms.
-The main objective was to use the TTM to increase condom and contraceptive use for woman at risk for contracting HIV.
-To reach women with high-risk behaviors in the diverse settings they frequent, investigators developed the following two types of interventions: one that was facility based (in Baltimore and Philadelphia) and one that intervened at the community level (in Pittsburgh,Portland, and Philadelphia). The goals of these projects were to reduce sexual behaviors that increase risk for HIV, increase the use of effective contraception, and strengthen reproductive decision-making skills.
-The TM was selected as the foundation for these projects because they felt that the description of behavior change was gradual, incremental, and dynamic and was appropriate and useful for characterizing the process of adopting condom and contraceptive use.
-Researchers conducted cross-sectional stage assessments of women in the community settings where the interventions would occur. These measurements deter-mined the distribution of the women’s stages for implementation of these interventions.
-surveys indicated that many women were in precontemplation for condom use by their main partners (51%), with 10% in contemplation, 18% in preparation, and only 20% in action or maintenance. For condom use by non–main partners, 12% were in precontemplation, none in contemplation, and 16% in preparation; there were more women in action and maintenance (56%).
-The TM was applied to (a) the production of print materials for at-risk women and (b) in dividua loutreach encounters conducted by trained community members in public housing developments and other residential areas, businesses, and public areas where women with risk behaviors congregate.
-Applying the TM to the production of print material derived in part from the groundbreaking work in HIV prevention by the AIDS community demonstration projects.
- Stage tailored messages were spread throughout the participating communities by having community volunteers distribute HIV prevention materials (e.g., flyers, brochures, and newsletters) containing role-model stories.
-The proportion of stories developed for each of the five stages,that is, precontemplation, contemplation, preparation,action, and maintenance, was determined by the pro-portion of women from the community who were in that stage at baseline.
-The activity of the peer networkers was complemented by a second strategy that integrated the TM: the stage-based outreach encounter.The stage-based outreach encounter was delivered by paraprofessionals called out-reach specialists who were most often community members who had been trained to apply the TM model. With standardized training on reflective listening skills and application of the Transtheoretical Model to real-life situations, the outreach specialists were skillful in approaching,engaging, and developing rapport with women.
-Repeated cross-sectional surveys were conducted annually.
-Results showed that women in the treatment communities who reported exposure to the intervention were more likely than those in the comparison communities to have attempted to get their main partner to use condoms (an increase of 37%) and were less likely to report never talking to their partner about and never using condoms.
Other application examples:
The Transtheoretical Model has been used to change many health behaviors such as smoking cessation, exercise, alcohol abuse, weight control, condom use, needle sharing, hypertension mediation compliance, sun protection behaviors, seat belt use, organ donation, mammography screening, and preventing domestic violence.
Determining what stage a person is in is essential to the success of the model. A person may be in precontemplation to quit smoking but may be in the action stage to improve physical activity. .
Determining what stage a person is in is essential to the success of the model. A person may be in precontemplation to quit smoking but may be in the action stage to improve physical activity. .
Reference:
-Velicer, W. F., Prochaska, J. O., Fava, J. L., Rossi, J. S., Redding, C. A., Laforge, R. G., Robbins, M. L. (2000). Using the Transtheoretical Model for Population-based Approaches to Health Promotion and Disease Prevention. Homeostasis in Health and Disease, 40, 174-195.
-Velicer, W. F., Prochaska, J. O., Fava, J. L., Rossi, J. S., Redding, C. A., Laforge, R. G., Robbins, M. L. (2000). Using the Transtheoretical Model for Population-based Approaches to Health Promotion and Disease Prevention. Homeostasis in Health and Disease, 40, 174-195.