The Transtheoretical Model Of Health Behaviour

The Transtheoretical Model Of Health Behaviour A Critical evaluation of the Transtheoretical model of health behaviour change in light of my own experience of exercise behaviour change. â€Å"Morbidity and mortality in industrialized societies is due, in part, to individual patterns of behaviour† (Bridle 2004). Individuals contribute to their own health by avoiding health damaging behaviours such as smoking, and by adopting health enhancing behaviours such as exercise or healthy eating. There are many heath interventions in place to help people make positive lifestyle changes, and these interventions are commonly based on stage theories/models of behaviour change, providing a diagrammatic approach and a framework for research, in order to understand, predict and ultimately change behaviour (Bridle 2004 pg284). Behaviour change is seen as a dynamic process involving movement through a sequence of discrete qualitatively distinct stages, and commonly stage based interventions are more effective then non-stage based interventions (Adams and White 2005). However, recent research into the effectiveness of stage based models suggests that despite the widespread popu larity in both practice and research, more caution is necessary (see Bridle et al 2004 for a review). For the purpose of this project I chose to adopt a healthier lifestyle by increasing the amount of exercise that I did each week. The benefits of exercise are well documented (Department of health 2004) and for the purpose of this study I set a target of exercising three times a week (this is around three times as much as I previously exercised) and I did this for a six week period. I began by jogging for as long as I could manage three times a week, but after the first two weeks I realised that I was lacking motivation, so instead I joined the gym, and continued my regime with the better facilities provided at the gym and monitored my progress in the form of a diary. In the forthcoming essay I will evaluate my experience in light of models of health behaviour change, but more specifically the Transactional model of health behaviour. There is no overall consensus regarding which is the best model of behaviour change but The Transtheoretical model (TTM) (Prochaska DiClemente, 1983; (also known as stages of change model) Prochaska, DiClemente Norcross, 1992)) is commonly considered the dominant model of behaviour change in health Psychology (Norman et al 2000). The TTM of health behaviour suggests that behaviour change is not a continuous process but something that occurs through a series of qualitatively different stages (Bridle et al pg284). It suggests a total of five stages that people go through when experiencing a behaviour change and in addition to these five stages, ten social and psychological aspects of health behaviour and different self-change strategies, the so-called ‘processes of change, that are involved in the movement between different stages (Prochaska et al 1997). Different stages are associated with different beliefs such as the assessment of the ‘pros and ‘cons of the behav iour and self-confidence in ability to change the behaviour. Prochaska et al (1997) argue that interventions to promote change should be designed so that they are appropriate to an individuals current stage and moving an individual from one stage to another using the TTM will eventually lead the person to achieve the ‘maintenance whereby long term change is achieved. The Transtheoretical model provided me with a great insight into my motivational behaviour and the factors that affected my motivation within each stage. For example, the transition between ‘contemplation and ‘action only occurred when I re-located my exercise behaviour to the gym, as described in the TTM, I required environmental re-evaluation and consciousness raising (provided by staff at the gym) before I could move to the ‘action stage. However, motivation was a serious problem, even when I was regularly exercising (weeks 5 and 6) my motivation would fluctuate or increase on a whim, my mood was a strong motivating and de-motivating factor and often other factors such as work, money and other commitments would take priority. These factors can be placed within the ‘decisional balance when weighing up the pros and cons, for example in the third week when I had a lot of university work to do, my exercise was less important which is why I moved from ‘act ion to ‘preparation then back to ‘action, and according to the TTM other factors such as self-efficacy and situational temptations may have also had an influence on my mood and exercise behaviour. However, this was not always the case and my behaviour was not always as structured or as cognitively coherent as the TTM describes. Even with support from peers to do more exercise and no reason not to do exercise, I was still not motivated to actually do it, suggesting that my behaviour did not always follow decision making rules such as the pros and cons of exercise behaviour that TTM proposes. West et al (2005) provides commentary on this by suggesting that by focussing on conscious decision making and planning processes draws attention away from what are known to be important underpinnings of human behaviour (West et al 2005). Even if my behaviour was accountable under the ‘processes of change it still remains that on some occasions these processes were not apparent to me, I simply did not want to do exercise and I easily fell into my old routine of no exercise. This however did lead to ‘regret which in turn motivated me. Sometimes I would chose not to do exercise and regret not doing it, then feel motivated by regret at a later date, it may be worth incorporating the Regret Theory (Bell 1982) into TTM as part if the ‘decisional balance. Another problem that I found with the TTM was that I felt that my behaviour was not always ‘stage specific and I at times I felt as though I was in both ‘pre-contemplation and ‘action stages at the same time. However as Sutton et al (1991) observed if one can be in more than one stage at once, â€Å"the concept of stages loses its meaning† (p.195). It is a bold suggestion to make when analysing a widely used model, and research into the evidence for qualitatively different stages has provided mixed outcomes. Prochaska DiClemente claim strong empirical support for the stages of change across a wide range of populations and problems (Prochaska, DiClemente, Velicer, Rossi, 1992; Prochaska Velicer, 1997; Prochaska, Velicer, et al., 1994; Velicer, Hughes, Fava, Prochaska, DiClemente, 1995; Velicer, Rossi, Prochaska, DiClemente, 1996). However a review of stages of change literature (Littell Girvin, 2002) has provided mixed results regarding the validity of t he qualitatively distinct stages. Identifying a person stage is a fundamental step in applying stage-based interventions, but few staging methods have been validated to confirm that they accurately place the individuals in the correct stage of activity change (Adams, 2005). Not only this, researchers often adapt and change existing algorithms when they are not comfortable with the existing one (Brug, 2003). Littells review provides evidence for and against SOC, from a variety of studies using factor analysis and/or cluster charts to reveal patterns of behavioural intention. The studies provided mixed results; Carey et al (1999) found that â€Å"the number of identifiable clusters is sample dependent and highly variable† and that some clusters â€Å"do not have clear correlates in the Transtheoretical Model† (p. 251), however a separate review (Davidson 1998) found â€Å"clear profiles corresponding to the predicted stages emerged with considerable consistency† ( p. 27). This mix match of results lead Littell at al to conclude; with the exception of pre-contemplation â€Å"stages do not emerge with any consistent manner, in principle components within problem behaviours, and rather then being in one stage or another clients show patterns of differential involvement in each of the stages† (Littell, 2002). This lends support to my personal experience of SOC with regards to exercise behaviour, suggesting that the distinct stages of behaviour change identified by Prochaska et al may not be as accurate as they had originally proposed and without an accurate measurement tool, stage based interventions are of limited utility. The application of stage based interventions to exercise has provided some positive results for short term behaviour change, however little research has found support for the long term benefits of stage based interventions in behaviour change. This has been a topic of much debate over recent years, and a review by Adams and White lead to three main reasons why this may be. The aforementioned problems with validated staging algorithms are noted in Adams et als research, but also the complexity of physical activity, and the possibility that the real determinants of activity change are not included in the Transtheoretical model. Adams et al suggest that the exercise behaviour is not a single behaviour but actually a complex set of behaviour patterns. By reducing exercise behaviour down to one single entity interventions are failing to measure a whole behaviour, rather a part of a behaviour. Marttila et al, for example, identified five different categories of physical activity (occupatio nal activities, fitness activities, life style activities, commuting activities, and sports activities), and peoples pros cons and self efficacy beliefs were different for each behaviour. In my case, I had pros associated with going to the gym during my behaviour change but I did not have pros associated with walking to work every day (occupational activities), or going dancing through the night (life style activities), these behaviours do however constitute as physical activity, I was trying to increase my fitness activities and not taking into account any occupational or life style activities. Unlike smoking or substance use, exercise behaviour is multi-faceted and by failing to recognise this, investigators may be failing to recognise the true complexity and specificity of interventions required to promote activity (Adams et al), not only this, it may explain, in part the problem of validating the stages because people are falling into two groups of behaviour change for different behaviours. Adams et al also suggest that motivational factors for exercise behaviour are more complex then TTM can account for, factors such as age, gender and socioeconomic position, these factors all have an effect of our behaviour but why not behaviour change? A study by Kearney et al (1999) looked at stages of change over a nationally representative sample and found that TTM was effective in identifying stage and attitudes towards exercise behaviour but there was considerable ‘intercountry and ‘sociodemographic variation in the distribution of stages of change. They concluded by suggesting that targeted programmes aimed at specific subgroups might be more effective in promoting physical activity. From this brief introduction to TTM research, and in light of my own behaviour change it would appear that TTM and other stage based interventions targeting exercise behaviour have a long way to go before they can significantly aid long-term behaviour change. I believe that the TTM provided me with a good insight into motivational elements my own behaviour change, however, in my opinion the spontaneous nature of my desire to/not to take part in physical activity did not always fall into the features described in the ‘processes of change or ‘decisional balance. My experience showed that consciousness raising and environmental evaluation had a part to play in stage movement, which allowed for a successful short term behaviour change, but I am not convinced that my behaviour was always stage specific. As mentioned by Bandura ‘human functioning is simply too multifaceted and multi-determined to be categorized into a few discrete stages (Bandura, 1997 pg8) and research h as provided evidence to suggest that the staging process may not be validated, confirming my experience of stages of change (TTM). Possible suggestions for the future of TTM are as follows: West et al argues that interventions should revert back to the simplistic supportive role that GPs took before stage based interventions were devised, focussing on desire to change as opposed to stages (West 2005) and Littell et al (2004) argues for a feedback system whereby stage based groups are coupled with discussions about motivation to change. In my opinion, further research is needed in to tailored behaviour interventions, and/or like Littell et al suggests coupling TTM with a personalized interview suitable for long term behaviour change. References: Adams J White, M. (2005) Why dont stage based activity promotion interventions work? Health Education Research. 20. 237-243. Bandura, A. (1977). Self efficacy: Towards a unifying theory of behavioural change. Psychological review. Bell, David E. (1982). Regret in Decision Making Under Uncertainty. Operations Research, 30, 961-981. Bridle, C; Riemsma, P; Pattenden J; Sowden A J, Mather L, Watt, I S; Walker A (2004) Systematic review of the effectiveness of health behaviour interventions based on the Transtheoretical model. Psychology and health, 20(3):283-301. Brug J. (2005) The transtheoretcial model and stages of change: a critique. Observations by five commentators on the paper b y Adams, J. and White M. (2004) Why dont stage based activity promotion interventions work? Health education research theory and practice, vol.20 no.2, 244-258. Carey, K. B., Purnine, D. M., Maisto, S. A.,Carey, M. P. (1999). Assessing readiness to change substance abuse: A critical review of instruments. In Littell, J. H. Girvin H. (2002) stages of change. A critique. Behaviour modification, 26.223-273. Davidson, R. (1998). The transtheoretical model: A critical overview. InW. R. Miller N. Heather (Eds.), Treating addictive behaviors (2nd ed., pp. 25-38). New York: Plenum. Department of health. (2004) At least five a week: evidence on the impact of physical activity and its relationship to health. A report from the Chief Medical Officer. London TSO. Kearney, J., de Graaf, C., Damkjaer, S. and Engstrom, L. (1999) Stages of change towards physical activity in a nationally representative sample in the European Union. Public Health Nutrition, 2, 115-124. Littell, J. H. Girvin H. (2002) stages of change. A critique. Behaviour modification, 26.223-273. Marttila, J., Laitakari, J., Nupponen, R., Miilunpalo, S. and Paronen, O. (1998) The versatile nature of physical activity. On the psychological, behavioural and contextual characteristics of health-related physical activity. Patient Education and Counselling, 33, s29-s38. Norman P, Abraham C, Conner M (2000) Understanding and changing health behaviour from health beliefs to self regulation, Harwood academic publishers: pg73-95. Prochaska, J. DiClemente, C. 1983. Transtheoretical therapy: toward a more integrative model of change. Psychotherapy: Theory, Research and Practise, 19, 276-288. Prochaska, J. O., DiClemente, C. C. (1992). Stages of change in the modification of problem behaviors. In M. Hersen, R. Eisler,P. M. Miller (Eds.), Progress in behavior modification (Vol. 28). New York: Academic Press. Prochaska, J. O., Velicer, W. F. (1997). Misinterpretations and misapplications of the transtheoretical model. American Journal of Health Promotion, 12, 11-12. Prochaska, J. O.,Velicer,W. F.,Rossi, J. S., Goldstein, M. G., Marcus, B. H., Rakowski,W., et al. (1994). Stages of change and decisional balance for 12 problem behaviors. Health Psychology,13, 39-46. Robinson, T, E Berridge, K C (2003) Addiction. Annual Review of psychology, 54, 25-53. In West R (2005) Time for a change: putting the Transtheoretical (stages of change) Model to rest. Society for the study of addiction. Sutton, S R (1996) Can ‘stages of change provide guidance in the treatment of addictions? A critical examination of Prochaska and DiClementes model. In Norman P, Abraham C, and Conner M; (2000) Understanding and changing Health behaviour p.g. 207-210 West R (2005) Time for a change: putting the Transtheoretical (stages of change) Model to rest. Society for the study of addiction.   

New York City A Diverse Area :: essays research papers

New York City is a diverse area. It contains hundreds of different tracts with one different from the other. I am going to be comparing Hunter's tract, which is 120 with my tract, which is 721. After comparing these two tracts, I am going to compare them both to the entire city of New York. The pace where I live in is Forest Hills, Queens. NYC contains Demographic Characteristics such as total population. In all of New York, to be exact, there are 8,008,278 people in all. Hunter's tract contains 3,965 people. In my tract there are 5,243 people. By looking at this data, it shows that there is a larger population in my tract. Sex and Age in my tract is similar to Hunter's tract and NYC. In all three there are more females than males. Tract 721 has 46% males and 54% females. Hunter's tract has 43.6% males and 56.4% females. NYC as a whole has 47.3% males and 52.7% females. The difference in all three is the median age. Hunter's tract is the oldest one with 51.1 years. The second oldest one is my tract with a median age is 41.9 years. NYC has a median age of 34.2 years. I believe it is so young because, a lot of babies are being born. Educational Attainment and Income are very important. It matters how much education you have in order to have a good job and a higher income. Hunter's tract is more educated then the tract where I live in. There is an enormous difference between the two. In Hunter's tract, people with no high school diploma are only 3.4%. My tract's calculation for no high school diploma is 17.9%. That's almost 6 times as much. With bachelors degree or higher in my tract, there is 38.7%. In Hunter's tract it is 74.8%. That's almost double. This shows that there are greater amounts of educated people in Hunter's tract then my tract. NYC as a whole has almost the same percentage with no high school diploma as to people with bachelor's degree or higher. No high school diploma is 24.7% and bachelors degree or higher is 27.4%. This shows that there are less educated people in New York. Income is the same as educational attainment. There is a much greater income in Hunter's tract than in my tract. The median household income in tract 721 is $33,402.

Ethnic Literature Essay

The term â€Å"ethnic† when in conjunction with the word â€Å"literature† in the academic discourse community of students, often brings out mixed feelings of excitement and dread. On the one hand, students understand that they will be getting away from the canonical American literature – which can equal boring in their eyes; on the other hand, students interpret the term â€Å"ethnic literature† to mean distinctive – which can equal confusing or ambiguous – and perhaps at times not relatable because it is outside their scope of experiences. Perhaps before jumping into why it matters, the term â€Å"ethnic literature† should be defined first and because I am still learning how to interpret this term myself, I searched for a suitable one I could agree with. I found one in an article entitled â€Å"Assessing Teachers’ Knowledge of Multi-Ethnic Literature†, and the article actually used another source themselves to come up with a workable, layman’s definition. Ethnic literature as defined by D.E. Norton (as the article’s source) is, â€Å"Literature about racial or ethnic minority groups that are culturally and socially different from the white Anglo-Saxon majority in the United States, whose largely middle-class values and customs are most represented in American literature† (qtd. in Hager & Thompson 22). I think this definition works well to define what ethnic literature is on a surface level, but the more I dig in, I feel that this idea goes much deeper. I asked myself, who can write about ethnic literature? Can anyone just pick up a pen so to speak and tell a story about a young Japanese boy, or a Hispanic family? Can an African-American writer write about Hispanic or Chinese people and claim it is ethnic literature? And the answer to myself is no. Why? Because unless that African-American has been submersed in the Hispanic or Japanese culture from the time of childhood, how are they going to capture the very essence of being, thinking, and living day-to-day in that culture? And even if that African-American had, they would still most likely have a different perspective from the average Hispanic or Chinese person because of being different themselves (i.e black) and perhaps are treated different by the community at large which corrupts the â€Å"normal† cultural thinking. At this deeper level I am trying to get at, I find John M. Reilly’s article â€Å"Criticism of Ethnic Literature: Seeing the Whole Story† helpful in acquiring this. He states that, â€Å"the assertion of ethnicity in literature can be made only through a procedure by which the writer resolves formal problems†¦ what moves from recognition of identity to creation of a strategy for handling reality still is not literature until the individual author sustains her or his ethnic identity through a sequence of formal choices† (4). I am interpreting this to mean that as a reader of this literature, I should see and feel throughout the story (perhaps subtlety) that in some way, the characters mindset (and perhaps actions) in the story differ from my own specifically because of the culture they have grown up in in, which has shaped that character’s thinking. There are thoughts and feelings – ideas, I don’t understand without further explanation from the author, which is sometimes provided, and sometimes not. An example of this is in Brando Skyhorse’s novel The Madonnas of Echo Park, I find myself wondering what the significance of the jacaranda trees mentioned in different parts of the book. Looking up what they are, it becomes apparent to me as jacaranda trees are native to Central America – roots back to their homeland. The blossoms from the trees fall and are scattered everywhere. Felicia in chapter 2 states that â€Å"there’s no way getting away from them† (25). Basically meaning, you cannot escape who you are and where you come from. I would not have understood this had I not explored the history of that tree to uncover the significance in the book. Another example is in Seventeen Syllables in the story â€Å"Seventeen Syllables†. The story about a Japanese family is easy to read, but is hard to connect with as I don’t share the same philosophies about a woman’s place in the Japanese culture. A specific instance in the story was when Mrs. Hayashi, Rosie’s mother received her the first place prize for her stellar Haiku. When the man from the newspaper presented her with a package, Mrs. Hayashi, stating she knew it was unorthodox, asked if she might open it because she was very curious. (Yamamoto 17). At this point, I am thinking to myself, â€Å"I don’t get it – why wouldn’t she open it?† but upon reflection, I considered the patriarchal society that is dominant in this culture, and perhaps it is the wife’s obligation to consult or have the husband open the gift, even if it is not specifically for him. Yet another example is in Oscar Wao by Junot Diaz. To come specifically to the point, I do not understand this idea of why it is understood that Dominican men are supposed to be these â€Å"manly men† that women flock to and fall on their knees for. That the sexual appetite along with innate sense of charisma from Dominican men is expected, and when it’s lacking, it doesn’t go unnoticed. â€Å"Anywhere else his triple-zero batting average with the ladies might have passed without comment, but this is a Dominican kid we’re talking about, in a Dominican family: dude was supposed to have Atomic Level G, was supposed to be pulling in the bitches with both hands† (24). Why is this idea so indoctrinated in this culture according to the book? This is perhaps something I will never understand, except that it is a part of their culture. All of these examples are all good and well, but the important question is why is ethnic literature important? What can be gained from reading it? From a most basic viewpoint, it is a highly effective vehicle for helping people understand themselves and the world around them. Thompson and Hager in their article state that, â€Å"multi-ethnic literature mirrors and validates the experiences for minority groups and juxtaposes the familiar with the less familiar for mainstream children† (22). In other words, through reading ethnic literature, readers can find ways to connect with others around them that are different. The article also states that when readers are exposed to divergent thoughts, language patterns, value systems, and different ways of living, that it can open up awareness about others and create compassion and understanding towards them that might not have happened without the literary exposure (23). To sum it all up, I will never argue against the instruction of ethnic literature in the school setting. In fact, I think teaching it should begin right from the beginning in kindergarten, and perhaps one day we won’t need the designated term â€Å"ethnic literature† – perhaps one day it can just be â€Å"American Literature† and part of the regular American canon of literature. Works Cited Diaz, Junot. The Brief and Wondrous Life of Oscar Wao. New York: Penguin, 2007. Print. Reilly, John. M. â€Å"Criticism of Ethnic Literature: Seeing the Whole Story†. Critical Approaches to Ethnic Literature. 5.1 (1978): 2-13. Web. 21 Apr. 2012. Skyhorse, Brando. The Madonnas of Echo Park. New York: Free Press, 2010. Print. Thompson, Deborah L. and Jane Meeks Hager. â€Å"Assessing Teachers’ Knowledge of Multi-Ethnic Literature†. Yearbook of the American Reading Forum. 1990. 21-29. Web. 21 Apr. 2012. Yamamoto, Hisaye. Seventeen Syllables. New Brunswick, NJ: Rutgers University Press, 2001. Print.

Short Story - 807 Words

The low murmuring in our head rises to a shout when we step through the doors of the institution. Its here to help, its here to help its here to help its here to- The voices in our head were suddenly shouting over each other, desperate to have their opinions heard. Were gonna die! Were gonna- Help me! Help m- â€Å"Are you Mr.Voces?† A nurse in all white appeared out of nowhere, and startled us from our thoughts. â€Å"Uh-† Say something! Say something! Say somethin- â€Å"Are you feeling well Mr.Voces?† The nurse placed a concerned look on her face and moved to touch our shoulder. â€Å"Oh, uh.. Yes! We’re†¦ Fine!† we finally forced that notion out of our mouth after much debate, and gave her a smile. Well†¦ A smile to the best of my ability. The†¦show more content†¦Ã¢â‚¬Å"I- we want to play†¦Ã¢â‚¬  We mumbled this under our breath, but some of the voices vetoed the idea right away. No No No NO! Dont play, dont play- Bad Idea! Bad Idea- We winced in pain from the impending headache, and reluctantly sat down in a black folding chair in the corner. â€Å"hey are y-you n-n-ew?† A young man came and sat beside us, seeming genuinely interested to know who we were, and why were we there. Say something! Say something! Say somethin- â€Å"Yes† That was all we gave him, and that was all we were interested in giving. â€Å"O-oh o-okay then.† He want to kill us! Were gonna die! Were gonna- Help me! Help m- The onslaught of voices grew ever so louder, and we cupped our head with our head, and let out a small breath of pain. â€Å"H-hey are y-you o-okay?† The man reached out and took ahold of our shoulder, and before we could blink our fist was swinging and landing straight in his lower abdomen. The walls around us started to close in, and we quickly and over into a corner desperately trying to hide. Run now! Run Now! Run- â€Å"NO!† I roared at the top of my lungs and pulled myself out of the corner. Hide hide hide hide hide hide- Run now! Run Now! Run- Were gonna die! Were gonna- Help me! Help m- â€Å"SHUT UP!† The voices all went off suddenly, and it was as if a dense fog was lifted from my head. The voices†¦ They were gone. Am I free? â€Å"Billy, are you okay?† The boy with the stutter was doubled over on the floor, holding his stomach tightly.Show MoreRelatedshort story1018 Words   |  5 Pagesï » ¿Short Stories:  Ã‚  Characteristics †¢Short  - Can usually be read in one sitting. †¢Concise:  Ã‚  Information offered in the story is relevant to the tale being told.  Ã‚  This is unlike a novel, where the story can diverge from the main plot †¢Usually tries to leave behind a  single impression  or effect.  Ã‚  Usually, though not always built around one character, place, idea, or act. †¢Because they are concise, writers depend on the reader bringing  personal experiences  and  prior knowledge  to the story. Four MajorRead MoreThe Short Stories Ideas For Writing A Short Story Essay1097 Words   |  5 Pageswriting a short story. Many a time, writers run out of these short story ideas upon exhausting their sources of short story ideas. If you are one of these writers, who have run out of short story ideas, and the deadline you have for coming up with a short story is running out, the short story writing prompts below will surely help you. Additionally, if you are being tormented by the blank Microsoft Word document staring at you because you are not able to come up with the best short story idea, youRead MoreShort Story1804 Words   |  8 PagesShort story: Definition and History. A  short story  like any other term does not have only one definition, it has many definitions, but all of them are similar in a general idea. According to The World Book Encyclopedia (1994, Vol. 12, L-354), â€Å"the short story is a short work of fiction that usually centers around a single incident. 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