302 transtheoretical model of behaviour change

What is it?

it outlines several processes and stages of change that explain how people typically modify their behaviours. It is used to assess one’s readiness to adopt a behaviour and provide stage-based interventions to support progress through these stages.

What are the 5 stages?

precontemplation, contemplation, preparation, action, maintenance

Precontemplation

• the individual is not considering changing their behaviour either because they do not recognise smoking as a problem or do not feel ready to change

• aim at this stage would be to increase the pts awareness and encourage them to begin considering cessation

Precontemplation- if the pt had no intention of stopping smoking, as an OHT…

I would not pressure them to quit. Instead I would use brief motivational interviewing techniques to raise awareness of the relationship between smoking and oral health. I would explain that smoking increases the risk of periodontal disease, caries, impaired healing, tooth loss and oral cancer

Contemplation

• the individual recognises that smoking is harmful and is considering quitting, but have not yet committed to take action

• the pt may recognise the benefits of quitting but also perceive barriers e.g. nicotine dependance, stress, etc

• I would use motivational interviewing and open-ended questions to explore their reasons for smoking alongside their reasons for wanting to quit. I could also discuss the short and long term benefits of cessation. This helps address ambivalence without being judgemental

Preparation

• stage where intention and action come together

• pt is aware that their behaviour is problematic and that change would be beneficial, they start taking small steps to prepare for change and intend to take action imminantly

preparation- individualised quit plan could include:

• identifying triggers and high risk situations (stress, alcohol, social situations)

• identify strategies to manage cravings e.g. exercise, drinking water, sugar-free gum

• setting a realistic quit date

• discussing nicotine replacement therapy and making a referral to an appropriate smoking cessation service

• discussing what to expect from nicotine withdrawal and how to manage it

• following up routinely to monitor progress

Action

• When the individual is actively changing their behaviour or environment to overcome the problem with the intention to keep moving forward with the change.

• I would provide ongoing support and positive reinforcement.

• Reinforce the oral health benefits of cessation following dental tx

• If a relapse occurs, I would avoid judgement and explore what triggered it, helping the individual develop further strategies including making a referral to the appropriate services

Maintenance

• individuals reach this stage once they have maintained the behavioural change(s) for at least 6 months

• the individual works to prevent relapse and consolidate gains to focus on the progress they have made

• this stage has no limit, they may stay at this stage indefinently

• the focus is now on preventing relapse and strengthening the individuals confidence that they can remain smoke-free

• as an OHT, routine dental appts provide opportunities to reinforce cessation and monitor improvements in oral health

Maintenance- continue to…

• reinforce the benefits of remaining smoke-free

• review potential triggers and coping strategies

• encourage continued social and professional support

• monitor oral health and provide positive feedback about improvements

• encourage the pt to recognise themselves as a non-smoker

What is important note about this model?

That this model does not represent a linear path, but a cyclic one. The individual can revert to earlier stages from any stage.