Planed Behavior In Nursing Education and Stages of Change Model and Theory of Reason Action
Stages of Change Model Health Behavior In Nursing Education
Another model that sheds light on the phenomenon of health behaviors of the learner is the stages of change model, also known as the transtheoretical model (TTM) of behavioral change (Prochaska & DiClemente, 1982). Originating from the field of psychology, this model was developed around addictive and problem behaviors. Prochaska (1996) notes that it encompasses six distinct time related stages of change:
1. Precontemplation: Individuals have no current intention of changing. Strategies involve simple observations, confrontation, or consciousness raising.
2. Contemplation: Individuals accept or realize that they have a problem and begin to think seriously about changing it. Strategies involve increased consciousness raising.
3. Preparation: Individuals are planning to act within the time frame of 1 month. Strategies include a firm. and detailed plan for action.
4. Action: There is overt/visible modification of behavior. This is the busiest stage, and strategies include commitment to the change, self-reward, countering (substitute behaviors), creating a friendly environment, and supportive relationships.
5. Maintenance: Maintenance is a difficult stage to achieve and may last 6 months to a lifetime. There are common challenges to this stage, including overconfidence, daily temptation, and relapse self-blame. The strategies in this stage are the same for the action stage.
6. Termination: This stage occurs when the problem no longer presents any temptation. However, some experts note that termination does not occur; instead, maintenance simply becomes less vigilant.
Implementation of Change Model In Nursing Education
The extent to which people are motivated and ready to change is an important construct. It is useful in health care to stage the client’s intentions and behaviors for change as well as to determine those strategies that will enable completion of the specific stage. More recent use of the stages of change model in health research has focused on its value in health pro- motion and the processes by which people decide to change (or not to change) behaviors.
The stages of change model have been used to investigate health behaviors, such as using sun protection (Prentice Dunn et al., 2009). managing weight loss (Mastellos, Gunn, Felix. Car, & Majeed, 2014), and exercising (Lowther. Mutrie, & Scott, 2007). It also has been used as a method of outcome evaluation in continuing education for nurses (Randhawa, 2012). This popular model can be used with children and adults, which has implications for a variety of educational settings.
Theory of Reasoned Action and Theory of Planned Behavior
The theory of reasoned action (TRA) emerged from a research program that began in the 1950s and is concerned with predicting and understanding any form of human behavior within a social context (Ajzen & Fishbein, 1980). It is based on the premise that humans behave in a rational way that is consistent with their beliefs (Fishbein, 2008).
This theory suggests that a person’s behavior can be predicted by examining the individual’s attitudes about the behavior as well as the individual’s beliefs about how others might respond to the behavior.
For example, when using this theory to predict how a client might respond to a weight reduction plan, it would be vital not only to consider the client’s beliefs about food and exercise but also to examine what the client thinks about how the people around him would view his attempts to lose weight.
It is important to note that reasoned action in this theory is not emotion free but rather based on beliefs that are influenced by emotion and mood (Fishbein, 2008). This theory is depicted as a sequential model.
In a two pronged linear approach, specific behavior is determined by:
(1) beliefs, attitude toward the behavior, and intention
(2) motivation to comply with influential persons (known as referents), subjective norm, and intention
The person’s intention to perform can be measured by relative weights of attitude and subjective norm.As the TRA began to be applied in the social sciences, Ajzen and other researchers realized the theory had several limitations (Godin & Kok, 1996).
One of the strongest limitations was use of the theory with people who felt they had little power over their behaviors. To remedy this, in 1985, Ajzen proposed a new model the theory of planned behavior (TPB). The TPB added a third element to the TRA model the concept of perceived behavioral control (Ajzen, 1991).
The TRA and the TPB have been used to determine nurses’ attitudes toward teaching particular health education topics (Kleier, 2004; Mullan & Westwood, 2010), as a framework in smoking prevention and intention studies (Hanson, 2005; McGahee, Kemp, & Tingen, 2000), for designing interventions to reduce heterosexual risk behavior (Tyson, Covey, & Rosenthal, 2014), to understand intentions to receive human papillomavirus vaccine (Fisher, Kohut, Salisbury, & Salvadori, 2013), and to study nursing care of individuals who are drug addicts (Natan, Beyil, & Neta, 2009).
The TRA and TPB are useful theories in predicting behaviors, which is particularly helpful for educators who want to understand the attitudinal context within which health behaviors are likely to change. Nurses as educators need to take beliefs, attitudinal factors, and subjective norms into consideration when designing educational programs intended to change specific health behaviors.
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