Behavoural changes ie smoking censation

Published Date: 23 Mar 2015

Behavoural Changes ie smoking censation

This essay will discuss the Behaviour Change Model of Health education or The Trans-theoretical Model, (TTM) in relation to smoking cessation. As G. K. Chesterton once said, “It isn't that they can't see the solution. It is that they can't see the problem.” Families, friends, neighbours, or employees, however, are often well aware that the pre-contemplators have problems.

Stages of Change

Prochaska & DiClement`s transtheoretical model (1984,1986; Prochaska et al 1992) is important in describing the process of change. The model derived from their work on encouraging change in addiction behaviours, although it can be used to show that most people go through stages when trying to change or acquire behaviours. American psychologists, Jim Prochaska and Carlo Di Clement,

Termination.

Process of change.

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4 ADDICTIONS NURSING NETWORKNOLUME 5, NUMBER 1,1993

In our studies using the discrete categorization measurement of stages of change, we ask whether the individual is seriously intending to change the problem behavior in the near future, typically within the next six months. If not, he or she is classified as a precontemplator. Even precontemplators can wish to change, but this seems to be quite different from intending or seriously considering change in the next six months. Items that are used to identify precontemplation on the continuous stage of change measure include “As far as I'm concerned, I don't have any problems that need changing” and “I guess I have faults, but there's nothing that I really need to change.” Resistance to recognizing or modifying a problem is the hallmark of precontemplation .

Splral Pattern of Change.

Many New Year's resolvers report five or more years of consecutive pledges before maintaining the behavioral goal for at least six months (Norcross & Vangarelli, 1989). Relapse and recycling through the stages occur quite frequently

as individuals attempt to modify or cease addictive behaviors. Variations of the stage model are being used increasingly by behavior change specialists to investigate the dynamics of relapse (e.g., Brownell et al., 1986; Donovan & Marlatt, 1988). Because relapse is the rule rather than the exception with addictions, we found that we needed to modify our original stage model. Initially we conceptualized change as a linear progression through the stages; people were supposed to progress simply and discretely through each step. Linear progression is a possible but relatively rare phenomenon with addictive behaviors. Figure 1 presents a spiral pattern that illustrates how most people actually move through the stages of change. In this spiral pattern, people can progress from contemplation to preparation to action to maintenance, but most individuals will relapse. During relapse, individuals regress to an earlier stage. Some

TERYINATION a YAHTENANCE

PRECONTEYPLATIOW CONTEYPLATKJN PREPARATKJ

relapsers feel like failures-embanassed, ashamed, and guilty. These individuals become demoralized and resist thinking about behavior change. As a result, they return to the precontemplation stage and can remain there for various periods of time. Approximately 15% of smokers who relapsed in our self-change research regressed back to the precontemplation stage (Prochaska & DiClemente, 1986).

Fortunately, this research indicates that the vast majority of relapsers--85% of smokers, for example- recycle back to the contemplation or preparation stages (Prochaska & DiClemente, 1984). They begin to consider plans for their next action attempt while trying to learn from their recent efforts. To take another example, fully 60% of unsuccessful

New Year's resolvers make the same pledge the next year (Norcross, Ratzin, & Payne, 1989; Norcross & Vangarelli, 1989). The spiral model suggests that most relapsers do not resolve endlessly in circles and that they do not regress all the way back to where they began. Instead, each time relapsers recycle through the stages, they potentially learn from their mistakes and can try something different the next time around (DiClemente et al., 1991). On any one trial, successful behavior change is limited in the absolute numbers of individuals who are able to achieve maintenance (Cohen et al., 1989; Schachter, 1982). Nevertheless, in a cohort of individuals, the number of successes continues to increase gradually over time. However, a large number of individuals remain in contemplation and precontemplation stages. Ordinarily, the more action taken, the better the prognosis. Much more research is needed to better distinguish those who benefit from recycling from those who end up spinning their wheels.

Arguments for and against

Conclusion

Influencing the people to change behaviours such as how they eat,excersice ,drink, smoke requires a long term commoitment but it is a process that they can sucseed. Nurses have a key role to play in influencing behaviour of their patients, and health promotion should be embed

MAINTENANCE:

practice required for the new behaviour to be consistently maintained, incorporated into the repertoire of behaviours available to a person at any one time.

ACTION: people make changes, acting on previous decisions, experience, information, new skills, and motivations for making the change.

PREPARATION:

person prepares to undertake the desired change - requires gathering information, finding out how to achieve the change, ascertaining skills necessary, deciding when change should take place - may include talking with others to see how they feel about the likely change, considering impact change will have and who will be affected.

CONTEMPLATION:

something happens to prompt the person to start thinking about change - perhaps hearing that someone has made changes - or something else has changed - resulting in the need for further change.

PRECONTEMPLATION:

changing a behaviour has not been considered; person might not realise that change is possible or that it might be of interest to them.

Source:

The Behavior Change spiral from "What do they want us to do now?" AFAO 1996 ded in daily practice. E

following review explores and considers some of the major theories of behaviour and behaviour change that may be pertinent to the development of effective interventions in travel behaviour, including theories and concepts from mainstream psychology, and the associated sub-disciplines of health, leisure, recreation, physical activity and exercise psychology.

For many years conceptual models of behaviour change, such as Bandura's Social Cognitive Learning Theory (1986), Becker's Health Belief Model (1974), Azjen and Fishbein's Theory of Reasoned Action (1975); have been applied across a wide variety of disciplines, including travel and road user behaviour.

Considerable attention has been given in the literature to models of individual behaviour change per se - but much less attention has been given to models or theories that attempt to understand behaviour change within groups, organisations and whole communities. The design of programs to reach populations requires an understanding of how those communities work, their barriers and enablers to change, and what influences their behaviours in general.

Stage Theories of Behaviour Change

Mounting evidence suggests that behaviour change occurs in stages or steps and that movement through these stages is neither unitary or linear, but rather, cyclical, involving a pattern of adoption, maintenance, relapse, and readoption over time. The work of Prochaska and DiClemente (1986) and their colleagues have formally identified the dynamics and structure of staged behaviour change. In attempting to explain these patterns of behaviour, Prochaska and DiClemente developed a transtheoretical model of behavioural change, which proposes that behaviour change occurs in five distinct stages through which people move in a cyclical or spiral pattern.

The first of these stages is termed precontemplation. In this stage, there is no intent on the part of the individual to change his or her behaviour in the foreseeable future. The second stage is called contemplation, where people are aware that a problem exists and are seriously considering taking some action to address the problem. However, at this stage, they have not made a commitment to undertake action. The third stage is described as preparation, and involves both intention to change and some behaviour, usually minor, and often meeting with limited success.

Action is the fourth stage where individuals actually modify their behaviour, experiences, or environment in order to overcome their problems or to meet their goals. The fifth and final stage, maintenance, is where people work to prevent relapse and consolidate the gains attained in the action stage. The stabilization of behaviour change and the avoidance of relapse are characteristic of the maintenance stage.

Prochaska and DiClemente further suggest that behavioural change occurs in a cyclical process that involves both progress and periodic relapse. That is, even with successful behaviour change, people likely will move back and forth between the five stages for some time, experiencing one or more periods of relapse to earlier stages, before moving once again through the stages of contemplation, preparation, action and eventually, maintenance. In successful behavioural change, while relapses to earlier stages inevitably occur, individuals never remain within the earlier stage to

MAINTENANCE:

practice required for the new behaviour to be consistently maintained, incorporated into the repertoire of behaviours available to a person at any one time.

ACTION:

people make changes, acting on previous decisions, experience, information, new skills, and motivations for making the change.

PREPARATION:

person prepares to undertake the desired change - requires gathering information, finding out how to achieve the change, ascertaining skills necessary, deciding when change should take place - may include talking with others to see how they feel about the likely change, considering impact change will have and who will be affected.

CONTEMPLATION:

something happens to prompt the person to start thinking about change - perhaps hearing that someone has made changes - or something else has changed - resulting in the need for further change.

PRECONTEMPLATION:

changing a behaviour has not been considered; person might not realise that change is possible or that it might be of interest to them.

Source:

The Behavior Change spiral from "What do they want us to do now?" AFAO 1996 which they have regressed, but rather, spiral upwards, until eventually they reach a state where most of their time is spent in the maintenance stage.

Further work undertaken and reported by Prochaska et el (1992) suggests that behaviour change can only take place in the context of an enabling or supportive environment.

Prochaska's and DiClemente's model has received considerable support in the research literature. Their model has also been shown to have relevance for understanding, among other things, patterns of physical activity participation and adherence and would have relevance in bringing about change in travel behaviours. Consistent with the above perspective, Sallis and Nader (1988) also have suggested a stage approach to explaining movement behaviour, particularly in family groups, with research aimed at understanding better the cyclical patterns of movement activity

SOCIAL FEATURES

- nature of personal elationships; expectations of class, position, age, gender;access to knowledge, information.

CULTURAL FEATURES

- the behaviours and attitudes considered acceptable in given contexts - eg. relating to sex, gender, drugs, leisure, participation.

ETHICAL & SPIRITUAL FEATURES

- influence of personal and shared values and discussion about moral systems from which those are derived - can include rituals, religion nd rights of passage.

LEGAL FEATURES

- laws determining what people can do and activities to encourage observance of those laws .

POLITICAL FEATURES

- systems of governance in which change will have to take place - can, for example, limit access to information and involvement in social action.

RESOURCE FEATURES

- affect what is required to make things happen - covers human, financial and material resources; community knowledge and skills; and items for exchange

Source:

The Behavior Change spiral from "What do they want us to do now?" AFAO 1996 involvement, including adoption, maintenance, and relapse, and interventions aimed at minimizing the amount of time individuals spend in the relapse stage as well as maximizing time spent in action or maintenance.

This stage approach is contrasted to the "all or none" approach to physical activity participation that often characterized early research on exercise adherence. Such a staged approach sits well with any school based program that is focussed on travel behaviour change - given that the context in which the program is to be applied would see fluctuations in the positive and negative influences according to such things as work and time demands of family members, weather, events or incidents in the local neighbourhood that may influence perceptions of safety.

Parallel with the work of Prochaska and DiClemente, Rogers, (1983) also developed a stage-based theory to explain how new ideas or innovations are disseminated and adopted at the community and population levels. Rogers identified five distinct stages in the process of diffusion of any new initiative or innovation. These are knowledge, persuasion, decision, implementation, and confirmation. Rogers argued that the diffusion of an innovation is enhanced when the perceived superiority of an innovation is high compared to existing practice (i.e. the relative advantage), and when the compatibility of the innovation with the existing social system is perceived to be high (i.e. compatibility).

Other important influences on the diffusion process are said to be complexity, triability, and observability, with innovations which are of low complexity, easily observed, and that are able to be adopted on a trial basis, being associated with greater adoption and swifter diffusion. Building success and comfort during the early stages of the implementation of the TravelSMART Schools program will be paramount to its success.

Rogers classifies individuals as innovators, early adopters, early majority, late majority, late adopters, and laggards, dependent upon when during the overall diffusion process they adopt a new idea or behaviour. While this model has not been tested empirically to date, it has been adapted and applied in health promotion settings usually in conjunction with social learning theory and/or self-efficacy theory, with some success. It certainly warrants attention in the development of the TravelSMART Schools program.

In summarizing the various stage models of behaviour change that have been proposed over the past two decades, Owen and Lee (1984) highlighted a number of commonalties they share.

These authors propose an integrated stage-based model in which behaviour change is viewed as a cyclical process that involves five stages of:

1. awareness of the problem and a need to change
2. motivation to make a change
3. skill development to prepare for the change
4. initial adoption of the new activity or behaviour, and
5. maintenance of the new activity and integration into the lifestyle.

In terms of a TravelSMART program this may mean:

Five stages of behaviour change Examples of content and processes

• Awareness of the problem and a need to change Provision of, or ways to seek information on the dependence on motorised travel; evidence of the greenhouse effect; issues relation to building relationships and fitness
• Motivation to make a change Benefits of increased personal fitness; benefits of leaving the car at home - eg. environmental and social
• Skill development to prepare for the change Mapping of the local area to identify alternative forms of travel, ways to negotiate with reluctant family members or peers to manage the need to carry; strategies for trip chaining and travel blending
• Initial adoption of the new activity or behaviour Self monitoring of newly adopted behaviours to, opportunities for reflections and comparisons
• Maintenance of the new activity and integration into the lifestyle Provision of feedback on how the change is going, and an injection of new ideas or strategy

An important aspect of both Prochaska's and DiClemente's approach and that suggested by Owen and Lee is that each of the five stages of behaviour change is said to involve different cognitive processes and require different treatments or intervention strategies for the overall change process to be successful. Prochaska and DiClemente (1992) outlined a number of cognitive change processes that have been found to be associated with each stage.

Other researchers also propose that different stages in the change process require different intervention strategies, and generally recommend a multifaceted, community-based approach to intervention in which all stages are addressed so that individuals at all stages of "readiness for change" can potentially be influenced. This sits well with the overall TravelSMART programs - TravelSMART Communities, TravelSMART Workplaces and TravelSMART Schools.

A major insight offered by stage theories of behaviour change, then, is the emphasis they place on matching interventions to the stage of readiness of the individual. This kind of approach provides an excellent framework for understanding and examining individual differences in motivation for, and involvement in, change in travel behaviours over time, including patterns of initiation, maintenance, relapse, and resumption.

In summary, theories that conceptualise behaviour change in terms of a cyclical process through which individuals move in stages, have received empirical support in the research, and appear to offer much promise for understanding travel behaviours and curricula to bring about changes in travel behaviour.

A major strength of the Stages of Change model is that it has also been used in conjunction with a variety of other theories and models that are relevant to different levels of influence at an intrapersonal, interpersonal, institutional, community or public policy level. (Glanz and Rimer (1995) as reported by Oldenberg et al (1999))

Social Cognitive-Behavioural Theories and Similar Theories

Social Cognitive Theory explains human behaviour in terms of a triadic, dynamic and reciprocal model in which behaviour, personal factors, and environmental influences interact. It addresses both the psychological dynamics underlying behaviour and their methods for promoting behaviour change. It is a very complex theory and includes many key constructs. Self-efficacy is one of the key concepts.

Self-efficacy refers to one's confidence in the ability to take action and persist in action. It is seen by Bandura (1986) as perhaps the single most important factor in promoting changes in behaviour. Measures of self-efficacy and some of the other key concepts from Social Cognitive Theory have also been identified as key determinants of movement through the stages of change, (Oldenburg, 1999).

Self-efficacy expectations have been found repeatedly to be important determinants of:

1. the choice of activities in which people engage
2. how much energy they will expend on such activities and
3. the degree of persistence they demonstrate in the face of failure and/or adversity.

In general, higher levels of self-efficacy for a given activity are associated with higher participation in that activity.

Similarly, and closely aligned to Social Cognitive Theory, Attribution Theory proposes that individuals generally view their performance (and thus, their successes and failures) as dependent upon ability, effort, task difficulty, and luck. In addition, causal influences are seen as either internal to the individual (e.g. personal ability), or external (e.g. barriers to community safety, lack of convenient and attractive travel alternatives).

The distinction between internal and external attributions is an important one, in that how we attribute our personal successes and failures has been shown to be related to not only our behaviour, but our self-esteem, our perceptions of personal control, our self-efficacy for different tasks and/or performance situations, and our ongoing involvement in different activities.

For example, a person who attributes their failure to change their dependence on motorised travel to their inherent lack of ability to identify and use alternatives will be less likely to continue with the alternative modes of travel after the educational program has ceased.

A person's attributions for personal success and failure in a given situation, then, determines how that person feels about the task, as well as the amount of effort he or she is likely to invest in the task the next time around. When failure is attributed to low personal ability and a difficult task, individuals are more likely to give up sooner, select easier alternatives, such as using personal motorised travel, and lower their goals. Conversely, when failure is attributed to external factors such as bad luck, individuals are likely to have higher motivations to continue and to try again for success.

Attitudes and their potential relationship to behaviour also have been studied extensively. In general, attitudes have not generally been found to be consistently related to behaviour. This failure to demonstrate a consistent relationship between attitudes and behaviour may be because situational factors also exert a powerful influence on behaviour. In addition, how attitudes have been defined and measured in different studies varies considerably.

Research has demonstrated consistently that an attitude is likely to predict behaviour when:

• the attitude includes a specific behavioural intention
• when both the attitude and the intention are very specific and
• when the attitude is based on first-hand experience .

These aspects of the behaviour-attitude relationship have been addressed in the Theory of Reasoned Action, which focuses on the role of context-specific attitudes in defining behaviour. In this model, behaviour is seen as a function of a person's intention, which in turn is comprised of the individual's attitudes towards performing the behaviour and the influence of perceived social norms concerning the performance of the behaviour. Attitudes are affected by the person's beliefs about the perceived consequences of performing a given action, and his or her subjective evaluation of each of the consequences.

Drawing this together, any published individually focused and community based health behaviour change and health promotion programs have generally been based on Social Cognitive theories utilising techniques that emphasise the cognitive and social mediators of behaviour. Interventions based on cognitive learning theory emphasize self-management principles and strategies.

Other Theories to Consider

Personality Theories

Personality theories explain behaviour largely in terms of stable traits or patterns of behaviour which are viewed as resistant to change and inalterable. Rogers', (1985), classification of individuals into the five categories of innovators, early adopters, early majority, late majority, late adopters, and laggards is an example of this kind of approach to understanding behaviour.

A major limitation of personality theories is that they do not take account of important aspects of the physical, social and economic environments, or the previous experiences of the individual, which also are known to strongly influence behaviour. For this reason, personality theories alone now are generally considered inadequate to explain behaviour change.

Learning and Behaviour Theories

Learning theorists have demonstrated that behaviour can be changed by providing appropriate rewards, incentives, and/or disincentives. In learning or behaviourist approaches, these rewards and incentives are typically incorporated into structured reinforcement schedules, and the process of behaviour changes is often termed behaviour modification.

While effective in bringing about behaviour change, such approaches require a high level of external control over both the physical and social environment, and the incentives (or disincentives) used to reinforce certain behaviours and discourage others. This kind of control is hard to maintain in real life settings, and thus, strict behaviourist approaches are subject to a number of limitations.

Social Learning Theory

Social learning theory is similar to learning and behaviour theories in that it focuses on specific, measurable aspects of behaviour. Learning theories, however, view behaviour as being shaped primarily by events within the environment, whereas social learning theory views the individual as an active participant in his or her behaviour, interpreting events and selecting courses of action based on past experience.

Again, one important theory deriving from social learning theory which has had a major impact on many current models of behaviour change is that of self-efficacy. As stated earlier, self-efficacy expectations have to do with a person's beliefs in his or her abilities to successfully execute the actions necessary to meet specific situational demands. Such expectations have been found to be consistently related to behaviour across a wide range of situations and populations sub-groups.

Social Psychological Theories

Social psychological theories are concerned with understanding how events and experiences external to a person (i.e. aspects of the social situation and physical environment) influence his or her behaviour.

Emphasis is placed on aspects of the social context in which behaviour occurs, including social norms and expectations, cultural mores, social stereotypes, group dynamics, cohesion, attitudes and beliefs. A number of useful concepts have emerged from social psychological theories, including attribution, locus of control, and cognitive dissonance, to name a few.

Social Cognitive Approaches

Social cognitive approaches combine aspects of social psychological theories with components of both social learning theory and cognitive behavioural approaches. Social-cognitive approaches emphasize the person's subjective perceptions and interpretations of a given situation or set of events, and argue that these need to be taken into account if we are to understand adequately both behaviour and the processes of behaviour change.

A number of social psychological concepts have been found to be consistently related to behaviour change across a wide range of situations. For example, the social reality of a the group (e.g. peer group, school group, family group etc.) will affect an individual's behaviour. All groups are characterized by certain group norms, beliefs and ways of behaving, and these can strongly affect the behaviour of the group members.

Expectations of significant or respected others can also have a strong influence on a person's behaviour. This phenomenon has been most consistently demonstrated in the early research on self-fulfilling prophecies, which showed that teachers' expectations of their students were consistently related to the students' subsequent performance, even when these expectations were based on falsified information. Thus, support and encouragement, or conversely, low expectations from significant or respected others, can affect and bring about, (or not), changes in individual behaviour.

Health Belief Model

The Health Belief Model attempts to explain health-behaviour in terms of individual decision-making, and proposes that the likelihood of a person adopting a given healthrelated behaviour is a function of that individual's perception of a threat to their personal health, and their belief that the recommended behaviour will reduce this threat.

Thus, a person would be more likely to adopt a given behaviour (e.g. walk or cycle regularly) if non-adoption of that behaviour (e.g. unclean air or confused traffic situations) is perceived as a health threat and adoption is seen as reducing that threat. To date, the Health Belief Model has not received consistent or strong support in explaining behaviour change. When the concept of self-efficacy is added to the model, however, prediction of behaviour increases.

Social Marketing

Another approach that has been used to bring about behaviour change is that of social marketing. The concept of social marketing is based on marketing principles and focuses on four key elements, including:

1. development of a product
2. the promotion of the product
3. the place
4. the price.

As such, this approach is not so much a theory of behaviour change but a proposed framework, which situates people as "consumer" who will potentially "buy into" a certain idea or argument, given the appropriate selling techniques are applied. It is then assumed that the "buying in" to that idea by individuals will result in behaviour change.

Theory of Interpersonal Behaviour

Habit strength is another concept that has been found to be important in predicting or changing behaviour. Habit is an important element of the theory of interpersonal behaviour, which proposes that the likelihood of engaging in a given behaviour is a function of:

1. the habit of performing the behaviour
2. the intention to perform the behaviour
3. conditions which act to facilitate or inhibit performance of the behaviour.

In turn, intentions are said to be shaped by a cognitive component, an affective component, a social component, and a personal normative belief. The theory of interpersonal behaviour argues that as behaviours are repeated, they become increasingly automated, and occur with little conscious control. That is, while individuals must first intend to participate in a given behaviour or activity, as the behaviour or activity is repeated over many occasions, participation becomes habitual and requires little conscious intervention. Driving a car along a familiar street is cited as an example.

To date, this model has not been tested as extensively as have the theory of reasoned action or the theory of planned behaviour. However, major components of the model appear to be consistent with the processes Prochaska and DiClemente to underlie the five stages of behaviour change - i.e. precontemplation, contemplation, and preparation, action and maintenance - and described earlier. In Summary

In addition to stage theories, in the research literature a number of other psychological theories have been proposed for explaining various aspects of human behaviour and behaviour change. While a number of different psycho-social theories and models have been developed over the past decades, these are by no means incompatible with a stage-based approach to understanding behavioural change.

Neither are the major theories used in considering behaviour change incompatible with each other. While each theory tends to offer unique concepts and insights, differences seem to be more a matter of emphasis, focusing on different aspects of behaviour, rather than complete contradictions.

No one theory is right or wrong. Rather, it is a matter of deciding:

1. which theories and/or concepts have most relevance and usefulness with respect to a given issue or question
2. at which stage of the overall stage process will the various theories and concepts have most meaning and application.

Other Considerations Relevant to Behaviour Change

In 1991 a Theorists Workshop was held in Washington to identify common elements between the most widely accepted models that are necessary for understanding, predicting and modifying human behaviour (eg. Azjen, Fishbein, Bandura, Becker). The result of this collaboration was the identification of eight key variables that accounted for most of the variance in any given behaviour. These eight key factors were identified as potential determinants of behaviour. These eight key factors were identified as potential determinants of behaviour and intervention points for behavioural change and included:

• an individual's behavioural intention
• environmental constraints
• skill or ability
• attitude or anticipated outcomes of a given behaviour
• norms
• self standards
• emotional reaction
• self-efficacy.

The theorists concluded that, generally speaking, for a given behaviour to occur, at least one of these eight factors must be true:

1. The person has formed a strong positive intention (or made a commitment) to perform the behaviour
2. There are no environmental constraints that make it impossible for the behaviour to occur
3. The person has the skills necessary to perform the behaviour
4. The person believes that the advantage (benefits, anticipate positive outcomes) outweigh the disadvantages (costs, anticipated negative outcomes) of performing a behaviour
5. The person perceives more social (normative) pressure to perform the behaviour than to not perform the behaviour
6. The person perceives that performance of behaviour is more consistent with his/her self image than inconsistent, or that its performance does not violate personal standards that activate negative self-sanctions
7. The person's emotional reaction to performing the behaviour is more positive than negative
8. The person perceives that her or she has the capabilities to perform the behaviour under a number of different circumstances. That is, they have the perceived selfefficacy to execute the behaviour in question.

The first three factors are viewed as factors “necessary and sufficient” for generating behaviour. That is for a given behaviour to occur, an individual must (a) have strong intentions to perform the behaviour, (b) have the necessary skills to do so and (c) not be restricted by environmental constraints.

The remaining factors are viewed as factors that can actively influence the strength and direction of behavioural intention. That is, these dimensions generate a degree of influence on changes in behaviour. In fact, the theorists argued that an individual will not form strong intentions to perform behaviour unless they perceive the positive outcome of performing the behaviour as greater than the negative or that they have the ability necessary to carry out the behaviour.

Conclusion

In considering the findings from the Theorists Workshop and the research around stage theories, particularly that of Prochaska and DiClemente, the TravelSMART team has a useful framework for:

• positioning the various theories and concepts within those stages within an overall change process
• matching intervention strategies with the stage of "readiness" of the individual.

Additionally, attention will be given to aspects of the physical, economic and social environments that act to constrain or facilitate behaviour.

When developing TravelSMART programs we need to be mindful to:

• Emphasize the positive personal consequences of adopting the new activity or changing the behaviour (rather than general consequences)
• Describe how to minimize any perceived negative personal consequences of the new activity (e.g. time debt, tiredness, lack of personal safety)
• Emphasize the negative effects of not changing the present (travel) behaviour
• Create social pressure to change ways to travel
• Increase people's belief that they have control over their travel-related behaviour
• Provide simple guidelines and information about how to bring about changes in their travel.

The messages and key concepts will be reinforced through a variety of media and transmitted through a range of sources.

Bibliography

Ajzen, I. and Fishbein, M. (1980). Understanding attitudes and predicting social behaviour. Prentice-Hall: Englewood Cliffs, N.J.

Bandura, A. (1986) Social foundations of thought and action; A social cognitive theory. Prentice Hall: Englewood Cliffa, N.J.

Becker, M. (1974) The health belief model and personal health behaviour. Health Education Monographs, 2, pp. 324-508

Glanz, K., Lewis, F.M. and Rimmer, B.K. (Eds) (1997). Health behaviour and health education: Theory research and practice: 2nd edition. San Fransisco: Jossey_Bass.

Glanz, K. and Rimer, B.K. (1995). Theory at a glance: A guide for health promotion practice. Bethesda, MD: National Institute for Health, National Cancer Institute. Oldenburg, B., Glanz, K. and Ffrench, M. (1999) The application of staging models to the understanding of health behaviour change and the promotion of health. Psychology and Health. 1999, Vol. 14, pp. 503-516 Owen and Lee (1984) TBA

Prochaska, J.O. and Di Clemente, C.C. (1986). Towards a comprehensive model of change. In: W.R. Miller and N. Heather (Eds), Treating addictive behaviours: Processes of change. NewYork: Plenum Press.

Prochaska, J.O. and Di Clemente, C.C. (1992) Stages of Change and the modification of problem behaviours. In M. Hersen, R.M. Eisler and P.M. Miller (Eds), Progress in behaviour modification. Sycamore: Sycamore Press. Rogers, E.M. (1983). Diffusion of innovations. New York: Free Press

Sallis, J.F. and Nader, P.R. (1988). Family determinants of health behaviours. In D.S. Gochman (ed) Health behaviour: Emerging research perspectives, pp. 107-119.

Comparison of Change Theories

Alicia Kritsonis

MBA Graduate Student

CaliforniaStateUniversity, Dominquez Hills

here are many change theories and some of the most widely recognized are briefly summarized in this article. The theories serve as a testimony to the fact that change is a real phenomenon. It can be observed and analyzed through various steps or phases. The theories have been conceptualized to answer the question, “How does successful change happen?”

Lewin's Three-Step Change Theory

Kurt Lewin (1951) introduced the three-step change model. This social scientist views behavior as a dynamic balance of forces working in opposing directions. Driving forces facilitate change because they push employees in the desired direction. Restraining forces hinder change because they push employees in the opposite direction. Therefore, these forces must be analyzed and Lewin's three-step model can help shift the balance in the direction of the planned change (http://www.csupomona.edu/~jvgrizzell/best_practices/bctheory.html).

INTERNATIONAL JOURNAL OF SCHOLARLY ACADEMIC INTELLECTUAL DIVERSITY

According to Lewin, the first step in the process of changing behavior is to unfreeze the existing situation or status quo. The status quo is considered the equilibrium state. Unfreezing is necessary to overcome the strains of individual resistance and group conformity. Unfreezing can be achieved by the use of three methods. First, increase the driving forces that direct behavior away from the existing situation or status quo. Second, decrease the restraining forces that negatively affect the movement from the existing equilibrium. Third, find a combination of the two methods listed above. Some activities that can assist in the unfreezing step include: motivate participants by preparing them for change, build trust and recognition for the need to change, and actively participate in recognizing problems and brainstorming solutions within a group (Robbins 564-65).

Lewin's second step in the process of changing behavior is movement. In this step, it is necessary to move the target system to a new level of equilibrium. Three actions that can assist in the movement step include: persuading employees to agree that the status quo is not beneficial to them and encouraging them to view the problem from a fresh perspective, work together on a quest for new, relevant information, and connect the views of the group to well-respected, powerful leaders that also support the change (http://www.csupomona.edu/~jvgrizzell/best_practices/bctheory.html).

The third step of Lewin's three-step change model is refreezing. This step needs to take place after the change has been implemented in order for it to be sustained or “stick” over time. It is high likely that the change will be short lived and the employees will revert to their old equilibrium (behaviors) if this step is not taken. It is the actual integration of the new values into the community values and traditions. The purpose of refreezing is to stabilize the new equilibrium resulting from the change by balancing both the driving and restraining forces. One action that can be used to implement Lewin's third step is to reinforce new patterns and institutionalize them through formal and informal mechanisms including policies and procedures (Robbins 564-65).

Therefore, Lewin's model illustrates the effects of forces that either promote or inhibit change. Specifically, driving forces promote change while restraining forces oppose change. Hence, change will occur when the combined strength of one force is greater than the combined strength of the opposing set of forces (Robbins 564-65).

Lippitt's Phases of Change Theory

Lippitt, Watson, and Westley (1958) extend Lewin's Three-Step Change Theory. Lippitt, Watson, and Westley created a seven-step theory that focuses more on the role and responsibility of the change agent than on the evolution of the change itself. Information is continuously exchanged throughout the process. The seven steps are:

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1. Diagnose the problem.
2. Assess the motivation and capacity for change.
3. Assess the resources and motivation of the change agent. This includes the change agent's commitment to change, power, and stamina.
4. Choose progressive change objects. In this step, action plans are developed and strategies are established.
5. The role of the change agents should be selected and clearly understood by all parties so that expectations are clear. Examples of roles are: cheerleader, facilitator, and expert.
6. Maintain the change. Communication, feedback, and group coordination are essential elements in this step of the change process.
7. Gradually terminate from the helping relationship. The change agent should gradually withdraw from their role over time.

This will occur when the change becomes part of the organizational culture (Lippitt, Watson and Westley 58-59). Lippitt, Watson, and Westley point out that changes are more likely to be stable if they spread to neighboring systems or to subparts of the system immediately affected. Changes are better rooted. Two examples are: the individual meets other problems in a similar way, several businesses adopt the same innovation, or the problem spreads to other departments of the same business. The more widespread imitation becomes, the more the behavior is regarded as normal (Lippitt, Watson and Westley 58-59).

Prochaska and DiClemente's Change Theory

Initially, the purpose of Prochaska and DiClemente model of change behavior was to show where a patient was in their journey to change certain health behaviors. Throughout the years, this model has been extended to other audiences other than solely health patients. The model defines a more general process of change and, therefore, it tends to be less specific. Prochaska and DiClemente found that people pass through a series of stages when change occurs. The stages discussed in their change theory are: precontempation, contemplation, preparation, action, and maintenance. Progression through the stages is cyclical, not linear. This is because initially many individuals relapse on their change efforts and do not successfully maintain their gains the first time around (Hicks 1). Prochaska and DiClemente have created a spiral model to represent the various stages of their theory. The first aspect of the model shows the movement of intentional change from precontemplation to contemplation of the issue. Precontemplation exists when an individual is unaware or fails to acknowledge the problems without engaging in any change process activities. Individuals in this stage do not want to change their behavior and may insist that their behavior is normal. Contemplation exists when the individual raises consciousness of the issue. Individuals in this stage are thinking about changing their behavior, but they are not ready to commit to the change process yet.

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next stage of Prochaska and DiClemente's change theory is preparation. Preparation occurs when the individual is ready to change their behavior and plans to do so within the next two weeks. These individuals will need counseling, social support, and assistance with problem solving during this stage of change. The action stage follows shortly thereafter. It is characterized by an increase in coping with behavioral change and the individual begins to engage in change activities. Finally, maintenance is the last stage of Prochaska and DiClemente's change theory. In this final stage, actions to reinforce the change are taken coupled with establishing the new behavioral change to the individual's lifestyle and norms. This stage may last six months up to the lifespan of the individual. Counseling to avoid relapses is necessary to ensure a successful long-term change. (http://northwestahec.wfubmc.edu/professional/Behavior%20Change%20Model.pdf#sear ch='prochaska%20and%20DiClemente').

In this spiral model, individuals have the ability to exit at any time if they decide not to change. The model takes into account behavioral relapses or return to the previously existing behavior. In the case of relapses, many individuals do not let up. They can revisit the contemplation stage and prepare for action in the future. The spiral pattern of the model suggests that many individuals learn from their relapses instead of circling around the issue (kumc.edu/instruction/conted/online/substance/module3/mod3comp1.html).

Social Cognitive Theory

Individuals can learn by direct experiences, human dialogue and interaction, and observation. Social learning theory, later renamed social cognitive theory, proposes that behavior change is affected by environmental influences, personal factors, and attributes of the behavior itself (Robbins 46-47).

The individual must possess self-efficacy. They must believe in their capability to perform the behavior and they must perceive that there is an incentive to do so. Social learning theory is an extension of operant conditioning. In other words, behavior is a result of consequences. Individuals react to how they perceive consequences of their behavior. Consequently for social learning to exist, the individual's positive expectations of the behavior should outweigh their negative expectations. The consequences or outcomes may be classified as having immediate benefits such as feeling energized or long-term benefits such as experiencing improvements in cardiovascular health. Selfefficacy is believed to be the most important characteristic that determines a person's behavioral change because these expected outcomes are filtered through a person's expectations or perceptions of being able to perform the behavior in the first place. Selfefficacy can be increased in several ways. Three methods to increase self-efficacy include: provide clear instructions, provide the opportunity for skill development or training, and model the desired behavior (http://newcity.ca/Pages/moorechange.html). When implementing employee-training programs, there are four processes that should be exercised that can significantly increase the likelihood of success. They include: attentional processes, retention processes, motor reproduction processes

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reinforcement processes. Attentional processes take into account that individuals learn from a model when they can relate to it and pay attention to its details. Individuals are more easily influenced when the model is neat, attractive, compelling, attention grabbing, and relates to something they care about. Retention processes take into account the degree of which an individual can remember the model and its characteristics.

Motor reproduction process illustrates an individual converting seeing (observation) into doing. Reinforcement processes are used when an individual changes behavior due to rewards and positive incentives. The changed behaviors that are targeted will be given greater attention, better rewards, and performed more often. To be effective, models must evoke trust, admiration, and respect from the observer. Conversely, models should not appear to represent a level of behavior that the observer is unable to visualize attaining (Robbins 46-47).

The Theory of Reasoned Action and Planned Behavior

The theory of reasoned action states that “individual performance of a given behavior is primarily determined by a person's intention to perform that behavior.” (http://www.csupomona.edu/~jvgrizzell/best_practices/bctheory.html).

There are two major factors that shape the individual's attention. First, the individual's attitude towards the desired behavior must be positive for change to occur. Second, the influence of the person's social environment or subjective norm is another factor that shapes the individual's attention. This includes the beliefs of their peers and what they believe the individual should do as well as the individual's motivation to comply with the opinions of their peers.

The theory of planned behavior includes the concept of perceived control over the opportunities, resources, and skills necessary to perform the desired behavior. The concept of perceived behavioral control is similar to the concept of self-efficacy. A vital aspect of the behavioral change process is perceived behavioral control over opportunities, resources, and skills necessary to perform a behavior (http://www.csupomona.edu/~jvgrizzell/best_practices/bctheory.html).

Comparison

This section of the article will compare the differentiating characteristics of each change theory to one another. Lewin's Three-Step Change Theory, Lippitt's Phases of Change Theory, Prochaska and DiClemente's Change Theory, Social Cognitive Theory, and the Theory of Reasoned Action and Planned Behavior have different methods

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assumptions that make each theory unique. It is important to note that some of the theories do share some commonalities with one another.

Lewin's model is very rational, goal and plan oriented. It doesn't take into account personal factors that can affect change. Conversely, social cognitive theory proposes that behavioral change is affected by environmental influences, personal factors, and attributes of the behavior itself. Lewin's model makes rational sense, but the Social Cognitive Theory because it takes into account both external and internal environmental conditions.

Lippitt's Phases of Change is an extension of Lewin's Three-Step Theory. The focus on Lippitt's change theory is on the change agent rather than the change itself. Lewin's change model attempts to analyze the forces (driving or restraining) that impacts change.

Prochaska and DiClemente's change theory is differentiated from the other theories discussed in this article. The model is cyclical, not linear. This theory takes relapses or failures to convert to the desired behavior the first time into account. Individuals that may relapse can revisit the contemplation stage and make plans for action in the future.

Self-efficacy is the most important characteristic of both the theory of planned behavior and social cognitive theory. Self-efficacy is defined as having the confidence in the ability to take action and persist in the action. Self-efficacy must be present in order for theory of planned behavior and Social Cognitive Theory to be applied resulting in successful change.

Summary

Lewin's model is very rational, goal and plan oriented. The change looks good on paper, as it makes rational sense, but when implemented the lack of considering human feelings and experiences can have negative consequences. There may be occasions when employees get so excited about a new change, that they bypass the feelings, attitudes, past input or experience of other employees. Consequently, they find themselves facing either resistance or little enthusiasm.

There is no right or wrong theory to change management. It is not an exact science. However through the ongoing research and studies by the industry's leading experts, a clearer picture of what it takes to lead a change effort effectively will continue to emerge. It is important that we must continually review and consider how our changing society and culture will require fresh insight on the appropriate change process.

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References

• “Behavioral Change Theory.” http://www.csupomona.edu/~jvgrizzell/best_practices/bctheory.html. Hicks, Vicki.
• “Change Theories.” kumc.edu/instruction/conted/online/substance/ module3/mod3comp1.html
• “How Social Change can Happen.” http://newcity.ca/Pages/moorechange.html. Lippitt, R., Watson, J. and Westley, B. The Dynamics of Planned Change. New York: Harcourt, Brace and World, 1958.
• “Prochaska and DiClemente: Behavior Change Model.” http://northwestahec.wfubmc.edu/professional/Behavior%20Change%20Model.pdf#searc h='prochaska%20and%20DiClemente'. Robbins, Stephen. Organizational Behavior. 10th ed. Upper Saddle River, NJ: Prentice Hall, 2003
• .New York: Plenum Press. According to Evers (2007) Scotland as well as being a non-smoking zone it also serves as a laboratory of sorts in which researches can study how a radical smoking ban, changes its society.
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