The Transtheoretical Model

Heart failure is a significant health problem that requires a multidisciplinary approach for successful intervention. It has been well documented how with an early identification and intervention of this disease process, the progression of heart failure can be slowed and even reversed. Change in lifestyle and adherence to a prescribed plan of care recommended for heart failure treatment can lead to improved quality of life. The direct expenditures for heart failure each year in the United States have been estimated over 60 billion. The Transtheoretical Model (TM) provides a framework for facilitating the behavioral changes necessary for the optimal treatment of heart failure

What is the Transtheoretical Model?

The TM is a framework for assessing and addressing the concept of readiness for behavior change, which occurs in a 6-step process. The model consists of 3 dimensions: the stages of change, the processes of change on which interventions are based, and the action criteria for actual behavior. The stages of change and interventions are used to assist patients with heart failure in progressing through those stages toward maintenance of changed lifestyle behaviors. This model is a synthesis of many behavioral change models that view change as a process rather than an outcome.

An initial step is to evaluate which areas the individual is ready to change. The medical providers must determine if the patient is ready to change any unhealthy behavior. A general rule of thumb for staging behaviors for change is as follows: 40% of the individuals will be in precontemplation, 40% in contemplation, and 20% in preparation. This implies that for each targeted behavioral outcome, 40% of the individuals will not be ready to make a change.

Adapting the behavior is needed to achieve desired goals. Changing poor lifestyle behaviors and following the suggested plan of care should lead to improved quality of life for these patients. We should encourage to loose weight and maintain an ideal body weight; quit tobacco; limit alcohol consumption; control other comorbid conditions; restrict dietary sodium and fluid intake; weigh themselves daily; exercise; and immunize against influenza and pneumonia. These are the areas in which health care providers and care takers can have the greatest impact on heart failure care. Patient teaching is also an important aspect overseen many times. There also has to be willingness from patients to accept changes to address poor health behaviors. For this reason, the TM provides an excellent framework for providers to prevent the progression of heart failure.