Transtheoretical model

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The transtheoretical model behavioral change is an integrative therapy theory that assesses the individual's readiness to act on new healthy behaviors, and provides a strategy, or change process to guide individuals. The model consists of constructs such as: stages of change, change process, rate of change, self-efficacy, and balance of decision.

The transtheoretical model is also known by the abbreviation " TTM " and sometimes with the term " stages of change ", although this last term is synecdoche because the stages of change are only one part of the model together with change process, change level, etc. Some self-help books - Changing for Good (1994), Changeology (2012), and Changing to Thrive (2016) - and articles in the news media has discussed the model. It has been called "arguably the dominant model of health behavior change, having received unprecedented research attention, yet simultaneously attracting criticism".

Video Transtheoretical model

History and core constructs

James O. Prochaska of the University of Rhode Island, and Carlo Di Clemente and colleagues developed a transtheoretical model beginning in 1977. This is based on the analysis and use of various psychotherapy theories, hence the name "transtheoretical".

Prochaska and colleagues refined their models based on the research they published in peer-reviewed journals and books.

Stages of change

This construction refers to the temporal dimension of behavioral change. In the transtheoretical model, change is "a process that involves progress through a series of stages":

• Precontemplation ("not ready") - "People do not intend to take action in the future, and can not be aware that their behavior is problematic"
• Contemplation ("getting ready") - "People are beginning to realize that their behavior is problematic, and start seeing the pros and cons of their ongoing actions"
• Preparation ("ready") - "People intend to take action in the near future, and may start taking small steps toward behavior change"
• Action - "People have made a blatant modification specifically in modifying the behavior of their problems or in acquiring new, healthy behaviors"
• Maintenance - "People have been able to maintain action for at least six months and try to prevent recurrence"
• Termination - "Individuals do not have temptations and they are confident they will not go back to old unhealthy habits as a way to cope"

In addition, the researchers made the concept of "Relapse" (recycling) which is not the stage itself but rather "back from Action or Maintenance to the previous stage".

The quantitative definition of the stages of change (see below) may be the most famous feature of the model. Yet it was also one of the most criticized, even in the field of smoking cessation, where it was originally formulated. It has been said that the quantitative definition (ie someone is in preparation if it wants to change within a month) does not reflect the nature of behavior change, that it has no better predictive power than the simpler question (ie "do you have plans to change... "), and has issues related to the reliability of the strings.

Communication theory and sociologist Everett Rogers stated that the stage of change is analogous to the stages of the innovation adoption process in Rogers diffusion innovation theory.

Details of each stage

Stage 1: Precontemplation (not ready)

People at this stage do not intend to initiate healthy behavior in the near future (within 6 months), and may not be aware of the need for change. People here learn more about healthy behaviors: they are encouraged to think about the pros change their behavior and feel the emotion about the effects of their negative behavior on others.

Precontemplators usually underestimate pro change, exaggerate the counter, and often unknowingly make such mistakes.

One of the most effective steps anyone can make at this stage is to encourage them to be more aware of their decision-making and more aware of the benefits of changing unhealthy behaviors.

Stage 2: Contemplation (get ready)

At this stage, participants intend to initiate healthy behaviors in the next 6 months. While they are usually now more aware of pro variations, their number is similar to their Pro. Ambivalence about these changes can cause them to delay taking action.

People here learn about the kind of people they can if they change their behavior and learn more from people who behave in a healthy way.

Others can influence and help effectively at this stage by encouraging them to work to reduce the losses of changing their behavior.

Stage 3: Get Started (ready)

People at this stage are ready to start taking action within the next 30 days. They take small steps that they believe can help them make healthy behaviors as part of their lives. For example, they tell their friends and family that they want to change their behavior.

People at this stage should be encouraged to seek support from friends they trust, tell people about their plans to change the way they act, and think about how they would feel if they behaved in a healthier way. Their main concern is: when they act, will they fail? They learn that the more prepared they are, the more likely they are to move on.

Phase 4: Action (current action)

People at this stage have changed their behavior in the last 6 months and need to work hard to keep moving forward. These participants need to learn how to strengthen their commitment to change and to resist the urge to retreat.

People in this stage are progressing by being taught techniques to maintain their commitments such as replacing activities related to unhealthy behavior with positive ones, rewarding themselves for taking steps towards change, and avoiding people and situations that tempt them to behave with unhealthy way.

Level 5: Maintenance (monitoring)

People at this stage changed their behavior more than 6 months ago. It is important for people at this stage to be aware of situations that may tempt them to re-engage in unhealthy behavior - especially stressful situations.

It is recommended that people at this stage seek support from and talk with people they trust, spend time with people who behave in a healthy way, and remember to engage in healthy activities to cope with stress rather than rely on behavior that not healthy.

Relapse (recycle)

Relapse in TTM specifically applies to individuals who successfully quit smoking or use drugs or alcohol, only to continue this unhealthy behavior. Individuals who seek to quit from highly addictive behaviors such as drugs, alcohol, and tobacco use are at high risk of recurrence. Achieving long-term behavioral changes often requires ongoing support from family members, health trainers, doctors, or other motivational sources. Support literature and other resources can also help to avoid recurrence.

Process changes

10 change process is "secret and open activity that people use to progress through the stages".

To progress through the early stages, people apply cognitive, affective, and evaluative processes. As people move towards Action and Maintenance, they rely more on commitment, conditioning, contingency, environmental control, and support.

Prochaska and colleagues stated that their research related to the transtheoretical model suggests that interventions to change behavior are more effective if they are "stage-matched", that is, "suitable for each individual change stage".

In general, for people to get ahead they need:

• The growing awareness that the advantages ("advantages") change is greater than the disadvantage ("cons") - TTM calls this balance of decisions .
• Confident that they can make and sustain change in situations that tempt them to return to their old unhealthy behavior - TTM calls this self-efficacy .
• Strategies that can help them create and sustain change - TTM calls this change process .

The ten change processes include:

1. Awareness raising (Get facts) - raise awareness through information, education, and personal feedback about healthy behaviors.
2. Dramatic relief (Being concerned about feelings) - feel fear, anxiety, or worry because of unhealthy behavior, or feel inspiration and hope when they hear about how people can turn into healthy behaviors.
3. Self-evaluation (Create a new self-image) - realize that healthy behavior is an important part of who they are and what they want.
4. Environmental reevaluation (Pay attention to your effects on others) - be aware of how their unhealthy behaviors affect others and how they can have more positive effects by changing.
5. Social liberation (Pay attention to public support) - recognize that people are more supportive of healthy behaviors.
6. Self-release (Commitment) - believes in a person's ability to change and make commitments and re-commitments to act on that belief.
7. Help relationships (Get support) - find people who support their changes.
8. Counter-conditioning - replaces the way you act and think healthy for unhealthy ways.
9. Strengthening management (Use awards) - increase the rewards derived from positive behaviors and reduce those that stem from negative behavior.
10. Stimulus Control (Managing your environment) - use reminders and gestures that encourage healthy behavior as a substitute for those who encourage unhealthy behavior.

Health researchers have extended 10 original change processes of Prochaska and DiClemente with an additional 21 processes. In the first edition of Health Promotion Program Planning , Bartholomew et al. (2006) summarize the processes they identified in a number of studies; however, the long list of processes has been removed from the next edition of the text. Additional processes from Bartholomew et al. is:

1. Risk comparison (Understanding risks) - comparing risk with the same dimension profile: fear, control, potential disaster and novelty
2. Cumulative risk (Get the whole picture) - processing cumulative probabilities rather than the probability of a singe incident
3. Qualitative and quantitative risk (Consider various factors) - processing different risk expression
4. Positive framing (Positive thinking) - focuses on success rather than failing framing
5. Self-examination is related to risk (Know your risk) - assess risk perception, e.g. personalization, impact on others
6. Reevaluation of results (Know results) - emphasize the positive outcomes of alternative behaviors and reevaluate results expectations
7. Benefit perceptions (Focus on benefits) - understand the advantages of healthy behaviors and losses from risky behaviors
8. Self-efficacy and social support (Get help) - mobilize social support; skills training to deal with emotional losses from changes
9. Perspective decision making (Deciding) - focus on decision making
10. Adjust the time horizon (Set timeframe) - merge the personal time horizon
11. Focus on important factors (Prioritize) - incorporate the most important personal factors
12. Try a new behavior (Try it out) - change something about yourself and gain experience with that behavior
13. Persuasion of positive results (Convince yourself) - promote the expectation of new positive results and strengthen existing ones
14. Modeling (Create scenario) - shows the model for effectively overcoming obstacles
15. Skills upgrading (Building a supportive environment) - the restructuring environment contains important, clear and socially supported gestures for new behaviors
16. Overcome obstacles (Plan to overcome obstacles) - identify bottlenecks and planning solutions when faced with these obstacles
17. Goal setting (Define goal) - setting specific and incremental goals
18. Skill enhancement (Adjust your strategy) - cues for restructuring and social support; anticipate and avoid obstacles; modify the destination
19. Dealing with barriers (Accept setbacks) - understand the setbacks is normal and insurmountable
20. Gift yourself for success (reward yourself) - feel good about progress; repeating the positive consequences
21. Overcoming skills (Identifying difficult situations) - identifying high-risk situations; choose a solution; practicing solutions; overcome recurrence

While most of these processes are related to health interventions such as smoking cessation and other addictive behaviors, some of them are also used in travel interventions. Depending on the behavior of the target, the effectiveness of the process should be different. Also some processes are recommended in certain stages, while others can be used in one or more stages. More recently, this process has been identified in travel interventions, expanding the scope of TTM in other research domains.

Balance of verdict

This core construction "reflects the individual's relative weighing of the pros and cons of change". Decision-making is conceptualized by Janis and Mann as the "determination balance" of comparative potential advantages and disadvantages. Steps in decision balance, pros and cons, have become important constructs in transtheoretical models. Pros and cons combine to form a "balance sheet" verdict of comparative potential advantages and disadvantages. The balance between pros and cons varies depending on the stage of change where the individual is.

Good decision-making requires consideration of potential (pro) and cost (counter) benefits associated with behavioral consequences. The TTM study has found the following relationship between pro, cons, and stages of change in 48 behaviors and over 100 populations studied.

• The cons change is greater than the pro in the Precontemplation stage.
• Pro goes beyond counter in middle stage.
• Pro beat the losses in the Action phase.

Evaluation of pros and cons is part of the formation of attitudes. Attitude is defined as "a psychological tendency expressed by evaluating a particular entity with some degree of kindness or dislike". This means that by evaluating the pros and cons, we shape a positive or negative attitude about something or someone. During the process of change, individuals gradually shift from counter to pro, forming a more positive attitude toward target behavior. Attitude is one of the core constructs that explains behavioral and behavioral changes in various research domains. Other behavioral models, such as planned behavioral theory (TPB) and self-regulated stage models of change, also emphasize attitudes as critical behavioral determinants. Development through various stages of change is reflected in gradual changes in attitude before individual action. Most of the change process aims to evaluate and re-evaluate and reinforce the specific elements of current and target behavior. The change process contributes greatly to the formation of attitudes.

Due to the use of synonyms of balance and decisional attitudes, behavioral travel researchers have begun to incorporate TTM with TPB. Go forward using TPB variables to further differentiate the different stages. Especially all TPB variables (attitudes, perceived behavior control, descriptive and subjective norms) positively show a gradually increasing relationship to the stage of change for motorcycles. As expected, the intention or willingness to perform the behavior increases according to the stage. Similarly, Bamberg uses a variety of behavioral models, including transtheoretical models, planned behavioral theories and norm-activation models, to construct self-regulated behavior stage models (SSBC). Bamberg claims that his model is a solution to the criticism raised against the TTM. Some researchers in travel, diet, and environmental research have conducted empirical studies, suggesting that SSBC may be the future pathway for TTM-based research.

Self-efficacy

This core construction is "a special confidence in the situation people have that they can cope with high-risk situations without recurrence with their unhealthy or high-risk habits". Its construction is based on Bandura's self-efficacy theory and conceptualizes the perceived ability of a person to perform on task as a performance mediator on future tasks. In his research, Bandura has determined that higher levels of self-efficacy lead to larger behavioral changes. Similarly, Ajzen mentions the similarity between the concept of self-efficacy and the control of perceived behavior. This underscores the integrative nature of transtheoretical models that incorporate various behavioral theories. Changes in the level of self-efficacy can predict long-lasting behavioral changes if there are adequate incentives and skills. The transtheoretical model uses an overall belief score to assess one's self-efficacy. Situational temptation assesses how tempted people are to engage in problem behavior in certain situations.

Rate change

This core construction identifies the depth or complexity of the problems that arise according to the five levels of increased complexity. Different therapeutic approaches are recommended for each level as well as for each stage of change. Levels are:

1. Situational/symptomatic problems: eg, motivational interviews, behavioral therapy, exposure therapy
2. Current maladaptive cognition: eg, Adlerian therapy, cognitive therapy, rational emotive therapy
3. Current interpersonal conflicts: e.g., Sullivanian therapy, interpersonal therapy
4. Family/system conflict: e.g., strategic therapy, Bowenian therapy, structural family therapy
5. Long-term intrapersonal conflict: eg, psychoanalytic therapy, existential therapy, Gestalt therapy

Maps Transtheoretical model

Program results

The results of the TTM computerized intervention given to participants in the pre-Action stage are outlined below.

Stress Management

National adult pre-action samples were given stress management interventions. At an 18-month follow-up, a much larger proportion of treatment groups (62%) effectively manage their stress when compared to the control group. Interventions also resulted in statistically significant reductions in stress and depression and increased use of stress management techniques when compared to the control group. Two additional clinical trials of the TTM program by Prochaska et al. and Jordan et al. also found a significantly greater proportion of treatment groups that effectively manage stress when compared to the control group.

Adherence to antihypertensive drugs

More than 1,000 members of New England group practice prescribed antihypertensive drugs participate in adherence to antihypertensive drug interventions. Most (73%) of the pre-Action intervention group followed a prescribed treatment regimen at 12 months follow-up when compared to the control group.

Adherence to lipid-lowering drugs

Members of New England's large health plan and various employer groups prescribed cholesterol-lowering drugs participate in adherence to lipid-lowering interventions. More than half of the pre-Action intervention group (56%) followed a prescribed treatment regimen at an 18-month follow-up. In addition, only 15% of those in the intervention group who are already in Action or Maintenance relapse to poor treatment compliance compared with 45% of controls. Furthermore, participants at risk for physical activity and unhealthy diet are given only stages-based guidance. The treatment group doubled the control group in percentage in Action or Maintenance at 18 months for physical activity (43%) and diet (25%).

Prevention of depression

Participants were 350 primary care patients who had at least mild depression but were not involved in care or planning to seek treatment for depression within the next 30 days. Patients who received TTM intervention experienced significantly greater symptoms decrease during the 9-month follow-up period. The greatest intervention effect was observed among patients with moderate or severe depression, and who were in the early stages of preemptive change or contemplation. For example, among patients in the Pre-Contemplation or Contemplation phase, the depression rates that are reliable and clinically significant are 40% for treatment and 9% for control. Among patients with mild depression, or who were in the early Action or Maintenance stage, interventions helped prevent progression of the disease to Major Depression during the follow-up period.

Weight management

Fifty-one hundred and seventy-seven overweight or moderate obese adults (BMI 25-39.9) are recruited nationally, especially from large employers. Those randomly assigned to the treatment group received a customized behavioral adjustment guide to the stages and a series of individualized interventions tailored for three very important health behaviors for effective weight management: healthy eating (ie, reducing caloric intake and fat diet), moderate exercise, and manage emotional stress without eating. Up to three customized reports (one per behavior) were submitted based on assessments made at four time points: baseline, 3, 6, and 9 months. All participants are followed up on 6, 12, and 24 months. Some Impression is used to estimate lost data. Generalized Labor Estimating Equations (GLEE) were then used to examine the differences between treatment and comparison groups. At 24 months, those in the pre-action stage for healthy eating at baseline and receiving treatment were significantly more likely to achieve Proton or Maintenance than the comparison group (47.5% vs. 34.3%). This intervention also affects the associated, but untreated behavior: the consumption of fruits and vegetables. Over 48% of those in the treatment group in the pre-Action stage at baseline stepped into Action or Maintenance to eat at least 5 servings a day of fruit and vegetables compared with 39% of the comparison group. Individuals in the treatment group who were in the pre-action stage for exercise at baseline were also significantly more likely to achieve Action or Maintenance (44.9% vs. 38.1%). Treatment also had a significant effect in managing emotional stress without eating, with 49.7% of those in the pre-Action stage at baseline moving into Action or Maintenance versus 30.3% of the comparison group. The groups differed in weight loss at 24 months among those who were in the pre-action stage for healthy eating and exercise at baseline. Among those in the pre-action stage for healthy eating and exercise at baseline, 30% of those who were randomized to the treatment group lost 5% or more of their weight vs.18.6% in the comparison group. Coaction of behavior change occurred and much more clearly in the treatment group with the treatment group losing significantly more than the comparison group. This study demonstrates feedback capabilities tailored to TTM to promote healthy eating, exercise, managing emotional stress, and population-based weight. Treatment produces the highest population impact to date on some health risk behaviors.

Smoking cess

Several studies have found individualized interventions adjusted for 14 TTM variables to quit smoking to effectively recruit and retain pre-action participants and produce long-term abstinence rates in the range of 22% - 26%. These interventions also consistently outperform alternative interventions including the best self-directed action-oriented, non-interactive manual-based programming, and other general interventions. Furthermore, these interventions continue to move pre-action participants to abstain even after the program ends. For a summary of clinical results of smoking cessation, see Velicer, Redding, Sun, & amp; Prochaska, 2007 and Jordan, Evers, Spira, King & amp; Close, 2013.

Example for TTM app on smoke control

In the treatment of smoke control, TTM focuses on each stage to monitor and progress to the next stage.

In each stage, a patient may have many sources that can affect their behavior. This may include: friends, books, and interactions with their health care providers. These factors can potentially affect how well a patient can move through different stages. It emphasizes the importance of continuing to monitor and efforts to sustain progress at every stage. TTM helps guide the treatment process at every stage, and can help healthcare providers make optimal therapeutic decisions.

Travel research

The use of TTM in the travel behavior intervention is rather new. A number of cross-sectional studies investigate the individual constructions of TTM, such as change stages, decision balance and self-efficacy, in relation to the choice of modes of transportation. Cross-sectional studies identify both motivators and obstacles at different stages of cycling, walking and public transportation. Motivations identified such as cycling/walking, avoiding congestion and improving fitness. Perceived obstacles such as personal fitness, time and weather. This knowledge is used to design interventions that will address attitudes and misconceptions to encourage increased use of bicycles and walking. This intervention aims to change people's travel behavior toward more sustainable and more active mode of transportation. In health-related studies, TTM is used to help people walk or cycle more than using a car. Most intervention studies aim to reduce car travel for commuters to achieve the recommended minimum level of physical activity 30 minutes per day. Another intervention study using TTM aims to encourage sustainable behavior. By reducing a single occupied motor vehicle and replacing it with so-called sustainable transport (public transport, car collection, cycling or walking), greenhouse gas emissions can be significantly reduced. Reducing the number of cars on our roads solves other problems like traffic jams, traffic noise and traffic accidents. By combining related health and environmental goals, the message becomes stronger. In addition, by emphasizing personal health, physical activity or even direct economic impact, people see the immediate results of their changed behavior, while saving the environment is more common and the effect is not immediately apparent.

Different outcome measures are used to assess the effectiveness of interventions. A health-centered intervention study measures BMI, weight, waist circumference and general health. However, only one out of three find significant changes in general health, while BMI and other measures do not have an effect. Sizes related to health and sustainability are more common. Effects are reported as the number of car trips, mileage, main mode sharing, etc. Results vary due to a very different approach. In general, the use of cars can be reduced between 6% and 55%, while the use of alternative modes (walking, cycling and/or public transportation) increases between 11% and 150%. These results suggest a shift to action or maintenance phase, some researchers investigating a shift in attitudes such as the desire to change. Attitudes toward the use of alternative modes increase by about 20% to 70%. Many intervention studies do not clearly distinguish between the five stages, but the participants are categorized in the pre-action and action stage. This approach makes it difficult to assess the effect per stage. Also, interventions include different change processes; in many cases, this process is not in accordance with the recommended stage. It highlights the need to develop a standardized approach to the design of travel interventions. Identifying and assessing which processes are most effective in the context of changes in travel behavior should be a priority in the future to secure the role of TTM in the study of travel behavior.

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Criticism

TTM has been called "arguably the dominant model of health behavior change, having received unprecedented research attention, yet simultaneously attracting criticism". Depending on the field of application (eg smoking cessation, substance abuse, condom use, diabetes care, obesity and travel), somewhat different critiques have been suggested.

In a systematic review, published in 2003, out of 23 randomized controlled trials, the authors found that "stage-based interventions were no more effective than non-stage-based interventions or no intervention in changing smoking behaviors, but also mentioned that the stage by Intervention often used and improperly implemented in practice.Therefore, criticism is directed at the use, not the effectiveness of the model itself, of looking at interventions that target smoking cessation in pregnancy finding that appropriate intervention stages are more effective than unsuitable interventions. is the greater intensity of the interventions that correspond to the stages. Also, the use of staged-stage interventions to quit smoking in mental illness has been shown to be effective. Further studies, such as randomized controlled traces published in 2009, found no evidence that interrupt intervention an TTM-based smoking is more effective than control interventions that are not adapted to the chan ge stage. The study claims that those who do not want to change (ie, precontemplators) tend to be unresponsive to both non-stage and stage-based interventions. Because stage-based interventions tend to be more intensive, they seem most effective in targeting contemplators and above rather than pre-contemplators. A systematic review of 2010 on the smoking cessation study under the Cochrane Collaboration found that "stage-based self-help interventions (expert systems and/or customized materials) and individual counseling are no more or less effective than their equivalent non-stage-based.

The main criticism arises about the "arbitrary dividing line" drawn between the stages. West claims that a more coherent and distinguishable definition for the stage is needed. Especially the fact that the stages are tied to a certain time interval is considered misleading. In addition, the effectiveness of stage-based interventions is different depending on the behavior. Ongoing versions of the model have been proposed, where each process is firstly used, and then declines in importance, because smokers make progress along several latent dimensions. This proposal suggests the use of the process without reference to the stages of change.

The model "assumes that individuals usually make a coherent and stable plan", when in fact they often do not.

In a study on the prevention of pregnancy and sexually transmitted diseases, a systematic review from 2003 came to the conclusion that "no firm conclusions" could be drawn on the effectiveness of interventions based on transtheoretical models. Once again this conclusion is achieved because of inconsistencies in the use and implementation of the model. The study also confirms that the better the phase that matches the intervention, the greater the effect to encourage condom use.

In the health research domain, a 2005 systematic review of 37 randomized controlled trials claims that "there is limited evidence for the effectiveness of stage-based interventions as a basis for behavioral change." Studies focused on increasing the level of physical activity through active travel but pointed out that stage-match interventions tend to have a slightly larger effect than a suitable non-stage intervention.Because many studies do not use all the TTM constructs, additional research suggests that the effectiveness of improved interventions is better tailored to all all the core constructs of TTM in addition to the stage of change.In diabetic research, existing data are insufficient to draw conclusions about the benefits of transtheoretical models "associated with dietary interventions.Again, studies with slightly different designs, eg using different processes, have proven effective in predicting the transition stage of intent to l atihan in relation to treat diabetes patients.

TTM generally finds greater popularity about research on physical activity, due to increased problems associated with unhealthy diet and sedentary life, such as obesity, cardiovascular problems. The Cochrane Systematic 2011 review found that there is little evidence to suggest that using Transtheoretical Stages of Change (TTM SOC) methods is effective in helping overweight and overweight people lose weight. Earlier in a 2009 paper, TTM was considered useful in promoting physical activity. In this study, the algorithms and questionnaires that researchers use to assign people to the stage of change have no standardization to be compared empirically, or validated.

Similar criticisms of standardization and consistency in the use of TTM were also raised in a recent review of travel interventions. With regard to travel interventions only the stage of change and sometimes construction of the verdict balance is included. The process used to construct interventions is rarely stage-matched and shortcuts are taken by classifying participants in the pre-action stage, which summarizes the precontemplation, contemplation and preparation phases, and the action/maintenance stage. More generally, TTM has been criticized in various domains due to limitations in research design. For example, many studies supporting the model are cross-sectional, but longitudinal study data will allow for stronger causal conclusions. Another point of criticism appears in a 2002 review, in which model stages are characterized as "not mutually exclusive". In addition, there is "little evidence of sequential movement through discrete stages". While research shows that movement through the stages of change is not always linear, a study conducted in 1996 showed that the probability of a forward-stage motion is greater than the probability of a backward-stage motion. Due to variations in the use, implementation and type of research design, the data confirm that TTM is ambiguous. Must be more careful in using the number of adequate constructs, reliable size, and longitudinal data.

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See also

• Change management
• The decision cycle

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Note

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References

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Further reading

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External links

• Pro-Change Behavior Systems, Inc. Company founded by James O. Prochaska. The mission is to enhance the well-being of individuals and organizations through the scientific development and dissemination of change management programs based on the Transtheoretical Model.

Source of the article : Wikipedia