Welcome

You can get garden variety health advice from the daily newspaper, the "health" section of most book stores, and of course thousands of web sites. I'm hoping to present thought provoking and maybe change provoking thoughts about individual and community health. This blog is not just what to do about health, but how to think about it. I'm looking forward to an exchange of ideas with readers. July, 2010

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Friday, January 7, 2011

Health Promotion Resolutions

Dyed-in-the-wool health promoters, on either side of a graduation are familiar with a theory called the Transtheoretical Model, sometimes also called stage theory.  There are just a few basic ideas needed to understand this theory.  People are at different points of readiness to change any particular health behavior: some are not interested in making a health-related change, some are in the process of changing, and some are trying not to relapse in their change.  The corollary is that health promoters must tailor their intervention efforts to the varying needs of people at different levels of readiness.  I want to relate this theory to New Year's resolutions.

It is customary for people to make pledges for self-improvement when they turn the calendar for the new year; often the intentions are health-related. Usually a price will be paid in doing something that takes discipline, changing time and schedule, and requires flexibility by significant others.  This tradition is still a good one:  Surely it is better to say "This year I want to quit smoking!" as opposed to "This year I want to put on 75 pounds!"  The problem of course is that most people have trouble carrying out their pledges.  Today we are one week into the new year and already the relapse curve is rising.  Why is it that doing good things for ourselves is so difficult?

We can think about this in terms of the Transtheoretical Model.  People who decide to make health-related changes are in a stage of readiness in which they are thinking about reasons to change and the benefits and barriers of doing so.  They are in that stage because of personal life events and broader social influences.  It is just by chance that their inclination to change coincided with the custom of New Year's resolutions.  Health  promotion agencies should be preparing people in November and December, so that when January rolls around they are in a frame of mind supportive of change.  This does happen, but the effort is not extensive enough to reach most people.

Continuing the theme of resolutions and theory, people more times than not will relapse.  It is not that the pledges were not genuine.  It was that they don't have the supports to move to the next levels of stage theory.  In order for people to act on their intentions, they need to have access to resources and must learn competencies and skills.  People are genuine when they say they want to lose 25 pounds in the new year.  What is lacking is a way for them to learn the necessary skills, such as how to grocery shop, plan meals, eat in restaurants, and obtain social support in ways that advance losing the weight.  Do they have access to safe places to exercise?  Without those things, their motivation isn't channeled into positive action. 

Another problem is that for many health-related changes, once the change is made and the goal is attained, communities don't provide resource and motivational ramparts to sustain the achievement long term.  We may say let people take care of their own stuff, and that is a legitimate point of view.  On the other hand, without communities taking a role in helping people, we can expect to see lots of health promotion relapse.  That is a choice society makes, but at the present time it is not an informed choice.

If you are a consumer trying to change, look for help in the surrounding community.  If you are a health promotion advocate, be the change you want to secure.

7 comments:

Real Life Health said...

Hello Dr. Wilson;
I enjoyed reading your post on behaviour change related to the TTM. As a health promoter, myself, I do consider this model of behaviour change frequently. I appreciate your comments on environment also because this, and other psycho-social factors, I believe, create barriers for many. In addition, I have witnessed (permanent) changes only when the health of the individual is at risk (HBM).
Personally, I'm a fan of the Theory of Planned Behaviour when applied to each stage in the TTM.
One thing is for sure, understanding theory and applying it to a population (such as the military) is one tough job.
I am starting to believe that the only way to successful change, both individually and environmentally is through a shift in culture (medical, military, north american and the like). It's through a shift in belief, attitude, and value that may lead to more successful health promotion and adaptation.....I'm still not sure what the hell the answer is...but I really appreciate reading your blog post!
Thanks.

Sincerely,

Kathi

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Personally, I'm a fan of the Theory of Planned Behaviour when applied to each stage in the TTM.

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Personally, I'm a fan of the Theory of Planned Behaviour when applied to each stage in the TTM. Thanks for information.