Application of Transtheoretical Model vs. Health Belief Model
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Introduction
Recently many research strategies have developed to identify the most efficient methods to achieve healthier outcomes. An accurate combination of personal behavior and health improvement has proffered the novel approaches to behavioral and medical experts. The outcomes of such intervention studies have provided potent insights in various chronic and infectious diseases and many theories that gained high appreciation are designed to define the scope of nursing practices. Currently, many conceptual models are applied in health promotion and education (Glanz, Rimer & Viswanath, 2008). The essay aims to synthesize, review, and evaluate the literature on cancer screening behavior. In this essay the two most frequently recognized theories; TTM and HBM are analyzed on breast cancer patients and who are susceptible.
The Health Belief Model (HBM) is broadly applied theoretical frameworks since the early 1950s. In health behavior and education it explicates change and maintenance in health-related behaviors interventions (Glanz, Rimer & Viswanath, 2008).
The HBM gives emphasis on what triggers in a patient to take action or what prevents. It includes the primary perception of behavior that deals with acceptance towards diagnosis, screening and control of disease (Noroozi, Jomand & Tahmasebi, 2011). These behavioral actions may include seriousness, doubts, benefits and barriers, cues to feat and most advanced is the belief of positive consequences after taking action against any susceptibility of disease (Glanz, Rimer & Viswanath, 2008).
The constructs of HBM are:
Perceived Susceptibility: It refers the belief or doubt about having or getting a disease condition. In the case of a woman that may require mammogram, it is necessary to make her believe that there is the susceptibility of getting breast cancer.
Perceived Severity: It will refer to a severe feeling of getting cancerous condition and fear of not getting the appropriate treatment that may include medical, clinical as well as social outcomes. Clinical outcomes may consist of pain, disability and death while social consequences are the impacting on work, family life, and relations. The perceived severity and susceptibility together can turn into perceived threat.
Perceived benefits: It refers the possible benefits acquired by a person after accepting the behavioral changes due to perceived threat. It may include the reduction in disease threat or non-health-related perceptions, for instance, financial saving due to early screening and diagnosis or having a screening test for pleasing any relative.
Perceived Barriers: It refers the negative aspects or obstruction towards a particular health action that may consist of-“What if screening test results are positive”, or other nonconscious decisions.
Cues to Action: Formulations of the HBM emphasize on triggering actions. According to experts willingness to go for a mammogram can be stimulated by other factors, such as environmental or bodily events, or media publicity.
Self-Efficacy: Self-efficacy is the final construct that defines the confidence in one’s capability to act. HBM provide training and guides the person to go through screening (Noroozi, Jomand & Tahmasebi, 2011). A study by Noroozi suggested that women who perceived more benefits are more interested in the regular examination (Noroozi, Jomand & Tahmasebi, 2011).
Figure 1: Health Belief Model Components and Linkages (Glanz, Rimer & Viswanath, 2008).
The Transtheoretical Model (TTM) and its constructs:
The Transtheoretical Model (TTM) works on the basis of stages of change to incorporate the values of change, and it has developed as a comparative analysis of foremost theories from psychotherapy and behavior change. Stages of change are a significant part of TTM as it represents a sequential dimension. Through a series of six stages, it posits the transformation as a process that unfurls gradually (Glanz, Rimer & Viswanath, 2008).
The constructs of TTM are:
Precontemplation stage: It is an early stage of TTM for managing any disease (Ex. breast cancer), and it takes time in convincing a person for the screening test. Usually, they take six months with variable outcomes. The denial of going for screening may be due to the unawareness of the consequences.
Contemplation: In this stage people are convinced to go for diagnosis in the period of next six months. They are conscious about the pros of change but still require knowing the cons.
Preparation: Person at this stage is determined to take action quickly as in one month. The adaptation to change has been reached to the next step and now they have a plan to respond.
Action Stage: Person in this stage has acquired specific and obvious transformations in his lifestyle. The action occupies only one of the six stages and changes are the main outcomes of the therapy. These actions may include screening tests, meeting a counselor, joining any health education class, conversing with a physician, and they can be engaged in action-oriented programs.
Maintenance stage: This stage assures that the individual does not intend to relapse. On the basis of literature and self efficacy data, it is suggested that maintenance may proceed from six months to five years.
Termination Stage: People in this stage exhibit zero enticements and complete self-efficacy, whether they are going through any psychological stress.
Comparison of HBM and TTM: According to the experts HBM in combination with TTM exhibit double efficiency as the HBM constructs show more appropriate outcomes when applied to the stage concept of TTM. It is observed that women who are not allowing for mammograms in pre-contemplation stage requires more rigorous intervention in comparison of those who are intended to be screened. Various studies have exhibited that women contemplators who are being screened for mammograms show intensely perceived threats and benefits in comparison of pre contemplators (Glanz, Rimer & Viswanath, 2008).
Comparative studies have revealed that among behavioral Models, the TTM has attained the highest positive outcomes (75%) that last for a longer period (Bélanger‐Gravel et al., 2011). While HBM helps in investigating the breast self-examination (BSE) rate among women (Noroozi, Jomand & Tahmasebi, 2011).
Similarities and Differences in TTM and HBM
The common feature of both models is perceived barriers that prevent acceptance of behavioral change. Self-efficacy is another construct that exists in the application of both models. The main difference exists in their anticipated scope. HBM emphasizes on the disease prevention before any diagnosis. HBM helps people in accepting the susceptibility towards breast cancer and get them ready for taking action for screening, and a diagnosis like procedures.
TTM put emphasis on post mammogram changes and provide potent support for the diagnosis that includes maintenance of the behavioral transformation, such as routine check-ups and counseling with physicians.
Critical assumptions and conclusion
The TTM involves five stages of change, depending on the nature of behavior change. In the case of a woman who needs support in dealing with breast cancer, the nature of behavioral changes during the therapy to adapt the lifestyle according to the condition facilitates the changes. According to Glanz, no single theory can describe all complications relevant to behavior change. To deliver more efficacy specificity will be required at specific stages (Glanz, Rimer & Viswanath, 2008).
Applying HBM has other benefits such as its innate reasoning as it is evidently centered to belief. In HBM, it is believed that principles and anticipating beliefs are significant in deciding behavior. Experts have given experimental support to HBM due to its aptitude of predicting behavior. In a research by Oyekale, they applied HBM on Nigerian youth for HIV test and risky behavior change and results exhibited 87.79% single youths became aware of HIV/AIDS, and 3.34% chose to perform HIV test. 71.73% abstained from risky behavior by limiting the quantity of sex partner (24.35%), or with the condom (14.29%) (Oyekale & Oyekale, 2010). Both therapies are undoubtedly appropriable theories for health behavior programs of breast cancer.
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