Literature Review & Transtheoretical Model

After just completing a literature review on the Transtheoretical Model (TTM), I would like to share some important points about this model and some of it uses in the field of public health.

  • The TTM is a theory of change originally developed in the 1970s by Prochaska & DiClemente
  • Has a psychology background
  • Originally used to describe addictive behaviors in a clinical context
  • Very adaptable – is used in many different settings and scenarios today
  • Currently the most popular theory
  • Focuses on the individual’s current level of readiness to change
  • Level of readiness is used to develop an intervention fitted to that individual
  • Goal is to move to next level – NOT to change behavior
  • Individualized interventions work better than generalized interventions.
  • TTM Constructs:

1. Stages of Change

2. Process of Change

3.  Decisional Balance

4. Self Efficacy

The Stages of Change are  the TTM’s most well know construct. The model is even frequently referred to as Stages of Change. These stages outline a spectrum on which an individual may lie, and where there intervention should then be planned from.

Construct 1: Stages of change

a. Precontemplation

Individual is unaware of the problem

b. Contemplation

Individual is considering change within the next 6 months

c. Preparation

Individual is planning to change in the next month

d. Action

Individual is in the process of changing; already taking steps

e. Maintenance

Individual is keeping up with and continuing the change that was made

Below is a diagram of the stages of change construct. [Click on it to go to the source]. I like this diagram because it also includes relapse. This is a very important concepts in stages of change because at any time an individual may regress to a previous stage. For example someone may be in action and then fall of the wagon and go back to contemplation. Relapse can happen at any time in the model but is more common in the action and maintenance phases.

Below is a diagram that shows the incorporation of the other constructs. [Click on diagram to go to the source]. Most diagrams only had the stages of change, so this one was more difficult to locate but does a good job displaying how all of the constructs work together. The stages of change are listed across the top; maintenance is not included in this diagram. I think the diagram does a good job of visually describing the other constructs as they relate to the stages of change. It shows at each stage where an individual will likely be in their process of change, decisional balance, and self efficacy. It is nice to simply see how all 4 constructs combine. There is further description below the picture.

Construct 2: Process of Change

  1. Conciousness raising: learning facts that support the new behavior
  2. Dramatic relief: experiencing negative emotions with the old behavior
  3. Environmental reevaluation: learning how the behavior is an important part of one’s environment
  4. Self-reevaluation: realizing that the behavior is an important part of one’s identity
  5. Self liberation: committing to change
  6. Counter conditioning: substituting new behaviors in place of the old behaviors
  7. Reinforcement management: rewarding for positive behaivor changes, decreasing rewards for negative ones.
  8. Stimulus control: removing reminders of the unhealthy behavior, adding reminders to engage in new behavior
  9. Helping relationships: social support for behavior change
  10. Social liberation: realizing social norms are changing to support change in behavior.

Construct 3: Decisional Balance

Involves looking at the benefits and barriers/pros and cons related to the change and weighing them to see if the change is worth it.

Construct 4: Self Efficacy

Refers to the confidence an individual has in their ability to perform a new behavior.

The literature shows that this model can be very effective when implemented correctly. If interventions are tailored according to the stage that each individual is on, results often show that these individuals are more successful that those who did not have stage-tailored interventions. Below are the studies I looked at for my literature review that show success with the TTM. Clicking on the names will open the PDF of the article.

1. Computer-Mediated Intervention Tailored on Transtheoretical Model Stages and Processes of Change Increases Fruit and Vegetable Consumption Among Urban African-American Adolescents

2. Transtheoretical Model-based multiple behavior intervention for weight management: Effectiveness on a population basis

3. Impact of a Stage-Tailored, Web-Based Intervention on Folie Acid-Containing Multi vitamin Use by College Women


Cancer Prevention Research Center. (n.d.). Detailed overview of the Transtheoretical Model. Retrieved from:

Edberg, M. (2007). Chapter 4: Individual health behavior theories. In R. Riegelman (Ed.), Essentials of Health Behavior: Social and Behavioral Theory in Public Health. Sudbury, Massachusetts: Jones and Bartlett Publishers.

Edwards, L., Jones, H., Belton, A. (1999). The Canadian experience in the development of a continuing education program for diabetes educators based on the Transtheoretical Model of Behavior Change. Diabetes Sepectrum 12(3), 157. Retrieved from

Johnson, S.S., Paiva, A.L., Cummins, C.O., Johnson, J.L., Dyment, S.J., Wright, J.A., … Sherman, K. (2008). Transtheoretical Model-based multiple behavior intervention for weight management: Effectiveness on a population basis. Preventative Medicine, 46. Retrieved from

Largo-Wight, E. (2012). TTM/Stages of Change [Power Point lecture]. Retrieved from Blackboard Online Web site:

Milan, J.E., & White, A.A. (2010). Impact of a stage-tailored, web-based intervention on folic acid-containing multivitamin use by college women. American Journal of Health Promotion, 24(6). Retrieved from

Noia, J.D., Contento, I.R., & Prochaska, J.O. (2008). Computer-mediated intervention tailored on transtheoretical model stages and processes of change increases fruit and vegetable consumption among urban African-American adolescents. American Journal of Health Promotion, 22(5). Retrieved from

Young, M. (2012). Client behavior change: A key to personal trainer success [picture]. Retrieved from


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