Fall Prevention through Behavior Change Exercise Interventions with

Fall Prevention through Behavior Change: Exercise Interventions with the Transtheoretical Model Patricia Burbank, DNSc, RN Professor URI College of Nursing RI Geriatric Education Center

Objectives n n Describe the Transtheoretical Model of Behavior Change as it applies to exercise and fall prevention. Assess the stages of change for exercise behavior. Discuss processes and strategies for exercise behavior change among older adults. Identify strategies for exercise behavior change to identified stages of change.

Transtheoretical Model of Behavior Change (TTM) Prochaska & Di. Clemente, 1984

Dimensions of TTM n Stages of change n Processes of change n Decisional balance n Self efficacy

Stages of change (5) Precontemplation - no intention to change behavior in foreseeable future n Contemplation - seriously considering changing behavior within 6 months n Preparation - Intending to take action within next month n

Stages of change (cont’d) n Action - successfully altered behavior for one day to 6 months n Maintenance - a continuation of changed behavior from 6 months to indefinite

Processes of change (10) Cognitive: n Consciousness raising n Dramatic relief n Environmental reevaluation n Self-reevaluation n Social liberation

Processes of change (cont’d) Behavioral: n Counter-conditioning n Helping relationships n Reinforcement management n Self-liberation n Stimulus control

Description of Processes Consciousness raising - seek new information about the behavior n Dramatic relief - Express feelings about problem or behavior n Environmental reevaluation - Assess how problem affects physical and social environment n

Description of Processes (cont’d) Self re-evaluation - Re-appraise values regarding the behavior n Social liberation - Develop awareness and acceptance of changed lifestyle n Counter-conditioning - Substitute alternative for problem behavior n

Description of Processes (cont’d) Helping relationships - Use support from others n Reinforcement management - Reward changed behavior n Self-liberation - Commit to action; belief that change is possible n Stimulus control - Control situations and cues that support problem behavior n

Decisional Balance n n Precontemplation - cons of changing outweigh pros Contemplation - pros stronger but still may not outweigh cons, crossover may occur Preparation - crossover (pros stronger than cons) Action cons pros

Self efficacy increases across stages n Temptation scores decrease across stages n Maximum self efficacy and minimal temptation occurs in maintenance n

Moving through Stages of Change Precontemplation Contemplation Relapse Preparation Maintenance Action Termination

Precontemplation: Goals and Strategies Increase awareness of need to change. Give personalized information and feedback n Encourage thinking about change n

Contemplation: Goals and Strategies Motivate and increase confidence in ability to change. Emphasize benefits of change n Express empathy and provide support n Explore concerns and fears n Clarify misconceptions n

Preparation: Goals and Strategies Negotiate a plan. Set realistic goals. n Recommend a plan; provide options n Individualize plan n Reinforce small change n

Action : Goals and Strategies Reaffirm commitment and follow-up. Reaffirm agreed-upon plan n Teach behavioral skills n Provide educational materials n Enhance social support n Arrange follow-up date n

Maintenance: Goals and Strategies Encourage active problem-solving. Encourage planning for potential difficulties n Enhance support network n

Relapse: Goals and Strategies Assist in coping. Help overcome shame and guilt n Reframe as learning opportunity n Analyze stumbling blocks n

Assessing Stage of Change Identify behavior first, then: n Yes, I have been for more than 6 months n Yes, I have been, but for less than 6 months n No, but I intend to in the next 30 days n No, but I intend to in the next 6 months n No, and I do not intend to in the next 6 months

Tailor interventions to stage of change

Summary Behavior change occurs in stages n TTM: 4 main components n Behavior change works better if interventions are tailored to stage of change n Design stage-tailored strategies for population group and setting n