Behavioural change in the primary prevention of Coronary Heart Disease (CHD) : evaluating the transtheoretical/stages of change behavioural model : a mixed methods study

• Main Author: Middlemass, Jo
• Published: University of Nottingham 2013
• Subjects: 616.123
• Online Access: http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.601802

Introduction In primary care, clinicians are engaged in trying to help patients change their behaviour in order to prevent heart disease. The risk of heart disease is increased by lack of exercise; smoking and eating a high fat diet, all of which are modifiable lifestyle behaviours. The aim of the thesis is to explore the potential for the use of the Transtheoretical Stages of Change CTIM/SOC) model in primary care and consider how the findings can be utilised by clinicians helping patients to change unhealthy behaviour. Method There are three parts to this study; the first is a structured review which examines studies using the TIM/SOC behavioural model in primary care, both when the intervention is tailored to the stage of change and/or when it is used as an outcome/predictor measure. The second part examines the secondary data from a cardiovascular disease study ('Realising the potential of the family history in risk assessment and primary prevention of coronary heart disease in primary care' - ADDFAM) which used the TIM/SOC model, to see what change predictors could be found. The third part comprises a qualitative study using semi-structured interviews to identify the facilitators and barriers of behaviour change as experienced by individuals attempting to change their unhealthy behaviour to see if these could be explained in terms of the TIM/SOC model. Results • There appears to be validity in the basic premise of moving through the stages of change which spanned the three distinct sources of evidence. However, in the interview data, no-one spoke in terms of a timeframe except for a social occasion or in terms of life priorities, which throws some doubt on the time-scales imposed on change process in the TIM/SOC model. • There is mixed evidence for the TIM/SOC model either as an intervention, or an outcome/predictor measure, in particular, there is some doubt that movement through the stages of changes equates to actual behavioural change. • There was evidence to suggest that the TIM/SOC constructs are used in the process of change. However, there were identified differences to the processes as outlined in the model, in particular the helping relationships construct was found to be in use throughout the change process, rather than as the TIM/SOC suggests between the action and maintenance stage. Specific constructs for sustaining behavioural changes are not covered under the TIM/SOC model and their inclusion may be helpful for the maintenance stage of the behaviour change. Additional constructs that may be useful to consider in the model include denial/fatalism; psychological aspects and demographic data. XlI Conclusions By triangulating the structured review with the ADDFAM study database results and findings from the qualitative interviews, this study has highlighted both positive and negative aspects of the TIMjSOC model for use in primary care. Suggestions are made for changes to the model that could be evaluated in future research and these include: comparing the TIMjSOC model against the PAPM (a non-timeframe model); inclusions of additional constructs for denial/fatalism; demographic details and psychological factors. The helping relationships construct should be expanded for use across all stages of change and specific new constructs evaluated for sustaining the change. In addition the similarities and differences between the constructs of self-efficacy and control should be explored and evaluated. The findings identified in the thesis have highlighted some areas that clinicians can focus on in primary care to help patients to change their unhealthy behaviours. Xlll