Transtheoretical model of health behavior change applied to voice therapy

Abstract

Studies of patient adherence to health behavior programs, such as physical exercise, smoking cessation, and diet, have resulted in the formulation and validation of the Transtheoretical Model (TTM) of behavior change. Although widely accepted as a guide for the development of health behavior interventions, this model has not been applied to vocal rehabilitation. Because resolution of vocal difficulties frequently depends on a patient's ability to make changes in vocal and health behaviors, the TTM may be a useful way to conceptualize voice behavior change processes, including the patient's readiness for change. The purpose of this paper is to apply the TTM to the voice therapy process to: (1) provide an organizing framework for understanding of behavior change in voice therapy, (2) explain how treatment adherence problems can arise, and (3) provide broad strategies to improve treatment adherence. Given the significant role of treatment adherence in treatment outcome, considering readiness for behavior change should be taken into account when planning treatment. Principles of health behavior change can aid speech pathologists in such understanding and estimating readiness for voice therapy.

Figures

FIGURE 1

A decision tree for determining readiness based on a transtheoretical approach. First, the behavior contributing to the voice disorder is identified. Next, the stage of readiness to change this behavior is identified. Depending on the stage (precontemplation, contemplation, or preparation) the clinician uses different strategies to either help the patient move to the next stage, or decide on a stage-appropriate treatment plan.

FIGURE 2

An illustration of the clinician’s role of exploring importance and building confidence toward the goal of behavior change, as conceptualized in Motivational Interviewing.,

FIGURE 3

Patient readiness for change is conceptualized as a combination of perceived importance of change and confidence in achieving change, as conceived in Motivational Interviewing., Visually, one can sort patients into four groups in a matrix: those with high confidence and importance regarding change; those for whom the change is not important but confidence to potentially succeed is high; those for whom the opposite is true; and those for whom both importance and confidence are low.

FIGURE 4

A readiness ruler to assess patients’ perceived importance of change and confidence in achieving change, as conceptualized in Motivational Interviewing.,