Thesis

 Several authors have voiced their opinions about the stages of change model; however, the article outlines the following main items. The article provides an understanding of the model whereby it is being portrayed as flawed, and diverse views on why it should be abandoned have been established. Similarly, the article explains the popularity of the model in terms of research literature. Additionally, the article describes and questions the scientific merits of the model.                                                                                            

                                                         Rationale

It is obvious that authors have to voice their opinions regarding the effectiveness of the model. According to Littell and Girvin (2002), the stages of change model has not at any particular point outlined the time individuals spend in the first three stages. Instead, the concept encompasses a mixture that includes the intention of a person to change, current behavior, his/her past quit attempts and the duration to abstain. Similarly, the empirical evidence portrayed shows little progress through the entire stage. In their opinion, a person is unlikely to agree that the stages reflect reality. Stages of change model instill little sense when an individual with different traits are classified in the same category. For example, grouping together individuals who portray different dependence levels, or have never endeavored to quit smoking with the category that has abstained for long. Ultimately, the model does not outline and consider the primary determinants of smoking. Besides, people’s dependency level, withdrawal symptoms are not taken into account.

Segan et al. (2004) explained that the main core of the model is to provide a description of the association between variables. Precisely, the description will entail stages and self-change strategies that will be outlined in sequential patterns. Therefore, the model should categorically do what is required at the right time. According to the author, the model does not in any way convincingly depict the idea of using distinct strategies to progress through distinct stages (Herzog et al. 1999). Dijkstra et al. (1998) supported it by saying that the fundamental tenets of the model are questioned by the idea of stage mismatch interventions being more effective than stage match interventions.
Response

I strongly agree with the questioning of the scientific merits of the stages of change model. The stages of change algorithm are questionable since it lacks a peer reviewed account of developmental research. The model has no gold standard that can be used to compare different staging algorithms. The researchers find it easy to change the existing algorithm when they feel that they are uncomfortable with the original one. Therefore, the current staging algorithms lack effectiveness and validity. Similarly, the staging algorithms are a collection of questionnaires and are therefore based on self-assessed behavior and motivation. The questionnaires have problems, and some of the items are based on yes-no response and arbitrary timeframe that do not need an expert to evaluate the problem. Therefore, it will be difficult to use a complex health behavior in this model. However, for the case of a complex health behavior, the algorithm should be included with a more objective assessment of behavior.

On the other hand, I disagree with the notion that the model should be abandoned because it is flawed. Although the model is flawed, it has been used to explain the process of a person’s behavior change due to dependence and substance use. Besides, the model has been applied to a variety of behavior, populations and also settings. Similarly, the model is being used as motivation to quit smoking. The researchers should not discard the model; however, they should work extra hard and improve the model so that it can be used for complex health behaviors. Moreover, they should also renew their efforts and use stages of change model to measure readiness to quit smoking. Additionally, smoking cessation has helped people to understand change process and hence outlining new directions for health promotion.
Strengths

The model is being used by clinicians as a therapeutic tool with clients. The assumption of the model is based on a rational actor of behavior change (Prochaska et al., 2008). Therefore, the change in the behavior of a person is based on a rational cognitive self-evaluation. The clients are provided with information on the stages of the model, and they determine by themselves where they fit exactly. The education and self-staging actions change are schemes that help clients organize their thoughts and actions towards change.

The other strength is that the model outlines a predictive validity of the stages. A person who is at earlier stages is less likely to change his/her behavior than an individual that is further along the continuum. Precisely, forward stage movements that result from therapeutic efforts poses a high chance of future change than interventions. However, interventions for this case do not lead to forward movement.

The model has a great influence on service delivery. The model has continued to gain popularity and accepted to provide services. Decisions on the kind of services rendered to an individual are determined on the stage of change assessment (Piper & Brown, 1998). People who are considered ready for a change are given priority for services over pre-contemplators. The model is being used as a motivational measure that helps people quit smoking.

  References

Dijkstra, A., De Vries, H., Roijackers, J. & van Breukelen, G. (1998). Tailored interventions to communicate stagematched information to smokers in different motivational stages. Journal of Consult Clinical Psychology, 66, 549–557.

Herzog, T. A., Abrams, D. B., Emmons, K. M., Linnan, L. A. & Shadel, W. G. (1999). Do processes of change predict smoking stage movements? A prospective analysis of the transtheoretical model. Health Psychology, 18, 369–375.

Littell, J. H. & Girvin, H. (2002). Stages of change. A critique. Behavior Modification, 26, 223-273.

Piper, S. & Brown, P. (1998) Psychology as a theoretical foundation for health education in nursing: Empowerment or social control? Nurse Education Today, 18, 637–641.

Prochaska, J.O., Butterworth, S., Redding, C.A., Burden, V., Perrin, N., Lea, Michael, Flaherty, Robb M., and Prochaska, J.M. (2008). Initial efficacy of MI, TTM tailoring, and HRI’s in multiple behaviors for employee health promotion. Preventive Medicine, 46, 226-231

Segan, C. J., Borland, R. & Greenwood, K. M. (2004). What is the right thing at the right time? Interactions between stages and processes of change among smokers who make a quit attempt. Health Psychology, 23, 86–93.

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