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In 1983, Prochaska and DiClemente developed the Transtheoretical
Model which is also known as the Stages of Change Model. The study and evidence
were based on changes in smokers’ behaviour. The model emphases on the
decision-making of the individual and is a model of premeditated change. The
stages of change Model functions on the assumption that people do not change
behaviours rapidly and decisively. Instead, change in behaviour, particularly
habitual behaviour, happens continuously through a cyclical process.  

Precontemplation: this when an individual
does not believe their behaviour is challenging with No intent to take any
action anytime soon.

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Contemplation: This when an individual
possibly understands the cost of their behaviour, and has the intention of
taking action soon.

Determination: this is when an Individual
has made the decision to change their behaviour. This stage is significant as
it can easily lead to relapse if the individual does not plan cautiously.

Action: this is when an
individual puts
their plan into action.

Maintenance: The individual
needs to sustain the change in behaviour with an intent to maintain the
change in behaviour going forward.

Relapse: An individual
Relapsing within the cycle of change considered as normal. It’s good to learn
from the relapse, e.g. what was the trigger; why the plan was ineffective. E.t.c


Concordance applies
to a consultation process that occurs between a health care professional and a
patient. The process of concordance improves power-shaping in
professional-patient collaboration, patient’s
viewpoint is valued; as well as recognizing that the patient has knowledge about
his or her illness and how well their body response to treatment.

Patient’s personal
expertise is not the same as the professional’s scientific knowledge when it
comes to in medication treatment selection however both knowledges relevant and
valued when it comes to deciding on the best treatment available. It has been researched
that concordance can impr9ove care satisfaction, knowledge of the condition and
treatment, treatment adherence and lots more.

Motivational Interviewing                                                                                                                                                     Motivational interviewing
is a therapeutic tactic that was initially
developed by W. Miller & S. Rollnick in 1991, the therapeutic tactic focuses
on person-centred counselling, which attempts to encourage an individual to
move through the stages of change and enabling an individual to go through the
stages of change, as well as make positive decisions and achieving established
goals along the way.

Key Elements of
Motivational Interviewing                                                                                                                                                                      The key elements of motivational interviewing which
is also known as the spirit of motivational interviewing refers to how this
technique is applied, there are 3 key elements which are;

Collaboration: is the alliance that is formed between a healthcare professional
and the patient. The healthcare professional will try to understand the
situation from the patient’s point of view and experiences. This is different
from some other approaches to counseling or treatment, which are based on healthcare
professionals taking the “expert” role, which can sometimes result to
challenging patients or imposing their own viewpoint on the patient’s unhealthy
behaviour, the suitable course of treatment and the outcome. Collaboration help
builds bond and enables trust in the relationship between the healthcare
professional and the patient. this does not mean that the healthcare
professional agrees with the patient automatically, about the complexion of the
problem or the appropriate changes that may be required. While they possibly
will see things inversely, the therapeutic procedure is focused on joint
understanding, not the healthcare professional or the patient being right.  

Evocation: in motivational interviewing approach
the healthcare professional draws out the patient’s own thoughts and ideas, instead
of the healthcare professional imposing their own thoughts. This means,
the patient will be more interested in changing and maintaining the change for
a longer period. In other types of counselling, like cognitive behavioral
therapy, patients are given information by healthcare professionals as encouragement
for them to change their ways of thinking, beliefs, or behaviours. sometimes,
this approach can lead to the patient becoming defensive.

Autonomy: Motivational
interviewing gives all power to the patient. The healthcare professional should
respect the patient’s responsibility and the ability to make decisions about
their care. Some other therapy approach sees
healthcare professionals as authority figure, Motivational Interviewing empowers
patients, but also allows them take responsibility for their actions.

The principles of Motivational Interviewing

Express Empathy: This principle focuses on
person-centered treatment, the healthcare professional sees the world through
the patient’s eyes, feels things the way the patient feels them, as well as
think about things like the way the patient thinks about them. By doing this,
the patient will feel that he or she is being understood, leading to them
opening up and sharing their experience accurately.  When a patient opens up and
share their experiences accurately, it enables the healthcare professional to
assess as to when, where and how the patient can be supported. Patients also
become a lot more comfortable, with assessment, more certainty about change and
less likely to be defensive. Healthcare
professionals can be trained to have Empathy skills, on how to understand the
feelings of patients over the use of reflective listening.  Empathy helps builds bonds and trust, leading
to a successful collaborative relationship with the patient after which the
healthcare professional can offer support for the anticipated change.

Develop discrepancy: with this principle the healthcare professionals must
allow patients point out the difference between what their current situation is
and their goals for the future.

The healthcare
professional role is to support the patient with focusing their attention on
how their current behaviour varies from the anticipated behaviour. The healthcare
professional uses interventions that are not based in confrontation to generate
this information. The healthcare professional asks a sequence of questions to
lead the patient to a natural conclusion.

Roll with resistance: just like other approach healthcare
professionals should expect there to be some resistance and reluctance from patients
during this process. Healthcare professionals will not try to force or
manipulate the patients into acceptance. The healthcare professional must work
to recognize the patient’s point of view and avoid the wish to rectify what could
be observed as defective ways of thinking in the means of contributing other
ways of thinking for the patient to consider.  

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