Transtheoretical Model, Don’t Let it Spook you. Rationale of the Week

Our October 6th Question quizzed test takers on the Transtheoretical Behavior Change Model. 50% of respondents chose the correct answer, while 50% did not. Since this is an important topic for the exam and our clinical practice, we want to explore this topic further.

Transtheoretical Model – Quick View

Before we dive into the rationale, let’s do a quick review of this model and the stages of change included in the Transtheoretical Model. The slide below, created by Diane Pearson, RN, MPH, CDCES, provides a quick visual view of the model including the different stages of change.

Take a minute to look through:

  • the name of each stage
  • the role of the educator, and finally
  • the phrase that describes what stage the person is in (right above the arrows).

Now that you have studied the model and you are ready to try the question, click here: Answer Question. If you have already answered the question, keep scrolling down for the rationales.

Question: JR has type 2 diabetes and an A1c of 9.4%. He is on 3 medications for diabetes and now needs to start insulin. JR says, “I just don’t know if insulin would help me. My brother took insulin and he had all kinds of problems.”

What best describes JR’s stage of change using the transtheoretical model? 

Answer Choices:

  1. Denial
  2. Bargaining
  3. Avoidance
  4. Contemplation

As shown above, the most common choice was option 4, the second most common answer was option 3, then option 1, and finally option 2

Getting to the Best Answer

If you are thinking about taking the certification exam, this practice test question will set you up for success. Test writers anticipate possible answers based on the details in the question. They will wave those “juicy answers” right under your nose. Your job is to be familiar with the most common behavior change theories and taking a person-centered approach. Then weed through the particulars, pluck out the most important elements, the cross of false answers, and choose the BEST answer.

Answer 1 is incorrect. 16.34% chose this answer, ” Denial”. There are 5 stages of change in the transtheoretical model, and denial isn’t one of them. It is true that the person in the vignette may be experiencing some degree of denial, but denial is not one of the stages of change in this model. To throw test-takers off a little, I used terms from the “Stages of Grief” model, by Kubler Ross. This was intentional on my part, to lure you in with juicy, but incorrect, answers.

Answer 2 is incorrect. 9.94% of you chose this answer, “Bargaining”. There are 5 stages of change in the transtheoretical model, and bargaining isn’t one of them. As with answer 1, “Denial,” I used terms from the “Stages of Grief” model, by Kubler Ross. This was intentional on my part, to lure you in with juicy, but incorrect, answers.

Answer 3 is incorrect. 23.89% chose this answer, “Avoidance”. There are 5 stages of change in the transtheoretical model, and avoidance isn’t one of them. It is true that the person in the vignette may be experiencing some degree of avoidance, but avoidance is not one of the stages of change.

Finally, Answer 4 is correct, “Contemplation” 49.83% chose this answer. YAY. Almost half of you chose the correct answer. Based on the content, we can tell that JR is “thinking about it” or contemplating making a change. As educators, we will explore this ambivalence and focus on past successes to increase feelings of self-confidence in achieving the new behavior.

“I just don’t know if insulin would help me. My brother took insulin and he had all kinds of problems.”

Educators might then say, I hear what you are saying. You are not sure if insulin would help you since your brother had all kinds of problems. Can you tell me more about this?

As the story unfolds, it provides opportunities to honestly explore some of the benefits and drawbacks of insulin therapy and gives space for JR to talk about their experience with insulin.

We hope you appreciate this week’s rationale! Thank you so much for taking the time to answer our Question of the Week and participate in this fun learning activity!


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