Transtheoretical model as a framework for promoting cardiovascular health through behaviour change: a systematic review

Transtheoretical model as a framework for promoting cardiovascular health through behaviour change: a systematic review

PhD, Ejiofor A. Ezika1* , MBBS, Adaobi Nwankwo-Ezika2

1School of Health and Life Sciences, University of the West of Scotland.
2Emergency Medicine Department, Southend University Hospital.

Introduction: Cardiovascular disease (CVD) remains the single leading cause of death around the globe. The Transtheoretical model (TTM) is a successful framework for guiding behaviour change programmes for several health behaviours, yet there are limited reviews on how TTM has been used to facilitate behaviour change associated with reduced CVD. Therefore, the aims of this systematic review are to determine (i) how TTM has been used in promoting physical activity, fruit and vegetable consumption, and smoking cessation and (ii) gaps in knowledge in the use of stage-based model to improve physical activity, intake of fruit and vegetables, and smoking cessation.

Materials and Methods: The approach to this systematic review was informed by current recommendations known as Preferred Reporting Items for Systematic Reviews and Meta-analysis Approach (PRISMA).

Results: Constructs of TTM were used in the design of studies, facilitation of health behaviour change, monitoring of change in the movement of the participants across the change continuum, and evaluation of the effectiveness of health behaviour programmes. TTM was incorporated with other models, including Health Belief Model (HBM), social-ecological model, and social cognitive theory to facilitate behaviour change. There were limited studies that used all the four constructs of TTM to promote health behaviour change.

Conclusion: TTM is a promising tool for designing, facilitating, monitoring, and evaluating behaviour change associated with reduced cardiovascular disease (CVD). TTM may be incorporated with other models, including HBM, social-ecological model, and social cognitive theory to facilitate behaviour change.

Keywords: Behaviour change; Transtheoretical model; Systematic review; Cardiovascular health

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How to cite this article:
Ejiofor A. Ezika, Adaobi Nwankwo-Ezika. Transtheoretical model as a framework for promoting cardiovascular health through behaviour change: a systematic review.International Research Journal of Public Health, 2020; 4:46. DOI: 10.28933/irjph-2020-09-2205


1. Abdullah AS, Mak YW, Loke AY, Lam, T (2005). Smoking cessation intervention in parents of young children: a randomised control trial. Addiction, 100: 1731 – 1740
2. Bennett DA, Du H, Clarke R, Guo Y, Yang L, Bian Z, Chen Y, et al. (2017). Association of physical activity with risk of major cardiovascular diseases in Chinese men and women. JAMA Cardiology, 2 (12): 1349-135
3. Crabtree VM, Moore JB, Jacks DE (2018). A transtheoretical case management approach to the treatment of pediatric obesity. Journal of Primary Care and Community Health, 1:4–7
4. Dawson KA, Tracey J, Berry T (2008). Evaluation of workplace group and internet based physical activity interventions on psychological variables associated with exercise behaviour change. Journal of Sports Science & Medicine, 7 (4): 537-543
5. De Vet E, De Nooijer J, De Vries NK, Brug, J (2006). The transtheoretical model for fruit, vegetable and fish consumption: associations between intakes, stages of change and stage transition determinants. International Journal of Behavioural Nutrition and Physical Activity, 3 (13): 1- 11
6. De Vet E, De Nooijer J, De Vries, NK, Brug, J (2005). Stages of Change in fruit intake: a longitudinal examination of stability, stage transitions and transition profiles. Psychology & Health, 20 (4): 415-428
7. Dunton GF, Robertson TP (2008). A tailored internet-plus-email intervention for increasing physical activity mong ethnically diverse women. Preventive Medicine, 47 (6): 605 -611
8. Fahs PS, Pribulick M, Williams IC, James GD, Rovynak V, Seibold-Simpson SM (2013). Promoting heart health in rural women. Journal of Rural Health, 29 (3):248 – 257
9. Gaal LFV, Mertens IL, Block CE (2006). Mechanisms linking obesity with cardiovascular disease. Nature, 444: 875 – 80
10. Gillespie ND, Lenz TL (2011). Implementation of a tool to modify behaviour in a chronic disease – management programme. Advances in Preventive Medicine, 2011: 1 -5
11. Huang C, Wu H, Huang S, Chien LY, GUO, J (2013). Transtheoretical model-based passive smoking prevention programme among pregnant women and mothers of young children. European Journal of Public Health, 23 (5): 777 – 782
12. Huang SJ, Hung WC, Chang M, Chang J (2009). The effect of an internet-based, stage-matched message intervention on young Taiwanese women’s physical activity. Journal of Health Communication, 14 (3): 210 – 227
13. Hubley J, Copeman J (2013). Practical health promotion. 2nd ed. Cambridge: Polity Press, 10
14. Hutton B, Salanti G, Deborah M, Caldwell DM, Chaimani A, Schmid CH, Cameron C (2015). The PRISMA extension statement for reporting of systematic reviews incorporating network meta-analyses of healthcare interventions: checklist and explanations. Annals of Internal Medicine, 162 :777 – 784
15. Lach, H., W., Everard, K., M., Highstein, G., and Brownson, C., A (2004). Application of the transtheoretical model to health education for older adults. Health Promotion Practice, 5 (1):88 – 93
16. Li, J. and Siegrist, J. (2012) Physical Activity and Risk of Cardiovascular Disease—A Meta-Analysis of Prospective Cohort Studies. International Journal of Environmental Research and Public Health, 2012 (9): 391-407
17. Liberati A, Altman DJ, Tetzlaff J, Mulrow C, Gotzsche PC, Loannidis JPA, Clarke M, (2009). The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. British Medical Journal, 339: 2700
18. Marshall SJ, Biddle SJH (2001). The transtheoretical model of behaviour change: a meta-analysis of applications to physical activity and exercise. Annals of Behavioral Medicine, 23 (4): 229 – 46
19. Mathers CD, Loncar D (2006). Projections of global mortality and burden of disease from 2002 – 2030. PLOS Medicine, 3(11): 442
20. Menezes MC, Mingoti SA, Cardoso CS, Mendonca RD, Lopez ACS (2014). Intervention basedon transtheoretical model promotes anthropometric and nutritional improvements–a randomised controlled trial. Eating Behaviours, 17: 37 – 44
21. Mochari H, Terry MB, Mosca L (2010). Does stage of change modify the effectiveness of an educational intervention to improve diet among family members of hospitalised cardiovascular -disease patient? Journal of the American Dietetic Association, 110 (7): 1027 – 1035
22. Nakamura M, Masui S, Oshima A, Okayama A, Ueshima, H (2004). Effects of stage-matched repeated individual counselling on smoking cessation: a randomised control trial for the high- risk strategy by lifestyle modification (HISLIM) study. Environmental Health and Preventive Medicine, 9: 152 – 160
23. National Institute of Health (2017) Quality assessment tool for observational cohort and cross-sectional studies, 07July, 2018
24. Prochaska JO, Norcross JC, Diclemente CC (2013). Applying the stages of change. Psychotherapy in Australia, 19 (2): 10 – 15
25. Prochaska JO, Velicer WF (1997). The transtheoretical model of health behaviour change. The Science of Health Behaviour Change, 12 (1): 38- 48
26. Reusch A, Strobl, V, Ellgring H, Faller H (2011). Effectiveness of small-group interactive education VS lecture-based information-only programs on motivation to change and lifestyle behaviours. A prospective controlled trial of rehabilitation inpatients. Patient Education and Counseling, 82 (2): 186 – 192
27. Robinson LM, Vail SR (2012). An integrative review of adolescent smoking cessation using the transtheoretical model of change. Journal of Pediatric Healthcare, 26 (5): 336 – 345
28. Salehi L, Mohammed K, Montazeri A (2011). Fr-uit and vegetables intake among elderly Iranians: a theory-based interventional study using five-a-day program. Nutrition Journal, 79 (9): 1218 – 1223
29. Skaal L, Pengpid S (2012) The predictive validity and the effects of using the transtheoretical model to increase the physical activity of healthcare workers in a public hospital in south Africa. Translational Behavioural Medicine, 2 (4): 384 – 391
30. Topp R, Jacks DE, Wedig RT, Newman JL, Hollingsworth A (2009). Reducing risk factors for ch-ild obesity. West Journal of Nursing Research, 31 (6): 715 -730
31. Velicer W, Prochaska J, Fava J, Norman G, Redding C (1998). Smoking cessation and stress management: applications of the transtheoretical model of behaviour change. Homeostasis 38: 216 – 233
32. Zhu L, Ho S, Sit JWH, He H (2014). The effects of a transtheoretical model-based exercise stage-matched intervention on exercise behaviour in patient with coronary heart disease: a randomised control trial. Patient Education and Counseling, 95 (3): 384–392

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