The Transtheoretical Model, in particular the Stages of Change construct, has become popular in several fields to guide interventions addressing a wide range of problem behaviours. Even so, the model has limitations that practitioners, service planners and policy makers should aware of.
Littell and Girvin (2002) reviewed 87 studies on the Stages of Change across problem behaviours. They concluded that, while the staged model has considerable heuristic value, its practical utility is limited by concerns about the validity of stage assessment. Further, they found little experimental evidence for sequential movement through discrete stages in studies of specific problem behaviours, such as smoking and substance abuse.
West (2005) elaborates on this theme, contending that the dividing lines between stages are too arbitrary. He questions the reliability of the model in making predictions about behaviour change. Adams and White (2005) found the methods applied to gauge an individual’s stage of change are not standardised, compared empirically or validated.
West (2005) also believes the model is based on a flawed assumption that individuals typically make coherent and stable plans for changing problem behaviours. He asserts that the choice to make health behaviour change is contingent on opportunities within the individual’s social and physical environment and on motivations, which are subject to a range of variables including “…desires, urges, needs, habits, evaluations and level of commitment to any prior resolutions” (p1059).
DiClemente (2005) acknowledges that some of the claims regarding the utility and scope of the Transtheoretical Model have been exaggerated and believes that critics have raised valid concerns that need further exploration. Even so, DiClemente strongly defends the value of the Stages of Change construct as a device for understanding and exploring the process of change with individuals.
He believes that the momentary influences on an individual’s behaviour identified by West (ibid) are part of a larger change process that can be guided intentionally. He also points out that anomalies in how a construct is operationalised are to be expected. He contends that both momentary change and sustained change are associated with a compilation of tasks and accomplishments that relate to the Transtheoretical Model’s stages and processes.
A meta-analysis of 57 studies of interventions tailored to the Transtheoretical Model (Noar, Benac & Harris, 2007) supports DiClemente’s comments on the ongoing utility of the model as a guide for practitioners and not a predictor of change. They found that programs tailoring interventions and responses according to each of the key constructs within the Transtheoretical Model (i.e. stage) achieve behaviour change and do better than those that do not (ibid).
There are also basic questions about intentional behaviour change in relation to the age it begins (Prochaska, Redding, & Evers, 2007). It is possible that young people’s capacity and motivation to engage in self-directed and intentional behaviour change is limited. This might explain why many young people who are using alcohol and other drugs, including those experiencing problems, are in the pre-contemplation stage.
However, the Stages of Change construct is still a useful way to understand how a young person with intensive usage patterns might be oriented towards their substance use. It is therefore important that practitioners factor each young person’s developmental status and capacity into considerations of stage and the types of interventions that might be efficacious.
It is worth noting that applied studies in school-based bullying prevention (Prochaska et al., 2007) and early intervention with adolescent smokers using treatments tailored to the Transtheoretical Model produced significant abstinence rates at 24 months that were almost identical to rates found with treated adult smokers (Hollis et al., 2005).
Prochaska, Redding and Evers (2007) also identify that the degree to which the Transtheoretical Model has cross-cultural relevance might be an issue. While there is no conclusive evidence as to the effectiveness of the model with young people from different cultural backgrounds, there are indications that the model has cross-cultural relevance. A meta-analysis of research on the relationships between stages and the pros and cons of changing across 10 countries revealed no significant effect by country (Hall & Rossi, 2008).
