Transtheoretical Model of Health Behavior Change Applied to Voice Therapy

Abstract

SummaryStudies of patient adherence to health behavior programs, such as physical exercise, smoking cessation, and diet, have resulted in the formulation and validation of the Transtheoretical Model (TTM) of behavior change. Although widely accepted as a guide for the development of health behavior interventions, this model has not been applied to vocal rehabilitation. Because resolution of vocal difficulties frequently depends on a patient's ability to make changes in vocal and health behaviors, the TTM may be a useful way to conceptualize voice behavior change processes, including the patient's readiness for change. The purpose of this paper is to apply the TTM to the voice therapy process to: (1) provide an organizing framework for understanding of behavior change in voice therapy, (2) explain how treatment adherence problems can arise, and (3) provide broad strategies to improve treatment adherence. Given the significant role of treatment adherence in treatment outcome, considering readiness for behavior change should be taken into account when planning treatment. Principles of health behavior change can aid speech pathologists in such understanding and estimating readiness for voice therapy.

Autoavaliação e prontidão para mudança em pacientes disfônicos

“…TTM investigates the readiness to change from motivational stages (13) . The readiness to change concept refers to the integration of awareness of individuals about their problem and confidence in their ability to change.…”

Estágio de prontidão de pacientes com disfonia comportamental pré e pós-terapia de voz de grupo

“…After considering their limitations and suggestions, the authors found most of the selected studies indicated group vocal therapy to be effective at all ages, and not only promoted vocal health, but also prevented dysphonia (3) . Unfortunately, there are few studies, in the literature, that have evaluated the patient's stage of readiness to speech therapy in the voice area (10,15,22) . Furthermore, there was no previous research into the efficacy of group therapy.…”

“…The only statistical difference was the reduction of patients in the contemplation stage. This may be due to factors such as the duration of the proposed treatment (18) ; patient motivation; commitment; vocal self-perception; personality of the therapist (6) ; exercise learning; self-regulation from the patient and a good relationship with the therapist (10) .…”

“…In Speech Therapy, especially in the area of voice, there are few references related to this type of study (10)(11)(12)(13) , despite it being a matter of extreme importance, considering that vocal therapy depends on the change in an individual's behavior and, therefore, on their active participation throughout the therapeutic process, that is, the patient's readiness stage.…”

“…This model aims to observe the patient's readiness to the change, in order to verify where the patient is at in this cycle (14) . It is quite often used for longitudinal treatments that require changes in health behavior and occur in the form of stages, that is, in a procedural way and not abruptly, for example with health programs, such as physical exercise, smoking and diet (10) .…”