Hudmon K S, Berger B A
Department of Epidemiology, University of Texas M. D. Anderson Cancer Center, Houston, USA.
Am J Health Syst Pharm. 1995 Feb 1;52(3):282-7. doi: 10.1093/ajhp/52.3.282.
The transtheoretical model for intentional behavior change is described, and pharmacists' use of the model in smoking-cessation interventions is discussed. This model combines elements of theories used in psychotherapy and behavior modification. In the model are five stages (precontemplation, contemplation, preparation, action, and maintenance) that describe when behavior change occurs. To be most effective, a health care provider's interventions should match the patient's stage of change. The model also includes 10 cognitive and behavioral processes that describe how change occurs while a person is moving among the stages. The processes (social liberation, dramatic relief, helping relationships, consciousness-raising, environmental reevaluation, reinforcement management, self-reevaluation, stimulus control, counterconditioning, and self-liberation) define change in terms of the coping strategies used. Before intervening, the pharmacist needs to ask questions about the patient's behavior that will identify the stage. If smokers in the precontemplation stage are receiving medications for chronic diseases, pharmacists can make them aware of the negative effects of smoking on their specific conditions. People in the contemplation stage are open to education about smoking and health, and those in the preparation stage are ready to set goals and choose methods for cessation. Smokers in the action stage are attempting to quit. Pharmacists can offer support, reinforcement, and guidance to people in the action and maintenance stages. Pharmacists can use the transtheoretical model to categorize patients by their stage of change and then devise and deliver appropriate and individualized interventions.
本文描述了用于有意行为改变的跨理论模型，并讨论了药剂师在戒烟干预中对该模型的应用。该模型结合了心理治疗和行为矫正中所使用理论的要素。模型中有五个阶段（前意向阶段、意向阶段、准备阶段、行动阶段和维持阶段），描述了行为改变发生的时间。为了达到最佳效果，医疗服务提供者的干预措施应与患者的改变阶段相匹配。该模型还包括10个认知和行为过程，描述了一个人在各阶段之间转换时改变是如何发生的。这些过程（社会解放、戏剧性缓解、帮助关系、意识提高、环境再评价、强化管理、自我再评价、刺激控制、对抗条件作用和自我解放）从所使用的应对策略方面定义了改变。在进行干预之前，药剂师需要询问患者的行为问题，以确定其所处阶段。如果处于前意向阶段的吸烟者正在接受慢性病治疗，药剂师可以让他们意识到吸烟对其特定病情的负面影响。处于意向阶段的人愿意接受关于吸烟与健康的教育，而处于准备阶段的人则准备好设定目标并选择戒烟方法。处于行动阶段的吸烟者正在尝试戒烟。药剂师可以为处于行动阶段和维持阶段的人提供支持、强化和指导。药剂师可以使用跨理论模型，根据患者的改变阶段对其进行分类，然后设计并提供适当的个性化干预措施。
