Using the Transtheoretical Model to Improve Community Disaster Preparedness

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Using the Transtheoretical Model to Improve
Community Disaster Preparedness

• Elizabeth M. Rash PhD, ARNP, FNP-C
• Assistant Professor
• School of Nursing

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Problem

• Poor community responsiveness to prepare for
  impending disasters (e.g. Katrina, Wilma,
  Charlie).

Tracking towards Naples, Southeast Florida
remained complacent
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Problem

• NY Survey
• less than 50 of public had no disaster
  preparedness plans.
• 76 without insurance, had no disaster plan.
• (Gjertsen, 1999)
• Are you ready?
• Failure to Plan not Failed Plans

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Problem

• Media alone has limited effect
• information is a necessary but not sufficient
  strategy for changing behaviors

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Problem
Policy makers 1st Responders Community Families
Individuals
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Barriers to Behavior Change

• Language culture
• Communication
• Trust
• Resources access
• False presumptions
• Perceived importance
• Complacency
• Self-efficacy learned helplessness
• Duct tape
• Societys responsibility
• Support networks
• Isolation
• Codependence

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Change Stimulants

• People change voluntarily only when they
• Become concerned about the need for change
• Become convinced that change is in their best
  interests or will benefit them more than cost
  them
• Organize a plan of action that they are committed
  to implementing (must be achievable)
• Take the actions that are necessary to make the
  change and sustain the change

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Purpose

• Explore the application of the Transtheoretical
  Model (TTM) (Prochaska, DiClemente, Norcross,
  1992) of behavioral change for disaster
  preparedness.

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TTM Stages of Change

• Precontemplation
• No intent to change in next 6 mos.
• Lack perceived importance, motivation /or
  self-efficacy
• Contemplation
• Aware of a problem thinking about changing in
  the next 6 mos. Not yet committed to change
• Lack motivation self-efficacy

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Preparation

• Intending to change in the next month. May have
  attempted change before without success.
• Lack self-efficacy
• Action
• Have initiated and are engaged in change for 1
  day to 6 mos.
• Need motivation (reinforcement) to sustain the
  activity
• Maintenance
• Building on gains and avoiding relapse for at
  least 6 mos.
• Need continued motivation

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TTM is CyclicRelapse or Lapse

• 80 typically cycle back to contemplation phase
• Associated with guilt, shame, demoralization,
  blame return to precontemplation
• Need self-reflection and learn from mistakes
• Analogy learning to walk

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TTM is Cyclic
Precontemplation (40)
Maintenance
Contemplation (40)
Action (20)
Preparation
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Stage Matching

• The wrong intervention at the wrong stage of
  change is ineffective and may lead to regression
• e.g. Teens
• Many supportive clinical studies
• Project MATCH test of treatment matching of 1,726
  clients with readiness to change alcohol
  behaviors.
• Outcome Txs effective but Matching ?
• (Project MATCH Research Group, 1993, p. 1130).

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Stage Matched Interventions
Maintenance Cognitive-behavioral Preparation/Acti
on Cognitive-behavioral Contemplation Experientia
l/Psychodynamic Precontemplation Experiential/Psy
chodynamic
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Integrating Processes with Stages
Freese, 1998
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Experiential/Psychodynamic Actions

• Conscious raising (awareness)
• Imagery
• Evaluate congruence of values behaviors
• Self Liberation
• Verbalize need for change
• Social Liberation
• Identifies negative social consequences of
  behavior
• Self-evaluation
• Decisional balance sheet
• Catharsis
• Express emotions related to change

Freese, 1998
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Cognitive/Behavioral Actions

• Counter-conditioning
• Substitution of positive behaviors
• Stimulus control
• Planning for eliminating obstacles providing
  cues to reinforce positive change
• Contingency management
• Reward positive behaviors
• Helping relationships
• Engaging support systems

Freese, 1998
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Case Example Katrina

• Precontemplation interventions
• Media hurricane damage imagery with successful
  preparation
• Decisional balance sheet pros/cons
• Contemplation Interventions
• Focus groups to explore emotions related to
  change
• Preparation/Action Interventions
• Creating emergency action plan
• Emergency preparation kits
• Maintenance Interventions
• Encourage social capital

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Key Points

• Understand cultural influences and barriers
• Be able to benchmark movement towards change
• Dont expect revolutionary change
• Offer a menu of options
• Offer repeatedly
• Recycling through stages
• Offer all options concurrently for community
  approach

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References

• Fresse, K. K. (1998). Breaking bad habits.
  Advance for Nurse Practitioners, 6, (4), 59-62.
• Gjertsen, L. A. (September, 1999). Survey says
  N.Y. flirts with disaster. Property and Casualty
  Risk and Benefits Management, 17-26.
• Prochaska, J. O., DiClemente, C. C. Norcross,
  J. C. (1992). In search of how people change.
  American Psychologist 47, (9), 1102-1114.