Reason Action and Planed Behavior In Nursing Education In nursing education, understanding health behavior and how individuals change over time is critical to developing effective teaching strategies and interventions. Two models that are particularly useful in this context are the Stages of Change Model (Transtheoretical Model) and the Theory of Reasoned Action (TRA), along with its extended form, the Theory of Planned Behavior (TPB). These models provide insights into the psychological and social factors that influence behavior change and how these can be applied in educational settings.

Stages of Change Model in Nursing Education

The Stages of Change Model, also known as the Transtheoretical Model (TTM), was introduced by Prochaska and DiClemente (1982) to explain the processes individuals go through when modifying problem behaviors, initially focusing on addiction. This model outlines a series of stages that people typically move through when making behavioral changes. In nursing education, this model is valuable for understanding how students and patients alike progress through health behavior changes.

The six distinct stages of the TTM are:

1. Precontemplation: In this stage, individuals do not have any intention to change their behavior in the near future. Strategies for educators might involve raising awareness, simple observation, or confronting misconceptions.
2. Contemplation: Here, individuals begin to acknowledge they have a problem and seriously consider changing their behavior. Educators can engage in strategies that promote consciousness-raising, helping students or patients weigh the pros and cons of their behaviors.
3. Preparation: Individuals in this stage are planning to take action within a month. The role of the educator is to support the development of a concrete, actionable plan that clearly outlines steps toward change.
4. Action: At this point, individuals have made visible, overt changes in their behavior. This stage is the most active, and strategies should focus on maintaining commitment, self-reward, and creating supportive environments.
5. Maintenance: Achieving and sustaining behavioral change over time is often difficult. The maintenance stage may last from six months to a lifetime. Educators can help by addressing challenges such as overconfidence, temptation, and relapse, encouraging ongoing support networks.
6. Termination: Ideally, individuals in this stage no longer experience any temptation to revert to previous behaviors. However, some experts argue that true termination is rarely achieved, with individuals remaining in a long-term maintenance phase.

Application of the Stages of Change Model in Nursing Education

In nursing education, the Stages of Change Model can be applied to guide both student learning and patient care. Understanding where a student or patient is in this progression allows educators to tailor their strategies to foster successful behavioral changes.

For example, this model has been used in health promotion strategies, such as encouraging the use of sun protection (Prentice-Dunn et al., 2009), weight management (Mastellos et al., 2014), and exercise (Lowther et al., 2007). Additionally, it has been employed to assess outcomes in continuing education for nurses (Randhawa, 2012), emphasizing its relevance across various educational settings.

By identifying the stage a learner or patient is in, educators can implement appropriate interventions and support to guide them through the behavioral change process. This adaptability makes the Stages of Change Model a versatile tool in both classroom and clinical settings, applicable to students of all ages and backgrounds.

Theory of Reasoned Action (TRA) and Theory of Planned Behavior (TPB)

The Theory of Reasoned Action (TRA), developed by Ajzen and Fishbein (1980), seeks to predict human behavior within a social context by examining an individual’s attitudes and social influences. According to this theory, behavior is largely influenced by an individual’s intention to perform it, which is shaped by two factors:

1. Attitudes toward the behavior: These are personal evaluations of whether engaging in a specific behavior is positive or negative. In a nursing education context, this could involve assessing a student’s or patient’s attitude toward adopting healthier lifestyle choices or learning new clinical skills.
2. Subjective norms: These refer to the individual’s perception of how significant others—such as family, friends, or colleagues—view the behavior. In health education, understanding how patients or students believe their peers or family would react to behavior changes can be pivotal in shaping outcomes.

For instance, when applying TRA to predict a patient’s response to a weight loss program, it is important to consider not only their beliefs about diet and exercise but also their perception of how their family or social group views these efforts. Social approval or disapproval can significantly impact their intention to engage in behavior change.

Limitations and the Evolution into the Theory of Planned Behavior (TPB)

While the Theory of Reasoned Action provides a solid framework for predicting behavior, it has limitations, particularly in cases where individuals feel they have little control over their actions. To address this, Ajzen introduced the Theory of Planned Behavior (TPB) in 1985, adding the concept of perceived behavioral control. This addition acknowledges that even if individuals have a positive attitude toward a behavior and believe their social group supports it, they may not engage in it if they feel they lack the power or ability to do so.

The TPB incorporates three core factors:

1. Attitudes toward the behavior: Personal beliefs about the positive or negative outcomes of the behavior.
2. Subjective norms: Perceptions of social pressure to perform or not perform the behavior.
3. Perceived behavioral control: The individual’s belief in their ability to perform the behavior, which can be influenced by past experiences, obstacles, or anticipated challenges.

Applications of TRA and TPB in Nursing Education

The TRA and TPB have been widely applied in nursing education and healthcare research. For instance, they have been used to explore nurses’ attitudes toward teaching health education topics (Kleier, 2004; Mullan & Westwood, 2010), to design smoking prevention programs (Hanson, 2005), and to understand intentions to receive vaccines, such as the human papillomavirus (HPV) vaccine (Fisher et al., 2013). These theories have also informed interventions to reduce heterosexual risk behaviors (Tyson et al., 2014) and studies on nursing care for individuals with addiction issues (Natan et al., 2009).

For nursing educators, the TRA and TPB offer valuable insights into how attitudes, subjective norms, and perceived control influence both student learning and patient behavior change. Understanding these elements allows educators to design more effective interventions, whether teaching students new skills or guiding patients through health behavior changes.

Conclusion

The Stages of Change Model, Theory of Reasoned Action, and Theory of Planned Behavior are vital frameworks in nursing education, offering tools for predicting, understanding, and facilitating behavior change. These models help educators tailor their approaches based on where students or patients are in the change process, their beliefs and attitudes, and the social pressures they face.

By incorporating these theories into nursing education, faculty can create more personalized, effective interventions that support both the learning and behavioral transformation processes. This approach not only enhances the educational experience but also equips nurses with the skills and knowledge to foster positive health outcomes in their future practice.