# 4.2: Application of the Transtheoretical Model

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Kagen S. Silver & Amber K. Worthington

Discrimination in the healthcare system can occur in multiple ways, including discrmination related to gender, sexual and gender minorities, and race/ethnicity (e.g., Ayhan et al., 2020; Fazeli Dehkordy, Hall, Dalton, & Carlos, 2016; MacIntosh, Desai, Lewis, Jones, & Nunez-Smith, 2013). Discriminative behaviors can include stigma, denial or refusal of healthcare, and verbal or physical abuse (e.g., Ayhan et al., 2020), which negatively impacts individual and population health.

One way to solve this problem is for individuals to find and use patient advocates in healthcare settings. A patient advocate looks out for the best interest of the patient. Insurance companies may sometimes provide advocates, and there are also non-profit organizations that specifically help communities that are more likely to be impacted by discrimination find patient advocates.

The Transtheoretical Model can be used to understand an individual’s readiness to find and use a patient advocate. A patient in the precontemplation stage may not recognize the problems of discrimination in healthcare and does not intend to use a patient advocate in the immediate future. In the contemplation stage, the patient is aware that not using a patient advocate may exacerbate discrimination in healthcare settings, and they are thinking about possibly using a patient advocate in the future. In the preparation stage, the patient has committed to using a patient advocate and is actively trying to find a patient advocate. A patient in the action stage is actively involved in changing the behavior and is using a patient advocate in healthcare settings. A patient in the maintenance stage always uses a patient advocate in healthcare settings.

According to the Transtheoretical Model, a persuasive message should be matched to the patient’s current stage of change. To move a patient from the early stages of precontemplation, contemplation, and preparation to the later stages of action and maintenance, the message should help the individual recognize the occurrence of discrimination and to perceive the importance of the benefits of patient advocates (i.e., increase the pros of changing the behavior in decisional balance). The persuasive message should also contain substantial information that will increase the patient’s self-efficacy to find and use a patient advocate, including specific phone numbers or organizations that the patient can call for more information.

Example by Kagen S. Silver

I created a message using the Transtheoretical Model that would be effective for patients in the precontemplation and contemplation stages of finding and using a patience advocate.

The goal of the opening lines for those in precontemplation is to gain their attention. Those in contemplation know that discrimination exists, and this opening line therefore functions as a reminder to increase the salience of the issue. The message also connects what the reader is seeing in the world to the doctor’s office, a place supposedly free of discrimination because it is a house of health and wellness.

The goal of the next lines (“Patient advocates can speak up for you in healthcare settings to reduce the chances that you will experience discrimination. The benefits of using a patient advocate make it worth it.”) is to increase the patient’s perceptions that the pros of finding and using a patient advocate outweigh the cons.

The following line (“If you or someone you know may face discrimination in healthcare settings, share these resources today”) ties in the idea that the patient can help themselves and others by sharing this information. This line may also create a norm that this information should be shared and will be accepted by others.

The last lines in the message are designed to increase the patient’s self-efficacy. Stating the consultation is free makes the resource accessible to all, and adding that patient advocates are covered by most insurance makes the reader see that help is attainable and may not require additional money. Providing a specific number and website would also increase a patient’s self-efficacy to find a patient advocate.

References

Ayhan, C. H. B., Bilgin, H., Uluman, O. T., Sukut, O., Yilmaz, S., & Buzlu, S. (2020). A systematic review of the discrimination against sexual and gender minority in health care settings. International Journal of Health Services, 50(1), 44-61.

Fazeli Dehkordy, S., Hall, K. S., Dalton, V. K., & Carlos, R. C. (2016). The link between everyday discrimination, healthcare utilization, and health status among a national sample of women. Journal of Women’s Health, 25(10), 1044-1051.

MacIntosh, T., Desai, M. M., Lewis, T. T., Jones, B. A., & Nunez-Smith, M. (2013). Socially-assigned race, healthcare discrimination and preventive healthcare services. PloS One, 8(5), e64522.

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