Table 3 Stages of change approach strengths and weaknesses
Approach | Strength | Weakness |
|---|---|---|
Precaution Adaption Processes Model (PAPM) | -Dichotomous model, practical for decision-making | -“Decision not to treat” may be viewed as unacceptable |
-Incorporates a distinct unawareness stage (versus unaware OR unengaged) with opportunity for education | -Emphasis on reading materials/pamphlets may need to be locally modified to literacy rates | |
-Challenge of measuring family’s exact stage of placement | ||
Transtheoretical Model (TTM) | -Removes assumptions about immediate readiness for behavior | -Danger of evolving into a self-help model without adequate support for change when the external forces of poverty and conflicting priorities are the reason for delay |
-Recognizes different families will be in different stages | ||
-Encourages inclusive, appropriately timed motivational readiness interventions | -Does not always recognize broader social and physical context | |
-May unintentionally imply blame on a family, whereas much of the impetus is a fractured system of care delivery | ||
-Supports families between decisional stages toward acceptance | ||
-Common phrases such as “self” efficacy and “self” realization may not be relevant in settings where health behaviors and outcomes are communally based | ||
Decision to not utilize stage- based model | -Potentially streamlined decision-making | -Population characteristics, needs, and values may be overlooked when community engagement is not prioritized (available and accessible does not equal acceptable, appropriate, or equitable) |
-Time and resources centralized to making treatment available and accessible | ||
-With limited funding sources, focuses resources on specific, measurable biological outcomes such as diagnostic accuracy and disease response | ||
-Risk imposition of an external “evidence based approach” which is not taking local evidence and local experience into consideration to facilitate service or intervention adoption and sustainability | ||
-Risk suboptimal allocation and mis-prioritization of resources toward well-intentioned empiric efforts that are however poorly aligned with target populations’ current stages of readiness for change |