Considerations for extending the transtheoretical model of behavior change to screening mammography

Abstract

This paper reviews issues that have arisen in the process of extending the Transtheoretical Model of behavior change (TTM) from smoking cessation to screening mammography. Conceptual and empirical considerations are discussed. Topics covered include defining the stages-of-adoption, writing items for the pros and cons, and identifying processes-of-change. Differences between smoking cessation and mammography as health-related behaviors are reviewed, as they have affected the adaptation of the model (e.g. prevention versus early detection; cessation versus initiation; periodicity; role of the provider). The fundamental appropriateness of mammography as a behavior to which the TTM should be extended is also addressed (i.e. clear behavioral guidelines, effective technology, a definitive target population). Several areas for further development of the TTM and mammography are presented.