Patient Education

Limitations and Barriers to Change

Kerri Z. Delaney and Leslie Barker

Limitations of the Transtheoretical Model

Limitations of the model include the following:

  • The theory ignores the social context in which change occurs, such as socioeconomic status and income.
  • The lines between the stages can be arbitrary with no set criteria of how to determine a person’s stage of change. The questionnaires that have been developed to assign a person to a stage of change are not always standardized or validated.
  • No clear sense exists for how much time is needed for each stage, or how long a person can remain in a stage.
  • The model assumes that individuals make coherent and logical plans in their decision-making process when this is not always true.

The Transtheoretical Model provides suggested strategies for public health interventions to address people at various stages of the decision-making process. Using strategies suggested by TTM can result in interventions that are more effective because they are tailored for a specific group of people. In other words, the interventions involve a message or program component that has been specifically created for a target population’s level of knowledge and motivation. The TTM encourages an assessment of an individual’s current stage of change and accounts for relapse in people’s decision-making process.

For more information about the TTM, especially as it relates to exercise, click on the link below:

TTM for Behavior Change

Lifestyle Modification Barriers

Dr. James M. Olson, a psychology professor at the University of Western Ontario, London, has identified several psychological barriers that commonly prevent people from taking action, even when inaction poses a threat to their health. It is important that nurses are aware of the challenges faced to make behaviour change.

Barriers to Admission of the Problem. The first step in lasting change is admitting a problem exists. People often fail to change behavior that poses a risk to their health because they deny a risk exists, trivialize their personal risk, feel invulnerable, make a faulty conceptualization, (i.e., they attribute early warning signs to a benign cause), or experience debilitating emotions when contemplating preventative measures.

Barriers to Initial Attempts To Change. At this stage, people acknowledge the need to change but struggle to accomplish their goals. This failure is a result of lack of knowledge, low self-efficacy (the belief in one’s own ability to succeed at change), and dysfunctional attitudes.

Barriers to Long-Term Change. Just because a person has experienced success in changing a behavior, that doesn’t mean the change is permanent. Barriers to long-term change include cognitive and motivational drift (diminishing enthusiasm for the need to change), lack of perceived improvement, lack of social support, and lapses.


About the authors


Foundations for Success in Nursing: Manual Copyright © 2021 by Kerri Z. Delaney and Leslie Barker. All Rights Reserved.

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