TABLE 3.
Education and self-management support by healthcare professionals based on the Transtheoretical Model (TTM). The recommendations are based on the authors’ clinical experiences and the TTM, which describes stages of change: precontemplation, contemplation, preparation, action, maintenance and termination (16, 17). The stages represent a time dimension, although people may advance through the stages non-linearly. Progressing through the stages is accompanied by (overt or covert) activities that are described as processes of change (e.g., consciousness raising, self-reevaluation, environmental evaluation, stimulus control). Based on these core constructs, each stage requires a distinct intervention approach.
| Theme | Transtheoretical model | Education and self-management support | ||
|---|---|---|---|---|
| Stage of change | Process of change | Aim | ||
| The arduous path back to living | Not applicable | Not applicable | • Priority is the physical and emotional recovery after LTx. Management of unplanned weight gain is most probably less important | |
| • Focus on relationship building during the frequent follow up appointments in the LTx center | ||||
| A pleasurable new phase of life | Precontemplation: A person does not intend to take any action to prevent weight gain in the near future (usually described as 6 months) | Consciousness raising | Increase awareness on causes, consequences and potential treatment | Provide information on |
| • Short- and long-term evolution of weight after LTx | ||||
| • Factors associated with weight gain in general | ||||
| • Body composition: offer repeated measurements to assess and specify the evolution of weight gain (e.g., increasing muscle mass or fat) | ||||
| • Risk of developing new-onset obesity and its associated outcomes after LTx (e.g., cardiovascular and metabolic comorbidities) | ||||
| • Concept of energy balance (calory consumption and expenditure) | ||||
| • Physical activity and healthy eating | ||||
| • Importance of self-monitoring of weight | ||||
| • The advantage of preventing excessive weight gain instead of losing weight afterwards | ||||
| Provide feedback | ||||
| • It may be important to acknowledge the patient’s healthy appearance with the regained weight. However, healthcare professionals should also critically question this development | ||||
| • Focus the communication on empowerment and self-management to intensify relationship building | ||||
| I am allowed to look like this now | Contemplation: A person intends to take action within the next 6 months | Self-reevaluation | Facilitate the person’s assessment that behavior change is part of the own identity | • Assess the perception of weight gain and a potential burden during clinical follow-ups |
| • Be aware of and listen to patient’s talking about pro and con arguments for changing their behavior | ||||
| • Identify the motivation, barriers and facilitators for behavior change | ||||
| Preparation: A person intends to take action within the next 30 days or has taken some behavioral steps already | • Define individual goals regarding the patients’ behavior (e.g., eating or activity) or weight loss (e.g., target weight) | |||
| • Make sure that goals are specific, measurable, achievable, relevant, and time bound. Pay special attention to feasible goals regarding activity in case of functional impairment | ||||
| • Identify strategies to achieve the goals | ||||
| • Plan timely follow-up appointments | ||||
| • Evaluate the involvement of a nutritionist and physiotherapist | ||||
| Action stage: A person has changed the behavior for less than 6 months | Self-liberation | Support the persons commitment to change | • Provide feedback on achievement and celebrate the success | |
| • Strengthen the patient’s self-efficacy and self-consciousness | ||||