College Quarterly
Fall 2006 - Volume 9 Number 4

Is Knowledge of Change Theory a Critical Competency in the Training of Health Care Practitioners?

by Marcia K. Anderson and Victoria L. Bacon


Allied health care practitioners, such as physical therapist and athletic trainers, are trained in the prevention, assessment, and management of injuries for athletes and the physically active. The effectiveness of treatment for physical conditions is directly linked to the client’s psycho-socio-emotional well-being. It is critical for practitioners to understand how psycho-social-emotional issues are interrelated and impact the physically active person’s recovery from injury.

Athletes and physically active individuals are considered to be at a higher risk for psycho-socio-emotional problems than their non-active peers. Current research has highlighted several areas: violent behavior, problematic gambling, drug and alcohol abuse, steroid use, disordered eating, and excessive exercise (Green, Uryasz, Petr, & Bray, 2001; Karlson, Becker & Merkur, 2001; Nelsen & Wechsler, 2001). These same areas are viewed as the most common mental health issues in the United States today (Vaas, 2003).

Health care practitioners provide a variety of health care services and are in a key position to identify psycho-socio-emotional concerns that interfere with optimal performance and overall well-being of their physically active clients. Despite this, there appears to be relatively little knowledge of, or use of, interventions by athletic trainers and other rehabilitation professionals (Francis, Anderson, & Maley, 2000; Hemmings & Povey, 2002). Suggested reasons to explain this low rate of use include a lack of knowledge of the potential benefits of intervention strategies, a lack of access to properly credentialed consultants or psychologists, and the perceived stigma among athletes that is associated with being referred for counseling (Gordon, Potter & Ford, 1998; Hemmings & Povey, 2002). Given this, there is a need for health care practitioners to master competencies in the psycho-socio-emotional domain as part of their formal academic and clinical training. Specifically, competencies need to include: effective helping skills, the ability to conduct an informal assessment of psycho-socio-emotional issues, and be able to provide education, support, and referrals.

Proposed Study

The Stages of Change Model (Prochaska, Norcosse, & DiClemente, 1994) has been well integrated into the core curricula in the United States for health care practitioners, such as health educators, physical therapists, occupational therapists, and nutritionists. Research has shown that effective change depends upon the practitioner’s ability to assess client readiness and utilize intervention strategies that are appropriate for the client’s stage of change (McConnaughy, Prochaska, & Velicer (1983). Multiple groups of practicing physical therapists and athletic trainers will be pre-tested on their knowledge and practical application of the Stages of Change. In particular, these individuals will be tested on their utilization of effective helping skills, on how they assess psycho-socio-emotional issues through the use of case studies, and the application of intervention strategies (i.e., education, support, and the referral process). Next, a workshop will be offered to practitioners that will include: an overview of the Stages of Change Model and the application of the Decision Making Model. Lastly, a post-test will be administered to ascertain the practitioner’s understanding of effective helping skills, assessment of psycho-socio-emotional issues, intervention strategies and their benefit to servicing their clients. The pretest instrument will include a section on practitioner preparation (i.e. education and clinical training to date) in addition to demographic characteristics.

Stages of Change Theory

In 1982, Prochaska and DiClemente developed the Transtheoretical Model for behavior change. The basic premise of the model, best described in, Changing for Good (Prochaska, Norcosse, & DiClemente, 1994) is, that change is a process, with predictable stages. There are specific processes that are effective for promoting change in each stage. Stages are not necessarily completed in order and difficulties may be encountered in any of the stages. There are five stages:

  • Precontemplation
  • Contemplation
  • Preparation
  • Action
  • Maintenance
  • Termination

A critical distinguishing factor in facilitating change in clients is the practitioner’s ability to assess the level of readiness of their client to change. This “readiness for change” is paramount in determining what strategies the practitioner can utilize to assist the client in making positive and enduring change.

The Decision Making Model

The Decision-Making Model (Bacon & Anderson, 2005), (Figure 1) is a protocol to guide the health care practitioner to first, make a preliminary assessment of the client, looking for red flags when individuals exhibit signs of psycho-social-emotional distress, and then to help facilitate client readiness for change. This Model provides a decision process for emergency situations and one for planned interventions. The framework for this Model was developed using theories and concepts from the fields of counseling and psychology (i.e. Stages of Change Model), and incorporates the competencies of the American College of Sports Medicine (1975).

Figure 1
The Decision Making Model

© Bacon & Anderson (2005)


In 1975, the American College of Sports Medicine began recommending the integration of change theory in the delivery of health-related and rehabilitation-based programs in which exercise prescription was a major part. The Stages of Change Model has been well integrated into the core curricula in the United States for many health care practitioners. Yet, athletic trainers whose sole focus is to prevent, assess, manage and rehabilitate sport related injuries for the physically active have no exposure to change theory in their educational preparation. The intent of this study is to utilize focus groups of practicing physical therapists and athletic trainers to assess their knowledge of change theory, its application for working with clients, specifically the practitioner’s ability to apply theory to practice. The outcome of the study will help to identify the various training needs of athletic trainers and potentially impact their academic and clinical preparation in Change Theory.


American College of Sports Medicine (2001). ACSM’s health and fitness certification Review. Baltimore: Lippincott Williams & Wilkins.

Bacon, V.L. & Anderson, M.K. (2005, January). The Decision Making Model: A protocol For Addressing the psycho-socio-emotional needs of the physically active. Paper presented at the 3rd Annual Hawaii International Conference on Education, Honolulu, Hawaii.

Francis S.T., Anderson, M.B., & Maley, P. (2000). Physiotherapists’ and male professional athletes’ views on psychological skills fro rehabilitation. Journal of Science in Medicine in Sport, 3:17-29.

Gordon, S., Potter, M., & Ford I.W. (1998). Toward a psychoeducational curriculum for training sport-injury rehabilitation personnel. Journal of Applied Sport Psychologist, 10: 140-156.

Green, G. A., Uryasz, F.D., Petr, T.A., & Bray, C.D. (2001). NCAA study of substance use and abuse habits of college student-athletes. Clinical Journal of Sport Medicine, 11: 51-56.

Hemmings B., Povey, L. Views of chartered physiotherapists on the psychological content of their practice: A preliminary study in the United Kingdom. British Journal of Sports Medicine, 36:61-64.

Hudd, S. (2000). Stress at college: Effects on health habits, health status and self-esteem. College Student Journal, 34(2): 217-227.

Karlson, K.A., Becker, C.B., & Merkur, A. (2001). Prevalence of eating disordered Behavior in collegiate lightweight women rowers and distant runners. Clinical Journal of Sports Medicine, 11: 32-37.

McConnaughy, E.A., Prochaska, J.O., & Velicer, W.F. (1983, Fall). Stages of change in psychotherapy: Measurement and sample profiles. Psychotherapy: Theory, Research and Practice, 20(3): 368-375.

Nelsen, T.P., & Wechsler, H. (2001). Alcohol and college athletes. Medicine and Science in Sports and Exercise. Retrieved on 9/01 from <http://www/>.

Prochaska, J.O., Norcosse, J.C., & DiClemente, C.C. (1994). Changing for good. NY: Harper Collins Pub.

Vaas, R. (2003). Fear not. Scientific American Mind, 14(1), 62-69.

Dr. Marcia K. Anderson is a Professor and Director of Athletic Training Education Program, Department. of Movement Arts, Health Promotion, & Leisure Studies at Bridgewater State College in Bridgewater, Massachusetts, USA. She can be reached at

Dr. Victoria L. Bacon is a Professor in the Department of Counselor Education at Bridgewater State College. She can be contacted at


• The views expressed by the authors are those of the authors and do not necessarily reflect those of The College Quarterly or of Seneca College.
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2006 - The College Quarterly, Seneca College of Applied Arts and Technology