Advances in Health Behavior Interventions for Patients Undergoing Gastrointestinal Polypectomy Based on the Transtheoretical Model

DOI: https://doi.org/10.62517/jmhs.202605113

Author(s)

Xiaoyan Li, Ying Sun*

Affiliation(s)

Gastroenterology Department, Hohhot First Hospital, Hohhot, Inner Mongolia, China *Corresponding AuthorGastroenterology Department, Hohhot First Hospital, Hohhot, Inner Mongolia, China *Corresponding Author

Abstract

Gastrointestinal polypectomy is a common minimally invasive procedure for colorectal polyps, and its long-term success critically depends on patients’ sustained adherence to postoperative health behaviors. However, in clinical practice, patients frequently exhibit poor dietary compliance, low medication adherence, and missed follow-up appointments, while traditional health education often shows limited effectiveness. The Transtheoretical Model (TTM), a stage-based theory integrating cognitive and behavioral perspectives, posits that individuals progress dynamically through five stages of behavior change: precontemplation, contemplation, preparation, action, and maintenance. This progression is facilitated by core constructs including decisional balance, self-efficacy, and processes of change. In recent years, TTM-based interventions have been increasingly applied to key health behaviors among patients after gastrointestinal polypectomy—such as dietary management, medication adherence, smoking and alcohol cessation, and follow-up compliance—demonstrating promising effects in advancing stage progression, enhancing self-efficity, and improving clinical outcomes. This article systematically reviews the theoretical foundation of TTM, its applicability in this population, intervention formats, evidence of effectiveness, and existing challenges. We propose that future efforts should focus on developing culturally adapted assessment tools, integrating multi-behavior interventions, leveraging digital health technologies, and conducting high-quality pragmatic trials to advance a precise and sustainable post-polypectomy health management system.

Keywords

Transtheoretical Model; Endoscopic Polypectomy; Health Behavior Interventions; Adherence; Self-Efficacy

References

[1] Zheng R, Chen R, et al. Analysis of cancer incidence and mortality in China, 2022. Chin J Oncol. 2024; 46(3):221–231. [2] Allemani C, Matsuda T, et al. Global surveillance of trends in cancer survival 2000–14 (CONCORD-3): analysis of individual records for 37,513,025 patients diagnosed with one of 18 cancers from 322 population-based registries in 71 countries. Lancet. 2018; 391(10125):1023–1075. [3] Zhao Y, Mi Y, et al. Effect of silent psychological therapy in patients undergoing endoscopic submucosal dissection for early upper gastrointestinal neoplasms. Cancer Progress. 2022; 20(18):1933–1936. [4] Guo Z, Li H, et al. Impact of psychological nursing intervention on preoperative blood pressure and anxiety in patients undergoing endoscopic polypectomy. Psychol Monthly. 2021; 16(7):169–170. [5] Prochaska JO, Velicer WF. The transtheoretical model of health behavior change. Am J Health Promot. 1997; 12(1):38–48. [6] Riemsma RP, Pattenden J, et al. A systematic review of the effectiveness of interventions based on a stages-of-change approach to promote individual behaviour change. Health Technol Assess. 2002; 6(24):1–231. [7] Okayama T, Kinouchi K, et al. The impact of mother–child dyad dietary intervention using the Transtheoretical Model on bone mineral density in Japanese female adolescents. J Pediatr Nurs. 2020; 50:e39–e47. [8] Kong D, Lu H, et al. Research progress on the application of the Transtheoretical Model in health behavior change. Nurs J Chin PLA. 2015; 32(13):28–31. [9] Ekberg K, Grenness C, et al. Application of the transtheoretical model of behaviour change for identifying older clients' readiness for hearing rehabilitation during history-taking in audiology appointments. Int J Audiol. 2016; 55 Suppl 3:S42–S51. [10] Yin B. The Transtheoretical Model of health behavior change. Chin Ment Health J. 2007; 21(3):194–199. [11] Zhang M, Ding Y, et al. A review of the development of the Transtheoretical Model and its application in information behavior research. Libr Inf Serv. 2022; 66(20):141–147. [12] Ai X, Wang L, et al. Effect of Transtheoretical Model–based nursing intervention in patients with type 2 diabetes. Mod Diagn Treat. 2025; 36(4):606–608. [13] Huang J, Zhang W, et al. Effect of Transtheoretical Model–based health education on patients with polycystic ovary syndrome. Chin Nurs Manag. 2025; 25(3):431–437. [14] Zhang J, Zhou W, et al. Evaluation of behavior-stratified management based on the Transtheoretical Model in patients with knee osteoarthritis. J Nurs Sci. 2024; 39(19):25–30. [15] Hu N, Liu Y, et al. Effect of a Transtheoretical Model–based health education program on glycemic control in patients with systemic lupus erythematosus. Med New Knowl. 2025; 35(7):791–799. [16] Hu X, Liang J, et al. Impact of Transtheoretical Model–based health education on patients in the recovery phase of cerebral infarction. Nurs Pract Res. 2018; 15(7):36–38. [17] Zhang W, Li Y, et al. Application of collaborative care based on the Transtheoretical Model in patients with hypertensive heart disease. Chin J Clin Med. 2025; 37(4):164–167. [18] Yang C, Liu Z, et al. Application of health belief model nursing intervention based on the Transtheoretical Model in patients with chronic renal failure. Jilin Med J. 2025; 46(8):2027–2030. [19] Kaplan Serin E, Citlik Saritas S. The effect of the Transtheoretical Model–based walking exercise training and follow-up on improving exercise behavior and metabolic control in patients with type 2 diabetes. Clin Nurs Res. 2021; 30(3):273–284. [20] National Clinical Research Center for Digestive Diseases, Chinese Society of Digestive Endoscopy, et al. Chinese consensus on screening, diagnosis, and management of Barrett’s esophagus and early esophageal adenocarcinoma (2017 Wanning). Chin J Pract Intern Med. 2017; 37(9):798–809. [21] Bureau of Medical Administration, National Health Commission of the People’s Republic of China. Guidelines for diagnosis and treatment of gastric cancer (2022 edition). Chin J Dig Surg. 2022; 21(9):1137–1164. [22] Lü Y, Fang X, et al. Application of Transtheoretical Model–based exercise and dietary behavioral intervention in patients undergoing bariatric surgery. Chin J Nurs. 2024; 59(18):2197–2205. [23] Zhu H, Li C, et al. Psychological nursing care for elderly patients with gastrointestinal disorders. Chin J Aesthetic Med. 2012; 21(Suppl 1):254–255. [24] Zhang L, Lu L, et al. Effect of Transtheoretical Model–based nursing intervention on self-efficacy and rehabilitation in patients after enterostomy for intestinal injury. Chin J Disabil Med. 2024; 32(10):114–116,120.