Does the Model Change the First Sentence? The Stages of Change and the Health Belief Model Applied to Hearing Protection on a Construction Site
Student Name
American College of Education
NUR4073: Health Promotion
Module 4 Assignment
Instructor Name
November 23, 2026
The Client and the Behavior
The client is the composite 44-year-old construction superintendent profiled earlier in this course. He has worked around heavy equipment, saws and jackhammers for twenty-two years, reports ringing in both ears after long days and has trouble following conversation in noisy restaurants. His employer provides foam earplugs and earmuffs at every site entrance, and he wears them, in his words, when I remember, which he estimates is about a third of the time on loud days. The target behavior is consistent use of hearing protection whenever he is in a high-noise area.
Noise-induced hearing loss is permanent and preventable, and Kerns et al. (2018) estimated that a majority of hearing difficulty among United States workers can be attributed to occupational noise. The information alone has not changed his behavior; he already knows noise damages hearing. That is the situation in which a behavior change model should earn its place. If a model is useful, it should change what the nurse says in the first thirty seconds, because that is when the client decides whether the conversation is worth having.
The Transtheoretical Model
Prochaska and DiClemente (1983) developed the Transtheoretical Model from studies of people who stopped smoking on their own and found that change moves through stages: precontemplation, in which the person is not considering change; contemplation, in which they are considering it within about six months; preparation, in which they intend to act soon and have taken small steps; action; and maintenance. The model's practical claim is that interventions should match the stage, because a person in precontemplation is not helped by an action plan, and a person in preparation is not helped by more reasons to change.
Assessed against the stages, the client is not in precontemplation, because he already uses protection some of the time and mentioned his ringing ears without being asked. He is not in action, because his use is inconsistent. His statement that he wears protection when he remembers suggests he believes he should and has not organized his day to make it automatic, which places him in contemplation moving toward preparation. The stage-matched task is to help him resolve his ambivalence and take one concrete step, not to repeat information he already has.
The model therefore changes the opening line. Without it, a nurse might begin: noise can cause permanent hearing loss, so it is important to wear your earplugs every time. That sentence assumes he needs information and invites him to agree politely and change nothing. With the model, the opening is: you mentioned your ears ring after long days, and that you wear protection some of the time; what gets in the way on the days you do not? The question acknowledges the step he has already taken and moves straight to the barrier.
The Health Belief Model
Its origins lie in 1950s public health studies of a puzzle: many people skipped screening, such as chest X-rays for tuberculosis, even when it cost them nothing. Rosenstock (1974) described its core: a person's readiness to act depends on perceived susceptibility to a condition, perceived severity of the condition, perceived benefits of the action and perceived barriers to it, with cues to action prompting behavior. Later versions added self-efficacy, a person's confidence in their ability to carry out the behavior.
Applied to this client, perceived susceptibility is high; he has symptoms and knows noise causes them. Perceived severity is uncertain, because many people see hearing loss as an inconvenience of aging rather than a disability, and he has joked that everyone in construction is a little deaf. Perceived benefits are real but distant. Perceived barriers are immediate: foam earplugs are uncomfortable in heat, earmuffs do not fit under his hard hat, and he needs to hear radio calls and workers shouting warnings. Cues to action are weak, since the protection sits at the site entrance and he is often already inside before the noise starts.
The Health Belief Model produces a different opening line from the Transtheoretical Model. Its analysis suggests that the problem is not motivation but barriers and severity, so the opening addresses those: you need to hear your crew and the radio, and the foam plugs cut everything out. Would it help if we found protection that lets you hear voices but cuts the machine noise? That line speaks to the most concrete barrier and signals that the goal is protection he can actually use.
Comparing What the Models Contribute
The two models agree that repeating information about noise and hearing loss would be a poor opening, because the client already has the information and it has not changed his behavior. They differ in where they place the problem. The Transtheoretical Model places it in readiness, and it directs the nurse to ask about ambivalence and the next step. The Health Belief Model places it in the balance of beliefs and barriers, and it directs the nurse to the specific obstacles. In this case, the barrier the Health Belief Model identified, the need to hear speech on site, is also the likeliest answer to the question the Transtheoretical Model prompted, so the two openings lead to the same conversation from different directions.
Motivational interviewing offers a way to combine them. Miller and Rollnick (2013) describe a style of conversation that evokes the person's own reasons for change and respects their autonomy, and its open question about what gets in the way is compatible with both models. A practical opening that draws on all three would be: you've told me your ears ring and that you use protection some days; what makes it hard on the other days? When he names the radio and the crew, the nurse can offer information about filtered or level-dependent earplugs that reduce harmful noise while allowing speech to pass, and ask whether a two-week trial would be worth trying. The models did not give the nurse better facts; they gave her a better question.
Both models also have limits worth naming. The stages of the Transtheoretical Model are easier to assign on paper than in conversation, and a client can move between them within a single week. The Health Belief Model treats behavior as the result of individual beliefs and says little about the workplace, where the supply of suitable protection, the example set by other supervisors and the noise level itself shape what a worker does. For this client, the most durable change may come from his employer offering filtered earplugs at every site, which neither model would have proposed on its own.
Conclusion
Applied to a construction superintendent who wears hearing protection a third of the time, both behavior change models changed the nurse's first sentence. The Transtheoretical Model replaced a warning with a question about what gets in the way, matched to a client who is considering change rather than resisting it. The Health Belief Model pointed the conversation at the most concrete barrier, protection that blocks the sounds he needs to hear. Neither model supplied new facts about noise. What they supplied was a way of starting the conversation that the client was likely to take seriously, which is the answer to the module's question: yes, a model changes the opening line, and the change is what makes the rest of the conversation possible.
References
Kerns, E., Masterson, E. A., Themann, C. L., & Calvert, G. M. (2018). Cardiovascular conditions, hearing difficulty, and occupational noise exposure within US industries and occupations. American Journal of Industrial Medicine, 61(6), 477-491. https://doi.org/10.1002/ajim.22833
Miller, W. R., & Rollnick, S. (2013). Motivational interviewing: Helping people change (3rd ed.). Guilford Press.
Prochaska, J. O., & DiClemente, C. C. (1983). Stages and processes of self-change of smoking: Toward an integrative model of change. Journal of Consulting and Clinical Psychology, 51(3), 390-395. https://doi.org/10.1037/0022-006X.51.3.390
Rosenstock, I. M. (1974). Historical origins of the health belief model. Health Education Monographs, 2(4), 328-335. https://doi.org/10.1177/109019817400200403
How this NUR 4073 Module 4 example is structured
NUR 4073 Module 4 usually brings in behavior change models and tests whether they change your opening line; your classroom's instructions decide which models and which client. This example explains each model with its original source, assesses the client with each in turn, and then writes the opening line each assessment produces, next to the opening line a nurse would use without either model. The comparison section shows what each model contributes and where they disagree, and the conclusion answers the module's question directly. Writing the actual sentences is what turns model knowledge into practice.
NUR4073 Module 4 questions, answered
What does NUR4073 Module 4 usually ask for?
NUR4073 Module 4 usually introduces behavior change models, such as the Transtheoretical Model and the Health Belief Model, and asks students to apply them to a client or population. Many sections ask how the model changes the nurse's approach. Your classroom's instructions decide which models, which client and whether you must write out a counseling script.
How do I show that a behavior change model changes practice?
Write the opening line you would use without the model, then the opening line the model produces, and explain the difference. A stage-matched question or a barrier-focused offer shows the model at work far more clearly than a summary of its constructs. Tie each choice to something specific the client said or did.
Which stage of change is a client in if they do the behavior sometimes?
Usually contemplation or preparation. Occasional behavior shows the person accepts the goal but has not made it routine, which differs from precontemplation, where change is not being considered, and from action, where the behavior is consistent. Use the client's own words about intention and timing to place them.
Write yours, or have the desk draft it
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