Theories & Approaches
Key Components of the Stages of Change Model
In their analysis of smokers who had succeeded in quitting, Prochaska and DiClemente noticed that the smokers had moved through distinct stages. If you have ever tried to change a behavior — such as dieting, quitting smoking, trying to get more exercise, or the like — these will seem very familiar.
Precontemplation is exactly what it sounds like: the person has not yet contemplated or thought about changing his or her behavior. (The key word here is "yet" — because the whole point of understanding stages of change is to learn how to nudge people along the path towards lasting behavior change.)
Some precontemplators are truly unaware of the consequences of their behavior (e.g., "you can't get an STD from oral sex." Others may be aware of the consequences but don't see any relevance to themselves personally (e.g., "I know you can get HIV from having unsafe sex, but it's really a disease that only gay men get. I'm not gay so I don't need to worry about it.") A shorter term for this situation is "denial."
In the contemplation stage, the person is taking the first incremental steps towards behavior change. He or she has a greater and more accurate understanding of the pros and cons of changing the behavior, but is not yet ready to change because the cons seem to outweigh the pros (e.g., "I know I should use condoms, but they ruin the moment and take away from the feeling.") The contemplation stage can last for six months or more, and often the person can be so ambivalent that he or she seems "stuck" in this stage.
In the preparation stage, a person is getting ready to take action relatively soon — within a month. This means that he or she has some kind of plan, whether it is to join an exercise or smoking cessation class, talk to a doctor or counselor, buy condoms and put them by the bedside, or take another definite step.
In the action stage, a person tries to change a behavior. Examples include quitting smoking, eating different foods, exercising, or using condoms. Note that before the Stages of Change model emerged, this action step was the only marker of behavior change. In this model, however, it is just one of six steps. Although it is important, it is no more so than the other stages.
As previously mentioned, one of the key insights of the Stages of Change model is its attention to relapse — not as a failure to change behavior but as an opportunity to learn from unsuccessful attempts and thus increase the chances of success in the future.
For one to avoid slipping back into past behaviors — particularly for addictive behaviors but for other behaviors as well — the process of change may require months or even years of vigilance. Therefore, the action stage is followed by a prolonged maintenance phase in which the behavior is more firmly and thoroughly adopted (e.g., using condoms correctly and consistently).
This phase allows one to learn more about why the behavior is so difficult to change. Better understanding increases the odds that future attempts at change will be successful.
For many people, the maintenance stage lasts forever. Some smokers and alcoholics, for example, will always fight at least an occasional craving for a cigarette or a drink. The Stages of Change model accepts this situation as normal. But for some people and some behaviors, the behavior change is so complete that they reach a stage of "zero temptation and 100% self-efficacy." This means they have complete confidence that they can maintain the behavior change forever, in any situation. This is the ideal but is not necessary for success and is rare for many behaviors. For this reason, many descriptions of Stages of Change include only the first five stages.
To see how each stage might apply to a behavior change situation, consider how the Stages of Change would look for someone at risk for STDs but not currently using condoms.1
||"I may have a lot of different sexual partners, but I don't need to use condoms because my partners are healthy."
||"I know I should wear a condom, but sex isn't the same when I wear one."|
||"I bought some condoms and I've decided to talk to my partner about trying them."
||"We used a condom for the first time, and it wasn't as bad as I thought it would be. We'll use them again."
||"I use condoms all the time now with my current partner; it's not a big deal for us … although I will have to talk to any new partners about it."|
||"I will always use a condom with my current and with all new partners."|
1Adapted from: Samuelson, M. Stages of Change: From Theory to Practice. The Art of Health Promotion [newsletter]. Vol. 2, No. 5, November/December 1998 and STD/HIV Prevention Training Center Participant Manual: Bridging Theory & Practice.
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