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ONLINE STUDENTS ONLY: Access the Assignment Log to confirm homework due dates throughout the quarter.

A PowerPoint presentation (no narration) containing much of this information is available at the below web page. Viewers who have PowerPoint software installed on their computers can view the actual PowerPoint presentation (look for the "change.ppt" file), or those without PowerPoint can view the information as a webpage, but only with MS Explorer 4.0 or above (look for "change.mht" file).

http://facweb.northseattle.edu/troot/HEA150/slides/ 

Stages of Change Theory

One of the objectives of this course is for students to apply health-related information and concepts to evaluate their own states of wellness. The information part is easy. The difficult part lies in what students do with the information. For example, most people know smoking tobacco can be dangerous to one's physical health. Television is bombarded with anti-tobacco campaigns, largely aimed at youth. While anyone viewing these campaign ads can appreciate how tobacco may ravage the human body, how many will stop smoking as a result? Behavior change, or behavior modification, is often extremely difficult.

There are different ways to assess how behavior modification occurs. One approach is the Stages of Change Theory, also known as the Transtheoretical Model. According to the Stages of Change Theory, behavior modification occurs through a series of stages, each stage describing not only where a person is in terms of the behavior change process, but also his or her motivational readiness within the stage.

Stage One: Precontemplation

Individuals within the precontemplation stage have no desire to change a behavior in the immediate future. Sometimes a person in precontemplation is unaware of the need for a behavior change. Other times, a person is fully aware of the consequences associated with the behavior, but continues that behavior anyway.

The "Four R's" are barriers associated with the Precontemplation stage:

In using the habit of smoking as an example, the precontemplator has no desire to quit. She may not be fully conscious of how smoking impacts her or those around her. She may have tried to quit in the past and, after having failed, feels no desire to repeat such a difficult process. She may feel resigned to smoking for the rest of her life, knowing that quitting has so many consequences. Perhaps she rationalizes, "I refuse to quit right now. Life is too stressful and smoking is one of the few ways I can deal with the stress."

Moving from Stage One to Stage Two can occur by improving behavior awareness. Taking a Health class, for example, may cause a shift in awareness.

Stage Two: Contemplation

In the Contemplation stage, the individual is aware of the problems a behavior is causing and is seriously taking steps toward changing the behavior. A person in the Contemplation stage will be undergoing behavioral change within six months. The contemplator is cognizant of the benefits and barriers associated with a behavior change. In the smoking cessation example, the smoker is seriously thinking of quitting in the next six months. She knows a tobacco-free body will be less at risk for cardiovascular disease and cancer (a benefit). She also knows, however, that she will require a lot of social support in order to make the change (a barrier).

Moving from Stage Two to Stage Three is associated with continued education in behavioral change. The Contemplator will need to identify as many benefits and barriers as possible before formulating an action plan. The Contemplator may need encouragement from others and should not feel rushed in the behavior change process.

Stage Three: Preparation

In the Preparation stage, the individual is intending to change a behavior within a month. This stage may be characterized by previous, unsuccessful attempts at behavioral change. For the smoker, she may have tried to quit tobacco a few times over the last several years. In the Preparation stage, she is well educated about the cessation process and is most ready for a change.

In moving from Stage Three to Stage Four, a set list of goals and objectives are in place. The individual will be enlisting needed support and may have made environmental changes to accomplish the behavior change. For example, if the smoker is concerned about smoking when studying at home, she may need to move her studies to a non-smoking environment such as a coffee shop or a library.

Stage Four: Action

In the Action stage, a distinct behavior change has occurred, one that is visible and receives the most attention or recognition. A successful Action stage requires much commitment, time and energy. Subsequently, relapses are common at this stage. In the smoking example, the person has completely stopped smoking.

In order for the Actor to move to Stage Five, the pro's of behavior change need to outweigh the con's. Specific guidelines, strategies must be followed, and the Actor needs continued reinforcement.

Stage Five: Maintenance

At least six months after the behavior change has taken place, the individual is working toward preventing relapse, and appreciating the positive effects associated with behavior change. The time spent in maintenance may be dictated by the behavior change. A major behavioral change will require more time than a minor change. Many people remain in the Maintenance stage and do not move on to the last stage. In the smoking example, the smoker has quit for at least six months and may be appreciating the benefits associated with cessation (easier breathing, e.g.).

In order to move to the final stage, the Maintainer must have a plan in the event of relapse. The individual needs to anticipate any temptation for relapse and create ways to cope with relapse. Note: if relapse occurs, a person can move down more than one stage of change. For example, the smoker, after 12 months of quitting, may relapse and give up, moving her down to the Precontemplation stage. Alternately, she may recognize her setback, and resume at the Action stage.

Stage Six: Termination

In this stage, the behavior change has been permanently adopted, without temptation for relapse. Since termination is rare and extremely difficult to achieve, perhaps a more realistic goal for the behavior modifier is permanent maintenance.

As this Health course progresses through a variety of topics, you will hopefully apply this model of behavior change to your own life. Perhaps there are changes you currently want or need; maybe you are currently in the middle of behavioral change or in the Maintenance stage. There may also be behaviors you do not yet know about....

Educational Enrichment

A detailed overview of Transtheoretical Model presented at the University of Rhode Island

The University of Rhode Island also provides an example of applying the Stages of Change theory to alcohol consumption

Last Revised: 6-28-10