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The Stages of Change Model:-key Maintenance

In their analysis of smokers who had succeeded in stopping, Prochaska and DiClemente noticed that the smokers had moved through distinct stages. If you have ever tried to change a behavior — such as dieting, stopping smoking, endeavoring to get more exercise, or the like — these will seem very familiar.

Precontemplation

Precontemplation: the person has not yet contemplated or thought about changing his/her behavior. (The primary word here is "yet" — because the whole point of understanding stages of change is to learn how to nudge individuals 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."

Contemplation

Contemplation stage: the person is taking the 1st 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 ought to 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.

Preparation

Preparation stage: an individual 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.

Action

Action stage: an individual tries to change a behavior. Examples include stopping smoking, eating various 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 vitally important, it is no more so than the other stages.

Maintenance

As previously mentioned, one of the primary 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 challenging to change. Better understanding increases the odds that future attempts at change will be successful.

Termination

For many individuals, 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 individuals 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 1st 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 Sexually Transmitted Diseases but not currently using condoms.1

The Stages of Change

Precontemplation

Characteristics

• No intention to change
• Unaware of problem or risk

Sample Statement

• "I may have a lot of different sexual partners, but I don't need to use condoms because my partners are healthy."

Contemplation    

Characteristics

• Aware of problem
• Would consider change, but no individual programs or commitment
• Ambivalence; feeling "stuck"

Sample Statement

• "I know I ought to wear a condom, but sex isn't the same when I wear one."

Preparation    

Characteristics

• Plan to take action soon
• May have tried before

Sample Statement

• "I bought some condoms and I've decided to talk to my partner about endeavoring them."

Action    

Characteristics

• Take concrete steps to address problem, but behavior change is not consistent yet

Sample Statement

• "We used a condom for the 1st time, and it wasn't as bad as I thought it would be. We'll use them again."

Maintenance    

Characteristics

• Generally free of addictive or problem behavior
• Engage in new, healthful behavior
• May relapse, but accept and commit to new behavior as part of daily life and routine

Sample Statement

• "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."

Termination    

Characteristics

• Not tempted to return to addictive or problem behavior
• Complete confidence in ability to maintain behavior change forever in any situation

Sample Statement

• "I will always use a condom with my current and with all new partners."

1 Adapted 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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