Prevention Counseling & Exercise

Stages of Readiness for Behavior Change

Stages of Readiness for Change Model

Precontemplation Uninformed about the risk and need for change, uninterested in changing behavior
Contemplation Thinking about change in the near future (next six months)
Preparation Ready to make a change in the next month
Action Implementation of specific action plans for six months
Maintenance Continuation of desirable actions for greater than six months, or repeating periodic recommended step(s)
Relapse* Successfully accomplished a behavior change in the past, but later returned to the unhealthy behavior

*Relapse: Patients in this stage can be classified in Precontemplation, Contemplation, or Preparation with respect to their next future effort to make a behavior change.

The whole point of categorizing people in stages is that people respond best to messages and strategies specific to their stage. So identifying a patient’s stage can be very helpful in figuring out what kind of questions to ask them, the type of information they need, and the kind of advice they may respond to best.

For example, patients who have failed two prior quit attempts and are uninterested in quitting smoking at the moment are not going to want to hear about how to use celery and carrot sticks to reduce cravings for cigarettes. They may, however, be moved closer to thinking about quitting by a review of the risks of smoking particular to them or by a brief discussion of newer methods of reducing nicotine cravings which they may not have heard about yet.

Most of the guidance this model provides is probably compatible with the intuitive or common sense approach to counseling about behavior you already take. However, it is likely that paying some more attention to patients’ stages and tailoring your counseling to stage will increase your effectiveness as a behavior change advocate.

The table on the following page provides more information about the three initial stages according to the Model. These three stages (precontemplation, contemplation, preparation) are the most important ones to be aware of when you are assessing patients prior to counseling them about a behavior change, because strategies for counseling patients in these stages vary quite a lot between stages and are also relatively complex. Patients in the Action stage, especially early Action, require vigilant engagement in setting strategies that address specific behavioral and cognitive issues. The Maintenance stage requires relatively straightforward reinforcement and support of patients’ behaviors. Patients in the Relapse stage can be categorized as precontemplators, contemplators, or in preparation with respect to their next attempt at behavior change.

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