Stages of Change Model

Introduction

In 1983, Prochaska and DiClemente developed the Stages of Change model which describes the different stages a person goes through in order to facilitate a behavioural change (e.g. stopping smoking).¹ 

This model helps healthcare professionals better understand what patients are thinking and feeling about their behavioural change. By identifying which stage your patient is at, you will be able to communicate at the same level without “pushing” someone over their limits.

Pre-contemplation

In the pre-contemplation stage, the patient has no interest in changing and mostly sees the behaviour (e.g. smoking) as a positive aspect of their lives.

Healthcare workers should try to implement the 5R’s of motivational intervention. For example, in the context of smoking:²

• Relevance: ask and assist patients in searching for reasons to quit that are relevant to them.
• Risks: discuss the negative aspects of smoking.
• Rewards: discuss the positive aspects of smoking.
• Roadblocks: encourage patients to identify the barriers to quitting.
• Repetition: repeat the motivational process and allow patients to understand that it commonly takes repeated attempts to be successful.

For more information, see the Geeky Medics guide to smoking cessation counselling.

Contemplation

In the contemplation stage, the patient recognises the negative aspects of the behaviour, however, ultimately they feel the positives outweigh these.

Actions for healthcare providers:³

• Same as pre-contemplation but with a focus on reinforcing their reasons for change and acknowledging their ambivalent feelings.
• Assist the patient by revisiting this issue at a future date.

Preparation

In the preparation stage, the patient understands why they should make a behaviour change and creates plans. 

Actions for healthcare providers:³

• Same as contemplation but prepare for change by identifying barriers and considering solutions to overcome anticipated obstacles.
• Assist the patient by setting up an action plan together.

Action

In the action stage, the patient attempts to change their behaviour (e.g. stop smoking).

Actions for healthcare providers:³

• Ask about side effects of pharmacological therapies and how the patient is generally managing to follow the plan.
• Assess the patient’s feelings and temptations.
• Advise on relapse prevention with further benefits from non-pharmacological therapies.
• Assist by focusing on successes, continuing with encouragement and support.

Maintenance

In the maintenance stage, the patient continues to make the behaviour change (e.g. remains smoke-free) but requires ongoing support and encouragement to prevent relapse.

Actions for healthcare providers:³

• Same as the action stage but do not forget to congratulate the patient

Relapse

In the relapse stage, the patient relapses (e.g. starts smoking again) and often returns to one of the earlier stages of change.

Actions for healthcare providers:³

• Remain non-judgemental.
• Reassure the patient that relapses are not a setback, but part of the process of change.
• Reassess the patient’s stage of change.

Reviewer

Dr Tony Foley

Consultant General Practitioner

Editor

Dr Chris Jefferies

References

1. Health Service Executive. Brief Interventions for Smoking Cessation. Published in 2014. Available from: [LINK]
2. Agency for Healthcare Research and Quality, Rockville, MD. Patients Not Ready To Make A Quit Attempt Now (The “5 R’s”). Published in 2012. Available from: [LINK]
3. Tobacco-Free RNAO. Stages of Change. Published in 2011. Available from: [LINK]