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Stay On Your Feet® - Stages of change

How do people actually change their behaviour, get rid of unhealthy habits and take up good behaviours?

While there have been many theories developed to try and explain how people change their behaviour, the most popular and useful of these theories is the ‘stages of change’ model (also known as the trans-theoretical model).

The six step 'stages of change' model

In the early 1980s, experts from the University of Rhode Island (James Prochaska and Carlo DiClemente) developed a five step model of behaviour change which was first used to work with people trying to give up smoking. Other researchers and practitioners later added a sixth stage. This model of human behaviour change has been widely used within the preventive health sector including injury prevention.

The ‘stages of change’ model proposes a series of clearly definable steps or stages that a person needs to go through when making major, permanent behavioural and lifestyle changes. Changing human behaviour is not an easy task. Even knowing the stages of change, often these stages do not follow a simple linear progression, people will make the required changes at their own pace, and in many cases, there will be relapses.

"Most people find themselves 'recycling' through the stages of change several times ('relapsing') before the change becomes truly established" [174].

What are the stages of behaviour change?

The six stages of behaviour change are:

  1. Pre-contemplative/unaware
  2. Contemplative
  3. Preparing
  4. Action/trying
  5. Maintaining
  6. Termination/advocacy/transcendence

More detailed information about these stages of behaviour change can be found in the following document:

As people progress through each stage, they need different kinds of messages, prompts, materials, training and support. Each stage is not limited by time. You can move through all stages rapidly or you could spend your whole life being ‘pre-contemplative’ about an issue and never make it to the next stage. It is also important to remember that real change must come from within. It cannot be externally imposed [175].

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How do people move from one stage to the next?

Once these stages of human behaviour change are understood, the next step is to identify how people move from one stage to the next. This complex process has been broken down into ten ‘processes’, each of which has been identified as being helpful at particular stages of behaviour change.

The processes of behaviour change are:

  1. consciousness-raising     
  2. dramatic relief
  3. self re-evaluation
  4. environmental re-evaluation
  5. self liberation
  6. social liberation
  7. counter conditioning
  8. stimulus control
  9. reinforcement management
  10. helping relationships [176].

Research indicates that different approaches work at different stages of behaviour change.

  • For the pre-contemplative stage: use consciousness raising, dramatic relief and environmental re-evaluation processes
  • For the contemplative stage: use self re-evaluation
  • For the preparing stage: use self-liberation
  • For the action and maintaining phase: use contingency management, helping relationships, counter conditioning and stimulus control processes [177].

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Other insights from the 'stages of change' model

Decisional Balance

At each step of the ‘stages of change’ model, people undergo a process of weighing up the importance of the advantages and disadvantages involved in any suggested change. In the early stages of change, the cons usually outweigh the pros but over time this balance shifts so that by the time the action and maintenance stages of change are underway, the pros heavily outweigh the cons [176].

Self Efficacy

Self efficacy refers to a person’s belief that they can cope with high risk situations without relapsing to their previous unhealthy or high risk habits. A person with strong self efficacy would believe that they are resilient and can deal with any problems thrown their way. They are self confident and feel able to negotiate difficult situations to ensure a positive result [176].

Temptation/Relapse

Research indicates three factors are involved in the most common types of tempting situations:

  • negative affect or emotional distress
  • positive social situations
  • craving [177].

“Change can spread, slowly at first, before reaching a ‘tipping’ point where the rest of the community adopts it and it becomes a ‘social norm’. However, you will need to accept that it always takes time to create a new social norm. It is likely that your project will require an ongoing effort to repeat, reinforce and maintain the new behaviour" [174].

A useful table listing the stages of behaviour change, the corresponding attitudes and behaviour of people in each of the stages and possible communication approaches to help move people to the next stage is available.

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Last updated: 3 October 2013