Six Stage Model of Behaviour Change

10 Key excerpts on "Six Stage Model of Behaviour Change"

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  The Complete Guide to Behavioural Change for Sport and Fitness Professionals

  • Sarah Bolitho, Debbie Lawrence, Elaine McNish(Authors)
  • 2013(Publication Date)
  • Bloomsbury Sport

    (Publisher)

  Put simply, a theory is a hypothesis, or suggestion, of why and how behaviours develop and change, which can be tested or investigated. A model is a prediction of the factors that lead to something occurring, in this case what needs to happen or be in place or occur for behaviour change. Change models fall very broadly into two types: staged models and psychosocial models. Each type has advantages and disadvantages and further reading is recommended to fully understand individual models and theories. The following are common theories and models used in the field of behaviour change and while they are not the only ones, they are the most frequently encountered. It should be noted that no single model can explain how and why people change in terms of lifestyle. Relapse Relapse Relapse Pre-contemplation Contemplation Preparation Termination/ change consolidated Maintenance Action Relapse Relapse Figure 3.1 Stages of behaviour change in the transtheoretical model THE TRANSTHEORETICAL MODEL OF CHANGE Initially developed by Prochaska and DiClemente in 1983 as a tool to help with smoking and drug-use cessation, this model has become widely used in other areas of health behaviour. It utilises different stages to identify how ‘ready’ an individual is to make changes and suggests strategies to help ‘nudge’ them into a further stage. The six stages in the transtheoretical model (TTM) are: 1 Pre-contemplation – not thinking about change 2 Contemplation – thinking about change 3 Preparation – preparing for change UNDERPINNING KNOWLEDGE 32 4 Action – starting to change 5 Maintenance – keeping change going 6 Termination/change consolidated – the changed behaviour change is now automatic There is a further element, relapse, represented by the anticlockwise arrows. Relapse can occur in any stage other than pre-contemplation and can undo any positive steps already made towards termination.

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  The Psychology of Lifestyle

  Promoting Healthy Behaviour

  • Kathryn Thirlaway, Dominic Upton(Authors)
  • 2009(Publication Date)
  • Routledge

    (Publisher)

  Figure 2.6 represents the basic structure of all stage theories. The roman numerals represent stages, of which there can be more than three. The letters represent the variables that are held to influence the stage transitions. Different factors are important at different stages, although the theory allows for some overlap. This is a basic structure of a stage theory in contrast to a continuum theory such as the theory of planned behaviour, when the likelihood of someone performing the behaviour is a linear function of the strength of the intention to do so, the stronger the intention the more likely the behaviour. A purist stage theory contests that each stage is qualitatively different to the next (Bandura 1998). Weinstein et al. (1998) argue that stage models should satisfy four principles:

  • stages should be mutually exclusive and qualitatively different categories
  • the stages should be sequential
  • each individual within a stage should be experiencing similar barriers to making a change
  • people in different stages should be experiencing different barriers to making a change.

  The transtheoretical model (TTM) is the dominant stage model in health behavioural change (Sutton 2005). It is often referred to as the stages of change model reflecting the well-described backbone of the model.

  Figure 2.6

  A hypothetical three-stage model

  However, it is actually a collaboration of several constructs. These constructs are: the stages of change, decisional balance, self-efficacy and processes of change. The model is an attempt to integrate constructs from different theories of behaviour change into a single coherent model (Sutton 2005). Consequently, in its aim of rationalising conceptual thinking in the area under one framework it is similar to SCT. However, frequently, researchers focus on the single construct ‘stages of change’ (Sutton 2005; see also Bandura 1998). In the full model the construct ‘stages of change’ provides the basis organising principle, which postulates that people move through stages in order, although they may relapse from action or maintenance to an earlier stage. The three other constructs are then postulated to influence the transition from one stage to the next. Decisional balance, although derived from Janis and Mann’s (1977) model of decision making, represents the for and against components that are present in most theories of health behaviour. Factors such as perceived severity, or perceived vulnerability (health belief model), social norms and barriers are relevant here. Self-efficacy has been introduced as the key component of social cognition theory earlier. Processes of change are the experiental and behavioural processes that people engage in to progress through the stages.

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  Intervention in Mental Health-Substance Use

  • David B. Cooper(Author)
  • 2016(Publication Date)
  • CRC Press

    (Publisher)

  These processes are critical for accomplishing both the precontemplation and contemplation tasks. Additionally, choosing a course of action to change the problem behaviour and committing to that choice (self-liberation) are essential for accomplishing the tasks of the preparation stage. Similarly, learning how to create or deconstruct cues to action (stimulus control), modify conditioned responses to cues (counter-conditioning), and create rewards for new behaviour (reinforcement management) are critical to the action and maintenance stages. As the individual moves through each of the stages, but particularly in the preparation stage, it is helpful if he/she has trusting and open discussions about the problem behaviour with a supportive individual (helping relationships). 1, 7, 11 Without successful engagement in these processes of change, the individual is unlikely to successfully accomplish the tasks of the stages, modify the target problem behaviour and sustain the new pattern of behaviour. However, the individual does not use processes in a vacuum, uninfluenced by contextual factors. The context of change: complicating problems and similar solutions Although many professionals claim to use holistic approaches to healthcare, most treat only diagnosable conditions and treat health and substance use behaviour problems in isolation. However, individuals concerned about or trying to change a single behaviour most often have multiple other concerns. The context of change acknowledges competing problems, complicating issues and environmental and systemic challenges that can interfere with engagement in processes of change, hinder accomplishment of stage tasks and complicate movement through the process of change. 1, 2 There also may be resources and protective factors in these contextual areas that can facilitate use of processes and more successful completion of stage tasks

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  The Transition Handbook

  From Oil Dependency to Local Resilience

  • Rob Hopkins(Author)
  • 2008(Publication Date)
  • Green Books

    (Publisher)

  I found his insights enormously illuminating, and around the same time I met Dr Chris Johnstone, an addictions specialist who has done a lot of work with the Stages of Change and applying them to social and environmental change work. Chris is author of Find your Power, 2 and also edits The Great Turning Times, 3 as well as run- ning workshops on ‘The Work That Reconnects’ around the UK. I find his take on change very inspiring and insightful, and the Transition approach is, in many ways, informed by some of these insights. Rather than trying to explain this to you myself, when I have no back- ground in psychology or addictions, I have del- egated this to Chris, and what follows is a dialogue we had exploring these issues. An interview with Dr Chris Johnstone What are the Stages of Change, and where did they come from? The Stages of Change model was developed by psychologists Carlo DiClemente and James Proschaska in the early 1980s. They wanted to map out a framework for understanding change that could apply to many different types of behaviour and that could also be used by peo- ple from varying theoretical backgrounds. For this reason it became known as the ‘transtheo- retical approach’. Chapter 6 Understanding the Psychology of Change “Creating the world we want is a much more subtle but more power- ful mode of operation than destroy- ing the one we don’t want.” – Marianne Williamson Understanding the psychology of change At the core of this model is a simple, and even obvious, idea: change doesn’t happen all at once. Rather it occurs in increments or stages. You can apply this to pretty much any type of change. For example, if you’re moving home, the actual moving is referred to as the Action Stage. But before you move, there’s some planning that’s needed – that’s the Preparation Stage. And before you plan, you make a decision that comes after a period of thinking about it – that’s the Contemplation Stage.

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  Understanding and Changing Health Behaviour

  From Health Beliefs to Self-Regulation

  • Charles Abraham, Paul Norman, Mark Conner(Authors)
  • 2013(Publication Date)
  • Psychology Press

    (Publisher)

  In stage models, transitions between adjacent stages are the dependent variables, and the other theoretical constructs are variables that are assumed to influence these transitions – the independent variables. But Martin, Velicer, and Fava (1996) refer to the processes of change as independent variables and the pros, cons, self-efficacy, and temptation as dependent variables. It is not clear if they mean that the processes of change influence stage transitions by way of the pros, cons, self-efficacy, and temptation. Those who develop stage models should clearly specify the causal relationships between the constructs. A well-specified stage model would postulate a causal model for each forward stage transition. Indeed, this is a prerequisite for developing stage-based interventions. Simply having a method of classifying people into stages is not a sufficient basis for developing interventions; it is necessary to specify, or at least hypothesise, the factors that need to be changed in order to produce the desired stage transitions.

  The Stages of Change

  The number and names of the stages and their operational definitions have changed over the years. Farkas, Pierce, Gilpin, Zhu, Rosbrook, Berry, and Kaplan (1996) tabulated some of the different definitions used in the studies by Prochaska and colleagues between 1983 and 1991. They note that the different classifications have never been compared empirically. This lack of standardisation makes it difficult to compare results from different studies and to accumulate the research findings into a coherent body of knowledge.

  The version of the TTM used most widely in recent years specifies five stages: precontemplation, contemplation, preparation, action, and maintenance (DiClemente, Prochaska, Fairhurst, Velicer, Velasquez, & Rossi, 1991). Table 10.1

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  State of the Art in Clinical Supervision

  • John R. Culbreth, Lori L. Brown, John R. Culbreth, Lori L. Brown(Authors)
  • 2009(Publication Date)
  • Routledge

    (Publisher)

  action stage begins when clients overtly change their behaviors and their environment in order to address their chosen issues (Connors et al., 2001). This stage is a behavioral manifestation of their commitment to the change process. Clients at this stage may be excited, nervous, and may experience a wide range of emotions dependent upon their successes and their failures in changing. Regardless of outcome, it is important that the client remain focused on moving forward and not fall back into absolute thinking patterns and consider one setback a reason for discontinuing change. Action stage clients are also more willing to follow suggestions from clinicians, including developing strategies and creating activities that support their change efforts. A significant risk at this stage is the possibility of clients determining that they are finished with treatment and ready to move on. Typically, this decision is premature and clients should be dissuaded from this action. Action stage clients are still too new to their changed behaviors and need a longer period of time to move into the next stage.

  After a period of time in the action stage, clients will begin to consider themselves in a maintenance phase or stage (Connors et al., 2001). This stage is a result of successful efforts to change, and is characterized by clients working to sustain these changes and adapt strategies for new situations and events in their lives as they move forward. A significant focus during this stage is anxiety concerning relapse or slipping back to old behaviors. There may be anxiety associated with various life situations, people, and environments that are cause for concern and increase the risk of relapse. Clients in the maintenance stage will continue to experience temptations to revert to their old behaviors; however, the frequency of these will decrease. Overall, this stage is marked by the clients’ efforts to continue doing what works, identifying risks and threats to their changes, and working toward becoming comfortable with new behaviors.

  Levels of Change

  The aforementioned processes and stages of change work on problems at five different levels of human functioning (Joseph et al., 1999). The first, and most common level of change is that of symptom relief or situational problems. This level is usually focused on a single, clearly defined problem. The second level of change addresses maladaptive cognitions that may create or exacerbate symptoms or situational issues. Current interpersonal problems, the third level of change, is an examination of clients’ interactions with others in their environment. This type of change takes a more systemic view, similar to the fourth level of change, which focuses on family systems conflicts. The final level of change is intrapersonal conflicts or working on change within the individual.

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  Group Treatment for Substance Abuse

  A Stages-of-Change Therapy Manual

  • Mary Marden Velasquez, Cathy Crouch, Nanette Stokes Stephens, Carlo C. DiClemente(Authors)
  • 2015(Publication Date)
  • The Guilford Press

    (Publisher)

  an overview of tHe Model The transtheoretical model (TTM) described earlier shows how people successfully make behavior changes in their lives. The TTM is based on the concepts and research of Prochaska and DiClemente (1984), who found a number of characteristics common C H A P T E R 1 How People Change The Transtheoretical Model 10 HOW TO HELP PEOPLE CHANGE to successful changes in many types of circumstances, with or without formal treatment (DiClemente, 2006). Specifically, they found that these characteristics or processes take place over time, marked by five distinct stages of change, each of which has spe- cific tasks that promote movement toward the next change stage: precontemplation— not considering change or seeing a problem; contemplation—seeing a problem and considering whether to act; preparation—making concrete plans to act soon; action— doing something to change; and maintenance—working to sustain the change. The 10 processes of change identified by Prochaska and DiClemente (1984) encom- pass experiences and activities that enable people to move from one stage to the next. In other words, the processes are the engines of change that help people accomplish essential tasks that promote successful change. These processes fall into two groups. The first group, the experiential processes, represent the person’s thoughts, feelings, and experiences regarding the problem behavior. Importantly, these types of “inter- nal” processes are most relevant in the early stages of change. The second group, the behavioral processes, are the action and behavior modification strategies that are more important in the later stages of change. In other words, these two clusters of processes help people “do the right thing at the right time” to successfully complete stage tasks that promote lasting change.

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  Successful Change Management in Health Care

  Being Emotionally and Cognitively Ready

  • Annette Chowthi-Williams, Geraldine Davis(Authors)
  • 2022(Publication Date)
  • Routledge

    (Publisher)

  et al., 2016).

  Social Learning theory and Nudge Theory are based in cognition. The first engages in intrinsic reinforcement of behaviours which are desirable within a change process, showing how to enable easier learning of the new behaviours. The second is about manipulating the environment to influence change, to make change easier so that there is no effort involved on the part of the individual. The third model, the transtheoretical model of behaviour change, draws on both the rational and the emotional. The main way in which these theoretical approaches can be useful is when planning for the maintenance and continuation of an implemented change. They are rarely referred to in any models of planned or emergent change.

  Taking a humanistic approach to human behaviour, writers such as Maslow and Rogers took the view that humans wanted to exert their free will and own their own development. Maslow’s work (1968) described a hierarchy of human needs, where fundamental needs to eat, sleep and keep warm must be met before higher needs could be realised. His work demonstrates insight which can be useful to change managers. Maslow puts the need for belonging immediately above fundamental physiological, psychological and physical needs and below the need for esteem, creativity and self-actualisation. When a change is proposed, any member of staff who considers their sense of ‘belonging’ to be threatened is likely to function less well in terms of their cognitive and creative abilities. In the same humanistic vein, Carl Rogers (1983) described that people typically have insights into their own challenges which enable them to find solutions. Neither of these approaches tend to feature in studies of change management, but both identify that people have a role to play in facilitating change and that people tend to want to achieve their own potential. These theorists have influenced educational approaches, and the importance of being student-centred, quite widely. However, they have not played their role in engaging with employees to promote successful change.

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  Principles and Practice of Social Marketing

  An International Perspective

  • Rob Donovan, Nadine Henley(Authors)
  • 2010(Publication Date)
  • Cambridge University Press

    (Publisher)

  125 6 Models of attitude and behaviour change This chapter presents a number of models useful for developing campaign strategies. These models are generally known as ‘knowledge–attitude–behaviour’ change (KAB) models or ‘social cognition’ models (Connor and Norman 2005 ; Godin 1994 ). While each can be classified as either ‘motivational’, ‘behavioural’, ‘cognitive’ or ‘affective’ in emphasis, they all deal with conceptualising the influences on behaviour, and hence provide a framework for formative research, strategy development and campaign evaluation. In general, changes in the major components in these models, such as attitudes, norms and efficacy, have been found to be good predictors of changes in behaviours and intentions (Webb and Sheeran 2006 ). There are a number of such models [Darnton ( 2008 ) lists and describes over thirty]. We will briefly describe each of the models most frequently mentioned in the health promotion and social marketing literature, before presenting a synthesis of the major variables across all models. We include brief discussions on two concepts generally ignored by the KAB models: morality and legitimacy (Amonini 2001 ). A notable omission from this chapter is Prochaska and DiClemente’s ‘Stages of Change’ model, which will be discussed in Chapter 10 . Most of these models are based on the assumption that an individual’s beliefs about some person, group, issue, object or behaviour will determine the individual’s atti-tude and intentions with respect to that person, group, issue, object or behaviour. These intentions, in turn, subject to environmental facilitators and inhibitors, social norms and self-efficacy, will predict how the individual actually acts with regard to that person, group, issue, object or behaviour. An understanding of KAB models provides us with directions for setting communication objectives and for generating message strategies to achieve these objectives.

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  The Psychology of Nursing Care

  • Neil Niven(Author)
  • 2006(Publication Date)
  • Bloomsbury Academic

    (Publisher)

  He proposed that perceived control was an important factor in behavioural intention. Thus one of the best predictors of weight loss is perceived control over one’s weight. It involves beliefs about abilities, opportunities and obstacles to the behaviour. The theory has been applied to smoking (Fishbein 1982), losing weight (Schifter and Ajzen 1985) and breast self-examination (Lierman et al. 1990). Norman and Smith (1995) used the TPB to predict exercise behaviour. They found that although the TPB factors of strong desire to exercise and pressure from others to exercise were related to future behaviour, the strongest predictor of future exercise behaviour was previous exercise behaviour indicating a significant habitual component. Stages of change Proshaska and Di Clemente (1982) put forward a transtheoretical model of behaviour change. They said that people are in a particular stage of change with respect to smok-ing, drinking, diet, etc. For example, people may be in a stage of: • Precontemplation : not intending to make any changes. • Contemplation : considering making changes. • Preparation : starting to make small changes. • Action : actually engaging in new behaviour. • Maintenance : maintaining the change over time. Again, there are strengths and weaknesses to this model. First, the changes do not always recur in a linear fashion. People may move back and forward between stages. Second, the stages not be so discreet (Sutton, 2000) and the cross-sectional designs of many studies rules out causal factors. However, broadly speaking if someone is toward the ‘front end’ of the model, interventions should be based on changing attitude. If a person wants to change but is having difficulty then one needs to concentrate on developing cogni-tive/behavioural techniques. Thus to summarise: • If the person lacks knowledge about health behaviour, then health education is the appropriate intervention. THE PSYCHOLOGY OF NURSING CARE 368

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