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Stages of Change/Transtheoretical Theory and Schools (EE)
This initial or rough draft of a summary (formatted in an Encyclopedia Entry format) has been started by the International School Health Network from a previous Canadian project. Visitors to and members of this wiki-based web site are welcome to edit the draft (using the Easy Edit" tool found at the top of the page or to comment on the draft by using the "thread" tool found at the bottom of the page. (All previous versions of this page are automatically saved by the system, so don't hesitate to edit this page). Eventually, when time and resources permit, this initial draft will be formatted in accordance with the outline for glossary terms, encyclopedia entries and handbook sections used in this knowledge exchange program for health,safety, educational and social development interventions.
This summary discusses one behavioural theory that underpins school health promotion, safety, social development and other similar programs. The summary is one of several that are being developed within this wiki-based web site. Please see our Call for Writers/Contributors/Sponsors on Behaviour Theories for a full listing of this series of summaries.
The Transtheoretical Model, or ‘Stages of Change Approach’ provides a framework that helps to understand not only the process involved in making changes, but also the activities individuals can engage in to make self-changes, or to assist others to make changes. The Transtheoretical Model is a model of intentional change that focuses on individual decision-making.
The Stages of Change is a simplistic framework, based on a number of basic beliefs about intentional change--it is gradual, logical, sequential and controllable. The framework does not look at different schools of psychology and sociology that attempt to explain why individuals have problems; it instead focuses on how people change. This model has attracted worldwide attention amongst health professionals, and addictions specialists,particularly in Canada and Great Britain.The AFM has incorporated this model into its programming.
The stages of change describe how willing an individual is to make particular changes in their life at that moment. As well, the stages describe what type of work the individualneeds and is able to do to make the change. The processes of change describe strategies that are useful to make changes. The techniques of change describe individual activities, specific to each person making changes.
The techniques of change help to achieve the strategies of the processes of change. When effectively combined, the stages, processes and techniques of change suggest a menu of options that help changers to know what to do, why to do it, and when to do it to be most successful in their change efforts. The Stages of Change Approach has been widely adopted as a practice model for service delivery by addictions agencies throughout Canada.
Stage Theories of Behaviour Change (Taken from http://www.travelsmart.vic.gov.au)
Mounting evidence suggests that behaviour change occurs in stages or steps and that movement through these stages is neither unitary or linear, but rather, cyclical, involving a pattern of adoption, maintenance, relapse, and readoption over time.
The work of Prochaska and DiClemente (1986) and their colleagues have formally identified the dynamics and structure of staged behaviour change. In attempting to explain these patterns of behaviour, Prochaska and DiClemente developed a transtheoretical model of behavioural change, which proposes that behaviour change occurs in five distinct stages through which people move in a cyclical or spiral pattern.
The first of these stages is termed precontemplation. In this stage, there is no intent on the part of the individual to change his or her behaviour in the foreseeable future. The second stage is called contemplation, where people are aware that a problem
exists and are seriously considering taking some action to address the problem. However, at this stage, they have not made a commitment to undertake action. The third stage is described as preparation, and involves both intention to change and
some behaviour, usually minor, and often meeting with limited success. Action is the fourth stage where individuals actually modify their behaviour, experiences, or environment in order to overcome their problems or to meet their goals. The fifth and final stage, maintenance, is where people work to prevent relapse and consolidate the gains attained in the action stage. The stabilization of behaviour change and the avoidance of relapse are characteristic of the maintenance stage.
Prochaska and DiClemente further suggest that behavioural change occurs in a cyclical process that involves both progress and periodic relapse. That is, even with successful behaviour change, people likely will move back and forth between the five stages for some time, experiencing one or more periods of relapse to earlier stages, before moving once again through the stages of contemplation, preparation, action and eventually, maintenance. In successful behavioural change, while relapses to earlier stages inevitably occur, individuals never remain within the earlier stage to which they have regressed, but rather, spiral upwards, until eventually they reach a state where most of their time is spent in the maintenance stage. Further work undertaken and reported by Prochaska et el (1992) suggests that behaviour change can only take place in the context of an enabling or supportive
environment
MAINTENANCE: practice required for the new behaviour to be consistently maintained,incorporated into the repertoire of behaviours
available to a person at any one time.
ACTION: people make changes, acting on previous decisions, experience, information, new skills, and motivations for making the
change.
PREPARATION: person prepares to undertake the desired change - requires gathering information, finding out how to
achieve the change, ascertaining skills necessary, deciding when change should take place - may include talking with others to
see how they feel about the likely change, considering impact change will have and who will be affected.
CONTEMPLATION: something happens to prompt the person to start thinking about change - perhaps hearing that someone has
made changes - or something else has changed - resulting in the need for further change.
PRECONTEMPLATION: changing a behaviour has not been considered; person might not realise that change is possible or
that it might be of interest to them.
Source: The Behavior Change spiral from "What do they want us to do now?" AFAO 1996
Prochaska's and DiClemente's model has received considerable support in the research literature. Their model has also been shown to have relevance for understanding, among other things, patterns of physical activity participation and adherence and would have relevance in bringing about change in travel behaviours. Consistent with the above perspective, Sallis and Nader (1988) also have suggested a stage approach to explaining movement behaviour, particularly in family groups, with research aimed at understanding better the cyclical patterns of movement activity
SOCIAL FEATURES - nature of personal relationships; expectations of class, position, age, gender; access to knowledge, information.
CULTURAL FEATURES - the behaviours and attitudes considered acceptable in given contexts - eg. relating to sex, gender, drugs,
leisure, participation.
ETHICAL & SPIRITUAL FEATURES - influence of personal and shared values and discussion about moral systems from which
those are derived - can include rituals, religion and rights of passage.
LEGAL FEATURES - laws determining what people can do and activities to encourage observance of those laws .
POLITICAL FEATURES - systems of governance in which change will have to take place - can, for example, limit access to
information and involvement in social action.
RESOURCE FEATURES - affect what is required to make things happen - covers human, financial and material resources;
community knowledge and skills; and items for exchange
Source: The Behavior Change spiral from "What do they want us to do now?" AFAO 1996
involvement, including adoption, maintenance, and relapse, and interventions aimed at minimizing the amount of time individuals spend in the relapse stage as well as maximizing time spent in action or maintenance.
This stage approach is contrasted to the "all or none" approach to physical activity participation that often characterized early research on exercise adherence. Such a staged approach sits well with any school based program that is focused on travel behaviour change – given that the context in which the program is to be applied would see fluctuations in the positive and negative influences according to such things as work and time demands of family members, weather, events or incidents in the local neighbourhood that may influence perceptions of safety.
List of Research References
(Taken from Literature Search done by the Health Communication Unit, University of Toronto, January 2006)
Greene GW, Rossi SR, Velicer WF, Fava JL, & Prochaska JO. Dietary applications of the stages
of change model. J Am Diet Assoc 1999; 99: 673-678.
Kristal AR, Glanz K, Curry SJ, & Patterson RE. How can stages of change be best used in
dietary interventions? J Am Diet Assoc. 1999; 99: 679-684.
Taylor T, Serrano E, Anderson J, & Kendall P. Knowledge, Skills, and Behavior Improvements
on Peer Educators and Low-Income Hispanic Participants After a Stage of Change-Based
Bilingual Nutrition Education Program. Journal of Community Health 2000; 25: 241-262.
Harrington, T., Bartholomew, J. B., Jowers, E. M., Loukas, A., McGregor, J. & Allen, J.M. The
physical activity stages of change for children: Validation of a new instrument. Annual Meeting
of the Society of Behavioral Medicine, Washington DC, 2002.
Bartholomew, J. B., Miller, B. M., Atwood, R. D., Ren, Y., & Gottlieb, N. H. Assessing the
stages of change for fruit and vegetable consumption: A visual analogue scale. Annual Meeting
of the American College of Sports Medicine, St. Louis, MO, 2002.
Domel SB, Baranowski T, Davis HC, Thompson WO, Leonard SB, Baranowski J. Measure of
Stages of Change in Fruit and Vegetable Consumption Among Fourth- and Fifth-Grade School
Children: Reliability and Validity. Journal of the American College of Nutrition. 1996; 15(1):56-
64.
Using Stage of Change Criteria to Increase Vegetable Intake Among WIC Children
http://www.fns.usda.gov/oane/menu/NNEC/Files/2003/StageofChangeCriteria.pdf
Reducing health service inequities for children: Adapting motivational enhancement and stages of change models for in-home lead reduction interventions by AmeriCorps volunteers The 130th Annual Meeting of APHA 5024.0: Wednesday, November 13, 2002 - Board 9 John A. Dougherty, PhD, Program Design and Evaluation Services, Multnomah County Health
Department, Oregon, 426 SW Stark Street, 6th Floor, Portland, OR 97204, 503-988-3663
x22290, John.X.Dougherty@co.multnomah.or.us
Stages of change for physical activity in a community sample of adolescents
De Bourdeaudhuij et al. Health Educ. Res..2005; 20: 357-366.
Heather A. Hausenblas, Claudio R. Nigg, Danielle Symons Downs, David S. Fleming, Daniel P.
Connaughton (2002) Perceptions of Exercise Stages, Barrier Self-Efficacy, and Decisional Balance for Middle-Level
School Students The Journal of Early Adolescence, Vol. 22, No. 4, 436-454 (2002)
Absolom K. Eiser C. Greco V. Davies H. (2004) Health promotion for survivors of childhood cancer: a minimal intervention.Patient Education & Counseling. 55(3):379-84, 2004 Dec
Day RS. Nakamori M. Yamamoto S. (2004) Recommendations to develop an intervention for Japanese youth on weight management. Journal of Medical Investigation. 51(3-4):154-62, 2004 Aug.
Littell JH. Girvin H. (2004) Ready or not: uses of the stages of change model in child welfare. [Review] [74 refs]
Source Child Welfare. 83(4):341-66, 2004 Jul-Aug.
Maisto SA. Chung TA. Cornelius JR. Martin CS.(2003) Factor structure of the SOCRATES in a clinical sample of adolescents.Psychology of Addictive Behaviors. 17(2):98-107, 2003 Jun.
Stevens SL. Colwell B. Miller K. Sweeney D. McMillan C. Smith DW. (2003) Differences in evaluations of a tobacco awareness and cessation program by adolescents in four stages of change. Addictive Behaviors. 28(3):471-82, 2003 Apr.
Prokhorov AV. de Moor CA. Hudmon KS. Hu S. Kelder SH. Gritz ER. (2002) Predicting initiation of smoking in adolescents: evidence for integrating the stages of change and susceptibility to smoking constructs. Addictive Behaviors. 27(5):697-712, 2002 Sep-Oct.
Cookson S. Heath A. Bertrand L. (2000) The HeartSmart Family Fun Pack: an evaluation of family-based intervention for cardiovascular risk reduction in children. Canadian Journal of Public Health. Revue Canadienne de Sante Publique. 91(4):256-9, 2000
Jul-Aug
Walton J. Hoerr S. Heine L. Frost S. Roisen D. Berkimer M. (1999) Physical activity and stages of change in fifth and sixth graders.
Journal of School Health. 69(7):285-9, 1999 Sep.
Berg-Smith SM. Stevens VJ. Brown KM. Van Horn L. Gernhofer N. Peters E. Greenberg R.
Snetselaar L. Ahrens L. Smith K. (1999) A brief motivational intervention to improve dietary adherence in adolescents. The DietaryIntervention Study in Children (DISC) Research Group.
Source Health Education Research. 14(3):399-410, 1999 Jun.
Domel SB. Baranowski T. Davis HC. Thompson WO. Leonard SB. Baranowski J. (1996) A measure of stages of change in fruit and vegetable consumption among fourth- and fifth-grade school children: reliability and validity.
Journal of the American College of Nutrition. 15(1):56-64, 1996 Feb.
This summary discusses one behavioural theory that underpins school health promotion, safety, social development and other similar programs. The summary is one of several that are being developed within this wiki-based web site. Please see our Call for Writers/Contributors/Sponsors on Behaviour Theories for a full listing of this series of summaries.
Stages of Change /Transtheoretical Theory & Schools
(Copied with permission from:http://www.afm.mb.ca/Learn%20More/Stages%20of%20Change5.pdf) and other sources
The Transtheoretical Model, or ‘Stages of Change Approach’ provides a framework that helps to understand not only the process involved in making changes, but also the activities individuals can engage in to make self-changes, or to assist others to make changes. The Transtheoretical Model is a model of intentional change that focuses on individual decision-making.
The Stages of Change is a simplistic framework, based on a number of basic beliefs about intentional change--it is gradual, logical, sequential and controllable. The framework does not look at different schools of psychology and sociology that attempt to explain why individuals have problems; it instead focuses on how people change. This model has attracted worldwide attention amongst health professionals, and addictions specialists,particularly in Canada and Great Britain.The AFM has incorporated this model into its programming.
- Precontemplative - the stage where the client is not considering change as there is noperceived need for any change.
- Contemplative - the stage where the client is thinking about making some changes.
- Preparation - the stage where the client is preparing or becoming determined to make change.
- Action - the stage where the client actively making changes through modifying behaviour.
- Maintenance - the stage where the client is consistently maintaining changes made over a period of time.
- Recycle - the stage where the client falls back to an earlier stage of change.
- Termination - the stage where the client no longer needs to attend to the task ofmaintaining the change.
The stages of change describe how willing an individual is to make particular changes in their life at that moment. As well, the stages describe what type of work the individualneeds and is able to do to make the change. The processes of change describe strategies that are useful to make changes. The techniques of change describe individual activities, specific to each person making changes.
The techniques of change help to achieve the strategies of the processes of change. When effectively combined, the stages, processes and techniques of change suggest a menu of options that help changers to know what to do, why to do it, and when to do it to be most successful in their change efforts. The Stages of Change Approach has been widely adopted as a practice model for service delivery by addictions agencies throughout Canada.
Stage Theories of Behaviour Change (Taken from http://www.travelsmart.vic.gov.au)
Mounting evidence suggests that behaviour change occurs in stages or steps and that movement through these stages is neither unitary or linear, but rather, cyclical, involving a pattern of adoption, maintenance, relapse, and readoption over time.
The work of Prochaska and DiClemente (1986) and their colleagues have formally identified the dynamics and structure of staged behaviour change. In attempting to explain these patterns of behaviour, Prochaska and DiClemente developed a transtheoretical model of behavioural change, which proposes that behaviour change occurs in five distinct stages through which people move in a cyclical or spiral pattern.
The first of these stages is termed precontemplation. In this stage, there is no intent on the part of the individual to change his or her behaviour in the foreseeable future. The second stage is called contemplation, where people are aware that a problem
exists and are seriously considering taking some action to address the problem. However, at this stage, they have not made a commitment to undertake action. The third stage is described as preparation, and involves both intention to change and
some behaviour, usually minor, and often meeting with limited success. Action is the fourth stage where individuals actually modify their behaviour, experiences, or environment in order to overcome their problems or to meet their goals. The fifth and final stage, maintenance, is where people work to prevent relapse and consolidate the gains attained in the action stage. The stabilization of behaviour change and the avoidance of relapse are characteristic of the maintenance stage.
Prochaska and DiClemente further suggest that behavioural change occurs in a cyclical process that involves both progress and periodic relapse. That is, even with successful behaviour change, people likely will move back and forth between the five stages for some time, experiencing one or more periods of relapse to earlier stages, before moving once again through the stages of contemplation, preparation, action and eventually, maintenance. In successful behavioural change, while relapses to earlier stages inevitably occur, individuals never remain within the earlier stage to which they have regressed, but rather, spiral upwards, until eventually they reach a state where most of their time is spent in the maintenance stage. Further work undertaken and reported by Prochaska et el (1992) suggests that behaviour change can only take place in the context of an enabling or supportive
environment
MAINTENANCE: practice required for the new behaviour to be consistently maintained,incorporated into the repertoire of behaviours
available to a person at any one time.
ACTION: people make changes, acting on previous decisions, experience, information, new skills, and motivations for making the
change.
PREPARATION: person prepares to undertake the desired change - requires gathering information, finding out how to
achieve the change, ascertaining skills necessary, deciding when change should take place - may include talking with others to
see how they feel about the likely change, considering impact change will have and who will be affected.
CONTEMPLATION: something happens to prompt the person to start thinking about change - perhaps hearing that someone has
made changes - or something else has changed - resulting in the need for further change.
PRECONTEMPLATION: changing a behaviour has not been considered; person might not realise that change is possible or
that it might be of interest to them.
Source: The Behavior Change spiral from "What do they want us to do now?" AFAO 1996
Prochaska's and DiClemente's model has received considerable support in the research literature. Their model has also been shown to have relevance for understanding, among other things, patterns of physical activity participation and adherence and would have relevance in bringing about change in travel behaviours. Consistent with the above perspective, Sallis and Nader (1988) also have suggested a stage approach to explaining movement behaviour, particularly in family groups, with research aimed at understanding better the cyclical patterns of movement activity
SOCIAL FEATURES - nature of personal relationships; expectations of class, position, age, gender; access to knowledge, information.
CULTURAL FEATURES - the behaviours and attitudes considered acceptable in given contexts - eg. relating to sex, gender, drugs,
leisure, participation.
ETHICAL & SPIRITUAL FEATURES - influence of personal and shared values and discussion about moral systems from which
those are derived - can include rituals, religion and rights of passage.
LEGAL FEATURES - laws determining what people can do and activities to encourage observance of those laws .
POLITICAL FEATURES - systems of governance in which change will have to take place - can, for example, limit access to
information and involvement in social action.
RESOURCE FEATURES - affect what is required to make things happen - covers human, financial and material resources;
community knowledge and skills; and items for exchange
Source: The Behavior Change spiral from "What do they want us to do now?" AFAO 1996
involvement, including adoption, maintenance, and relapse, and interventions aimed at minimizing the amount of time individuals spend in the relapse stage as well as maximizing time spent in action or maintenance.
This stage approach is contrasted to the "all or none" approach to physical activity participation that often characterized early research on exercise adherence. Such a staged approach sits well with any school based program that is focused on travel behaviour change – given that the context in which the program is to be applied would see fluctuations in the positive and negative influences according to such things as work and time demands of family members, weather, events or incidents in the local neighbourhood that may influence perceptions of safety.
List of Research References
(Taken from Literature Search done by the Health Communication Unit, University of Toronto, January 2006)
Greene GW, Rossi SR, Velicer WF, Fava JL, & Prochaska JO. Dietary applications of the stages
of change model. J Am Diet Assoc 1999; 99: 673-678.
Kristal AR, Glanz K, Curry SJ, & Patterson RE. How can stages of change be best used in
dietary interventions? J Am Diet Assoc. 1999; 99: 679-684.
Taylor T, Serrano E, Anderson J, & Kendall P. Knowledge, Skills, and Behavior Improvements
on Peer Educators and Low-Income Hispanic Participants After a Stage of Change-Based
Bilingual Nutrition Education Program. Journal of Community Health 2000; 25: 241-262.
Harrington, T., Bartholomew, J. B., Jowers, E. M., Loukas, A., McGregor, J. & Allen, J.M. The
physical activity stages of change for children: Validation of a new instrument. Annual Meeting
of the Society of Behavioral Medicine, Washington DC, 2002.
Bartholomew, J. B., Miller, B. M., Atwood, R. D., Ren, Y., & Gottlieb, N. H. Assessing the
stages of change for fruit and vegetable consumption: A visual analogue scale. Annual Meeting
of the American College of Sports Medicine, St. Louis, MO, 2002.
Domel SB, Baranowski T, Davis HC, Thompson WO, Leonard SB, Baranowski J. Measure of
Stages of Change in Fruit and Vegetable Consumption Among Fourth- and Fifth-Grade School
Children: Reliability and Validity. Journal of the American College of Nutrition. 1996; 15(1):56-
64.
Using Stage of Change Criteria to Increase Vegetable Intake Among WIC Children
http://www.fns.usda.gov/oane/menu/NNEC/Files/2003/StageofChangeCriteria.pdf
Reducing health service inequities for children: Adapting motivational enhancement and stages of change models for in-home lead reduction interventions by AmeriCorps volunteers The 130th Annual Meeting of APHA 5024.0: Wednesday, November 13, 2002 - Board 9 John A. Dougherty, PhD, Program Design and Evaluation Services, Multnomah County Health
Department, Oregon, 426 SW Stark Street, 6th Floor, Portland, OR 97204, 503-988-3663
x22290, John.X.Dougherty@co.multnomah.or.us
Stages of change for physical activity in a community sample of adolescents
De Bourdeaudhuij et al. Health Educ. Res..2005; 20: 357-366.
Heather A. Hausenblas, Claudio R. Nigg, Danielle Symons Downs, David S. Fleming, Daniel P.
Connaughton (2002) Perceptions of Exercise Stages, Barrier Self-Efficacy, and Decisional Balance for Middle-Level
School Students The Journal of Early Adolescence, Vol. 22, No. 4, 436-454 (2002)
Absolom K. Eiser C. Greco V. Davies H. (2004) Health promotion for survivors of childhood cancer: a minimal intervention.Patient Education & Counseling. 55(3):379-84, 2004 Dec
Day RS. Nakamori M. Yamamoto S. (2004) Recommendations to develop an intervention for Japanese youth on weight management. Journal of Medical Investigation. 51(3-4):154-62, 2004 Aug.
Littell JH. Girvin H. (2004) Ready or not: uses of the stages of change model in child welfare. [Review] [74 refs]
Source Child Welfare. 83(4):341-66, 2004 Jul-Aug.
Maisto SA. Chung TA. Cornelius JR. Martin CS.(2003) Factor structure of the SOCRATES in a clinical sample of adolescents.Psychology of Addictive Behaviors. 17(2):98-107, 2003 Jun.
Stevens SL. Colwell B. Miller K. Sweeney D. McMillan C. Smith DW. (2003) Differences in evaluations of a tobacco awareness and cessation program by adolescents in four stages of change. Addictive Behaviors. 28(3):471-82, 2003 Apr.
Prokhorov AV. de Moor CA. Hudmon KS. Hu S. Kelder SH. Gritz ER. (2002) Predicting initiation of smoking in adolescents: evidence for integrating the stages of change and susceptibility to smoking constructs. Addictive Behaviors. 27(5):697-712, 2002 Sep-Oct.
Cookson S. Heath A. Bertrand L. (2000) The HeartSmart Family Fun Pack: an evaluation of family-based intervention for cardiovascular risk reduction in children. Canadian Journal of Public Health. Revue Canadienne de Sante Publique. 91(4):256-9, 2000
Jul-Aug
Walton J. Hoerr S. Heine L. Frost S. Roisen D. Berkimer M. (1999) Physical activity and stages of change in fifth and sixth graders.
Journal of School Health. 69(7):285-9, 1999 Sep.
Berg-Smith SM. Stevens VJ. Brown KM. Van Horn L. Gernhofer N. Peters E. Greenberg R.
Snetselaar L. Ahrens L. Smith K. (1999) A brief motivational intervention to improve dietary adherence in adolescents. The DietaryIntervention Study in Children (DISC) Research Group.
Source Health Education Research. 14(3):399-410, 1999 Jun.
Domel SB. Baranowski T. Davis HC. Thompson WO. Leonard SB. Baranowski J. (1996) A measure of stages of change in fruit and vegetable consumption among fourth- and fifth-grade school children: reliability and validity.
Journal of the American College of Nutrition. 15(1):56-64, 1996 Feb.
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