“The stages of Change Model was developed by Prochaska and DiClemente and evolved from work with smoking cessation and the treatment of drug and alcohol addiction and has recently been applied to a variety of other health behaviors. The basic premise is that behavior change is a process and not an event, and that individuals are at varying levels of readiness to change.” (1)
“The health education literature suggests that “one size fits all” programs fail to motivate large segments of the population who are at different stages of change. Thus, interventions should be tailored to the needs and concerns of individuals at each stage of the change process.” (1,2)
According to the Stages of Change approach, individuals can be categorized according to their readiness to change. It is important to note that this is a circular, not a linear model, and people can enter and exit at any point. For instance, individuals may progress to action but then relapse and go through some of the stages several times before achieving maintenance. (2) The stages include:
Contemplation – thinking about changing, usually within 6 months
Preparation –intends to take action within the next month – have a plan of action
Action – has made changes within the past 6 months
Maintenance – has maintained new behavior for at least 6 months and is working to prevent relapse.
Behavior change strategies will likely be more effective when they are designed to match an individual’s stage in the change process. Example: If an individual has a low fruit and vegetable intake, there is no point in providing detailed information and recipes. It would be more appropriate to focus the nutrition message on increasing the individual’s awareness of the benefits of eating fruits and vegetables before suggesting action-oriented strategies.
Stages of Change is an approach which can be used to assist WIC participants in changing behaviors associated with nutrition issues. What is unique about this
approach is that counselors engage in a dialogue with participants to move participants from the stage they are in to the next stage. Data indicate that the five stages are indeed quite distinct in behavioral habits and attitudes and thus analysis of their unique characteristics are vital (3).
The dialogue, at first, can be a set of questions and algorithms (see example in this section) which is used to assess the stage of readiness to change. As the counselor becomes more proficient, the stage is easier to identify. Strategies can be developed for helping participants move to the next level (See example in this section). Examples of counseling can even be developed for specific nutrition topics (See example, folic acid).
Nutrition professionals strive to promote healthy eating and physical activity behaviors. An understanding of behavior change theory helps to better understand the many factors influencing health-related behaviors and the most effective ways of promoting change. The bottom line is that programs, interventions, and messages that are guided by behavior change theory have a much greater chance of achieving positive behavior change.
Glanz K, Rimer BK. Theory at a Glance: A Guide for Health Promotion Practice. U.S. Department of Health and Human Services, Public Health Service, National Institutes of Health; July 1996.
Owen AL, Splett PL, Owen GM. Nutrition in the Community: The Art and Science of Delivering Services, Boston, MA: WCB/McGraw-Hill; 1999.
McDonell G, Roberts D, Lee C. Stages of Change and Reduction of Dietary Fat: Effect of Knowledge and Attitudes in an Australian University Population. Society for Nutrition Education: 1998, 37-44.
QUESTIONS AND ALGORITHM USED TO ASSIGN STAGES OF CHANGE FOR A LOW-FAT DIET
How high is your overall diet in fat? Is it…
How long have you followed a diet low in fat? Would you say…
Less than one month OR