The trans-theoretical model of change aims to help people change their health behaviour.
Originally proposed by two US psychologists (Prochaska and DiClemente), in the early 1980's, it has been successfully applied in a wide variety of behavioural changes including exercise initiation, reduction of dietary fat, quitting smoking, weight control and sunscreen use.
The model proposes that rather than changing behaviour at a fixed point in time, on a "whim" or "inspiration", behavioural change is most successfully achieved through a series of progressive stages.
The model proposes six chronological stages,
- pre-contemplation
- contemplation
- preparation
- action
- maintenance
- termination
At this stage an individual is not thinking about changing their behaviour. They have no intent to change in the next 6 months, as often they do not recognize or deny they have any inherent problems with their health.
They may be perceived as unmotivated, and tend to avoid information or discussion about the proposed behaviour. Often they feel pressured and may be defensive and agitated by offers of assistance to help change.
At this stage it's often best just to provide information about the dangers of not exercising and the benefits of initiating some activity.
In the contemplation stage individuals will state their intent to change within the next 6 months. They are aware of the need to change but are yet to make the commitment.
They may be perceived as procrastinating, but are willing to receive information about possible changes.
Contemplators are assessing the cause of their current "unhealthy" behaviour and are weighing up the options for change that are available. When the benefits of change appear to outweigh the costs, change begins to occur.
In the preparation stage, an individual has decided to make the change within the next month or so.
They have decided that the benefits outweigh the disadvantages and may even have begun minor modifications in their behaviours.
The "preparator" is beginning a period of introspection and reaffirmation about their need and desire to change. It's useful that they receive practical information about how to initiate the change in terms of types of exercise available, what's appropriate for them, time, locality and cost issues.
The action stage sees the individual implementing some of the practices required for successful behavioural change. The individual has made overt, perceptible lifestyle modifications.
During this phase (up to 6 months) an individual is still vulnerable to "re-lapse"
It's useful to have a plan of action in case some pitfalls fall across your intended path.
In the maintenance stage, one tries to consolidate the behavioural changes made in the action stage.
"Maintainers" have high self-efficacy (the belief that they are capable of maintaining the changes implemented) and are less frequently tempted to relapse.
Termination is the stage where the behaviours are essentially entrenched.
Your confidence is high and it has become easier to maintain the changes.
Problem behaviours are now no longer perceived as desirable, indeed, missing a session is more frustrating than enjoyable.
