Facilitating Behavior Change
Applying Prochaska’s
Transtheoretical Model
Bev Schalk, R.N., M.Ed.
Objectives
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Discuss Prochaska’s Transtheoretical model.
Describe the stages of change.
Match typical statements with the stage of
change they represent.
Give examples of interventions tailored for
each stage of change.
Transtheoretical Model of Change
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People move through distinct stages on the road to successful
change.
Actions or interventions are most successful when tailored to
the individual’s particular stage of change.
At each stage, an appropriate approach can produce progress
towards the next stage.
A health coach can use the model to assess readiness to
change, plan and deliver targeted interventions and help
patients move along the continuum towards successful,
sustained behavior change.
Sources:
Prochaska, James O. and Wayne F. Velicera, “Behavior Change: The Transtheoretical Model of Health Behavior Change”
American Journal of Health Promotion: Vol. 12, No. 1, pp. 38–48.
Prochaska, James O. and John C. Norcross, “Stages of Change” Psychotherapy: Vol. 38, No. 4, pp. 443-448.
Stages of Change
1.
2.
3.
4.
5.
6.
Precontemplation
Contemplation
Preparation
Action
Maintenance
Termination
Stages of Change
1. Precontemplation
Not intending to take action in the next six months
I Won’t
Stages of Change
2. Contemplation
Intending to take action in the next six months
I Might
Stages of Change
3. Preparation
Intending to act in the next 30 days
I Will
Stages of Change
4. Action
Made changes for less than six months
I Am!
Stages of Change
5. Maintenance
Made and sustained changes for more than six months
I Have
Stages of Change
Section Review: Group Activity
Precontemplation  Contemplation  Preparation  Action  Maintenance
“I’ve signed up for an exercise class. I start next week.”
“I’ve started walking for 30 minutes each evening with my
neighbor.”
“I haven’t smoked for a year! I feel so much better.”
“My grandpa smoked his whole life and lived to be 94 years old.
I’m not going to quit, either.”
“I’ve been thinking about losing weight but I don’t know where to
begin. I’ve tried so many diets before but I always gain the
weight back.”
Interventions
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Interventions are most successful when they
are tailored to the individual’s readiness to
change.
Interventions
1. Precontemplation
Not intending to take action in the next six months
•Provide information
•Communicate willingness to
assist and support
•Help identify discrepancies
“My grandpa
smoked his whole
life and lived to be
94 years old. I’m
not going to quit,
either.”
Interventions
2. Contemplation
Intending to take action in the next six months
•Review benefits of lifestyle
change
•Provide information and
referrals
•Support and encourage
“I’ve been thinking about
losing weight but I don’t
know where to begin. I’ve
tried so many diets
before but I always gain
the weight back.”
Interventions
3. Preparation
Intending to act in the next 30 days
•Identify and address barriers
•Encourage support systems
•Set achievable goals
•Develop action plan
•Help anticipate challenges
“I’ve signed up for
an exercise class.
I start next
week.”
Interventions
4. Action
Made changes for less than six months
•Review benefits of lifestyle change
•Discuss setbacks or barriers
•Encourage incremental steps
•Reinforce and track progress
•Celebrate accomplishments
•Prepare for challenges
“I’ve started
walking for 30
minutes each
evening with my
neighbor.”
Interventions
5. Maintenance
Made and sustained changes for more than six months
•Provide ongoing monitoring and
reinforcement
•Address challenges and relapses
•Review and revise goals
•Identify helpful circumstances or
conditions
“I haven’t
smoked for a
year! I feel so
much better.”
Summary
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James Prochaska’s Transtheoretical Model of Change states that
people go through distinct stages on the road to successful change.
The stages that health coaches typically work with include:
1.
Precontemplation (“I won’t”)
2.
Contemplation (“I might”)
3.
Preparation (“I will”)
4.
Action (“I am”)
5.
Maintenance (“I have”)
Interventions are most successful when tailored to the individual’s
readiness to change. A health coach can help facilitate a person’s
progress through this continuum by recognizing the stage of change
and providing targeted information, assistance and support.
Questions?
Bev Schalk, R.N., M.Ed.