Using the Stages of Change Model
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The Stages of Change model can contribute to interactions as personal as communications between Wellness Coach and client, and as broadly applied as a new program or intervention. The primary, of course, is locating ways to learn and interpret information about participating members' stages of change.
Here are three tools to consider: A quick stage evaluation that can be adapted for different behaviors, a chart listing pros and cons, and an organizational evaluation.
Quick Stage Assessment1
Instructions: Answer yes or no to the following three questions:
1. Are you planning to change in the next six months?
2. Are you planning to change in the next month?
3. Have you tried to change in the past 12 months?
Scoring:
• Precontemplation: No to #1
• Contemplation: Yes to #1 and No to either #2 or #3
• Preparation: Yes to #1, #2, and #3
The Decisional Balance Scale 2
We all think we know the pros and cons of changing a behavior, but, in fact, it always assists to write them down and to be as specific as possible. Whether you're contemplating a change yourself or assisting someone else do so, try filling out this chart and repeat it at regular intervals to track how your sense of pros and cons shifts over time.
Be prepared for changes in your list. For example, your initial interest in diet and exercise might be driven by appearance alone, but over time, you may see the benefits as having to do with improved overall health and energy. Likewise, a tobacco user may initially quit to prevent his family from nagging him about it, but over time, he may gain a sense of accomplishment and triumph — and feel better as well.
These types of motivations are not mutually exclusive, of course, but it does assist to know why you're pursuing a goal and how your perceptions of it may change over time. Also, seeing the list of pros grow and the list of cons shrink is a sure sign that you're moving from one stage to another!
• Pros of Changing
• Cons of Changing
• Personal consequences
• Consequences to others
• My reactions
• Reactions of others
An Organizational Assessment
Beyond using Stages of Change on a personal level or one-on-one with individuals, how do you incorporate it into your initiative's or agency's work? Here are some suggestions, adapted from a column by Larry Chapman in The Art of Health Promotion:3
• Evaluate your own knowledge and understanding: Do you know the specifics of each stage and how the processes contribute?
• Evaluate your initiative's target groups or populations. Does the Stages of Change model make sense for them and for your interaction with them? Are there ways to assess your individuals' stages? Do they group together in a way that would make sense for program delivery (e.g., all precontemplators and contemplators receive this type of intervention, while those in the preparation or action stages receive a different intervention)?
• Where can your program incorporate Stages of Change and its processes? In what ways can staff support stage-sensitive progress for individuals or participating members? How can staff reinforce Stages of Change concepts? Beyond the interventions themselves, are there opportunities to collect and evaluate data on stages? Could this data be incorporated into screening? Staff training?
• Identify new opportunities. Looking ahead, how could Stages of Change contribute to even more effective programs and outcomes? What's missing from your current set-up that would assist individuals in your programs change their behaviors?
1. Samuelson, M. Stages of Change: From Theory to Practice. The Art of Health Promotion [newsletter]. Vol. 2, No. 5, November/December 1998.
2. Adapted from: Prochaska, J.O., Norcross, J.C., and DiClemente, C.C. 1994. Changing for Good: A Revolutionary Six-Stage Initiative for Overcoming Bad Habits and Moving Your Life Positively Forward. New York: Avon Books.
3. Chapman, L.S. Ready or Not? Closing Thoughts column in The Art of Health Promotion [newsletter]. Vol. 2, No. 5, November/December 1998.
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