The Stages of Change model in practice

Supporting someone to change their health behaviours is a responsibility for the whole health care team working in partnership with the person, and might include health promotion specialists. It can involve risks – stepping up a person’s physical activity levels, for instance – so it’s not something you should take forward on your own without advice and supervision from experienced colleagues. But as someone who’ll be spending a lot of time with the person, you’ve a big role to play.

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Stages of change

At the 'precontemplator' stage of change, the aim is to get a person to start thinking about how their behaviour is having an negative impact on their health.

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Stages of change

In a binge drinking example, a question like, "Do you think your weekend drinking may be contributing to these accidents?" may be sufficient to plant a seed in the person's mind.

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Stages of change

At the 'contemplator' stage, a deeper conversation is possible which includes answering a person's questions about why they need to change and how and providing them with appropriate information leaflets.

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Stages of change

The 'action' stage is relatively easy in the change process. This is where the person recognises they need help and is ready to take action.

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Stages of change

It is important that this opportunity is seized and an appointment is made available to see a health professional or other appropriate source of help and support.

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Stages of change

The 'action' stage may also present with an ideal opportunity for the timely provision of some key health education information.

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Stages of change

The 'maintainer' stage is the really hard part. This involves lots of support and encouragement together with advice and guidance for continuing through the change process. Tracking progress is a great way of keeping motivation levels high.

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Stages of change

The 'relapse' stage is a normal part of the change process. It is important to speak to people about relapses and provide support and encouragement so they are not too hard on themselves when it happens. Together you can develop a plan to get them back on track.

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Stages of change

Supporting people to change their harmful health behaviours is a job for the whole health team. Understanding the change process will help you to provide the kind of help that is appropriate for the stage of change a person has reached and have the best chance of being effective.

The following suggests some approaches that might be used with people at different stages of the model.

  • Precontemplator: the aim here is just to help the person to start thinking about his or her health issue, so you’re simply asking a few questions such as, ‘Have you thought about …?’, or ‘Would you feel better if …?’. Don’t let a straight ‘no’ put you off – remember, the person won’t see the issue as a problem in the precontemplation stage. You might raise the issue again at a later stage, or leave an appropriate information leaflet and say you’re happy to discuss it with him or her any time.
  • Contemplator: the person might now be ready to ask some questions. Commonly, these questions fall into three categories:
    1. Why should I change – why is it important?
    2. How can I change – have I the confidence and ability to do it, and who can help me?
    3. When should I change – now, or at some later date?
  • Prepared/determined: the person recognises the need for change and wants to make the change, so now needs information and support to help him or her move into the action stage. You can use your knowledge of available expert advice and information sources that will provide the support he or she needs. Be encouraging here – the person is taking a brave step that deserves to be acknowledged.
  • Actor: the person is now ready to make the change and might look to you and the team for support in coming up with a plan and setting targets. Key specialists might be involved here – a dietician for someone wanting to lose weight or a smoking cessation specialist, for instance. Try to make sure the person doesn’t aim for targets that are too ambitious – there’s nothing as dispiriting as constantly failing to meet targets. Encourage him or her to keep changes small, simple and achievable, and agree a schedule for checking on progress – ‘let’s look at it again a month from now’, for instance. And remember that the person’s family will be involved as well – don’t leave them out, unless the person has specifically requested that you do so .
  • Maintainer: the hard bit! You can make a big contribution here by offering support and encouragement, lifting the person’s resolve when his or her spirits are low and suggesting changes and modifications that might help.
  • Relapser: the most important thing here is not to allow the person to be too hard on him or herself – you can reinforce the fact that relapse is common and to be expected, and that the most important thing now is to see where the person is, remember the benefits he or she has already gained from the behaviour change, and set a plan to move on.

The RCN has developed an online learning programme specifically on helping patients/clients to change their health behaviours that you may want to have a look at. In particular, you can see a video showing two different approaches – one where the health care worker tells the patient what is best for him, and the other where she explores with him what he wants to do and achieve. You can access the whole programme at Support behaviour change.

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