Stages of Change model

It’s very important that we understand something about where people come from in relation to making changes in their lifestyle that will promote their health. There is a very well-established model for this called the Stages of Change.

The Stages of Change model describes the different stages we go through when we want to change something in our everyday lives.

Precontemplation: this is where we’re not thinking seriously about making a change in our health behaviour (such as reducing alcohol intake, taking part in more physical activity, reducing or stopping smoking, or organising our lives to ensure we get more ‘downtime’); if anyone says to us when we’re in this stage ‘you should be thinking about changing that’, we’re likely to dismiss it, because we don’t really see it as a problem.

Contemplation: we’re now beginning to think about our behaviour. Maybe we feel our clothes are a bit tighter than they were last year, or we can’t remember what happened after we left the pub on Saturday night, or we’ve seen the latest statistics on smoking and lung cancer, or we’ve just shouted our kids out for something pretty trivial. We’re beginning to see that maybe there is a problem that’s affecting our health.

Preparation/determination: by now, we’ve realised that something needs to change, and we’re ready to make changes – but maybe we don’t know exactly how. So we start to read up on the issue, ask advice from friends and family, maybe go onto some websites for more information. We might even turn to a health professional – a GP or practice nurse, for instance – to discuss the issue.

Action: we now know what we want to change, we’ve researched how we can change it, and we’re got a plan to put into action. We understand, having read about the issue or discussed it with others that the changes we’re looking for won’t happen overnight, but that over time, things will improve as long as we stick to our plan. We might have set ourselves some targets – taking a short walk four or five times a week, cutting our 20 cigarettes a day down to 15, sticking to three glasses of wine on a Saturday instead of five or six, or organising at least one hour of quality time with the family each week. We see these as small steps to get us going, and we’re prepared to increase our actions as time moves on and we gain confidence that we can do it.

Maintenance: the aim of the whole Stage of Change model is help us get to a position where we can maintain the maintenance stage and sustain our new, healthier lifestyle. But for many people, this is the hardest part, even harder than making the initial changes. This is about trying to ensure we don’t just slip back into our old behaviours. Maybe we go out and have a slap-up meal with all the trimmings, washed down by a few glasses of wine and followed by a sly cigarette. Or maybe we go on holiday and do that on five or six separate occasions. That’s all fine as a one-off, but we recognise that it’s very easy to reintroduce the same old unhealthy habits into our lifestyle, almost without noticing it.

Relapse: relapse is recognised as a definite step in the Stages of Change model. It isn’t outside the model – it is part of the model, because we understand that as humans, we’re all subject to temptation, and that we may revert to our old ways. The important thing is that we don’t feel bad about ourselves, but recognise exactly where we are in the model at this point – we’re at the relapse stage, which means we’re introducing unhealthy habits back into our lifestyle. We might feel that this isn’t a problem – in effect, going back to the ‘precontemplation’ stage – but if we see our relapse as an issue and feel we don’t want to lose the benefits we gained through the ‘action’ and ‘maintenance’ stages, perhaps our best plan now is to re-enter the ‘contemplation’ stage and begin the process again.

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