Stages of Change Model

(Transtheoretical Model of Change) developed by Prochaska and Carlo DiClemente

Now that you have completed the self-assessment rating exercise, you may have determined that you want to make a personal behavioral change in one the eight dimensions of wellness.  You may want to make more than one behavioral modification in one or more dimension of wellness.  It is generally recommended, however, to prioritize your modifications and focus on only one behavioral change at a time.  Choose one small target behavior to focus on initially.  The process for change will take time and will involve a gradual process of awareness, preparation, and finally action.  Before reaching your final goal of termination, where the new behavior is ingrained and has now become the dominant habit, you will likely encounter numerous short term setbacks and relapses.  This is to be expected.  Progression through these stages is most often not linear.  You will likely cycle back and forth between stages numerous times before being successful at changing the behavior for good.  Do not panic or stop.  Just refocus and continue striving to make this behavioral change.  You may want to examine some of your current habits to recognize behavioral patterns.  Consider how long this behavior has been going on?  How often is this behavior occurring and how serious are the consequences?  Why am I continuing this behavior and what is triggering and reinforcing it?  There could be many factors to access, such as, demographics, friends, attitudes and beliefs, age, sex, race, income, and family background.  TV and social media, education, and access to health care could also be factors.   Below are the definitions for the specific stages of behavioral change and additional information regarding each stage of change.  There is also a sample stage of change personal contract.  There are numerous other examples available online.  It is recommended that you utilize a written contract and sign it in front of someone you know to help hold yourself accountable and committed to reaching your behavioral change goals.  In addition, if you are contemplating making a behavioral change in the area of physical wellness, you need to complete a PAR-Q (Physical Activity Readiness Questionnaire) or PAR-Q & YOU  (sample available below) either individually or with the help of a heath professional.  NOTE: Follow the directions, and see a doctor BEFORE you begin any fitness programs if you answered YES to any of the key health questions listed in the PAR-Q & YOU form.  Any quality gym or trainer should require you to fill out a PAR-Q questionnaire before beginning any physical activity program.

(PAR-Q) Physical Activity Readiness Questionnaire

Regular physical activity is fun and healthy, and increasingly more people are starting to become more active every day. Being more active is very safe for most people. However, some people should check with their doctor before they start becoming much more physically active.

If you are planning to become much more physically active than you are now, start by answering the seven questions below. If you are between the ages of 15 and 69, the PAR-Q (Physical Activity Readiness Questionnaire) will tell you if you should check with your doctor before you start. If you are over 69 years of age, and you are not used to being very active, check with your doctor.

Common sense is your best guide when you answer these questions. Please read the questions carefully and answer each one honestly: Check YES or NO

YES        NO

1. Has your doctor ever said that you have heart condition and that you should only do physical activity recommended by a doctor?
2. Do you feel pain in your chest when you do physical activity?
3. In the past month,  have you had chest pain when you were not doing physical activity?
4. Do you lose your balance because of dizziness or do you ever lose consciousness?
5. Do you have a bone or joint problem that could be made worse by a change in your physical activity?
6. Is your doctor currently prescribing drugs (for example, water pills) for your blood pressure or heart condition?
7. Do you know of any other reason why you should not do physical activity?

If you answered:

Yes to one or more questions

• Talk with your doctor by phone or in person BEFORE you start becoming much more physically active or BEFORE you have a fitness Tell your doctor about the PAR-Q and which question(s) you answered YES.
• You may be able to do any activity you want as long as you start slowly and build up

Or, you may need to restrict your activities to those which are safe for you. Talk with your doctor about the kinds of activities you wish to participate in and follow his/her advice.

No to all questions

• If you answered NO honestly to all PAR-Q question, you can be reasonably sure that you can:

–Start becoming much more physically active-begin slowly and build up gradually. This is the safest and easiest way to go.

–Take part in a fitness appraisal-this is an excellent way to determine your basic fitness so that you can plan the best way for you to live actively.

 

Delay becoming much more active:

• If you are not feeling well because of a temporary illness such as a cold or a fever- wait until you feel
• If you are pregnant- talk to your doctor before you start becoming more active.
• If your health changes so that you then answer YES to any of the above questions, tell your fitness or health professional. Ask whether you should change your physical activity plan.

 

Participant’s Signature_________________ Date           _____

 

STAGE ONE– PRECONTEMPLATION:  This is the stage where you may not be totally aware that you need to make any specific behavioral change in any area and are not ready to focus on evaluating the need to make serious changes.  Or, you may have tried to make some behavioral changes in the past but gave up.  This stage will require that you weigh the pros and cons of adopting a new behavior.  The pros must outweigh the cons in your mind if you are going to be successful.  Are you at that point yet???

BARRIERS TO OVERCOME:

1. Emotional Stress
2. Cravings
3. Social Situations
4. Friends
5. Old habits
6. Lack of patience
7. Feeling a loss of “internal locus of control” – The feeling that control over life’s events and changes come primarily from within.

COMMON EXCUSES FOR NOT MAKING A BEHAVIORAL CHANGE:

1. Feeling that I am young and have plenty of time to make changes later down the road.
2. There is just too much contradictory information floating around. I can’t stay current on the latest survey, study or research paper.
3. I don’t have the time.
4. I can’t afford it.
5. I don’t have access to the equipment, facilities or support.
6. It is mostly genetic and I can’t control that anyway.
7. Believing in the “external locus of control”-The feeling that control over life’s events and changes comes primarily from outside of one’s self.

NOTE:  REMEMBER THIS QUOTE:   “PAY ME NOW OR PAY ME LATER” Health issues generally develop slowly over time.  Good health starts now with the habits you are currently exercising.

 

STAGE TWO – CONTEMPLATION:  This is the stage that occurs when you become aware that you have a problem and recognize that you need to seriously consider making a behavioral change in the very near future to protect your health and wellness.  This stage generally takes quite a bit of time and soul searching.  This stage will require that you carefully evaluate the individual issues to be focused on and then increase your overall awareness and general knowledge, regarding that specific behavior.  You have to honestly ask yourself if you are truly ready to make this change at this time.

POSSIBLE MOTIVATING FACTORS:

1. Current health issues or concerns.
2. Healthy aging issues.
3. Physical appearance concerns.
4. Employability and job concerns.
5. Being a role model for a child or another person.
6. Stress reduction.
7. Striving for a better long-term health.
8. Family genetic concerns.
9. Social acceptance. (Peer Pressure)
10. Wanting to have more energy and feel better.
11. Learning or improving a physical skill.
12. Wanting a new challenge.
13. Wanting to get actively involved in a group activity and meet new people.
14. Being motivated by individual and group competitive physical activities.
15. Sudden life changing events.

 

Whatever your motivation, you must be honest with yourself.  If you are not truly motivated to make this behavior change, chances are you will not be successful.  Finding out what inspires you to make a behavioral change will be a critical factor in your success.  The goal needs to have be valuable to you personally, not only the other people in your life.  The degree to which you believe in yourself (self-efficacy) will be key.

Maslow’s Hierarchy of Needs:  This recognized sociological model, defining the hierarchy of basic human needs, may help you recognize your own personal needs, and help you prioritize them and determine what behavioral changes you need to make to achieve them.

STAGE THREE – PREPARATION:  This is the stage where you have made a personal wellness assessment and have chosen a specific target behavior to change or modify. You are ready to make specific preparations, including researching positive examples online, observing live role models, and setting realistic goals for yourself by utilizing the SMART goal system listed below.  You have also analyzed the potential barriers and road blocks defined earlier in the Contemplation Stage and are now ready to make a commitment to change and create a personal behavior change contract.

SMART GOAL SYSTEM:

S = Specific, M = Measureable, A = Action-oriented, R = Realistic, T = Time-oriented.

POTENTIAL BARRIERS TO ANTICIPATE AND OVERCOME:

1. Not assessing your current health status correctly and trying to advance too quickly
2. Not having the support of your family or friends.
3. Having over ambitious goals that are difficult to meet.
4. Being too hard on yourself if you don’t make the immediate progress you desired.
5. Making the steps to change will be all work with no fun activities involved.
6. Making the steps to change boring and not mixing up activities and not adding technology.

After you assess and reflect on various factors that influence the behavior you wish to change, as described in the first two stages of the STAGES OF CHANGE MODEL above, and you have determined that you are now prepared to begin the process of making a specific behavioral change, it is time to create a BEHAVIOR CHANGE CONTRACT, which is a formal written document designed to help keep you on track to reaching your behavioral change goals.  You are going to make this written commitment to yourself as a public declaration of intent, in which you will develop and describe a specific organized plan of action with beginning and ending dates and a daily action schedule.  You should also list possible barriers to overcome and support systems available to help you achieve your behavioral change goal.  An example is listed below and can be downloaded.

SAMPLE BEHAVIORAL CHANGE CONTRACT

My behavior change will be: ______________________________________________________

_____________________________________________________________________________

My long term goal for this behavioral change is _______________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

 

These are the obstacles to making this behavioral change:

1. _______________________________________________________________________

 

2. ________________________________________________________________________

 

3. ________________________________________________________________________

 

4. ________________________________________________________________________

 

5. ________________________________________________________________________

 

Here are the strategies I plan to use to overcome these potential obstacles:

1. ________________________________________________________________________

 

2. ________________________________________________________________________

 

3. ________________________________________________________________________

 

4. ________________________________________________________________________

 

5. ________________________________________________________________________

 

 

Here is a list of resources I plan to use to successfully help me make this behavior change:

1. ________________________________________________________________________

 

2. ________________________________________________________________________

 

3. ________________________________________________________________________

 

4. ________________________________________________________________________

 

5. ________________________________________________________________________

 

Short term goals to help me achieve my long term goals:

1. _______________________________________________________________________

 

Target date: ______________- Reward _______________________________________

 

2. ________________________________________________________________________

 

Target date: ______________- Reward ________________________________________

 

3. ________________________________________________________________________

 

Target date: ______________- Reward ________________________________________

Reward for achieving my long term goal will be: _______________________________________

______________________________________________________________________________

Target date for achieving my long term goal is: ________________

I intend to make the behavior change described above.  I will use the strategies and rewards listed above to help me achieve my goal which I know will contribute to a personal healthy behavioral change.

 

Signed:  _______________________________________________ Date: ________________

 

Witness: ______________________________________________ Date: _________________

 

STAGE FOUR – ACTION:   This is the stage where you actually begin to take action by implementing the plan you have developed and outlined.  It is very important to keep a daily log and accurate records of your progress.

STRATEGIES TO HELP KEEP YOUR ACTION PLAN ON TRACK:

1. Visualize your new goals by using a form of mental practice called visualization, in which you picture yourself overcoming potential obstacles in advance and practice ways to counter them and accomplish your goals.
2. Learn to “Counter.” Countering is another term for substituting a desired behavior for an undesirable one.  Example: Substituting a piece of fruit for a snack instead of a slice of pie.
3. Learn to block or stop negative Self talk. Self-talk is that voice in your head that is always talking to you and is a major factor in determining your actions and your attitude.  Learning to block or stop negative thoughts and replace them with positive ones is key in helping you change your habits and achieve your goals.
4. Learn to Control your Environment: Put yourself around supportive people and situations that will help reinforce desired behaviors and help control the triggers that could affect your behavior negatively.
5. Practice “” Shaping is the process of making a series of little changes and making sure you master each small step one at a time before moving on to the next step towards your overall goal. This sequential progressive process will help keep you from becoming overwhelmed, frustrated and help avoid over-use injuries.  Try to develop a series of short-term goals that will lead to the achievement of your overall long term goal.
6. Reward Yourself: Rewards can be anything from a snack to a full meal or an activity. Small rewards, for achieving short-term goals, is a great way to help keep you motivated on the road to reaching your overall goal.  NOTE: Make sure the rewards are designed into the program.
7. Use Journaling as a Tool: Journaling, or writing down your personal experiences each day is a great way to keep track of your progress and recognize the obstacles you are encountering.  Keeping an accurate record of you progress is an important factor in reaching your ultimate goal.
8. Learn to overcome human nature. Human nature can be described as that internal drive in every living creature that dictates that we all naturally seek the most possible pleasure, with the least amount of time, effort, or pain.  Pleasure can be defined in many terms depending on the goal.  In this case, pleasure represents the goal to change a negative personal wellness habit and replace it with a positive one.  The natural desire to avoid the commitment to the time, the effort, and in some cases being uncomfortable, must be taken into account if you are going to reach your goal.  Understanding and recognizing these factors in yourself and developing the self-discipline to overcome them will be key to achieving overall success in a behavioral change.

STAGE FIVE – MAINTENANCE:   This is the stage where you have attained the desired behavioral change and have sustained this new habit for over six months.  At this point, the change has become the dominant habit and requires less conscious effort to maintain.  You are continuing the actions you began in the action stage, but as this stage progresses, the temptation to resume the old habit steadily decreases. You must, however, remain aware of the potential for relapses and develop strategies for dealing with such challenges. Remember, the time you spend in each of the previous stages is highly individual and many people often move back and forth between stages several times before they are able to make the desired behavioral change permanent.

STAGE SIX – TERMINATION:  This is the final stage where a person has maintained the desired behavior for more than two years.  At this point the healthy new behavior has become the normal dominant behavior and there is little or no fear of relapse.  You have new confidence in your ability to make positive behavioral changes to improve your mental and physical health and you are prepared to make other life changes if necessary.

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