and DiClemente noticed that the tobacco users had moved through distinct

stages. If you have ever tried to change a behavior ? such as dieting,

quitting smoking, endeavoring to get more exercise, or the like ? these will

seem very familiar.

Precontemplation

Precontemplation: the person has not yet contemplated or thought about

changing his or her behavior. (The main word here is "yet" ? because the

whole point of understanding stages of change is to learn how to nudge

individuals along the path towards lasting behavior change.)

Some precontemplators are truly unaware of the consequences of their

behavior (e.g., "you can't get an STD from oral sex." Others may be aware of

the consequences but don't see any relevance to themselves personally (e.g.,

"I know you can get HIV from having unsafe sex, but it's really a disease

that only gay men get. I'm not gay so I don't need to worry about it.") A

shorter term for this situation is "denial."

Contemplation

Contemplation stage: the person is taking the 1st incremental steps towards

behavior change. He or she has a greater and more accurate understanding of

the pros and cons of changing the behavior, but is not yet ready to change

because the cons seem to outweigh the pros (e.g., "I know I should use

condoms, but they ruin the moment and take away from the feeling.") The

contemplation stage can last for six months or more, and often the person

can be so ambivalent that he or she seems "stuck" in this stage.

Preparation

Preparation stage: an individual is getting ready to take action relatively

soon ? within a month. This means that he or she has some kind of plan,

whether it is to join an exercise or smoking cessation class, talk to a

doctor or counselor, buy condoms and put them by the bedside, or take

another definite step.

Action

Action stage: an individual tries to change a behavior. Examples include

quitting smoking, eating different foods, exercising, or using condoms. Note

that before the Stages of Change model emerged, this action step was the

only marker of behavior change. In this model, however, it is just one of

six steps. Although it is important, it is no more so than the other stages.

Maintenance

As previously mentioned, one of the main insights of the Stages of Change

model is its attention to relapse ? not as a failure to change behavior but

as an opportunity to learn from unsuccessful attempts and thus increase the

chances of success in the future.

For one to avoid slipping back into past unhealthy behaviors ? particularly

for addictive behaviors but for other behaviors as well ? the process of

change may require months or even years of vigilance. Therefore, the action

stage is followed by a prolonged maintenance phase in which the behavior is

more firmly and thoroughly adopted (e.g., using condoms correctly and

consistently).

This phase allows one to learn more about why the behavior is so challenging

to change. Better understanding increases the odds that future attempts at

change will be successful.

Termination

For many individuals, the maintenance stage lasts forever. Some tobacco

users and alcoholics, For example will always fight at least an occasional

craving for a cigarette or a drink. The Stages of Change model accepts this

situation as normal. But for some individuals and some behaviors, the

behavior change is so complete that they reach a stage of "zero temptation

and 100% self-efficacy." This means they have complete confidence that they

can maintain the behavior change forever, in any situation. This is the

ideal but is not necessary for success and is rare for many behaviors. For

this reason, many descriptions of Stages of Change include only the 1st five

stages.

To see how each stage might apply to a behavior change situation, consider

how the Stages of Change would look for someone at risk for STDs but not

currently using condoms.1

The Stages of Change

Precontemplation

Characteristics

? No intention to change
? Unaware of problem or risk

Sample Statement

? "I may have a lot of different sexual partners, but I don't need to use

condoms because my partners are healthy."

Contemplation     

Characteristics

? Aware of problem
? Would consider change, but no individual initiatives or commitment
? Ambivalence; feeling "stuck"

Sample Statement

? "I know I should wear a condom, but sex isn't the same when I wear one."

Preparation     

Characteristics

? Plan to take action soon
? May have tried before

Sample Statement

? "I bought some condoms and I've decided to talk to my partner about

endeavoring them."

Action     

Characteristics

? Take concrete steps to address problem, but behavior change is not

consistent yet

Sample Statement

? "We used a condom for the 1st time, and it wasn't as bad as I thought it

would be. We'll use them again."

Maintenance     

Characteristics

? Generally free of addictive or problem behavior
? Engage in new, healthful behavior
? May relapse, but accept and commit to new behavior as part of daily life

and routine

Sample Statement

? "I use condoms all the time now with my current partner; it's not a big

deal for us ... although I will have to talk to any new partners about it."

Termination     

Characteristics

? Not tempted to return to addictive or problem behavior
? Complete confidence in ability to maintain behavior change forever in any

situation

Sample Statement

? "I will always use a condom with my current and with all new partners."

1 Adapted from: Samuelson, M. Stages of Change: From Theory to Practice. The

Art of Health Promotion [newsletter]. Vol. 2, No. 5, November/December 1998

and STD/HIV Prevention Training Center Participant Manual: Bridging Theory &

Practice.