Question
What is the Stages of Change model?
Answer
Prochaska and DiClemente's Stages of Change Model
This model has been out for almost 40 years now, but it is still very much relevant. The idea with this model was that there are six different stages of change:
- Pre-Contemplation: no intention on changing behavior
- Contemplation: Aware problem exists but with no commitment to action
- Preparation: Intent on taking action to address the problem
- Action: Active modifications of behavior
- Maintenance: Sustained change, new behavior replaces old
- Relapse: Fall back to old patterns of behavior
It's very helpful to think about where a patient might be in their stages of change, in order to facilitate the way that we talk and engage with them.
In Pre-contemplation, the patient has absolutely no intention on changing their behavior. They have no intention to better manage their respiratory needs or take their medication. Jumping in to tell them all the things they need to change may not work well.
Once we move past Pre-contemplation to Contemplation, a patient may be aware of a problem and know it exists. They may have thought about committing to action but they don't have a specific plan or process in place.
After that, a patient moves into the Preparation phase, which means that they're actually intent on taking action to address a problem and make a behavior change. They haven't actually taken steps to do that behavior change but they're coming up with a more crystallized clear plan.
Action is when they start to engage in some behavior change. They're taking steps to modify the issue.
Maintenance is, "I've made this change, I'm engaging this change, and I'm maintaining it for a while."
Relapse can happen where you fall back, relapse, and stop doing that change.
When we are dealing with families, particularly complex ones, and we want them to change their behaviors or get them to do something different, it can be very helpful to consider which of these stages they are in. If I am trying to get a patient to Action, maybe that patient is actually still in Pre-contemplation and they're not even acknowledging that this issue that you're trying to address is a problem. Trying to jump them to Action and skip three or four steps is not going to work well. Acknowledge where they are and maybe just have a super brief conversation at that time, to move them from Pre-contemplation to Contemplation. Then, next time you keep going based on which stage they are in.
