Chelsea Moore, MS, CN, CHC
People don’t change overnight. And, they don’t change until they’re ready. These are important truths to remember as you embark on your health journey.
Like most things, change is a process. James Prochaska, PhD, a pioneer of behavior change theory, found that people change by moving through a series of stages. His findings are presented in his remarkable book: "Changing for Good: A Revolutionary Six-Stage Program for Overcoming Bad Habits and Moving Your Life Positively Forward."
We don’t all begin our change journey at stage one. At each level, Prochaska and his colleagues found different strategies were best suited to facilitate the journey forward.
Interestingly, they also found that for different challenges and behaviors, we can be in different levels. For example: a person could be taking a blood pressure medicine (Action), but neglecting to work on, yet aware of, elevated (pre-diabetic) glucose levels (Pre-contemplation).
Prochaska’s six stages of change are:
Pre-contemplation: you don’t know that you should change and don’t intend to.
Contemplation: you understand why change is important and consider it.
Preparation: you start looking for resources and intend to make changes soon.
Action: you’re actively changing your behavior.
Maintenance: the behavior is established and requires less effort.
Termination: the behavior is now part of your lifestyle.
Unfortunately, change is rarely linear. We can all remember a time when we fell off the wagon after making a commitment to ourselves. This is called relapse – and it often involves moving backward two stages to an earlier stage of change. So, falling out of Action requires returning to Contemplation (sometimes, it may be a quick revisit) before moving forward to Preparation.
As said, each stage of change has a unique set of tools. When used, these tools can propel you forward.
Moving from Pre-contemplation to Contemplation
People in the Pre-contemplation stage usually lack awareness. They may not know their health status or understand why their current behaviors are unhealthy. Other times, people are in this stage because past failures have left them discouraged. If you’re in this stage, here’s what you can do to move forward:
Notice when you don’t feel well or when you aren’t able to do what you'd like to do.
Be open to conversations with others about their concerns.
Check-in with those you trust, (family, friends, maybe your healthcare practitioners) about where you are.
Think about what a higher level of health would feel like.
Moving from Contemplation to Preparation
People in the Contemplation stage carefully weigh the pros and cons of changing their behavior. This process can create a great deal of uncertainty and often leads to procrastination. Sometimes the costs of change appear to outweigh the benefits and no action is taken. If you’re in this stage, here’s what you can do to move forward:
Consult with trusted professionals to make a full assessment, being realistic about benefits, risks and costs.
Talk to someone who has successfully made the change.
Moving from Preparation to Action
People in the Preparation stage are getting ready to change. They complete tasks that increase their ability to make changes and stay on track. If you’re in this stage, here’s what you can do to move forward:
Obtain the knowledge and skills you need to make the change.
Identify resources such as a local gym or support group.
Set clear goals and put them somewhere visible.
Start with a smaller change that feels manageable.
Pick a start date.
Moving from Action to Maintenance
People in the action stage are actively engaging in the new behavior. This can be a challenging time. In this stage, they learn what works and what doesn’t. They experience failures and setbacks that require compromise. Sometimes they lose motivation and feel like giving up. If you’re in this stage, here’s what you can do to move forward:
Remove obstacles that threaten your success.
Work with a health coach or lifestyle educator for extra support.
Make sure your goals are realistic. Don’t be afraid to change them.
Moving from Maintenance to Termination
People in the maintenance stage try to avoid relapse. Relapse occurs when we completely fall back into our old habits. People in this stage may also experience lapses – moments when they don’t engage in the new behavior. Unlike a relapse, we can quickly get back on track after a lapse. If you’re in this stage, here’s what you can do to move forward:
Don’t aim for perfection. Know the difference between a lapse and a relapse.
Be prepared to take immediate action after a lapse.
Use self-monitoring tools like a pedometer or goal tracking chart.
While some of us achieve Termination, many need to work on behaviors long term. Successful, yet prolonged, Maintenance stages produce meaningful health benefits and help us turn actions into habits.
Takeaways from behavior change research
In a study of more than 1,300 overweight patients with Type 2 diabetes, participants were further along in the change process for healthy eating than for exercise. In addition, recently diagnosed patients were more likely to change their behavior than patients who were diagnosed 10 or more years ago.
What this means for you: If you’ve been diagnosed with a health condition, try to make behavior changes as soon as possible. Focus on diet first if you’re feeling overwhelmed.
In a randomized controlled trial involving more than 1,200 overweight adults, participants who received personalized behavior change information were more successful at: eating healthy, exercising, managing stress, and losing weight. In addition, participants who progressed to the action or maintenance stage for one behavior were up to five times more likely to make progress on other behaviors.
What this means for you: Work with healthcare professionals who can assess your readiness for change. Use positive momentum to tackle more than one goal.
Bottom line
Behavior change is a process. It involves moving through a series of stages: Pre-contemplation, Contemplation, Preparation, Action, Maintenance, and Termination. Knowing which stage you’re in (and using the right tools for that stage) can help you achieve your goals. Remember: don’t hold off on making changes, especially if you’ve been diagnosed with a health condition.
Further resources
“90 Minutes of Re-Creation and Visioning” – Join Dr. Lamb and his colleagues on April 24, 2021 at 9 am PDT on Facebook Live to listen to their seminar about facilitating successful behavior change. This seminar will be archived on Facebook for future viewing.
Healthy Transformation Group Experiences – The Personalized Lifestyle Medicine Center in Gig Harbor regularly conducts Group Medical Visits to promote ‘Changing for Good.’ Call our clinic at 253-853-7233 for details about our next series.
Chelsea Moore, MS, CN, CHC is a Certified Nutritionist and Health Coach. She graduated from the Institute for Integrative Nutrition and completed her Master of Science in Applied Nutrition at Northeastern University.
Chelsea is passionate about lifestyle education and women's health issues. She is a member of the International Association for Health Coaches and the Society for Nutrition Education and Behavior.
(253) 853-7233
References
Prochaska J, Norcross J, DiClemente C. Changing for Good: A Revolutionary Six-Stage Program for Overcoming Bad Habits and Moving Your Life Positively Forward. New York, NY: Quill; 1994.
Arloski M. Wellness Coaching for Lasting Lifestyle Change. 2nd ed. Duluth, MN: Whole Person Associates, Inc.; 2014.
Glanz K, Rimer BK, Viswanath K. Health Behavior: Theory, Research, and Practice. 5th ed. San Francisco, CA: Jossey-Bass; 2015.
Contento IR. Nutrition Education: Linking Research, Theory, and Practice. 3rd ed. Burlington, MA: Jones & Bartlett Learning; 2016.
Centis E, Trento M, Dei Cas A, Pontiroli AE, De Feo P, Bruno A, et al. Stage of change and motivation to healthy diet and habitual physical activity in type 2 diabetes. Acta Diabetol. August 2014; 51(4): 559–566. doi: 10.1007/s00592-013-0551-1.
Johnson SS, Paiva AL, Cummins CO, Johnson JL, Dyment SJ, Wright JA, et al. Transtheoretical model-based multiple behavior intervention for weight management: effectiveness on a population basis. Prev Med. March 2008; 46(3): 238-46. doi: 10.1016/j.ypmed.2007.09.010.