Stages of Health Behavior

Researchers know that health behaviors can be changed. They also know that changes occur not all at once but in stages. Dr. James Prochaska and his colleagues developed the "stages of change" idea beginning in the 1970s as a result of research related to smoking behavior; therefore, the example given in figure 5 relates to smoking. There are five stages of health behavior change, ranging from precontemplation to maintenance. The goal is to move from lower stages to higher stages; the ultimate goal, of course, is stage five.

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Figure 5 Stages of health behavior.

In the first stage, a person refuses to recognize that change is necessary. For example, a smoker may deny the need to stop smoking. The person might say, "I have no intention to stop." A person at stage 2 is thinking about making a change but has not taken steps to implement it. This person might say, "I'm thinking about stopping." At stage 3, a person has not only thought about changing but also taken steps toward making the change. In the example shown in the figure, the person might have accessed a website for advice about how to stop smoking or investigated joining a smoking cessation group.

By the time a person reaches stage 4, he or she has already made some changes but still needs to make more. The person in figure 5 might have cut down the number of cigarettes per day or even stopped smoking for a few days. At stage 5, a person has made a definitive change and is sticking with it. For example, he or she might have stopped smoking for six months or more. This stage is often referred to as maintenance, because the person is adopting the healthy behavior on a regular basis.

It would be nice if people who want to change health behaviors could always move quickly from stage 1 to stage 5. But this is not always the case. For example, smokers who quit (reach maintenance) often do not find success right away. For some smokers, it takes several tries over a period of many months. Others move through the stages more quickly. Regardless of how long it takes, people often move from a low stage to a higher stage and then fall back to a lower stage. Then they try again, each time moving to a higher stage. Of course, there are exceptions, but gradual change is most common. Since the original research, the stages have been used to help people improve all sorts of health behaviors, including eating patterns, physical activity, adoption of personal health habits, and avoidance of destructive habits other than smoking.

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