Behavior change is a process that unfolds over time through several stages. Understanding these stages can help guide efforts to promote healthy behaviors. Here we provide an overview of key behavior change models and their stages.
The Transtheoretical Model
The Transtheoretical Model, developed by Prochaska and DiClemente, is one of the most influential models of behavior change. It describes change as a process involving progress through six stages:
- Precontemplation – Not yet considering change
- Contemplation – Considering change
- Preparation – Preparing for change
- Action – Actively engaging in new behavior
- Maintenance – Sustaining new behavior over time
- Termination – Complete integration of new behavior
People can cycle back and forth through these stages multiple times before achieving lasting change. The model highlights that change unfolds gradually and it takes time to progress through the stages.
Key aspects
- Change involves moving through stages over time
- Relapse to earlier stages is common
- Each stage requires different strategies/interventions
The Health Belief Model
The Health Belief Model focuses on attitudes and beliefs as the main drivers of health behaviors. It outlines several cognitive factors that influence behavior change:
- Perceived susceptibility – How vulnerable someone feels to a health threat
- Perceived severity – How serious someone considers a health threat to be
- Perceived benefits – Belief in efficacy of advised action to reduce threat
- Perceived barriers – Obstacles to taking advised action
- Cues to action – Strategies to activate readiness
- Self-efficacy – Confidence in ability to take action
These factors interact to determine someone’s readiness to act. Interventions aim to shift attitudes and beliefs to motivate change.
Key aspects
- Beliefs determine readiness to act
- Education can motivate change by altering beliefs
- Barriers need to be addressed
- Self-efficacy is key
The Stages of Change Model
The Stages of Change Model evolved from the Transtheoretical Model but focuses specifically on intentional behavior change. It outlines five stages:
- Precontemplation – Not considering change
- Contemplation – Considering change within next 6 months
- Preparation – Planning to act within 30 days
- Action – Recent overt behavior change
- Maintenance – Sustained change for over 6 months
This model highlights that change involves both cognitive shifts (early stages) and overt behavior change (later stages). Different change processes are relevant at each stage.
Key aspects
- Intentional change unfolds through distinct stages
- Different psychological processes drive change at each stage
- Action requires planning and initial behavior change
- Maintenance of new behavior is challenging
The Precaution Adoption Process Model
The Precaution Adoption Process Model describes how people move from lack of awareness to action. It outlines seven stages:
- Unaware – Issue never crossed mind
- Unengaged – Heard about issue but not attending to it
- Undecided – Considering pros and cons of acting
- Decided not to act – Concluded action unnecessary
- Decided to act – Concluded action worthwhile
- Acting – Implementing action
- Maintenance – Sustaining action over time
This model highlights the role of mental engagement and decision-making in motivating action. Interventions aim to shift people through these stages.
Key aspects
- Awareness and mental engagement precede action
- Weighing pros and cons leads to decisions about acting
- People may decide action is unnecessary
- Sustained action requires commitment and effort
The Theory of Planned Behavior
The Theory of Planned Behavior explores how behavior intent forms and leads to actions. It outlines three drivers of intent:
- Attitudes – Evaluations of the behavior’s consequences
- Subjective norms – Perceived social pressure regarding the behavior
- Perceived behavioral control – Perceived ease/difficulty of performing the behavior
These factors combine to determine behavioral intention, which predicts engagement in the behavior when there is actual control over the behavior.
Key aspects
- Attitudes, social norms, and perceived control shape intent
- Intentions are a key predictor of behavior
- Perceived and actual control can limit enacting intentions
- Changing attitudes, norms, and perceived control promotes change
Key Similarities and Differences
While behavior change models have unique aspects, they also share some common features:
- Behavior change is a process that unfolds over time.
- Motivation builds through specific stages before action occurs.
- Self-efficacy facilitates progress and enactment of behavior.
- Relapse to earlier stages is common and not considered failure.
Key differences between models include:
- Number and description of stages
- Extent of focus on cognitive vs. behavioral processes
- Inclusion of social and environmental factors
- Role of habits in sustaining change
Selecting suitable models depends on behavior type and context. Integrating concepts across models offers a more complete picture of the change process.
Application to Health Behaviors
These models offer useful frameworks for promoting public health behaviors like:
- Healthy eating
- Physical activity
- Reducing alcohol use
- Quitting smoking
- Medication adherence
For example, applying the Health Belief Model to encourage healthy eating involves raising awareness of diet-related health risks while emphasizing the benefits of and ways to overcome barriers to healthy eating. Motivational interviewing can also elicit and reinforce people’s own reasons for change.
Strategies Based on Change Models
Some strategies for applying behavior change models to health promotion include:
- Tailor messaging and strategies to stage of change
- Promote awareness of health risks to increase engagement
- Highlight benefits of behavior change
- Provide counseling to improve self-efficacy
- Set incremental goals to build toward target behaviors
- Assist with planning and feedback to enact intentions
- Connect people to social support and positive peer norms
- Foster motivation and skills to maintain change long-term
Different combinations of these strategies are optimal at each stage to promote progress through the behavior change process.
Examples of Staged-Based Interventions
Here are some examples of health interventions tailored to stages of change:
Precontemplation
- Raising awareness through mass media campaigns
- Passive information brochures to prompt contemplation
Contemplation
- Motivational interviewing to elicit change talk
- Decisional balance exercises to weigh pros and cons
Preparation
- Assisting with setting a change start date
- Helping select appropriate strategies/treatments
Action
- Providing skills training and follow-up support
- Giving rewards and positive feedback on progress
Maintenance
- Extended care management and contact
- Relapse prevention planning
Programs spanning multiple sessions can combine activities suited to participants’ current stages.
Tailoring Public Health Campaigns
Media campaigns promoting behavior change can also segment target audiences into stages to tailor messages, as exemplified in this table:
| Stage | Potential Campaign Strategies |
|---|---|
| Precontemplation | Increase risk awareness; promote positive outcomes of change |
| Contemplation | Motivate intention to act; prompt evaluation of pros and cons |
| Preparation | Assist with formulating plans; boost self-efficacy |
| Action | Highlight health benefits; assist with barriers; reinforce gains |
| Maintenance | Remind of benefits; assist with coping strategies and supports |
This staged approach allows communication strategies to be matched to individuals’ readiness.
Criticisms and Limitations
While behavior change models highlight key influences and processes, limitations include:
- Linear stage models may be unrealistic; change can be cyclical and recursive
- Cognition is overemphasized compared to emotional, social, and contextual factors
- Categorization into discrete stages can be simplistic
- Behavior initiation and cessation may involve distinct processes
- Habit formation and disruption require additional considerations
Additionally, these models focus on the individual level, whereas socioecological frameworks address broader determinants of behavior.
Integrated Frameworks
Some emerging frameworks integrate key constructs across models and apply them to specific behaviors. Some examples include:
- The Integrated Behavior Model – combines the Theory of Reasoned Action, Theory of Planned Behavior, Social Cognitive Theory and Health Belief Model.
- The Technology Acceptance Model – applies concepts from behavioral models to understand technology use.
- The Health Action Process Approach – incorporates motivation, volition, and self-regulation to explain health behaviors.
These integrated frameworks aim for a comprehensive picture of behavior change.
Conclusion
In summary, major behavior change models include the Transtheoretical Model, Health Belief Model, Stages of Change, Precaution Adoption Process, and Theory of Planned Behavior. While differing in specifics, common principles are that behavior change unfolds over time, involves cognitive shifts and intention formation, and requires perceived ability and motivation to progress through stages. Knowledge of behavior change models can aid in promoting health behavior change through targeted strategies matched to individuals’ readiness to act.
