Stages of behaviour change models

The behaviour-change-stage model¹ offers an explanation of the stages through which an individual will progress during a change in health behaviour. It is not so much a theory of how behaviour change happens as a ‘meta-theory’ of stages people go through in changing their behaviour, regardless of the underlying drivers of that change.

This model is particularly associated with notions of ‘relapse’ behaviour, and has been used widely in the treatment of alcoholism and smoking. It divides behaviour change into the following stages:

• pre-contemplation – lack of awareness of risk, or no intention to change risk behaviour
• contemplation – beginning to consider behaviour change without commitment to do anything immediately
• preparation – a definite intention to take preventive action in the near future
• action – modification of behaviour, environment or cognitive experience to overcome the problem
• maintenance – the stabilisation of the new behaviour and avoidance of relapse.

This model was used as the basis for the US AIDS Community Demonstration Projects, which targeted five at-risk populations in five US cities. Messages were developed from the experiences of community members to model behaviour-change steps, and messages were developed to target people considered to be at each of these five stages.

A similar model is Catania’s AIDS Risk Reduction Model,² which divides behavioural change into three stages, each with several influencing factors.

Both theories attempt to define a sequence of stages that go from behaviour initiation to adoption to maintenance. Successful interventions should be the ones that focus on the particular stage of change the individual is experiencing and facilitate forward progression.

Presumably, knowledge of HIV/AIDS or more general risk perceptions may serve to prompt change when people are not yet performing the behaviour, but may not elicit movement beyond the initial stage. Similarly, inducing favourable attitudes may be important at the very initial stages, but not when people are already performing the behaviour and are aware of its outcomes. People who have already adopted the idea of change and begun to perform the behaviour may then need new skills to foster complete success.

This finding should give some cheer to the developers of mass-media and prevention-information campaigns. They imply that although behavioural-skills training is generally a necessary part of an effective HIV-prevention programme, the provision of information, although it does not effect change in itself, can prompt people to think about changing and can help them maintain safer behaviour when they have made changes.