Models for Health Education – Stages of Change

The Transtheoretical Model was developed by James O. Prochaska and Carlo Di Clemente in 1977.  It outlines the different stages a person goes through to make a health behavior change, hence the reason it is also called “Stages of Change”.  It starts by the person not being ready to make a change to the final stage of dropping the old behavior in favor of a new one.  Here is what the model looks like (By Philciaccio (Own work) [CC BY 3.0 (], via Wikimedia Commons):


Here is the meaning of each stage:

  • Precontemplation: At this point the person is not aware of any change that needs to be made. They are not ready to change.
  • Contemplation: This is the realization that the current behavior is unhealthy and it needs to change to something better.  This is where a person starts to research whether change is beneficial.
  • Preparation: This is where small changes are made. The person tries out the new behavior.
  • Action: Bigger changes are now being made. The person is going all in on the behavior change.
  • Maintenance: Sticking with a behavior change for six months.
  • Termination: Not looking back. The person has changed and has no desire to go back to their old ways.

My issue with this model is that it’s overly simplistic and does not account for barriers.  One thing in particular I see is that the person may see the necessity to change their behavior and will want to change it.  However, if there are strict cultural tenants that person adheres to, they may not be able to make that change easily.  For example, if someone knows they have to change their diet to be healthier and they can do so at home.  However, as their culture dictates, every Sunday the extended family has a big feast where the preparers of this feast would be horribly offended if the person didn’t eat as much as their stomach will fit.  That would make eating healthy portions near impossible to stick to.  It’s also not just convincing a person to change, in this case it would be the whole family that would need to be accepting of the change.

There are also many times where a person refuses to believe a behavior is unhealthy.   The model suggests a person will always follow this path when hearing their behavior is unhealthy.   The model does not account the difficulty in moving someone along this continuum.  They model also has a decision balance at each stage.  This is the balance between the pros and cons of change.  The model suggests a person will balance the pros and the cons rationally and come to make the decision to change.  In reality, that doesn’t happen.  If the pros are health benefits but the big con is your family will not support you, you’re not going to make the change.