Change Occurs in Stages

The Stages of Change Model devised by Prochaska and Di Clemente suggests that there are five stages of behavior change.1 These stages are:

  1. Precontemplation – not thinking about changing.
  2. Contemplation – beginning to think change may be a good thing.
  3. Preparation – making small changes.
  4. Action – undertaking the new behavior.
  5. Maintenance – the new behavior becomes habitual.1
Figure 2. The Stages of Change Model.
Figure 2 - Stages of Change
Adapted from:

Taking an example from dentistry, a patient who has never considered their soda-drinking habit to be relevant to the number of fillings they have (precontemplation) may be advised by their dentist to reduce sugary soda intake (contemplation). The patient might then start to make small changes at first by reducing the number of sodas they get at the vending machine at the office (preparation) and after another prompt from the dental professional, might cut out sodas altogether, as well as avoid the candies and chocolate they snack on throughout the day (action). Over time, the caries-preventing low-sugar diet becomes the norm (maintenance).

To help the student understand how stages of change can be applied to everyday statements, here are a few examples:

  • “Interproximal cleaning? I have never heard of that!” – example of precontemplation.
  • “Could you tell me more about x-rays? What are the pros and cons?” – example of contemplation.
  • “The first step I’m taking is that I’m stopping going to the office candy jar.” – example of preparation.
  • “I made an appointment to have my teeth cleaned.” – example of action.
  • “It’s been almost 6 months now that I’ve stopped drinking sodas and snacking on candy throughout the day.” – example of maintenance.

The dental professional should be aware that an individual may move back and forth between the stages, occasionally falling back to previous ones (relapsing). It is important to continue to encourage and advise a patient even when they relapse to previous unhealthy habits. Encouragement is a positive act, which can help the patient re-establish a healthy habit. On the other hand, reprimanding a patient when they relapse (such as if they go back to sipping sodas throughout the day) could lead to a sense of failure in the patient that does not encourage the re-establishment of a healthy behavior.3,7-9

The health professional should also be aware that the first two stages of change—precontemplation and contemplation—can be very lengthy, and a host of factors, such as the barriers to change mentioned before, can influence whether or not a patient takes the recommended action. Also, even though no change has yet been observed, it is very possible that a patient is moving toward change; they may simply be lingering in the contemplation stage and continuing to gather information or seek advice or support that will bring on the change.3