Assessing Readiness for Learning or Change


One of the most important aspects of providing health promotion education is assessing the patient’s stage of change and tailoring the intervention to match. The stages of change are part of the Transtheoretical Model of Change and have been used since 1990 to assist with behavior change from cessation of tobacco, alcohol and drugs to dietary modification, exercise adoption and pregnancy prevention.4,11

Stages of change consist of five stages along a continuum that are associated with a person’s interest and motivation to change current behavior. In the stages of change, individuals move from being unaware or unwilling to do anything about a problem to considering the possibility of change, to preparing to make a change, to action to make the change and finally to a maintenance phase.13

Stages of ChangeCharacteristics of Stages of Change
Stage 1PrecontemplationThe individual is not willing to change oral health habits in the next 6 months and may not even recognize there is a problem.
Stage 2ContemplationThe individual is considering change and undergoing a process of evaluating the pros and cons of the problem behavior and the changes that need to take place. This person is open to collaboration with healthcare providers and is ready to change current behavior within 6 months.
Stage 3PreparationThe individual is ready to make a commitment to change oral health habits in the next 30 days and to set a target date.
Stage 4ActionChange or modification of behaviors actually takes place.
Stage 5MaintenanceThis individual has had 3 to 6 months of successful behavior change and is focusing on lifestyle modifications in order to avoid relapse and stabilize behavior change.

At any one time 80% of people are in either the precontemplation or contemplation stages of change, yet a majority of interventions are oriented at those 20% in the action stage.11 This emphasizes the need to develop interventions to assist moving those in precontemplation and contemplation stages to the action stage in order to increase the impact and effectiveness of oral health education. The following diagram (Figure 1) provides an example of the strategies to assist in moving a patient from one stage to the next.

Figure 1. Stages of Change and Strategies for Promoting Change.

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