There are four principal elements and assumptions of change theory: a category system to define the stages, an ordering of the stages, an explanation of common barriers facing people in the same stage, and an explanation of barriers facing people in different stages.
1. A Category System to Define Stages
Given the theoretical nature of health theories, there is no textbook definition for how stages should be written or implemented (Weinstein). Simple human diversity makes it impossible to classify everyone into a stage of a health theory, but there are still a few general stages of change that recur throughout health theories.
Recurring Stages:
- Behavioral Contemplation : Education, Resources, SES/Demographic
- Efficacy Build-up/ Motivation : Confidence, social support (socio-ecological model)
- Planning/Action : Financial situation, self efficacy level, quality of plan
- Maintenance : Potential relapse, potential termination
Transtheoretical Model Stages:
- Precontemplation
- Contemplation
- Preparation
- Action
- Maintenance
- Relapse/”Termination”
Precaution Adoption Process Model:
- Unaware of issue
- Unengaged by issue
- Undecided about acting—->Decided not to act
- Decided to act
- Acting
- Maintenance
“Health behaviors do not exist in a vacuum” (Dr. Jessica Kruger). They are influenced and changed by an enormous quantity of social, environmental, and economic variables. An organized system of stages gives health educators greater leverage in creating change and overcoming these variables (Weinstein).
2. An Ordering of the Stages (provide specific health behavior example i.e. weight loss)
With a system of stages created, the next core concept of stage theory is an order for an individual to pass through the stages. Once this order has been developed, it is possible to insert the health behavior. Here we see several examples of health behaviors inserted into the Precaution Adoption Process Model:
Source: Glanz, K., & Bishop, D. B. (2010). The role of behavioral science theory in development and implementation of public health interventions. Annual review of public health, 31, 399-418.
Passing through the stages in the correct order is neither necessary or guaranteed (Weinstein), as both the PAPM model and Transtheoretical Model both take into account relapse in behavior or the decision to not act. Some criticisms against stage theory are that human variables are too varied to create an order to stages at all, or that the time spent in each stage is ambiguous (Munro).
3. Common Barriers to Change Facing People In The Same Stage
Following the creation of order in a health theory, there will still be a lack of detail pertaining to the health behavior, and an accounting must be made of the universal barriers. Helping people overcome health barriers is oftentimes the goal of public health professionals, and many barriers are consistent in different stages of different theories (Weinstein). Some of these common barriers include accessibility, knowledge, attitudes, culture, available resources, finances, and policies (Grol). Any of these barriers can cause an individual to remain in a stage for a lengthy period of time.
Source: Grol, R., & Wensing, M. (2004). What drives change? Barriers to and incentives for achieving evidence-based practice. Medical Journal of Australia, 180(6 Suppl), S57
4. Different Barriers to Change Facing People in Different Stages
While the barriers to change are widely varied, it is also crucial to note that they are not the same across all stages. While lack of motivation may hinder a person from exiting the contemplation stage, it may be a lack of finances that keeps them stuck in the planning stage. The necessity of creating a variety of health interventions stems from this diversity of barriers (Weinstein).
