Stages of Readiness
Stages of Readiness
1. Precontemplation.
• The patient is not ready to act and has no intention of acting in the next six months.
• The patient avoids reading, talking, and thinking about the behavior that needs to be changed.
• The patient feels pressured by others to take action but often has developed defenses to cope with those pressures.
2. Contemplation.
• The patient intends to take action within the next six months.
• The patient substitutes thinking for action.
• The patient appears to be waiting for the right time to take action.
• The patient feels unprepared to change.
• The patient is ambivalent about changing.
3. Preparation.
• The patient begins practicing the behavior.
• The patient intends to start changing the behavior in the next 30 days.
• The patient is more confident and less tempted.
• The patient is most likely to participate in a program and benefit from that program.
4. Action.
• The patient has started to change the behavior.
5. Maintenance.
• The patient has changed the behavior consistently for more than six months.
(For details on how one health plan is integrating these stages in disease management efforts, see story at right. Also, see Case Management Advisor, June 1998, pp. 96-97, 107-108. Descriptions of ongoing research on the stages of readiness and a review of current literature on the model are available at www.uri.edu/research/cprc.)
Is your patient ready to change?
Finding out may be easier than you think
HealthPartners in Minneapolis integrates the Transtheoretical Model of Health Behavior Change into all its health promotion programming. "We use the stages of readiness to find a leverage point to move members up the ladder from pre-action to action stages," says Nico Pronk, PhD, senior director of the Center for Health Promotion for HealthPartners.
A member’s stage of readiness is determined on the basis of a couple of simple questions asked over the telephone, he explains. "The questions link the behavior we’re targeting, such as establishing an exercise routine, to the time frames suggested by the model. For example, we might ask, How likely are you to begin exercising in the next six months?’ The objective is to put the patient in a certain stage and target your interventions based on that stage."
Pronk adds that in HealthPartners’ experience, willingness to communicate is an accurate predictor of a health plan member’s willingness to change. "We’ve found that if a member is willing to talk about health improvement, it’s a great gateway to readiness to change."
Phone calls improve outcomes
HealthPartners also has found that the stages-of-readiness model is an effective tool for changing health behaviors in managed care members. A random sample of members receiving phone-based counseling based on the stages of readiness model to encourage regular physical activity yielded the following outcomes:
• After eight telephone calls during the six-month intervention period, 38% of precontemplators moved into action.
• Of 53% of members in the action stage at baseline, 91% remained in action stages at six month follow-up.
• Members in a control group moved in and out of readiness changes with no across-the-board changes maintained.
"We not only moved members from preaction to action, but more importantly, we prevented members in action stages from relapsing," Pronk says.
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