The Stages of Change – How We Make Health-Related Behaviour Changes

The following blog discusses the Stages of Change, the processes we go through when making any health-related behaviour changes. It was originally was posted as six different blogs. Enjoy!

Is It Time For Change?

Could you have better posture? Would better posture equate to pain-free movement? Do you experience pain with daily activities or exercise? Do you think changing your current behaviour could have a positive impact on how you think, feel and move?

The Health Belief Model looks at how you make actions to better your health.

Can you recognise that you had have a health-related issue that needs to be addressed?

• You constantly have a sore back or tight neck and shoulders at the end of your work day.

Let’s change your perception of susceptibility to move towards behaviour change.

Do you understand that you may be vulnerable to a poor health outcome?

• You finish more days with a sore back or neck than not.
• You’ve developed headaches and can’t focus on your work or your kids.
• You’ve stopped your normal exercise routine; its constantly aggravating your lower back

Let’s increase your awareness of how serious the outcomes of your current behaviour are in order to improve your quality of life.

Do you realise that changing your behaviour can be beneficial and the benefits of that change will outweigh any associated costs?

• Better posture: alleviation of headaches, neck pain and back pain.
• Pain-free movement: regular exercise, able to play with the kids without worrying you’ll aggravate your old back injury.
• In the long run, you’ll spend less money on physio, chiro, osteo, massage, etc.

Once we understand your individual perspective, it is important to understand how modifying factors can affect your decision to make a change.

What is the perceived threat? Will your poor sitting posture lead to ongoing lower back or neck pain? Does your sedentary job contribute? Are those niggles in your neck or lower back impacting your ability to exercise?

If you answered yes to any of these questions…change may be just what you need!

This Isn’t For You!

You don’t think you have a problem. You don’t know you have a problem.

How you can you change your current behaviour if you don’t realise it’s problematic in the first place?

Above, I discussed how you first need to recognise that you have a health-related problem to make a change.

Becoming more aware of the potential negative consequences of that behaviour is part of the process to push you along the path to making a positive change to your current situation.

As a physiotherapist I use the example of posture and pain-free movement as it is something I address on a daily basis. It can be easy to recognise that you need to make a change, but it is completely different to actually follow through with it.

Prochaska and Diclemente developed the Stages of Change as part of their Transtheoretical Perspective. When making changes to better ourselves you will go through these stages, albeit not in a linear fashion.

The first stage is Precontemplation.

How do you know if you are in this stage?

You don’t.

You don’t think you have a problem.

You’re not aware your current behaviour is having a negative impact on your health.

All that sitting, working over that laptop. All those nights you complain about tight neck and shoulder muscles and your sore back. You probably know your posture isn’t great.

You just haven’t made the connection.

In this stage you have no intention to change.

Those around you are more aware you have a problem and may encourage you do something about it. They may suggest: “Maybe you should go see my physio about the back pain you’re always complaining about”.

It is only once you recogniz\se the issue and plan to make a serious change that you can you progress on to the next stage…Contemplation.

Thinking About A Change…

Now you’re starting to think.

To ponder.

To contemplate.

About making that change that has been a long time coming.

You’re thinking, “I have a problem with my posture and I really think I should do something about it.”

You’ve thought about your current situation. You’ve considered the impact your behaviour is having on your health and well-being. You realise something needs to change.

Above I discussed the first stage of change, precontemplation; the stage in which you are unaware that your current behaviour is negatively impacting your health.

People can remain in this stage for a long time; in one study looking at smokers, they remained in this stage for 2 years without making any shift toward contemplation.

In the second stage, contemplation, you have acknowledged that you have a problem and you begin to think about how you can address it, but have yet to make any concrete plans.

However, unlike those in the last stage, you’ll making a move somewhere in the next 6 months.

It’s not easy though.

You’re struggling.

Maybe your posture isn’t that bad.

Surely seeing someone to address it won’t help that much.

You’re not sure whether the energy and cost will be worthwhile.

Or maybe it will?

You’ve noticed how you slouch in photographs.

And your chin pokes out.

You’ve always had tension in your neck and shoulders, and now the headaches are getting worse.

Surely it can get better?

Lightbulbs are going off. Your posture isn’t great; you don’t fully understand why, but may be thinking your headaches are due to the long hours sitting staring at your computer screen.

You’ve done some thinking. You may even have had someone who has pushed you along the way. But you’re not there yet, now you have to prepare yourself!

Are You Getting Ready?

The third stage in the stages of change model is preparation.

To prepare is “to make something ready for use or consideration.”

Simply put, to prepare is to get ready for action!

Thus far, you have moved for being unaware you need to change to becoming aware – once you started to connect the dots- that your current behaviour is detrimental to your overall well-being and quality of life.

Now that you are aware your posture is a problem and you have made the connection to how it is contributing to your headaches and back pain, you need to do something about it.

You’re ready to change.

But wait! Is it that easy?

Step 1: Unaware of problem.
Step 2: Aware of problem.
Step 3: Problem solved?

If only it was that easy.

You’re just getting started!

Now it’s time to think about how you’re going to make that change.

But you’re ready.

You’re taking steps in the right direction.

You’ve talked to a few friends.

You’ve gone online and done your research.

You’ve contacted the physiotherapist your good friend recommended.

You’ve been doing some reading. Tips on how to fix your posture at work.

You’ve even made some adjustments to your work station. Youtube videos. Instagram posts.

You’re seeing a lot of information out there. Almost to the point of excess. The problem now is that there is too much information to the point of confusion.

You made an appointment with the physio, but then you cancelled it. The week got too busy or something more important came up.

This is common for people in the preparation stage. Taking the steps, but failing to follow through. You’re still ready and in the coming weeks you’ll be more successful.

Take 22: Action!

At this point you’ve probably made more than a few attempts to change your behaviour.

And more than likely you’ve failed a couple times too.

But that’s part of the process. Remember you don’t move through the stages in a linear fashion, but spiral back and forth.

Anyway, you’ve thought about the changes you needed to make, you’ve done your research and now you’ve made the plunge. And in the end, doing what you needed to do wasn’t so hard.

You made it the physiotherapy appointment you booked. You had your assessment and learned a few interesting things. Your headaches and back pain both ARE related to your posture. Your work station needs a few modifications. The way you sit could use a bit of work, and you really DO need to get up from your desk more than 3 times a day!! And of course, you were given a few exercises – got to remember to do those now too!

Just like you, I too have had to struggle through the processes of change.

Getting back into regular exercise after a break.

Being more aware of my posture.

Returning to my morning meditation ritual.

We’re all fallible, so don’t be so hard on yourself.

Now that your taking action, people are starting to take notice.

Your co-workers comment on how much your posture has improved.

Your partner notices you’re not complaining about your headaches or your lower back pain.

It feels good that people are noticing. After all, you did put a lot of time and energy into make all these changes happen.

You’ve now made the change and have kept with it all for the last 6 months.

Now can you continue to maintain your new healthy behaviours or will you relapse? How do you set yourself up to succeed? Is failure inevitable?

Keep Going!

You did it.

You made the changes necessary and you’re sticking with it.

It only took you 22 attempts (give or take) and months of going back and forth deciding whether changing your current health behaviour would be worth it in the long run.

Well it was.

Worth it.

Aren’t you happy you made it this far?

The fifth stage. The MAINTENANCE stage.

At this point, you are working hard to consolidate the gains you have made over the last several months and preventing yourself from relapse. Stabilising your behaviour change and avoiding relapse are the hallmarks of this stage.

I used the example of poor posture and how it can negativity affect your body resulting in headaches and lower back pain. This is because I am a physiotherapist and posture is part of my passion. Re-training posture and movement allows people to move better, feel better and ultimately be better!

If you have seen a physiotherapist, you likely received education on correcting your posture as part of your treatment, and with the right exercises and manual therapy felt much better for it.

Sometimes, good postural advice is all you need!

In this series of blog posts, posture and pain are examples. But you could easily substitute other health behaviours such as regular exercise, healthy eating, quitting smoking…the list goes on.

To change any other health behaviour you will go through the same stages, from precontemplation all the way to action.

The internal conversations will be very similar.

There will be false starts. You will zig zag through the stages of change.

Remember, you don’t move through them in a linear fashion.

And once you make the desired changes to your target behaviour, don’t forget to reward yourself for all the hard work.

Keep going! Your body and your mind will thank you for it.

Go Again

So, you messed up.

You missed a day at the gym.

And a few days of your physio exercises.

But it’s ok. You can get back on track. It will be easy.

Or not.

You did it again! No gym for 3 weeks. No physio exercises for the last 4 weeks.

Now you’ve officially RELAPSED.

You’ve failed to maintain all those healthy changes you put in place to better your health.

And you were loving the results.

But the holidays came around and you slipped up and then it was something else, and you never got back on track.

Now you don’t feel so good. Your lower back hurts and you’re having more frequent headaches.

You feel like a failure. You’re ashamed. You’re embarrassed. You feel guilty.

Truly demoralised. How could you let all that hard work go to waste?

If you’ve reached this point of self-doubt and self-depreciation, you may return to the precontemplation stage. Here you’ll be back to resisting the idea of behaviour change.

In a study by Prochaska and DiClemente, 15% of relapsers regressed to the precontemplation stage, while the remaining 85% moved back to contemplation and then preparation and eventually to action.

So, you can get back on track. And maybe it will be easier the second time.

Winston Churchill once said, “Success is not final, failure is not fatal: it is the courage to continue that counts.”

Key word – continue. Change is not linear. You will zig. You will zag.

You must keep going.

For most of us it is inevitable that at some point we will fail to maintain all the healthy behaviour changes we make to better our lives. Ideally when we do relapse it’s only for a few days or couple weeks at most. If you do miss a few days or couple of weeks, it is not the end.

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