Module 7: The Stages of Change and Risk Reduction Steps
| Site: | UCSF Collaborative Learning Environment |
| Course: | Advanced Counselor Skills Pre-Training Course |
| Book: | Module 7: The Stages of Change and Risk Reduction Steps |
| Printed by: | Guest user |
| Date: | Friday, July 17, 2026, 11:10 AM |
Description
Module 7: The Stages of Change and Risk Reduction Steps
Module 7:
The Stages of Change and Risk Reduction Steps
Module 7: The Stages of Change and Risk Reduction Steps, Screen 2 of 11
Introduction
Have you ever tried to stop smoking, lose weight, get more exercise, or stop nagging your children? If you have ever tried to make a major change in your behavior, you know how hard it is.
You probably went through several stages, starting with not wanting to change at all. Maybe later you considered the pros and cons of changing for a long time. Perhaps you had a few unsuccessful attempts before you succeeded in making a change, or maybe you’re still thinking about whether you want to try.
That’s totally normal. Two researchers, James Prochaska and Carlo DiClemente, discovered that there is a series of Stages of Change that almost everyone goes through when faced with changing an ingrained behavior.
As HIV test counselors, understanding the Stages of Change can be important. The more we adapt our discussion with a client to the client’s stage, the more likely we are to be effective. Let’s look at those stages.
Introduction
Have you ever tried to stop smoking, lose weight, get more exercise, or stop nagging your children? If you have ever tried to make a major change in your behavior, you know how hard it is.
You probably went through several stages, starting with not wanting to change at all. Maybe later you considered the pros and cons of changing for a long time. Perhaps you had a few unsuccessful attempts before you succeeded in making a change, or maybe you’re still thinking about whether you want to try.
That’s totally normal. Two researchers, James Prochaska and Carlo DiClemente, discovered that there is a series of Stages of Change that almost everyone goes through when faced with changing an ingrained behavior.
As HIV test counselors, understanding the Stages of Change can be important. The more we adapt our discussion with a client to the client’s stage, the more likely we are to be effective. Let’s look at those stages.
Module 7: The Stages of Change and Risk Reduction Steps, Screen 3 of 11
The Stages of Change
According to Prochaska and DiClemente, there are five stages of change:
On the following screens, we’ll look at each stage one at a time.
The Stages of ChangeAccording to Prochaska and DiClemente, there are five stages of change:
Precontemplation
Contemplation
Preparation (Ready for Action)
Action
Maintenance
Contemplation
Preparation (Ready for Action)
Action
Maintenance
On the following screens, we’ll look at each stage one at a time.
Module 7: The Stages of Change and Risk Reduction Steps, Screen 4 of 11
Precontemplation
Prochaska and DiClemente’s research classified people as precontemplative if they had no serious intention to change the problem behavior. People in this stage are often unaware of the problems presented by their behavior--they are not having difficulty in finding solutions, but instead in seeing that a problem exists in the first place. People in the precontemplation stage often seek social services or HIV counseling because of external pressures, for example, from family members, the courts, and employers.
Precontemplation
Prochaska and DiClemente’s research classified people as precontemplative if they had no serious intention to change the problem behavior. People in this stage are often unaware of the problems presented by their behavior--they are not having difficulty in finding solutions, but instead in seeing that a problem exists in the first place. People in the precontemplation stage often seek social services or HIV counseling because of external pressures, for example, from family members, the courts, and employers.
Module 7: The Stages of Change and Risk Reduction Steps, Screen 5 of 11
Contemplation
During the contemplation stage, a person recognizes that a problem exists and is seriously thinking about changing a behavior, but has not yet committed him or herself to taking action. Prochaska and DiClemente’s research classified people as contemplative if they indicated they were seriously considering changing their behavior within the next six months.
In one of Prochaska and DiClemente’s studies of smokers, the most common outcome among 200 contemplators was no progression to the next stage of change over the two years of the study. The contemplation stage can last for long periods of time. The person in this stage knows where he or she wants to go but is not ready to do what is necessary to get there. Contemplators spend considerable effort weighing the pros and cons of the problem and its solutions. The hallmark of this stage is the serious consideration of change without adequate motivation to endure the effort of change and sustain the loss that change requires.
Contemplation
During the contemplation stage, a person recognizes that a problem exists and is seriously thinking about changing a behavior, but has not yet committed him or herself to taking action. Prochaska and DiClemente’s research classified people as contemplative if they indicated they were seriously considering changing their behavior within the next six months.
In one of Prochaska and DiClemente’s studies of smokers, the most common outcome among 200 contemplators was no progression to the next stage of change over the two years of the study. The contemplation stage can last for long periods of time. The person in this stage knows where he or she wants to go but is not ready to do what is necessary to get there. Contemplators spend considerable effort weighing the pros and cons of the problem and its solutions. The hallmark of this stage is the serious consideration of change without adequate motivation to endure the effort of change and sustain the loss that change requires.
Module 7: The Stages of Change and Risk Reduction Steps, Screen 6 of 11
Preparation
During the preparation stage, a person brings together the intention to change and the preliminary behavioral efforts to make the change. Prochaska and DiClemente’s research classified people as preparing if they intended to take action within the next month or had unsuccessfully taken action in the past year.
Preparation might include, for example, someone who wants to stop smoking and has actually cut back the number of cigarettes he or she smokes each day. It might also include someone who had quit completely smoking for two months, relapsed and started smoking again, and intends to quit again within a month.
Preparation
During the preparation stage, a person brings together the intention to change and the preliminary behavioral efforts to make the change. Prochaska and DiClemente’s research classified people as preparing if they intended to take action within the next month or had unsuccessfully taken action in the past year.
Preparation might include, for example, someone who wants to stop smoking and has actually cut back the number of cigarettes he or she smokes each day. It might also include someone who had quit completely smoking for two months, relapsed and started smoking again, and intends to quit again within a month.
Module 7: The Stages of Change and Risk Reduction Steps, Screen 7 of 11
Action
During the action stage, a person makes adaptations in order to change his or her attitudes, behaviors, or environment. Prochaska and DiClemente’s research classified people in the acting stage if they had successfully altered their behavior for a period ranging from one day to six months. The researchers defined “success” using criteria such as complete abstinence from smoking or drug use. The action stage demands considerable time and energy and is notable for overt and visible changes in behavior.
While action can be a dramatic and rewarding stage, merely acting is not the same as successfully achieving and maintaining behavior change. In addition, people in the action stage are particularly susceptible to relapse to an earlier stage: for example, an individual may give up heroin use completely for three months and then use again; or someone may have been consistent about using a condom for every act of anal intercourse for a month and then may slip and have unsafe sex.
Action
During the action stage, a person makes adaptations in order to change his or her attitudes, behaviors, or environment. Prochaska and DiClemente’s research classified people in the acting stage if they had successfully altered their behavior for a period ranging from one day to six months. The researchers defined “success” using criteria such as complete abstinence from smoking or drug use. The action stage demands considerable time and energy and is notable for overt and visible changes in behavior.
While action can be a dramatic and rewarding stage, merely acting is not the same as successfully achieving and maintaining behavior change. In addition, people in the action stage are particularly susceptible to relapse to an earlier stage: for example, an individual may give up heroin use completely for three months and then use again; or someone may have been consistent about using a condom for every act of anal intercourse for a month and then may slip and have unsafe sex.
Module 7: The Stages of Change and Risk Reduction Steps, Screen 8 of 11
Maintenance
During the maintenance stage, a person’s efforts focus on sustaining a change in behavior, preventing relapse to the behavior, and consolidating the gains of the action stage. Prochaska and DiClemente’s research classified people as “maintaining” if they had successfully sustained their behavior change for six months or longer.
Maintenance was once considered static, as represented by the statement, “Once you’re there, you’ve arrived.” It is now viewed as the continuation of change, rather than its absence, as represented by the statement, “Once you’re there, there is still plenty of work to do.” Relapse to an earlier stage is always possible.
Maintenance
During the maintenance stage, a person’s efforts focus on sustaining a change in behavior, preventing relapse to the behavior, and consolidating the gains of the action stage. Prochaska and DiClemente’s research classified people as “maintaining” if they had successfully sustained their behavior change for six months or longer.
Maintenance was once considered static, as represented by the statement, “Once you’re there, you’ve arrived.” It is now viewed as the continuation of change, rather than its absence, as represented by the statement, “Once you’re there, there is still plenty of work to do.” Relapse to an earlier stage is always possible.
Module 7: The Stages of Change and Risk Reduction Steps, Screen 9 of 11
Matching Interventions to Stages
The following table illustrates the kinds of interventions that may be most effective for clients in each stage of behavior change. To find more information on the stages of change, including examples of interventions and information on eliciting self-motivational statements, go to the following article: Harm Reduction and Motivational Interviewing
Ask yourself: Why won’t suggesting a risk reduction option help a client who is contemplative? If you’re not sure, reread the last few screens.
Matching Interventions to Stages
The following table illustrates the kinds of interventions that may be most effective for clients in each stage of behavior change. To find more information on the stages of change, including examples of interventions and information on eliciting self-motivational statements, go to the following article: Harm Reduction and Motivational Interviewing
Ask yourself: Why won’t suggesting a risk reduction option help a client who is contemplative? If you’re not sure, reread the last few screens.
Module 7: The Stages of Change and Risk Reduction Steps, Screen 10 of 11
Precontemplative and Contemplative—
Practice Exercise
While it is important to be familiar with each of the stages of change, research has shown that 85 percent of people who come in to test at California state-funded HIV test sites are in either the pre-contemplative or the contemplative stage. Sometimes it can be difficult to tell the difference between these two stages, but it is important to understand the difference, since the interventions will be very different for each stage.
Read the statements below in the left column, then click and drag the statement to the column you feel is the appropriate state of change. If you dragged the statement to the correct column, then you'll get the thumbs up. If incorrect, you'll get a thumbs down. Either way, you will see the correct answer on the far right with the reason why it is either precontemplative or contemplative.
Don’t worry: there are no grades for this game. I just want you to feel comfortable with understanding the differences between the two stages.
AHP has compiled more information on the Stages of Change in a PDF that you can download from our Web site
Precontemplative and Contemplative—
Practice Exercise
While it is important to be familiar with each of the stages of change, research has shown that 85 percent of people who come in to test at California state-funded HIV test sites are in either the pre-contemplative or the contemplative stage. Sometimes it can be difficult to tell the difference between these two stages, but it is important to understand the difference, since the interventions will be very different for each stage.
Read the statements below in the left column, then click and drag the statement to the column you feel is the appropriate state of change. If you dragged the statement to the correct column, then you'll get the thumbs up. If incorrect, you'll get a thumbs down. Either way, you will see the correct answer on the far right with the reason why it is either precontemplative or contemplative.
Don’t worry: there are no grades for this game. I just want you to feel comfortable with understanding the differences between the two stages.
AHP has compiled more information on the Stages of Change in a PDF that you can download from our Web site
Module 7: The Stages of Change and Risk Reduction Steps, Screen 11 of 11
Conclusion
How does what we learned about the Stages of Change relate to Laurie and Ingrid? Laurie is doing at least two things that put her at risk for HIV transmission: She’s having unprotected intercourse with her boyfriend, who is in the window period; and she’s sharing needles and works with him and sometimes other people, too, when they can’t get to the needle exchange.
Ingrid needs to use open-ended questions to find out how Laurie feels about changing either of these situations. If Laurie is precontemplative, it won’t do any good for Ingrid to offer lots of good options, because Laurie won’t be interested in changing.
If Laurie is contemplative, helping her think about the pros and cons of changing—in a nonjudgmental way—could be supportive and effective.
If Laurie is in the preparation stage, then Ingrid might try to find out if Laurie has ideas for how she could change and whether Laurie is interested in more options.
In the next module, we’ll see more of Ingrid and Laurie’s counseling session.
Conclusion
How does what we learned about the Stages of Change relate to Laurie and Ingrid? Laurie is doing at least two things that put her at risk for HIV transmission: She’s having unprotected intercourse with her boyfriend, who is in the window period; and she’s sharing needles and works with him and sometimes other people, too, when they can’t get to the needle exchange.
Ingrid needs to use open-ended questions to find out how Laurie feels about changing either of these situations. If Laurie is precontemplative, it won’t do any good for Ingrid to offer lots of good options, because Laurie won’t be interested in changing.
If Laurie is contemplative, helping her think about the pros and cons of changing—in a nonjudgmental way—could be supportive and effective.
If Laurie is in the preparation stage, then Ingrid might try to find out if Laurie has ideas for how she could change and whether Laurie is interested in more options.
In the next module, we’ll see more of Ingrid and Laurie’s counseling session.