The Stages of Change model can contribute to interactions as personal as communications between counselor and client, and as broadly applied as a new program or intervention. The key, of course, is finding ways to learn and interpret information about participants' stages of change.

Here are three tools to consider: A quick stage assessment that can be adapted for different behaviors, a chart listing pros and cons, and an organizational assessment.

Instructions: Answer yes or no to the following three questions:

1. Are you seriously intending to change in the next six months?
   
   
2. Are you planning to change in the next month?
   
   
3. Have you tried to change in the past 12 months?

• Precontemplation: No to #1


• Contemplation: Yes to #1 and No to either #2 or #3


• Preparation: Yes to #1, #2, and #3

We all think we know the pros and cons of changing a behavior, but, in fact, it always helps to write them down and to be as specific as possible. Whether you are contemplating a change yourself or helping someone else do so, try filling out this chart and repeat it at regular intervals to track how your sense of pros and cons shifts over time.

Be prepared for changes in your list. For example, your initial interest in diet and exercise might be driven by appearance alone, but over time, you may see the benefits as having to do with improved overall health and energy. Likewise, a smoker may initially quit to prevent his family from nagging him about it, but over time, he may gain a sense of accomplishment and triumph — and feel better as well.

These types of motivations are not mutually exclusive, of course, but it does help to know why you are pursuing a goal and how your perceptions of it may change over time. Also, seeing the list of pros grow and the list of cons shrink is a sure sign that you are moving from one stage to another!

Beyond using Stages of Change on a personal level or one-on-one with clients, how do you incorporate it into your program's or agency's work? Here are some suggestions, adapted from a column by Larry Chapman in The Art of Health Promotion:³

• Assess your own knowledge and understanding: Do you know the specifics of each stage and how the processes contribute?



• Assess your program's target groups or populations. Does the Stages of Change model make sense for them and for your interaction with them? Are there ways to assess your clients' stages? Do they group together in a way that would make sense for program delivery (e.g., all precontemplators and contemplators receive this type of intervention, while those in the preparation or action stages receive a different intervention)?



• Where can your program incorporate Stages of Change and its processes? How can staff support stage-sensitive progress for clients or participants? How can staff reinforce Stages of Change concepts? Beyond the interventions themselves, are there opportunities to collect and evaluate data on stages? Could this data be incorporated into screening? Staff training?



• Identify new opportunities. Looking ahead, how could Stages of Change contribute to even more effective programs and outcomes? What's missing from your current set-up that would help people in your programs change their behaviors?