The transtheoretical model of health behavior change is described and supporting empirical work is presented that reviews the central constructs of the model: the stages of change, processes of change, decisional balance, confidence, and temptation. Model-based applications to a broad range of problem behaviors are summarized. Applications to human immunodeficiency virus (HIV) prevention behavior changes are highlighted for each variable. Finally, several questions about the area of sexual behavior change to reduce risk of HIV exposure are explored and future research ideas are described within the context of this model.
Get full access to this article
View all access options for this article.
References
1.
Prochaska JO : Assessing how people change. Cancer67:805-807, 1991.
2.
Prochaska JO, DiClemente CC: Stages of change in the modification of problem behaviors, in Hersen M, Eisler RM, Miller PM (ed.): Progress in Behavior Modification . Sycamore, IL: Sycamore Publishing Co, 1992.
3.
Catania JA, Kegeles SM, Coates TJ: Towards an understanding of risk behavior: An AIDS risk reduction model (ARRM . Health Educ Q17:53-72, 1990.
4.
Coates TJ: Strategies for modifying sexual behavior for primary and secondary prevention of HIV disease. J Consult Clin Psychol58:57-69, 1990.
Kelly JA, Murphy DA: Psychological interventions with AIDS and HIV: Prevention and treatment . J Consult Clin Psychol60:576-585, 1992.
7.
Prochaska JO, DiClemente CC: Common processes of change for smoking, weight control, and psychological distress, in Shiffman S, Wills T (eds): Coping and Substance Abuse . New York, NY: Academic Press , 1985.
8.
Prochaska JO, DiClemente CC: Toward a comprehensive model of change, in Miller W, Heather N (eds.): Treating Addictive Behaviors. New York, NY: Plenum Press, 1986.
9.
Prochaska JO , DiClemente CC, Norcross JC: In search of how people change: Applications to the addictive behaviors. Am Psychol47:1102-1114, 1992.
10.
Prochaska JO, Prochaska JM: A transtheoretical model of change for addictive behaviors, in Gossop M, Casas M (eds.): Recaidaz y Prevencion de Recaidor, pp. 85-136Sitges , Spain: Citran, 1993.
11.
Prochaska JO, Prochaska JM: Why don't continents move? in Arkowitz H (ed.): Why don't People Change? New Perspectives on Resistance and Noncompliance. New York, NY: Guilford (in press).
12.
DiClemente CC , Prochaska JO, Fairhurst SK, Velicer WF, Velasquez MM, Rossi JS: The process of smoking cessation: An analysis of precontemplation, contemplation, and preparation stages of change. J Consult Clin Psychol59:259-304, 1991.
13.
Prochaska JO , DiClemente CC: Stages and processes of self-change in smoking: Towards an integrative model of change. J Consult Clin Psychol51:390-395, 1983.
14.
Prochaska JO , DiClemente CC: Self change processes, self-efficacy, and decisional balance across five stages of smoking cessation, in Anderson PF, Mortenson LE , Epstein LE (eds): Advances in Cancer ControlNew York, NY: Alan R. Liss, Inc., 1984 .
15.
Prochaska JO , DiClemente CC, Velicer WF, Rossi JS: Standardized, individualized, interactive and personalized self-help programs for smoking cessation. Health Psychol12:399-405, 1993.
16.
Redding CA , Rossi JS, Velicer WF, Prochaska JO: The Pros and Cons of Safer Sex: A Measurement Model. Paper presented at the 97th annual convention of the American Psychological Association , New Orleans, LA, August 1989.
17.
Prochaska JO , Harlow LL, Redding CA, Snow MG, Rossi JS, Velicer WF: Stages of Change, Self Efficacy, and Decisional Balance of Condom Use in a High HIV Risk Sample . Technical Report for Centers for Disease Control Contract Grant 0-4115-002, 1990.
18.
Freeman A., Cohn D., Corby N., Wood R.: Patterns of sexual behavior change among homosexual/bisexual men: Selected U.S. sites, 1987-1990. MMWR40:792-794, 1991.
19.
O'Reilly KR , Higgins DL: AIDS community demonstration projects for HIV prevention among hard-to-reach groups. Public Health Rep106:714-720, 1991.
20.
Grimley D. , Riley GE, Prochaska JO, Redding CA, Ruggiero L., Rossi JS, Velicer WF: The Stages of Change Model and Reproductive Health in High-Risk Populations . Technical Report for the Centers for Disease Control and Prevention Contract Grant CSA-92-109, 1992.
21.
Schnell DJ, Galavotti C., O'Reilly KR: An evaluation of sexual behavior change using statistical and cognitive models . Stat Med12:219-228, 1993.
22.
Redding CA, Rossi JS: The processes of safer sex adoption. Ann Behav Med15:S106 (Abstract), 1993(Suppl.).
23.
Redding CA , Rossi JS: Self-Efficacy for Safer Sex: Stage and Gender-Based Differences on Situational Subscales. Paper presented at 27th annual meeting of the Association for the Advancement of Behavior Therapy , Atlanta, GA, November 1993 .
24.
Grimley D., Riley G., Bellis JM, Prochaska JO: Assessing the stage of change and decision-making for contraceptive use for the prevention of pregnancy, sexually transmitted diseases, and acquired immunodeficiency syndrome. Health Educ Q20:455-470, 1993.
25.
DiClemente CC, Hughes S.: Stages of change profiles in outpatient alcoholism treatment. Journal of Substance Abuse2:217-235, 1990.
26.
Norcross JC , Prochaska JO, Hambrecht , M.: Treating ourselves vs. treating our clients: A replication with alcohol abuse. Journal of Substance Abuse3:123 - 129, 1991 .
27.
Snow MG, Prochaska JO, Rossi JS: Processes of change in alcoholics anonymous: Maintenance factors in long-term sobriety. J Stud Alcohol (in press).
28.
Rossi JS, Rosenbloom D., Monti PM, Rohsenow DJ, Prochaska JO, Martin RA: Transtheoretical Model of Behavior Change for Cocaine Use. Paper presented at the 101 st annual meeting of the American Psychological Association in Toronto, Ontario, Canada, August 1993.
29.
Rossi JS, Rosenbloom D., Monti PM, Rohsenow DJ, Redding CA, Prochaska JO: Stages of change and the pros and cons of quitting cocaine (unpublished manuscript).
30.
O'Connell D. , Velicer WF: A decisional balance measure and the stages of change model for weight loss . Int J Addict23:729-750, 1988.
31.
Clark MM, Abrams DB, Niaura RS, Eaton CA, Rossi JS: Self-efficacy in weight management. J Consult Clin Psychol59:739-744, 1991.
32.
Curry SJ, Kristal AR, Bowen DJ: An application of the stage model of behavior change to dietary fat reduction . Health Educ Res7:95-105, 1992.
33.
Prochaska JO , Norcross JC, Fowler JL, Follick MJ, Abrams DB: Attendance and outcome in a work site weight control program: Processes and stages of change as process and predictor variables . Addict Behav17:35 -45, 1992.
34.
Rossi SR, Rossi JS, Rossi-DelPrete LM, Prochaska JO, Banspach SA, Carleton R.: A processes of change model for weight control for participants in community-based weight loss programs. Int J Addict29:161-177, 1994.
35.
Campbell MK , DeVellis BM, Strecher VJ, Ammerman AS, DeVellis RF, Sandler RS: The impact of message tailoring on dietary behavior change for disease prevention in primary care settings. Am J Public Health84:783-787, 1994.
36.
Rossi JS, Rossi SR, Velicer WF, Prochaska JO: Motivational readiness to control weight: The transtheoretical model of behavior change, in Allison DB (ed.): Methods for the Assessment of Eating Behaviors and Weight Related Problems . Newbury Park, CA: Sage Publications Inc. (in press).
37.
Sonstroem RJ : Psychological models, in Dishman R (ed.): Exercise Adherence. Chicago, IL: Human Kinetics Books, 1988.
38.
Marcus BH, Banspach SW, Lefebvre RC, Rossi JS, Carleton RA: Using the stages of change model to increase the adoption of physical activity among community participants. Am J Health Promotion6:424-429, 1992.
39.
Marcus BH, Rakowski W., Rossi JS: Assessing motivational readiness and decision-making for exercise . Health Psychol11:257-261, 1992.
40.
Marcus BH, Rossi JS, Selby VC, Niaura RS, Abrams DB: The stages and processes of exercise adoption and maintenance in a worksite sample. Health Psychol11:386-395, 1992.
41.
Marcus BH, Selby VC, Niaura RS, Rossi JS: Self efficacy and the stages of exercise behavior change. Res Q Exerc Sport63:60-66, 1992.
42.
Lam CS, McMahon BT, Priddy DA, Gehred-Schultz A.: Deficit awareness and treatment performance among traumatic head injury adults . Brain Injury2:235-242, 1988.
43.
Rakowski W. , Dube CE, Marcus BH, Prochaska JO, Velicer WF, Abrams DB: Assessing elements of women's decisions about mammography. Health Psychol11:111-118, 1992.
44.
Rakowski W. , Fulton JP, Feldman JP: Women's decisions about mammography: A replication of the relationship between stages of adoption and decisional balance. Health Psychol12:209-214, 1993.
45.
Skinner CS, Strecher VJ, Hospers HJ: Physician recommendations for mammography: Do tailored messages make a difference ? Am J Public Health84:43-49, 1994.
46.
McConnaughy EA, Prochaska JO, Velicer WF: Stages of change in psychotherapy: Measurement and sample profiles. Psychother Theory Res Practice20:368-375, 1983.
47.
Norcross JC , Prochaska JO: Psychotherapist heal thyself—I. The psychological distress and self-change of psychologists, counselors, and laypersons . Psychotherapy23:102-114, 1986.
48.
Norcross JC , Prochaska JO: Psychotherapist heal thyself—II. The self-initiated and therapy facilitated change of psychological distress . Psychotherapy23:345-356, 1986.
49.
Norcross JC , Prochaska JO, DiClemente CC: Self-change of Psychological distress: Layperson's vs. psychologist's coping strategies. J Clin Psychol42:834-840, 1986.
50.
McConnaughy EA , DiClemente CC, Prochaska JO, Velicer WF: Stages of change in psychotherapy: A follow-up report. Psychotherapy26:494-503, 1989.
51.
Prochaska JO , Rossi JS, Wilcox NS: Change processes and psychotherapy outcome in integrative case research. J Psychother Integration1:103-120, 1991.
52.
Rossi JS: Radon and ultraviolet light: Emerging cancer risk factors, in Prochaska JO (chair); Stages of Change: Extensions to New Areas of Behavior Change . Symposium presented at the 98th annual convention of the American Psychological Association, Boston, MA, August 1990.
53.
Stem R., Prochaska JO, Velicer WF, Elder J.: Stages of adolescent cigarette smoking acquisition : Measurement and sample profiles. Addict Behav12:319-329, 1987.
54.
Elder JP, DeMoor C., Young RL, Wildey MB, Molgaard CA, Golbeck AL, Sallis JF, Stem RA: Stages of adolescent tobacco-use acquisition. Addict Behav15:449-454, 1990.
55.
DiClemente CC, Prochaska JO, Gibertini M.: Self-efficacy and the stages of self-change of smoking. Cognitive Ther Res9:181-200, 1985.
56.
Prochaska JO , DiClemente CC, Velicer WF, Ginpil S., Norcross JC: Predicting change in smoking status for self-changers . Addict Behav10:395-406, 1985.
57.
Velicer WF, DiClemente CC, Prochaska JO, Brandenburg N.: A decisional balance measure for assessing and predicting smoking status. J Pers Soc Psychol48: 1279-1289, 1985 .
58.
Prochaska JO , Velicer WF, DiClemente CC, Fava J.: Measuring the processes of change: Applications to the cessation of smoking. J Consult Clin Psychol56:520-528, 1988.
59.
Rossi JS, Prochaska JO, DiClemente CC: Processes of change in heavy and light smokers. Journal of Substance Abuse1:1-9, 1988.
60.
Fitzgerald TE, Prochaska JO: Nonprogressing profiles in smoking cessation: What keeps people refractory to self-change? Journal of Substance Abuse2:92-111, 1990.
61.
Gottlieb NH , Galavotti C., McCuan RS, McAlister AL: Specification of a social cognitive model predicting smoking cessation in a Mexican-American population: A prospective study. Cognitive Ther Res14:529-542, 1990.
62.
Pallonen UE , Murray DM, Schmid L., Piri P., Luepker RV: Patterns of self-initiated smoking cessation among young adults. Health Psychol9:418-426, 1990.
Beiner L., Abrams DB: The contemplation ladder: Validation of a measure of readiness to consider smoking cessation. Health Psychol10:360-365, 1991.
65.
Prochaska JO , Velicer WF, Guadagnoli E., Rossi JS, DiClemente CC: Patterns of change: Dynamic typology applied to smoking cessation. Multivariate Behav Res26:83-107, 1991.
66.
Ahijevych K. , Wewers ME: Processes of change across five stages of smoking cessation. Addict Behav17:17-25, 1992.
67.
Kristeller JL, Rossi JS, Okene JK, Goldberg R., Prochaska JO: Processes of change in smoking cessation: A cross-validation study in cardiac patients . Journal of Substance Abuse4:263-276, 1992.
68.
Okene J., Kristeller JL, Goldberg R., Okene I., Merriam P., Barrett S., Pekov P., Hosmer D., Gianelly R.: Smoking cessation and severity of disease: The coronary artery smoking intervention study. Health Psychol11:119-126, 1992.
69.
Pallonen UE , Fava JL, Salonen JT, Prochaska JO: Readiness for smoking change among middle-age Finnish men. Addict Behav17:424-436, 1992.
70.
Stillman FA , Bone LR, Rand C., Levine DM, Becker DM: Heart, body and soul: A church-based smoking cessation program for urban African-Americans . Prev Med22:335-349, 1993.
71.
Rossi JS: Exploring behavioral approaches to UV risk reduction, in Moshell A, Blankenbaker LW (eds.): Sunlight, Ultraviolet Radiation, and the Skin . Bethesda, MD: National Institutes of Health, 1989.
72.
Rossi JS: The hazards of sunlight. Health Psychol11:4-6, 1989.
73.
Rossi JS, Blais LM, Weinstock M.: The Rhode Island Sunsmart project: Skin cancer prevention reaches the beaches . Am J Public Health84:672-674, 1994.
74.
Brownell KD , Marlatt GA, Lichtenstein E., Wilson GT: Understanding and preventing relapse. Am Psychol41:765-782, 1986.
75.
Horn D.: A model for the study of personal choice health behavior. Int J Health Educ19:89-98, 1976.
76.
Rosen TJ, Shipley RH: A stage analysis of self-initiated smoking reductions. Addict Behav8:263-272, 1983.
77.
Velicer WF, Prochaska JO, Rossi JS, Snow M.: Assessing outcome in smoking cessation studies. Psychol Bull111:23-41, 1992.
78.
Weinstein ND : Reducing unrealistic optimism about illness susceptibility. Health Psychol2:11-20, 1983.
79.
Weinstein ND : Why it won't happen to me: Perceptions of risk factors and susceptibility. Health Psychol3:431-457, 1984.
80.
Tsoh J., Rossi JS, Prochaska JO: Effects of Intention and Behavior on Contemplating Smoking Cessation . Paper presented at the 100th annual meeting of the American Psychological Association, Washington, DC , August 1992.
81.
DiClemente C.C.Self-efficacy and the addictive behaviors . J Soc Clin Psychol4:302-315, 1986.
82.
Marlatt GA, Gordon JR (eds.): Relapse Prevention: Maintenance Strategies in the Treatment of Addictive Behaviors. New York, NY: Guilford Press, 1985.
83.
Prochaska JO : Systems of Psychotherapy: A Transtheoretical Analysis. Homewood, IL: Dorsey Press, 1979 .
84.
Rossi JS: Common Processes of Change Across Nine Problem Behaviors. Paper presented at the 100th annual convention of the American Psychological Association, Washington, DC, August 1992.
85.
Baranowski T.: Reciprocal determinism at the stages of behavior change: An integration of community, personal and behavioral perspectives . Int Q Community Health Educ10:297-327, 1990.
86.
Janis IL, Mann L.: A conflict theory approach to attitude and decision making, in Greenwald A, Brook T, Ostrom T (eds.): Psychological Foundations of Attitudes. New York, NY: Academic Press, 1968.
87.
Janis IL, Mann L.: Decision Making: A Psychological Analysis of Conflict, Choice and Commitment . New York, NY: The Free Press, 1977.
88.
Prochaska JO , Velicer WF, Rossi JS, Goldstein MG, Marcus BH, Rakowski W., Fiore C., Harlow LL, Redding CA, Rosenbloom D., Rossi SR: Stages of change and decisional balance for twelve problem behaviors. Health Psychol13:39-46, 1994.
89.
Prochaska JO : Strong and weak principles for progressing from precontemplation to action based on twelve problem behaviors. Health Psychol13:47-51, 1994.
90.
Bandura A.: Self-efficacy: Toward a unifying theory of behavioral change. Psychol Rev84:191-215, 1977.
91.
Bandura A.: Self-efficacy mechanism in human agency. Am Psychol37:122-147, 1982.
92.
Bandura A.: Social Foundations of Thought and Action: A Social Cognitive Theory .
93.
Englewood Cliffs, NJ: Prentice Hall, Inc., 1986.
94.
Goldman JA , Harlow LL: Self-perception variables that mediate AIDS-preventive behavior in college students. Health Psychol12:489-498, 1993.
95.
Harlow LL , Quina K., Morokoff PJ, Rose JS, Grimley DM: HIV risk in women: A multifaceted model . J Appl Biobehav Res1:3-38, 1993.
96.
Kelly JA, St. Lawrence JS, Brasfield TL, Lemke A., Amidei T., Roffman RE, Hood HV, Smith JE, Kilgore H., McNeill C.: Psychological factors that predict AIDS high-risk versus AIDS precautionary behavior. J Consult Clin Psychol58:117-120, 1990.
97.
Usdhhs: The Health Benefits of Smoking Cessation . Washington, DC: US Government Printing Office, No. 90-8416, 1990.
98.
Velicer WF, Prochaska JO, Bellis JM, DiClemente CC, Rossi JS, Fava JL, Steiger JH: An expert system intervention for smoking cessation. Addict Behav18:269-290, 1993.
