Creating a Desire for Change: Part 1

MI Science Staff: March 2016

For a number of years now, the Transtheoretical Model of Health Behavior Change has been used in health care settings to help bring about positive behavioral changes, such as weight loss and smoking and alcohol cessation. This theory of change, originally developed in 1983 by Carlo C. DiClemente and J.O. Prochaska1, was more specifically targeted for helping health care workers assess people’s readiness for change in 1997 by Prochaska and Velicer.2 By understanding a patient’s readiness for change, the clinician can then develop strategies for moving their patients toward lasting behavioral change.

Medical Institute supports the use of the transtheoretical model in encouraging patients, clients, and students to move from risky sexual behaviors toward avoidance of sexual risks, by limiting sexual activity to a mutually monogamous relationship (such as marriage), in which both partners are disease free. By understanding the stage of readiness to change, a clinician, educator, counselor, or even a parent can decide what type of information or support will be most effective. There are six “stages” to be aware of, and ten “processes” of change.2

The first stage is one in which there is no intention of changing at all.  This is called the precontemplation phase. People in this phase are saying to us: “Get off my back!” Some students in public school health classes are in the precontemplation stage. They may find themselves enduring a day or two of sex education, as a part of a required “health class”. Often, these students do not believe that the sexual behaviors that they are involved with are exposing them to risks that can affect the course of their lives. They can be characterized as unmotivated and resistant to change. They tend to avoid thinking about their high risk behaviors and do not seek out information regarding sexual health.

There are three processes that help a person in the precontemplation stage to move toward change:

Using the example of the student in the sex education class in the previous paragraph, let’s explore the three processes of promoting change for someone in the precontemplative stage of readiness. Since there is at this point, no desire for change, the educator must help create a desire for change.

Consciousness Raising means that the student finds and learns new facts, ideas, and tips that support a healthy behavior change. The educator already has these facts, ideas and tips, but now must find a way to successfully transfer them to the student, who is completely disinterested in learning them. Fortunately, sex is a topic that is hard to ignore.

When the student begins to experience negative emotions that go along with unhealthy behavior risks, the process of Dramatic Relief comes into play.  The risks of sexually transmitted diseases and pregnancy can certainly push the student towards dramatic relief. Additionally, case studies, or involving people that students can identify with such as teen mentors are effective tools.

The third process is called Environmental Reevaluation. When the student realizes the negative impact of the risky behavior on one’s proximal social and physical environment, environmental reevaluation begins to take place. Essentially, when the student realizes that his/her social standing at school or with their friends might be affected, it could be time for a change.

This article serves simply as an introduction to the Transtheoretical Model of Change, discussing only the first of six stages of readiness for change. Medical Institute incorporated this change model into an educational program called “Clinical Intervention”, designed to teach the health care worker, counselor, and sex educator how to promote healthy sexual behavior decisions among patients, clients, and students.  The Clinical Intervention Program is currently being re-structured and updated and MI would like your feed-back. Please feel free to comment on this article or to write us at [email protected]. We would love to hear from you.



  1. ISchool Cooaborative, “Motivation at a Glance: Transtheoretical Model of Change,” Acessed March 2016
  2. Prochaska J.O., Velicer WF, “The Transtheoretical Model of Health Behavior Change,” Am J Health Promot 1997, 0890-1171/97/$5.00+0