I've had a couple of requests for information on the Stages of Change
(Transtheoretical Model of Change) so thought others might also be interested.

This theory has been tested across a wide number of behaviours (smoking,
drinking, sunscreen use/sun avoidance, etc.) The workshop I attended was for
people involved with the Canada Prenatal Nutrition Program of Health Canada,
so breastfeeding came up during discussions, but the researchers haven't
done anything specific in this field. If you have a chance to go to a
workshop with these researchers, I'd certainly recommend it. This could also
be a potential conference session for ILCA.

There are 5 (possibly 6) stages of change. As you read these, think about
clients you've encountered who were probably in the various stages. Also
think about yourself and a behaviour you have that may need changing--for
example, exercising regularly if you don't already (theory holds for both
extinguishing and acquiring behaviours):
Precontemplation: Not thinking about change; Cons of change greatly
outweight Pros.
Contemplation: Starting to consider the change. Cons are decreasing but
still are greater than Pros.
Preparation: Getting ready to make a change. Pros and Cons are about equal
(this is where getting the right information or the right help can make
quite a big difference).
Action: Doing it. Pros outweigh Cons.
Maintenance: After 6 months of Action, considered to be in this stage.
Termination: Controversial, not a formal part of the stages yet. May be
possible that some people, after a period of time in Maintenance, will never
go back to a behaviour (e.g., smoking) while others will always be in
Maintenance.

In these stages, people use different Processes. We can help by increasing
the number of processes a person is using in each stage, which can increase
the Pros and decrease the Cons. There are Experiential and Behavioural
Processes. I won't explain them all, but the Experiential ones are:
Consciousness Raising (increasing awareness of problem through information
seeking, education, use of feedback); Dramatic Relief (making effective use
of a strong emotional experience to events occurring in the environment as a
means to change--an example of this would be a dramatic video on the effects
of smoke on a fetus; we don't tend to use this in breastfeeding
promotion,but it could certainly be interesting!); Environmental
Reevaluation; Self-Evaluation;  Social Liberation (when changes in the
environment make it easier to change and stick with it--for example,
smoke-free space; campaigns such as Health Canada's on breastfeeding
"anytime, anywhere."

Behavioural Processes include: Counter Conditioning (substituting new or
competing behaviour for problem one); Helping Relationships; Reinforcement
Behaviour; Self-Liberation Stimulus Control.

This is a very positive theory, and one of the most important points is that
when we evaluate programs, we need to evaluate based on these stages,
because moving a person just one stage means there is more potential for
change. Most programs are evaluated in a much too short-term manner (change
occurs over the long term), and in an either/or mode. So, if we move someone
from Precontemplation to Contemplation regarding breastfeeding, we've done
LOTS. Too often we despair because we haven't made someone change behaviour.
I don't know about you, but when I'm in Precontemplation and someone tells
me I should change, I get very contrary.

Researchers who presented at the workshop I attended:
Drs. Joe Rossi, Susan Rossi, Laurie Ruggiero.

Dr. James Prochaska seems to be the grandaddy of this research. He has a
book called "Changing for Good" (co-authored with Carlo DiClemente) but
since the researchers didn't even mention it during their presentation, I'm
not sure whether it's still considered valid. I found it helpful to read.

You'll find lots of stuff if you do a search with Prochaska, DiClemente,
Norcross. Here are a couple of references:
"In Search of How People Change: Applications to Addictive Behaviors"
Prochaska, DiClemente, Norcross. American Psychologist Sept/96 pp 1102-1114
"What Causes People to Change from Unhealthy to Health Enhancing Behavior",
Prochaska. in CC Cummings & J.D. Floyd (eds) HUMAN BEHAVIOR AND CANCER RISK
REDUCTION, 1989.

These researchers are at the University of Rhode Island, USA.

Hope you find this as interesting as I do! If not, apologies for the length
of the post.
Leslie Ayre-Jaschke
Peace River, Alberta, Canada