Where does stages of change collide?

The transtheoretical model describes health behavior change as movement through a sequence of stages, usually named precontemplation, contemplation, preparation, action, and maintenance. Prochaska and DiClemente built it in 1983 from studies of how smokers quit, pairing the stages with a set of change processes, a weighing of pros and cons they called decisional balance, and a person's confidence in changing. Prochaska, DiClemente, and Norcross set it out for addictive behaviors more broadly in 1992, and it became one of the most cited frameworks in health promotion. In this reading the thing being described is one person's readiness to change a specific behavior, placed in one of a small number of ordered categories. Programs are then matched to the stage a person is thought to occupy. The claim that gives the model its name is that these stages are real and distinct, not just points on a smooth scale.[1][2]

Unit

A person's readiness to change a health behavior, sorted into one of five stages

Recovery means

People can relapse to an earlier stage, and the model treats recycling through the stages as ordinary rather than as failure

Measured by

Short staging algorithms based on intention and past behavior, or questionnaires such as the URICA, place a person in a stage; later behavior is the criterion

In change management, stages of change names a different thing: the phases an organization or group passes through when it deliberately changes how it works. Lewin's 1947 account is the common ancestor, describing change as a move from one quasi-stationary equilibrium to another through three steps often summarized as unfreezing, changing, and refreezing. Later practitioner models, such as multi-step programs for leading change, extend the same staged picture to whole firms. Here the thing being described is a planned transition of a collective, not the private readiness of one person to alter a habit. The stages set out what managers are meant to do to loosen old routines, install new ones, and make them hold. The shared phrase hides that the unit of analysis has shifted from an individual to an organization.[3]

Unit

The phases a group or organization passes through during a planned change

Recovery means

Refreezing is the step that stabilizes the new state so the group does not slide back to the old equilibrium

Measured by

Assessed through case studies and organizational surveys of whether new practices have taken hold, not by staging an individual

In writing on dying and bereavement, stages of change names yet another thing: the emotional responses a person may pass through when facing loss. Kübler-Ross described five in her 1969 book On Death and Dying, usually listed as denial, anger, bargaining, depression, and acceptance, drawn from her work with terminally ill patients. The thing being described here is an inward emotional process after loss, not a behavior someone is trying to change or a program a manager is running. Kübler-Ross presented the responses as ones that need not occur in a fixed order or in every person, though the model is often repeated as a fixed sequence. Maciejewski and colleagues tested that sequence empirically in 2007 and found only weak support for people moving through the stages in the stated order. The word stages is shared with the health and organizational models, but the thing it points to is different again.[4][5]

Unit

The emotional responses a person may pass through after a loss

Recovery means

Acceptance is described as the final response, but Kübler-Ross did not treat reaching it as guaranteed or as an end point that holds

Measured by

Described from clinical observation and interviews; later work has tried to test the ordering with repeated ratings of grief over time