Stages of Change


Quit rates aren't the only measure of success when you counsel clients. Moving a person from one stage to another can be considered a success as it is one step closer to a quit attempt.

It is important to keep in mind that the process of quitting smoking is not always linear. Most smokers will cycle through the stages 3 to 4 times before quitting for life.

 Nurses and clients should keep in mind that each attempt offers the opportunity to learn new skills and new techniques that will help clients in their next attempt.

Remember that relapse is a normal event in the process of making behavioural change.

See the Video Vignette section of this website to view a short video "Stages of Change to Music", created by Deanna Abbott-McNeil and Nancy Melville of KFL&A Public Health. The video matches music to each of element of the Transtheoretical Model by Prochaska & DiClemente (1983) of behavioral change.

The Stages of Change

1. Pre-contemplation

Unaware or unwilling to change. Not thinking of quitting in the next 6 months.

Goal: Help the client begin to think seriously about quitting.

  • ASK regarding feelings about smoking
  • ASK about the pros and possible cons of smoking
  • ADVISE by offering quitting information and assistance at any time

2. Contemplation

Ambivalent, but thinking about quitting within 6 months.

Goal: To help smoker move towards a decision to stop smoking. To help them feel more confident.

  • ASK about the pros and cons of both continuing to smoke and quitting (decision balance). Acknowledge ambivalent feelings.
  • ASSIST by reinforcing their reasons for change, and exploring new ones
  • Suggest they cut back or stop for a day
  • ASSIST by offering a future visit and information

3. Preparation

Getting ready to stop within the next 30 days. Have set stop smoking date. Have made a 24 hour quit attempt in the last 12 months.

Goal: To help smoker prepare for and anticipate positively a quit date.

  • ASK about concerns, preparations and lessons learned from previous attempts.
  • ADVISE by identifying barriers to stopping and elicit solutions.
  • ASSIST by offering Booklet, Action Plan, Nicotine Replacement, Date for quitting (also known as B.A.N.D.).

4. Action

Have quit smoking within past 6 months and are actively applying cessation skills.

Goal: To help client stay off tobacco products and recover from relapses.

  • ASK how the client is doing: relapses, temptations, successes, NRT use.
  • ADVISE re: relapse prevention, weight gain, triggers.
  • ASSIST by focusing on successes, encourage self rewards and increase support, · elicit solutions for problems.

5. Maintenance

Quit for more than 6 months. Integrating smoke-free living into their routine.

Goal: To help client remain smoke-free for a lifetime.

  • ASK how the client is doing: risk situations, relapses.
  • ASSIST by offering suggestions for difficult times, support, encouragement.
  • Congratulate!