Many unhealthy behaviors that require change (smoking, alcohol, addiction) often contribute to negative health outcomes and common diseases. The Behavioral Change Transtheoretical Model (Prochaska & DiClemente, 1983; Prochaska, DiClemente, & Norcross, 1992) has been used for years to assist individuals in recognizing a behavior and then taking action to change it.
It’s easy for workers to develop bad habits and become normalized, meaning they no longer regard an action as dangerous because previously doing the action didn’t result in a bad outcome.
This can be a learned behavior done through a routine. An action performed enough times that it becomes instinctual and performed without thinking or what we would call a HABIT.
The key to achieving success with any change that you want to occur is understanding how habits work. By harnessing this science, we can transform our culture, employees, and ourselves.
By the time most of us recognize the need for change, unhealthy behaviors have already become deeply ingrained habits. While we may blame lack of motivation, willpower, and confidence for our inability to change, the Stages of Change theory suggests that we may just not be ready to act yet or may not recognize that we need to. When we understand our readiness to change, we can identify the tools we need to succeed at any stage.
Let’s look at how this transform into changing safety behaviors.
Why is change so hard? Changing a behavior takes work, energy, and the understanding of why a person needs to change, and each individual could have a completely different attitude and belief that makes them resistant or ready for change.
It’s important to understand which stages employees are in, to then determine how to approach moving someone along the stages of change.
Pre-contemplation
At this stage, employees don’t realize that they need to make a change, and they are unaware that a problem or risk exists. This could be true even when those around them might be hinting, telling, or suggesting that they have a problem or that they need to adjust their behavior.
Here’s an example of how it may play out in the workplace
An individual’s job is starting to create some physical discomfort, but they don’t realize what this discomfort stems from. They think that their physical ailments are a symptom of aging, or their old mattress, rather new job tasks that require a significant amount of lifting.
How to influence this stage
Educate and bring awareness to the problem or concern; the goal is to engage the worker and bring personal reference if possible. Why would this person want to consider changing? What’s in it for them to want them to consider moving to the next stage.
Example coaching questions
Can I share some information with you about stretching? What do you feel you need to know about stretching? What do you know about stretching and back health?
Contemplation
In this stage, employees are starting to consider or think about making a change. They still have not committed but are starting to weigh the pros and cons of their actions.
Here’s an example of how it may play out in the workplace
An employee notices that every time they did a certain job task, they were getting back tightness at the end of the day. They recognize they could probably work on their lifting technique to assure they are lifting correctly and or maybe that stretching could assist, but don’t want to change anything about their work routine.
How to influence this stage
Continue to educate and bring ongoing opportunities for self-evaluation.
Example coaching questions
What do you notice about how you’re lifting? When does your back feel its best or worst? Continue making a connection to back discomfort and change.
Preparation
At this point, the employee knows that they’d like to make a change and want to have their situation be different from what it is currently. Many people get stuck in this stage, preparing for a long period of time. They know that they’d like to change but find themselves unwilling or unable to take the initial steps.
Here’s an example of how it may play out in the workplace
An individual recognizes that their back pain is causing them not to be able to sleep well or participate in recreational activities outside of work. They decide that they’ll learn how to incorporate stretching before and after work and begin to practice better lifting techniques; however, they haven’t yet started stretching or looked up resources to assist with better body mechanics or lifting techniques.
How to Influence this stage
What would intrinsically motivate this person to change? It must be about the individual, not about what the company wants or needs.
Example coaching questions
Why is starting to stretch important to you? What’s your biggest motivation for wanting to make a change?
Action
In this stage, the employee may be modifying their environment, behavior, or experience. Action doesn’t mean that real change has occurred yet. This is where an employee could be starting to try the new behavior but have not yet carried it into something that is occurring automatically.
Here’s an example of how it may play out in the workplace
An individual who frequently feels back discomfort at the end of the workday is now stretching on a regular basis and has started utilizing new lifting techniques that have improved their ability to work without back discomfort.
How to influence this stage
Provide encouragement, recognition, and ongoing reinforcement of positive actions.
Example coaching questions
Great work; what do you feel is working for you?
Maintenance
In this stage, change has occurred and has become part of the normal routine. During this stage, a person might be able to see some of the positive outcomes of their action and provide feedback and support to others.
Here’s an example of how it may play out in the workplace
An individual practices stretching every day before and after because it helps his backstay loose. This employee has also made some changes to the lifting technique to ensure lifting is done in a way that protects the back. They haven’t missed a day of stretching in months and have become a coach to others on the importance of stretching and good lifting technique.
How to influence this stage
Acknowledge and reinforce the positive change and that it still takes work to maintain.
Example coaching questions
How will you continue to maintain this success?
Most safety programs focus on a one size fits all approach: Research shows this strategy does not work and what we have learned is that we need to meet our employees where they fall in Prochaska’s stages of change model. Most programs focus on the ACTION Only stage, where only about 20% of most employees will fall. These employers go straight to the behavior, which means many stages have been skipped, which has left a lot of things undone. It’s how you engage and motivate the other 80% that need to go through the various stages of change before they are ready for action.
Prochaska’s Stages of Change: Transtheoretical Model
James Prochaska (1943–present) is a professor of Psychology who specialized in the study of the dynamics of behavior change. In 1977, Prochaska, Carlo Di Clemente, and colleagues developed the Transtheoretical Model of behavior change, which has become one of the dominant models of health behavior modification.
Reference
Prochaska, J.O., DiClemente, C.C., & Norcross, J.C. (1992). In search of how people change: Applications to the addictive behaviors. American Psychologist, 47, 1102-1114. PMID: 1329589.
