Behavior change is rarely a discrete, single event. The stages of change model shows that, for most, change in behavior occurs gradually. By identifying a patient's position in the change process, providers can tailor interventions so that the focus of the patient encounter is not to convince the patient to change behavior, but to help the patient move along the stages of change continuum.

The stages of change are:

• Pre-contemplation Stage - During the pre-contemplation stage, patients do not even consider changing. Smokers who are "in denial" may not see that the advice applies to them personally.
• Contemplation Stage - During the contemplation stage, patients are ambivalent about changing. Giving up an enjoyed behavior causes them to feel a sense of loss despite the perceived gain. During this stage, patients assess barriers (e.g., time, expense, hassle, and fear: "I know I need to, doc, but ..."), as well as the benefits of change.
• Preparation Stage - During the preparation stage, patients prepare to make a specific change. They may experiment with small changes as their determination to change increases.
• Action Stage - Any action taken by patients should be praised because it demonstrates the desire for lifestyle change.
• Maintenance and Relapse Prevention - Maintenance and relapse prevention involve incorporating the new behavior "over the long haul."

Most patients find themselves "recycling" through the stages of change several times before the change becomes truly established.