Unfortunately, the stages of change model has become ubiquitous to many social marketing programs. First the disclaimer or bonafide: I was using this theory to develop the "Imagine Action' community physical activity campaign many years ago – long before Alan Andreasen popularized it in his book and since has been promulgated by others (including Kotler & Lee) as THE social marketing theory. However, stages of change has been used, in my opinion, more often as a segmentation system (think of it as behavioral epidemiology, descriptive but not very helpful to change agents) than as the tool it was meant to be to select specific types of interventions to match people where they were in the stages of change process. And the notion that it is all about increasing the benefits and reducing the costs of engaging in a behavior is being waaay too simplistic. If people really acted that rationally we wouldn’t need behavioral economics for example – not to mention several hundred theories of learning and behavior change.
What I talk with my students about is that all theories of behavior are initially developed to explain a particular type of problem. Originally, stages of change was an attempt to develop a typology of psychotherapies – that’s why it is know formally as the ‘transtheoretical model’ (hmmm, social marketing as mass psychotherapy?). It quickly found utility and parsimony in working with addictive disorders – smoking cessation in particular, though over the years many of us have pushed its applications. The Health Belief Model, to pick on another frequently invoked theory among social marketing and health communications people, was developed to explain, predict and increase screening behaviors (NOTE: someone can fix the Wikipedia entry, it is wrong). Not that these humble beginnings should stop you from using them in other circumstances, but being mindful of their limits is important – and one reason why HBM in particular has spawned so many offshoots to explain other types of health behaviors.
So when a family planning program wants to use the stages of change model – why do I cringe? Well, because there is a better model specifically developed to address issues of family planning. And, here’s the punch line, it looks remarkably similar to stages of change with one notable exception. It allows us to look at the social context of the behaviors. Indeed, it offers a very cogent, theoretical rationale for why we should be using social media to address family planning issues.
The Process of Behavior Change framework proposes that people seeking or using family planning and reproductive health services move through a variety of intermediate steps, or stages, in the behavior change process. These stages are:
Preknowledgeable where they are unaware of the problems or their personal risk.
Knowledgeable in which people are aware of the problem and understand what the desired behaviors are (i.e., use of modern contraceptive methods).
Approving is the stage at which they personally are in favor of the desired behaviors.
Intending is the stage at which people personally express the desire to take the desired action.
Practicing or when people are actively using contraceptive methods.
Advocating is when people not only practice family planning methods, but advocate them to others. Once people reach this stage, they become effective change agents among their peers and within their social networks that, in turn, acts to reinforce their continuing to engage in contraceptive practices. That is, it is a strong predictor of people adhering to and not discontinuing their birth control practices.
For the family planning program, this model allows us to think about and talk with people at each of these stages who may constitute distinct audiences or segments for our program, each requiring different methods and actions they can take that are relevant to their current situation with respect to using family planning methods. What is noteworthy here is the notion of the advocacy behaviors within one’s social network as a behavioral maintenance strategy, a recruitment strategy and as a social media one. For us the obvious became: how do we work with users to become advocates for family planning through their SNS and mobile tools and networks?
That’s a very different slant than just thinking about reducing environmental constraints, addressing intentions and improving skills. Let alone simply focusing on increasing benefits and reducing costs. One theoretical model is rarely enough in the complex world of learning new behaviors. Or as I leave my class:
- Theories should be tools – not straight jackets
- Theories can inform – and blind
- “The one with the biggest toolbox wins” - Frank Lawlis, one of my psychotherapy mentors
- “It’s a complex world” - The Young Adults
- “There’s nothing so practical as a good theory” - Kurt Lewin