Health Behavior Insights—The Transtheoretical/Stages of Change Model: Carlo C.

DiClemente, PhD
Author(s): Chudley E. (Chad) Werch, Steven Ames, Michele J. Moore, Dennis Thombs
and Andrea Hart
Source: Health Promotion Practice , January 2009, Vol. 10, No. 1 (January 2009), pp. 41-
48
Published by: Sage Publications, Inc.

Stable URL: https://www.jstor.org/stable/26736423

JSTOR is a not-for-profit service that helps scholars, researchers, and students discover, use, and build upon a wide
range of content in a trusted digital archive. We use information technology and tools to increase productivity and
facilitate new forms of scholarship. For more information about JSTOR, please contact support@jstor.org.
Your use of the JSTOR archive indicates your acceptance of the Terms & Conditions of Use, available at
https://about.jstor.org/terms

Sage Publications, Inc. is collaborating with JSTOR to digitize, preserve and extend access to
Health Promotion Practice

This content downloaded from

202.51.89.151 on Sun, 27 Jun 2021 10:46:2 1976 12:34:56 UTC
All use subject to https://about.jstor.org/terms
 Health Behavior Insights—The Transtheoretical/
Stages of Change Model: Carlo C. DiClemente, PhD
Chudley E. (Chad) Werch, PhD
Steven Ames, PhD
Michele J. Moore, PhD
Dennis Thombs, PhD
Andrea Hart, MPH

Showcased in this article is an interview with Carlo C.

► dr. CARLO C. DICLEMENTE: PERSONAL
DiClemente, PhD, an internationally renowned healthAND PROFESSIONAL PROFILE
behavior researcher and codeveloper of the Transtheo
retical or Stages of Change Model. In this verbatim Carlo C. DiClemente, PhD, is cur
interview transcript, later edited by the authors and inter rently a professor of psychology at
viewee, Dr. DiClemente, he provides practical information the University of Maryland
and frank commentary on the steps to follow and pitfalls Baltimore County. He received his
to avoid in developing, implementing, evaluating, and MA in psychology at the New
School for Social Research in 1974
disseminating efficacious programs for affecting the
health and well-being of individuals and populations. and his doctorate in clinical psy
A concluding section summarizes key lessons learned chology at the University of Rhode
from the professional experiences of Dr. DiClemente Island in 1978 as well as completing
and discusses implications for advancing health a postdoctoral research fellowship at the Texas Research
behavior intervention practice and research. Institute of Mental Sciences in 1979.
Dr. DiClemente is the codeveloper of the Transtheo
Keywords: health behavior; transtheoretical; stages retical Model of behavior change with Dr. James
of change; tacit experiences; practitioners; Prochaska. Dr. DiClemente is the author of numerous
researchers scientific articles and book chapters on motivation and
behavior change and the application of this model to a
variety of addictive and health behaviors. Dr.
DiClemente is a coauthor of a self-help book based on
this model of change, Changing for Good, and several
professional books, The Transtheoretical Model,
Substance Abuse Treatment and the Stages of Change,
and Group Treatment for Substance Abuse: A Stages of
Change Therapy Manual. His book, Addiction and
Change: How Addictions Develop and Addicted People
Recover, was published by Guilford in 2003. His cur
rent projects involve smoking prevention and cessa
tion, brief interventions for problem drinking in
Authors' Note: This material was developed in part with the sup
port of grants from the National Institute on Drug Abuse (Grant
Health Promotion Practice #DA018872 and #DA019172) and the National Institute on
January 2009 Vol. 10, No. 1, 41-48 Alcohol Abuse and Alcoholism (Grant #AA9283). We also thank
DOI: 10.1177/1524839908323519 Melissa Wezniak, BA, and Jennifer Hamilton, BA, for their com
©2009 Society for Public Health Education ments on earlier drafts of this article.

41

This content downloaded from

202.51.89.151 on Sun, 27 Jun 2021 10:46:28 UTC
All use subject to https://about.jstor.org/terms
 own. I think that really started a whole line of
The Authors research looking at how do people change and that
is really what I have been doing most of the time
Chudley E. (Chad) Werch, PhD, is a professor and direc although I have moved from smoking to alcohol, to
tor of the Addictive & Health Behaviors Research Institute, diet and exercise, and to a number of other health
Department of Health Education Sr Behavior, University of behaviors. The organizing principle underneath it is
Florida in Jacksonville, Florida.
really trying to understand how people change.
There are a lot of interesting things happening in
Steven Ames, PhD, is an assistant professor and chair of this area on how people change. I think motivation has
Cancer Control and Prevention, Division of Hematology finally received the attention it deserves. What moti
and Oncology, Department of Psychiatry and Psychology,
vates people to make behavior changes? I think brief
Mayo Clinic in Jacksonville, Florida.
interventions are really interesting. How can you get
individuals just with very brief, but not excessively
Michele J. Moore, PhD, is an associate professor in the
Department of Public Health, University of North Florida
brief, contacts to make behavior changes? We know
in Jacksonville, Florida. there are a lot of people who do not make behavior
changes, so what are the mechanisms in terms of not
Dennis Thombs, PhD is an associate professor in the changing? I am very interested in mechanisms that
Department of Health Education & Behavior, University of move people through this process of change. That con
Florida in Gainesville, Florida. tinues to excite me because we still do not know
enough about it. We have tended to focus more on the
Andrea Hart, MPH, is a research associate in the Addictive Sr interventions and what the interventions are doing
Health Behaviors Research Institute, Department of Health and less on what the individual is doing, and it is
Education Sr Behavior, University of Florida in Jacksonville, really what the individual is doing that is more impor
Florida. tant than the interventions. I think that as the field
keeps moving, it must keep moving toward under
standing people and the process.
Q: What theories or conceptual models have you used
or tested?
medical settings, adolescent and adult dietary change A: Well, in terms of health behavior change models, I
and health risk reduction, and addiction prevention have looked at and used a lot of them. If you think
and treatment. about the health belief model, if you think about the
For the past 25 years, he has conducted funded intentional or planned behavior change model, and
research in health and addictive behaviors. He has if you think about social learning models, all of
directed an outpatient alcoholism treatment program and these models are part of what I do in everyday life
serves as a consultant to private and public treatment andbecause all of them touch on different aspects of
prevention programs. In 2002, he was given the Distinwhat I think are critical dimensions of the process of
guished Contribution to Scientific Psychology award bychange. We created our own model obviously. Jim
Prochaska
the Maryland Psychological Association. For his work in and I early in the 1980s began looking at
the addictions, he was given the Innovators Combating this process of change and realized that we needed
Substance Abuse award by the Robert Wood Johnson to find some dimensions that the field did not really
Foundation in 2003 and the John P. McGovern Award have to talk about the process of change. There was
a lot of work being done on motivation, but the cur
from the American Society on Addiction Medicine
rent view on motivation did not really describe what
(ASAM) in 2006. He has served as president of the APA
we were doing. I mean, people were either moti
Division on Addictions (50) and was recently named a
vated or they were not motivated. What we did was
fellow of the American Psychological Association.
design a model that said, wait a minute, let's spread
When not working, Dr. DiClemente enjoys traveling,
out this process. We can understand more dimen
spending time with his family, and helping coach socsions if we can label some stages of change, and that
cer, hiking, and skiing. is where we went, with developing the concept of
client stages. We began by looking at the multiple
behavioral and experiential processes of change,
Health Behavior Intervention Research and Theory
what the clients were doing. Then we discovered
that well you can't really understand the processes
Q: What is the current line of research you are presently
working on and what excites you most about it? of change unless you understand the stages, so we
A: Well, interestingly, I started working in smoking andworked back and forth between the stages and the
looking at how people change that behavior on their processes trying to understand how these interacted,

42 HEALTH PROMOTION PRACTICE / January 2009

This content downloaded from

202.51.89.151 on Sun, 27 Jun 2021 10:46:28 UTC
All use subject to https://about.jstor.org/terms
 specifically in self-change. We then expanded that Q: What new research methods and/or statistical analy
model to understand one behavior, but any one
behavior of an individual occurs in the context of
that individual's life. Although I am interested in A: We have gotten into much more linear modeling. To
you quitting smoking, I need to know that you are
also obese and you don't exercise and there are a
number of other issues that you have got to face that
interfere with your health. So I need to realize that
any single, targeted behavior change that I am focus
ing on currently occurs in a life context. You may be
seriously depressed. You may have family or marital
problems. There are a lot of other things going on in
that individual's life. If I get too far away, I just see
lots of problems, get overwhelmed, and then I can't
change anything, but I can't ignore the fact that all
these other things are going on and so that is really
where the model then incorporates a kind of contex
tual and environmental dimension as well. If you
look back at social learning models, they have simi
lar kinds concepts called social processes. I would
say that the social learning model, the transtheoreti
cal model, the cognitive models of behavior change
and some of the health behavior change models are
the ones that have influenced me the most.
Q: What mediators and/or moderators have you exam
ined of health behavior and/or of health interven
tions if any?
A: Well, that is an interesting question. It depends on
whether it is a mediator or a mechanism, I guess. The
main thing I have been looking at for almost my entire
career is motivation and how can you understand
when people are motivated, so I think this is a really
critical mediator. What I understand now is that moti
vation is really best understood as a series of tasks.
That is, what the stages try to do is to set up these
tasks, namely, concern, decision making, preparation,
planning and commitment, taking effective action,
revising plans, and integrating behavior change into
your lifestyle. These are really critical tasks that need
to be done well to change successfully. In that sense,
they can be either the objects of what we do or the
mediators of the process. I have also looked at self
efficacy. Self-efficacy always intrigued me from my
days at graduate school, so I included a self-efficacy
measure in my very first independent research project
(that was in my dissertation) trying to understand
people's evaluations. How I see myself and my sense
of confidence that I can do something is really an
important variable. I bought Bandura's idea that self
efficacy is a mediator of behavior change because
individuals who have less self-efficacy tend to do less
in terms of the behavior change. So I think self
efficacy is another very important mediator and
mechanism underlying behavior change and one that
is really critical.
sis procedures are you currently using in your stud
ies and why?
understand process, you really need a statistical pro
cedure that allows you to look at influences over
time. That also allows you to look at what are called
multilevel influences trying to separate those out. I
am not very good at stats and that is not my field of
expertise; but I have tried to get some folks to help
me who really understood these important tools. It is
critical to have methods that can look at a couple of
dimensions at the same time and how they relate to
the process of change and outcomes. I think this is a
critical piece. In some recent research, we have been
examining odds ratios in large samples. We have had
access to very large data sets, so you have to be very
careful because you can find a lot of significance in
large data sets. We have been trying to understand
effect sizes and looking at odds ratios to understand
the impact of a particular intervention or the amount
of variance accounted for rather than just looking at
traditional p values of .05. We have been misled
with a lot of large studies and p values that really do
not mean anything. They are not clinically signifi
cant. They are not practically significant. They are
just statistically significant.
There was some interesting work we just did on a
project for the Department of Health. There is a
program called ARC (Applied Regression Including
Computing and Graphics, University of Minnesota)
that is actually a free software program. What we did is
look at the counties in Maryland and examine their
smoking rates and how, over time, adolescent smoking
has decreased. If you look at the decrease by comity,
the counties differ dramatically. What this software
enabled us to do is look at two or three dimensions at
the same time and to understand where the counties
fall on those dimensions. It is a visual graphic plotting
of where the counties fall on several dimensions. You
can put two different dimensions down and you can
see whether the counties fall out the same way on these
dimensions as they do on some other dimensions like
size and adult smoking. We are using this to find and
compare two counties, one with rates of reduction in
smoking that are a little less dramatic than the other
and trying to understand whether these other dimen
sions make those two counties different. There are
many new software programs both to present data and
also to analyze data that are exciting.
Health Behavior Intervention Practice
Q: What are the main implications of your research,
first for practitioners and second for researchers?

Werch et al. / HEALTH BEHAVIOR INSIGHTS 43

This content downloaded from

202.51.89.151 on Sun, 27 Jun 2021 10:46:28 UTC
All use subject to https://about.jstor.org/terms
 A: Practitioners are always searching for ways to do
things a little bit differently, but I think they need to be
guided by the process that they are interacting with. It
has been really interesting work that I have done with
the stages of change and the processes of change.
Actually, with Mary Velasquez, I just help complete a
group therapy manual for addictions (Velasquez,
Gaddy-Maurer, Crouch, & DiClemente, 2001). Practi
tioners are really hungry for this perspective, under
standing the process and how they can do something
that would make the process a little bit different. That
I think is the real key for the practitioners. If we can
empower them with more information and under
standing of the client personal process of change, then
I think they can design what they do a little bit better
to interact with that process.
For researchers, I think that again the big issue for
them is also to move away from simply focusing on
themselves and what they do in terms of the inter
ventions and focus more on what is happening on
the other side of the equation. I think once you
understand that it is the client's motivation, it is
the client's processes of change, it is the client's self
efficacy, and it is the client's decisional balance that
are critical dimensions that you are interacting with,
and you focus on and study those, I think then we
will be able to design interventions that actually
move these client processes. If the intervention does
not do anything to these client activities and mech
anisms, then the intervention, even if it is a wonder
ful intervention, is not interacting with the active
ingredients that are going on in the client.
Q: What types of strategies have you been testing or
examining that might hold promise for enhancing
individual or group health?
A: Well, what I have been looking at most recently are
things like feedback—trying to design personalized
feedback that might be really helpful in giving an
individual the information that they need about
themselves or about their process of change that
might help them move forward. I think feedback is a
very important dimension—how you give it,
whether you have to have it written down—those
are dimensions I am interested in looking at that we
still do not really understand. The other focus is
brief interventions, opportunistic interventions, and
teachable moments. We just finished a project in the
trauma unit at the University of Maryland in
Baltimore. What we did there was try to capitalize
on an admission to the trauma unit. Somebody obvi
ously has been injured, injured seriously enough to
go to a trauma unit, and we were going to assess
whether they drink excessively and then intervene
with them to make a difference in their drinking.
Even though what we did consisted of only 15 or
44 HEALTH PROMOTION PRACTICE / January 2009
This content downloaded from
202.51.89.151 on Sun, 27 Jun 2021 10:46:28 UTC
All use subject to https://about.jstor.org/terms
20 min of assessment and then a brief motivational
interview with some follow-up phone calls at 2
weeks and 6 weeks, those kinds of activities, even
the control condition which only received advice,
self-help, and one telephone call, helped drive the
drinking and binge levels down. So these people,
even with a brief intervention in this teachable
moment, seem to really benefit in terms of reducing
their drinking, at least in the first 6 months and often
all the way out to 12 months after the event. It is
exciting that you can do that with some brief inter
ventions rather than more extensive treatments.
Becoming a Successful Health Behavior
Researcher or Practitioner
Q: What professional goals do you have for yourself as
a health researcher?
A: Obviously one of the goals is to produce good work
and get well known. I mean that is a goal always to do
work that gets recognized and that makes a difference.
In lots of ways, I think with the Transtheoretical
model and the work that I have done we have already
met that goal. I think the goal now for me is to see if
the work that I do can have an impact on practition
ers and individuals. If it can really help people in the
trenches working with the kids who are at risk for
developing addictions, working with people who are
obese, working with people who are still smoking,
working with people who have drinking and drug
problems, this will be a success. So I am really trying
to disseminate. It may be a time and career thing
because, at this point, one of the things I really would
like to see is this work making a difference in the
community. It has already done that to a degree, but I
think I could also facilitate doing that a little bit more.
The other professional goal at this time is to con
tinue to develop new researchers. I am doing a lot of
mentoring actually, trying to mentor not only my
students but different other people who ask ques
tions and seek assistance. I have a mentee, Dr.
Melanie Gold, who is working in Pittsburgh, who is
applying this (Transtheoretical) model to contracep
tion and protection against HIV and STDs. There is
Dr. Luis Manzo, working to address college drinking,
so I am helping him design programs. As well, I
work with a lot of collaborators to get them to use
the model in a way that is accurate. I think part of
the problem in this area is that people say they are
measuring some things, but if you do not do it well,
you are not measuring the construct. Then people
are upset about the construct when it is really a mea
surement issue. Trying to clarify that distinction
between construct and the measure is another goal I
have been working on the last year or two.
Q: What has been the secret to your success as a health important research in communications. We have
researcher over the years? been doing research in advertising, for example,
A: Well, I do not know. I'm not sure. Some of it is per since the fifties and sixties. We need to get a broad
sistence. I think that is always an important key, perspective on all the influences that can help us
especially as you try to go after funding. I think a lot understand the phenomenon we are interested in
of it has been that I have been able to work with and can help us look at health promotion.
some really talented people. I have always found If you just take obesity for example. Yesterday
that it is in the synergy of working with other people I was sitting in the airport between flights and
that a lot of good ideas get developed. Jim Prochaska watching people walk up and down, and you can
and I, at the very beginning, would get together and see clearly that we are a very heavy nation. If a
there was a flow of ideas back and forth and a cre young professional is going to tackle that problem,
ativity that was really helpful. The team up in Rhode however, there are multiple dimensions to it. There
Island that I worked with was really helpful. Then I are environmental dimensions. I mean we have
created a team down in Houston and had some McDonald's. I see young people coming by drinking
people who really were always asking good ques large lattes from Starbucks. That is a recent phe
tions and challenging. I think having some good col nomenon. There were not Starbuck lattes before. We
leagues, that is, having some collaborators that are have Starbucks stomachs these days. There are envi
really both challenging and thoughtful is useful. ronmental perspectives. Then there is the individ
Then I had the opportunity to work on Project ual. We are a developed country. We have access to
MATCH which was a wonderful study. We did not lots of food, but we have not taught people how to
find what we said we were going to find (all the eat healthfully. There is an education perspective.
treatment matches), but the group setting—the syn We are moving to more of a technological society
ergy among 20 to 25 of the best and the brightest where we sit and watch things, whether it is com
alcohol researchers in the psychosocial area—was a puters or TVs or whatever, or we sit and listen to
tremendous experience and an opportunity to grow music, but we need to be more physically active. So
and develop. If anything, I think that being open to there are a lot of dimensions that a young researcher
growing is really a critical aspect. I am still learning, would have to look at. Now you do not have to
which is really the way to keep fresh and keep my tackle all of them or try to do all of it at the same
professional development going. time, but you need to realize that whatever you are
Q: What would you suggest to early career profession going to do in one area is part of this larger context.
als regarding how they can make a significant con Again I think persistence is another good skill.
tribution to the study and practice of health behavior You have got to keep working. It will not come eas
intervention?
ily. You have got to really work hard at keeping at it.
A: Well, I think there are a couple of things. One is Finally, some things will make sense to you and will
understand the field and where we are. I think too be publishable and can make a difference. This will
often what young professionals are trying to do is to lead to establishing your identity in the field and
find something hot so they can get funded. That is creating some body of research. Think about
okay, but it won't give you a long career. I think find research as a program of research and not a single
ing some critical mechanism, or some critical prob research study. How would you build a research
lem that you really are interested in and you could program that you can be interested in and make a
get invested in is the key. Understanding what has career of? What is fun is if you get paid for what you
gone before us. I think that is also critical. Many really like to do rather than having to get paid to do
people come in and try to start from scratch, but in things that you don't like to do.
essence, what they are doing is really trying to rein Q: As an established health researcher, what do you
vent the wheel. There is a lot of interesting research need most to continue a successful line of research?
that has been done that needs to be understood. A: A good question. I think innovative funding oppor
Another is to be broad in your perspective on tunities are needed. If you think about going across
research and scholarship. I mean, there is nursing multiple health behaviors, the more standard mech
research, there is social work research, there is psy anisms of funding are problematic. I need innova
chology research, there is psychiatry research, there tion in funding mechanisms that will permit looking
is medical research, and there is social action or across behaviors and looking at the interaction of
community research. There is a whole broad range individual and societal change. Those are hard
of research out there, and there is also research in grants to write, and they are very difficult to get
areas around mechanisms of change from biological funded. It is much easier to fund something with
to psychosocial. Well I almost forgot. There is also small mechanisms and that are small in size.

Werch et al. / HEALTH BEHAVIOR INSIGHTS

45

This content downloaded from

202.51.89.151 on Sun, 27 Jun 2021 10:46:28 UTC
All use subject to https://about.jstor.org/terms
 We also need to nonpoliticize some of these issues.
A lot of the health and addictive behavior issues are
overly politicized. By that, I mean that they are seen
in the context of political correctness. They are seen
in the context of the powerful and the less powerful.
Addicts and people with severe health problems are
the least powerful people in our society. They are also
people whom I think society cares least about a lot of
times. When it is in your family, it is a very different
thing. What has often happened to help funding is
having politicians who have had some of these issues
in their families. So you have a politician or a family
member who has cancer, or heart disease, or an addic
tion and you have somebody who now understands;
oh this isn't just happening to everybody else, it is
happening to me.
If we could move back to understanding these
problems a little bit better, without trying to put solu
tions on them right away, A typical reaction is that we
have got to go into the schools to stop everybody from
using Oxycontin because it is a new problem drug.
Wait a minute. Why did it get started? How did it get
started? Where did it get started? Beginning to step
back and understand what is going on before we rush
to solving the problems is important. That is what I
also mean by being overly politicized.
The Future of Health Behavior Intervention
Q: What are the most pressing issues or problems fac
ing health behavior research and practice?
A: There are a number of issues that I think are impor
tant for both addictions and health behaviors. One is
at a real basic level. Again, I think we really need to
understand the change process a little bit better. We
need to understand social influences better. We need
to understand policy better. It is really clear that the
policies we create really do make a difference in
terms of creating these addictions and helping or
hindering us from solving the addiction problem.
The challenge is to change our thinking about addic
tions and health behaviors. We have gone after
health behaviors individually, and you can see that
at the National Institutes of Health where we have
an institute for this behavior and another institute
for that problem. We look at individual behaviors,
and there is some benefit to doing that. Obviously,
diabetes is not hypertension and cancer is not heart
disease. However, there are some underlying con
cepts and issues in terms for health behavior change
that we should look at in an integrated manner.
Some of the work that is being done currently is
beginning to look at multiple behaviors. Is there a Prochaska, PhD, has had an impact on addictive and
health orientation that would help us to understand health behavior intervention like few others have had
how people organize the variety of health behaviors?
46 HEALTH PROMOTION PRACTICE / January 2009
This content downloaded from
202.51.89.151 on Sun, 27 Jun 2021 10:46:28 UTC
All use subject to https://about.jstor.org/terms
It is true that even healthy people (or people who
think they are healthy) can get hooked on some
things. Just look at the steroids issue. These are ath
letes. These are people who should know better in
terms of the dangers, but they get lured by the
promise of what steroids will do for them, in terms
of competitiveness and in terms of how they will
look. I think there is a challenge to seeing how mul
tiple behaviors and multiple problems fit together,
and I think that is a real important issue. The same
is true with addictions. We have tried to isolate
addictions, particularly with illegal drugs. People
say that person has a cocaine addiction. Well, that is
true to a certain degree, but many also smoke ciga
rettes and have problematic use of alcohol and do a
lot of other kinds of harmful things. I think the focus
on just a single behavior, and trying to isolate and
pretend that is the only thing that is going on, is
finally breaking down. We are also looking at mental
illness and addictions because there are numerous
co-occurring or dual-diagnosis issues.
I think we need to also look at how society deals
with these particular problems. What we have done
is criminalized addictions to a degree that has just
overwhelmed our jail system. We need to think dif
ferently about that. We need to think about how we
can address these problems. They are serious prob
lems and problematic substances. I am not arguing
that we should make them good things, but we need
to figure out how to deal with them effectively. All
of our jailing of individuals has not really changed
the drug problem. With all the ways that we have
gone about attacking the supply side of drug behav
ior, some would say that it has been a total failure.
We have to change the way we think about how we
address these problems.
These are two challenges, namely, (a) multiple
kinds of behaviors and interactions among those
multiple health and addictive behaviors and (b) how
we deal with them in a policy perspective. A third
issue would be continuing to understand the prob
lem at an individual level. We need to understand
individuals and how they start new behaviors, how
they stop problematic behaviors, and how they mod
ify some problem behaviors.
►summary and implications
We are honored to have had a researcher of the caliber
and international acclaim of Dr. Carlo C. DiClemente,
PhD, as the focus of Health Behavior Insights. His work
alone and in concert with his mentor and colleague Jim
in our lifetimes. The development and continued
application and testing of the Transtheoretical or Stages of Research examining how feedback and other brief
Change Model has so influenced contemporary profes interventions are provided (e.g., written, verbal, elec
sional practice and research in health behavior interven tronic), to whom, in what settings, and under what cir
tion it is inconceivable that it is not being utilized to some cumstances is needed and, as Dr. DiClemente states, is
extent in nearly every setting in which health advance exciting given that some brief interventions can have
ment or protection is a goal. The quality of lives of count the impact of some more extensive treatments on criti
less individuals throughout the United States and abroad cal health behaviors.
have been improved by receiving stage-based health Dr. DiClemente's comments regarding research
programs emanating from the work of Dr. DiClemente and methods reflect the current trend toward using more
his colleagues. linear modeling to examine multilevel influences in
health behavior and intervention effects. His practice of
Health Behavior Intervention Research, adding individuals to his research team who have these
Theory, and Practice analytic skills is an important suggestion for all who
wish to be successful health behavior researchers.
Dr. DiClemente's research suggests that human moti Likewise, his recent practice of looking at effect sizes
vation is best viewed as a process involving dimen and odds ratios is a trend in the literature aimed at
sions or stages. This is a unique perspective, given the moving away from examining statistical significance
common thinking prior to this was that people were alone and reflects an attempt to determine the clinical
either motivated to change, or they were not. The or practical significance of intervention effects.
Transtheoretical or Stages of Change Model as it is per
haps more readily known, provides both a process for
Becoming a Successful Health Behavior
change (the stages) as well as processes (client/participant Researcher or Practitioner
actions) for moving through stages. The implications of
his work are that both practitioners and researchers Dr. DiClemente's professional goals are to do good work
should spend more time addressing the process of that gets recognized and makes a difference. A laudable
change among individual participants, rather than goal for any professional. For health behavior researchers,
focusing solely on a specific intervention when devel producing work that has an impact on practitioners and
oping and evaluating health behavior programs. This is individuals is the ultimate objective, and Dr. DiClemente's
already occurring, as research by DiClemente and oth career is an exemplary example of how this can be accom
ers publish more research examining specific mecha plished. He also has as a top goal to mentor new
nisms, such as stages of change, self-efficacy, and researchers, which is essential to advancing the profession
decisional balance, to better understand how interven and represents a key responsibility, especially for highly
tions influence individuals. successful and experienced individuals. Dr. DiClemente's
Dr. DiClemente also suggests that practitioners andcomments highlight a particular problem in the field, that
researchers should attempt to address multiple behavbeing accurately measuring theoretical constructs. He
iors, not merely one health habit at a time, and consider therefore has spent some of his time trying to help others
contextual and environmental factors necessary toto operationalize constructs of the Transtheoretical Model
understand the big picture and more effectively influinto valid measures.
ence health behaviors. Unfortunately, the question Dr. DiClemente's secrets for success include persis
remains as to how to effectively go about accomplishtence, particularly when attempting to get your work
ing these complicated problems. It is unclear whatfunded. This idea can't be understated as high quality
insights the Transtheoretical Model can provide inresearch, which oftentimes necessitates funding, is a
addressing them. Undoubtedly, these problems are crit long-term proposition and a process in itself. Another is
ical areas for more research and practice. For example,collaborating with talented others, which he has found
others have recently called for more research examincreates a synergy increasing the creative flow of ideas,
ing health interventions addressing multiple behaviorschallenging concepts, and asking good questions. The
(Nigg, Allegrante, & Ory, 2002; Prochaska & Sallis,development of a team of researchers, or at least part
2004; Werch, Moore, & DiClemente, 2005). ners, who are thought provoking is an important step for
Research conducted by Dr. DiClemente has examprofessional development at least sometime during one's
ined the efficacy of personalized feedback regarding career. In addition, Dr. DiClemente's suggestion to be
stage status and has found that brief, opportunistic open to growing, no matter what phase of your career, is
interventions in a hospital trauma unit can have sus an important lesson to keeping fresh and continuing to
tained behavior outcomes a year after intervention. learn throughout one's professional career.

Werch et al. / HEALTH BEHAVIOR INSIGHTS 47

This content downloaded from

202.51.89.151 on Sun, 27 Jun 2021 10:46:28 UTC
All use subject to https://about.jstor.org/terms
 As for early career professionals, Dr. DiClemente National Institutes of Health are organized. Another issue
suggests again, persistence in terms of keeping at it, is how society presently views and deals with health prob
along with hard work. He feels that with this comes lems and addictions through public policy. At the present,
being published leading to creating a body of research an emphasis is being placed, for example, on addressing
and establishing your identity in the field. In other addictive behaviors by criminalizing the behavior.
words, as Dr. DiClemente states, one should think This is related to Dr. DiClemente's notion that we are
about his or her work as a program of research, not a overly politicizing certain health behaviors and that what
single research study. With this in mind, it becomes is needed is societal change in terms of how we think
important to ask yourself what intellectually excites about and address health and addictive behaviors. Finally,
you that you can have fun with while making a career Dr. DiClemente thinks it is critical to better understand
studying it. Dr.DiClemente highlights common pitfalls health problems at an individual level. Specifically, how
among early career researchers, such as chasing the lat do people start, stop, and modify health behaviors?
est trends in an attempt to get funded quickly, which Without this basic knowledge, we will be unable to fully
prevents investing in establishing a long-term career understand and solve problems caused by problematic and
built on addressing a critical problem over time. risky behaviors.
Another frequent mistake among young professionals
is not taking time to examine the breadth of research REFERENCES
conducted across various disciplines. This commonDiClemente, C. C. (2003). Addiction and change: How addictions
error precludes one from fully understanding the con develop and addicted people recover. New York: Guilford.
text, as well as all of the factors influencing the health Nigg, C. R., Allegrante, J. P., & Ory, M. (2002). Theory-comparison
problem, as well as possible solutions. and multiple-behavior research: Common themes advancing health
behavior research. Health Education Research, 17, 670-679.
Prochaska, J. J., & Sallis, J. F. (2004). A randomized controlled trial of
The Future of Health Behavior Intervention single versus multiple health behavior change: Promoting physical
activity and nutrition among adolescents. Health Psychology, 23,
Future challenges facing the field, according to 314-318.
Dr. DiClemente, include how to successfully address
Velasquez, M. M., Gaddy-Maurer, G. G., Crouch, C. & DiClemente,
multiple behaviors and their interactions in interventions, C. C. (2001). Group treatment for substance abuse: A stages of
given our past emphasis on isolating health behaviors. change therapy manual. New York: Guilford.
Related to this is the issue of getting cross or multiple Werch, C. E., Moore, M. J., & DiClemente, C. C. (2005). A multi
behavior health intervention research funded. Unfortu health behavior intervention integrating physical activity and
nately, the history of health behavior intervention research substance use prevention for adolescents. Prevention Science, 6,
has centered on specific behaviors, as seen in the way the 213-226.

48 HEALTH PROMOTION PRACTICE / January 2009

This content downloaded from

202.51.89.151 on Sun, 27 Jun 2021 10:46:28 UTC
All use subject to https://about.jstor.org/terms