I heard about the Transtheoretical Model of Change a couple weeks ago. I attended a training designed to help build confidence in the covid-19 vaccine. The instructor helped us separate vaccine education from encouragement to get vaccinated. Of course we want people to get vaccinated. With covid cases spiking around the world, vaccines are the only way we’ll stop the spread. But the instructor made clear that vaccines are personal medical decisions. We should answer questions about the vaccine in a way that helps people understand it. We can give them our professional opinion, but they may not know us well enough to trust us. This guidance is the same approach healthcare workers use to explain any risky-but-beneficial treatment. We describe in detail what we know, answer questions, and leave the autonomy to the patient.
When we split the education from the vaccine, we allow that some people we talk to will choose not to get the vaccine. That doesn’t mean they won’t get it ever. They might need to sleep on it, or talk about it with their family. We learned about the Transtheoretical Model of Health Behavior Change (TTM). Prochaska, Di Clemente, and others first proposed the model in 1977. They developed it from their work helping people to quit smoking. Here, my instructor used the model to help us understand vaccine contemplation. Our education about the vaccine might help nudge a person from refusal to acceptance—or even enthusiasm.
Learning about the TTM got me thinking. In the antiracism world, we talk a lot about how to change the minds of people we talk to. Could I apply this model to that effort? I decided to give it a try.
The Transtheoretical Model of Change consists of 5 major stages. Pre-contemplation, Contemplation, and Preparation take place before a person decides to do anything different. Pre-contemplation means a person has no intent to act within the next six months. Contemplation means they’ve decided to do something at some point in the next six months. Preparation happens right before an action, when a person makes plans to change. Next, Action signals a tangible change in a person’s life. Once they’ve acted on their decision to change, Maintenance helps them stay changed.
It’s easy to understand these changes in the context of a person who’s decided to quit smoking. One can think about quitting smoking, but they have to actually quit for it to count. Once a person quits, for many, staying a nonsmoker is a lifetime struggle. What about for someone’s antiracist journey? What’s the turning point? I’d define it as a person making a tangible antiracist act in their life that has an impact on others. Let’s apply the model and see what happens.
processes of change
Wait! Before we get started, I have to explain the Processes of Change. Prochaska et al define these as, “the covert and overt activities people use to progress through the stages.” Each stage of the TTM draws from these ten processes. These are actions a person can take to move themselves into another stage. We may not even know or see it happen until the shift is complete.
We can define a person in this stage as having no plan to take action in the next six months. People in this stage are either unaware or don’t know enough about the consequences of their behavior. They may not know they should change, or they may not want to change. It shouldn’t be hard to imagine the vast number of people who refuse to believe racism is a problem in the u.s. They may not understand a movement like BLM. They may not know what critical race theory is, but that won’t stop them from shouting at people about it.
processes of change for this stage
consciousness raising: increasing one’s awareness of the issue.
dramatic relief: spiking one’s emotions to make a change more palatable.
environmental reevaluation: realizing the effect one can have on others.
At this stage, we’re not going to see a lot of self-starting actions from people. That’s reflected in the processes, which are heavy with self-reflection. When interacting with people at this stage, I’d recommend:
- talking about it with and around them, depending on their comfort
- adding equity requirements into job postings
- creating an environment of antiracism and making it an expectation for success
A person in contemplation is ready to do something within the next six months or so. They may have realized the benefits of making a change towards antiracism. They are even more likely to be aware of the pains of inaction. Either way, they may spend a long time in this stage. Prochaska et al calls people in this stage behavioral procrastinators. I imagine there’s a lengthy cost-benefit analysis people do in their heads. But this really isn’t a bad stage. This is the point where people may wish for the bliss of ignorance. Don’t let them have it!
processes of change for this stage
self-reevaluation: imagining oneself as both the new and the old versions of themselves.
This is it! This is the fulcrum. It’s also where the antiracism stuff is hard to picture. When I started getting into my own education, I was equal parts excited and discouraged. It would be so much easier to rationalize or ignore the pains of the status quo. Instead, I’d make sure to show that it’s not only possible to be antiracist, it’s an aspirational place to be. What we want here is to nudge people towards the next stage, preparation. When interacting with people at this stage, I’d recommend:
- utopias! afrofuturism and solarpunk are two favorite genres of mine
- identifying antiracism role models
- learning about collectives and other means of cooperative solidarity
We’re getting even closer to action now! This stage is for people who are ready to do something within the next month. They may have also taken some action within the last year. They often have a plan for how they want to move forward. They’re not just thinking about doing it, they’re thinking about how to do it.
processes of change for this stage
self-liberation: one believes that change is possible, and one is willing to act on that belief.
There are so many options for this stage! Engagement here means showing people the array of options that are out there for every taste. People comfortable among strangers can find an affinity group or book club. People on the introverted side can dive into learning or talk to a friend about it. The TTM finds that a buffet of actions increases the likelihood of a person taking one. When interacting with people at this stage, I’d recommend:
- going to affinity groups or caucuses
- speaking up about discomfort
- taking equity-based education or training
- reading books, listening to podcasts, watching videos or seminars
- making a plan to interrupt microaggressions or change policies
We’re here! At this stage, a person has made specific changes to their life in the past six months. That’s right, by the time you’re at the action stage, it’s already happened. Prochaska et al note that not all behavior changes are significant enough to call “action.” The change must be enough to reduce a person’s risk. Consider the source material: a smoker is not a nonsmoker until they quit smoking. A person is not antiracist until they take antiracist actions. A commitment to learn doesn’t make you an antiracist. You have to take meaningful actions, again and again, until we’re done.
processes of change for this stage
contingency management: creating rewards for moving in the right direction. TTM notes that creating punishments for doing the wrong thing count too, but they don’t work as well.
helping relationships: providing positive reinforcement for taking the action. This also includes building trust, openness, and acceptance.
counterconditioning: learning healthy behaviors that can replace problem behaviors.
stimulus control: removing the triggers that lead to unhealthy behavior. Adding prompts for healthier ones.
Once people get a taste for antiracism, we want to keep the fire going. It’s tempting to take the pat on the back and sit down after a single accomplishment. Instead, it’s the start of helping oneself to resist and reject the racist status quo of our world. For many people, taking racist or nonracist actions is the easiest thing in the world. It’s only easy because of repetition. Taking antiracist actions can feel that intuitive, too. When interacting with people at this stage, I’d recommend:
- Celebrating the wins! You are on the right track. Feel the validation and solidarity.
- Keep learning. The more I learn, the more I commit myself to changing our trajectory.
- Create environmental cues that can reach others in precontemplation. Use the strategies that work for you and support the strategies of others.
This last action is so, so important. Think about how fast we shifted to a society of non-smokers. In 1965, 43% of people in the united states smoked cigarettes. Today, only 14% of the country does. I used to love going to concerts and coming home reeking of cigarette smoke. That was less than twenty years ago. I still love going to concerts, and I can’t wait to do so after covid ends. But now I don’t stink afterwards and it’s healthier for everyone involved. It’s not possible to create equity and leave room for racists. We have to do what’s just without ever closing off the opportunities for change.
Maintenance and action are very intertwined. People in this stage are working to keep from sliding back into old habits. They are not usually as active about it as people in the action stage might be. This stage, surprisingly, lasts between six months and five years. In smokers, the TTM study found that their risk of relapse after five years dropped 36%.
By this stage, we have an ongoing commitment to do better. I’ve found lots of opportunities to deepen my own understanding. I would not have found those if I had stopped trying to learn, or thought I was already done.
This is not an official stage in the Transtheoretical Model. It means a regression from action or maintenance to an earlier stage. I couldn’t find any articles by people announcing they were “no longer antiracist.” That doesn’t mean they aren’t out there. We might not even realize it. Angela Davis describes this about another fight for justice in her book, Women, Race & Class. Elizabeth Cady Stanton is well-known as one of the faces of feminism and women’s suffrage. But justice for her was giving white, well-to-do women the right to vote. After the civil war, she and others had to choose whether to support Black enfranchisement in the 15th Amendment. She advocated against support for the amendment, thus dismissing the intersectional concerns of Black women. There is a risk, when fighting for a cause, that we overlook the bigger picture. Rights for white women while ignoring Black women. Gay liberation while ignoring trans and nonbinary issues. We don’t know what we don’t know. We must stay aware to ensure we are not oppressing a smaller group with even less agency.
I’m writing and thinking about all this at the doorstep of the other global calamity of our lives. The climate change report is equal parts crushing and unsurprising. What’s more, the report has already fallen off most media coverage because of the u.s. withdrawal of troops from Afghanistan. The same day also saw a devastating earthquake and then hurricane in Haiti. Climate change created or made worse both of these events, but they were presented without that context. Even with the dire warnings in the report, it’s not too late. I know that some people feel we’re doomed. I know that others refuse to see what is staring them right in the face. But no matter who we are, someone can reach us. Someone can help us change. We can inspire that change for someone else.
It’s not our responsibility to change anyone’s mind except our own. But if we want to try, it could make all the difference.