Table 1.

Processes of Change Definitions, Sample Interventions, and Illustrative Program Activities, by Stage

Stage/Process	Definition: Sample Interventions	Illustrative Program Activity
Precontemplation
Consciousness raising	Raising awareness about unhealthy dietary behaviors: feedback, education, confrontation, interpretation, bibliotherapy.	Interactive assessment with feedback for raising users’ awareness of the number of daily servings of fruits and vegetables they are in the habit of eating.
Dramatic relief	Experiencing and expressing feelings to help motivate dietary change: psychodrama, role playing, grieving, personal testimonies.	Personal testimonial regarding losing a loved one to cancer, followed by a discussion of lifestyle habits associated with increased cancer risk.
Environmental reevaluation	Assessing the impact of one’s unhealthy dietary behavior on others and raising awareness that one can serve as a role model for others: empathy training, documentaries, family interventions.	Vignette depicting a boy who experiments with different strategies for increasing his intake and notices the positive impact his behaviors are having on family members and close friends.
Contemplation/preparation
Self-reevaluation	Examining how one thinks and feels about oneself with respect to unhealthy dietary behavior: value clarification, exposure to healthy role models, imagery.	Guided imagery exercise for helping users understand the health consequences of not eating enough fruits and vegetables.
Self-liberation	Choosing to act or belief in ability to change dietary behaviors: behavioral resolutions, public testimonies, exposure to multiple alternatives for modifying behavior.	Identification of a daily fruit and vegetable goal and development of a 1-wk menu and action plan for reaching the goal.
Action/Maintenance
Reinforcement management	Rewarding oneself or being rewarded by others for making dietary changes: contingency contracts, overt and covert reinforcements, positive self-statements, group recognition.	Multimedia presentation addressing strategies for rewarding oneself or being rewarded by others for continuing to eat five to nine daily servings of fruits and vegetables.
Helping relationships	Being open about problems with someone who cares: providing support for healthy behavior, therapeutic alliance, buddy systems.	Development of a “buddy contract” for teaming up with someone else who is interested in maintaining an intake of five or more daily servings of fruits and vegetables.
Counterconditioning	Substituting alternatives for problem behaviors: relaxation, desensitization, assertion, positive self-statements.	Interactive activity for helping users identify problem behaviors that prevent them from maintaining intake followed by a multimedia presentation of healthy replacement behaviors to try instead.
Stimulus control	Avoiding or countering stimuli that elicit problem behaviors: avoidance, environmental reengineering, self-help groups.	Environmental assessment activity for determining characteristics of home, neighborhood, and school environments that may encourage unhealthy eating, followed by a discussion of strategies for changing or handling environmental aspects that are problematic.