Chart 3. Stages of behavioral change.

Stage	Description of the stage and motivational counseling strategies
Precontemplation	There is no intention to stop in the foreseeable future (next 6 months); nor is there even the realization that the smoking behavior is undesirable. Counseling strategy: patients should be educated about the risks of smoking.
Contemplation	Although there is awareness that smoking is a problem, there is ambivalence about the perspective of changing; the patient plans to quit within the next 6 months. Counseling strategy: patients are receptive to information about how to change their behavior.
Preparation (determination)	There is a readiness to stop smoking, often within the next month, and the patient is determined to do so. Counseling strategy: patients should actively plan a cessation date as a strategy to change the behavior.
Action	Smoking cessation: the patient takes the action that leads to the desired change in behavior. Counseling strategy: patients should change their behavior and quit smoking.
Maintenance (prevention of relapse)	The patient finalizes the change process or relapses. Counseling strategy: patients should learn strategies to resist triggers and prevent relapse.

Adapted from Prochaska & DiClemente. ³⁰