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Inside Dental Hygiene
April 2023

Treatment Acceptance: The 6 Stages of Behavior Change

Follow these steps to guide patients on their path to dental health

Janiece C. Ervin, RDH, BSDH

Dental hygienists burst with joy when patients begin their dental conversation by saying, "After I left my dental appointment last visit I went to the store, purchased what you recommended, and followed the home-care instructions that you gave me. I was excited to come in today to see if I am improving." This brings hygienists the greatest feeling of success. But what made that appointment different from all the other appointments I have had with this patient? What did I do differently that influenced them to take action?"

As dental professionals, we assess our patients clinically and develop treatment strategies to help them combat disease. But failing to also evaluate a patient's willingness to accept, listen, and take action toward dental wellness can hinder both the patient and the dental professional. During our clinical evaluation, we also need to recognize where our patients are in their dental health journey.

Understanding the six stages of behavior change that were developed in 1983 by Prochaska and DiClemente1 has helped healthcare professionals provide a framework for understanding how individuals change their behaviors and evaluate how ready they are to change. Using this framework allows us to recognize and meet our patients where they are in their behavioral change journey and allows us to create a customized treatment action plan for each individual. Here are the stages and the steps required for each:

Stage 1: Precontemplation—the "ignorance is bliss" stage

In this stage, the person does not even know or does not want to believe there is a problem. This stage is difficult for a healthcare professional because the patient has no interest in creating a behavioral change.

Steps for the healthcare professional:

• Build rapport.

• Have empathy.

• Educate and inform.

• Review the risks if action is not taken.

Stage 2: Contemplation—the "maybe" stage

In this stage, the patient has some awareness of the problem but goes back and forth on whether they need or want to change. Trust has been built between the patient and the healthcare professional.

Steps for the healthcare professional:

• Explain reasons to change and risks of not changing.

• Continue to strengthen the patient's self-efficacy.

• Educate and inform.

Stage 3: Preparation—the "I am ready" stage

In this stage, the patient is ready to change. They have decided that they are ready to address the issue and are readying themselves to take action.

Steps for the healthcare professional:

• Set small, achievable goals.

• Identify support and resources available for the patient.

• Partner with the patient to create a plan to attain their goals.

Stage 4: Action—the "look at me" stage

In this stage, the patient has developed a clear plan of change and is executing the steps consistently.

Steps for the healthcare professional:

• Offer consistent periodic reviews.

• Praise success.

• Provide additional support and resources as needed.

Stage 5: Maintenance—the "I got this" stage

In this stage, the patient identifies and implements strategies to maintain progress and to reduce the likelihood of slips or full relapse into old behaviors.

The role of the healthcare professional:

• Continue to strengthen the patient's self-efficacy.

• Provide consistent periodic reviews.

• Continue to support and give resources to prevent relapse of old behavior.

Stage 6: Relapse—the "life happens" stage

We are all human, and life can create obstacles that derail your patient's best efforts. The patient usually is disappointed and feels like a failure.

The role of the healthcare professional:

• Help identify the cause.

• Adjust the treatment plan to meet the patient's current needs.

• Identify support and resources available to them.

• Offer consistent periodic reviews.

Each patient is unique. As healthcare professionals, we can become frustrated with our patients for not taking positive action toward their dental health. Recognizing the six stages of behavior change gives us a clear framework to help strategically sift through all the personal information, clinical evaluations, and behavioral cues in our clinical appointments.

Utilizing this information will create a partnership between you and your patient that will allow you, as the healthcare professional, to develop patient goals, customize clinical strategies, and be a continued resource for maintenance and support in your patient's dental health journey.


1. Prochaska, J.O., DiClemente, C.C. Stages and processes of self-change of smoking: Toward an integrative model of change. Journal of Consulting and Clinical Psychology. 1983;51(3):390-395.

About the Author

Janiece C. Ervin, RDH, BSDH, is the founder of the Dental Explorer Network in Denver, Colorado.

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