Van Gool & Bridges
A further consideration in effectiveness involves asking why some people alter their
behaviour and others do not. The ‘stages of change’ model (Prochaska, 1992) tries to
explain this phenomenon. The model works on the premise that different people are at
different levels of awareness, and preparedness to modify their behaviour. In other
words, whilst some people may not even be aware of the risk related to their behaviour,
others are aware and are contemplating behaviour modification.
If we accept the premise of the ‘stages of change’ theory, then any health education or
promotion program should recognise that individuals may be at different stages. Hence
we may need a range of interventions that guide individuals (or communities) through
those different stages (Kok et al. 1996).
A further concern about the effectiveness of nutrition interventions is highlighted by
studies conducted by Smith et al (1995) and Elliot (1995). Smith et al (1995) found that
volunteers for a nutritional education program had made more recent dietary changes
than the rest of the population sample.
This leads to the conclusion that those who Volimteered for the education program are
more likely to have definite plans for behaviour change or have already started making
such changes. Smith et al state that “ changes to dietary intake at the population level
will require multiple interventions that are appropriate to these different stages of
readiness for change”.
This finding is backed by the results from a study by Elliott (1995) who concludes that
“voluntary participation by people with heart disease in a community nutrition
education campaign is low and that there is self-selection bias, with those at highest
dietary risk being least likely to attend”. This study highlights the weakness of a
community nutrition campaign that is not designed to reach the target population.
One question that needs to be asked in light of the Smith and Elliott findings is whether
one intervention can guide people through different stages of the model? For example,
can a media campaign guide some people through the ‘pre-contemplation’ stage and
others through the ‘preparation’ stage?
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Chere Project Report 11- November 1999