✅ Reviewed for accuracy and relevance by Deanna Cooper Gillingham, RN, CCM, FCM on July 22, 2025.
Understanding behavioral change theories and models enables case managers to assess clients’ readiness for lifestyle changes and offer appropriate support. The following models help case managers determine a client’s stage of change and identify ways to assist them.
The 5 Stages of Change
The Transtheoretical Model, also known as the 5 Stages of Change, is one of the most widely used models for understanding behavior change. Knowing a client’s current stage enables the case manager to provide appropriate support, increasing the likelihood of engagement.
- Pre-contemplation – The individual does not intend to take action in the foreseeable future. He may not think about the change or will be resistant to it. Pressuring the client at this stage is usually ineffective. A typical statement at this stage might be, “I don’t want to quit smoking.”
- Contemplation – The individual considers a change in the next six months but has not committed to it. He may be open to information on the benefits of change and how to do so successfully. At this stage, you might hear, “I know I need to quit smoking; I just don’t know how.”
- Preparation – The individual actively plans to make a change within the next month and may even have taken small steps toward change. A client in this stage might say, “I got my nicotine patches today and have set my quit date.”
- Action – The individual has successfully made and sustained a change for less than six months. He will seek reinforcement and encouragement. For example, he might say, “I have not had a cigarette in nine days.”
- Maintenance – The change has been sustained for over six months.
Note that relapse can occur at any stage.
Health Belief Model
The Health Belief Model explains how clients’ perceptions of health risks and the benefits of taking action influence their readiness to change. It theorizes people are more likely to change if they:
- Perceive themselves to be at risk due to a lack of adoption of healthy behavior (perceived susceptibility)
- Perceive their medical conditions to be serious (perceived severity)
- Believe in the positive effects of the suggested treatment (perceived benefits)
- Have channels to address their fears and concerns (perceived barriers)
- Perceive themselves as having the requisite skills to perform the healthy behavior (self-efficacy)
By identifying gaps in these beliefs, the case manager can address misconceptions and enhance readiness for change.
Patient Activation Measure
Client activation describes the knowledge, skills, ability, willingness, and confidence a person possesses that allows them to become actively engaged in managing their health and healthcare. It is specific to each client.
The Patient Activation Measure (PAM) was developed to assess a client’s level of activation. Studies have shown that clients with higher PAM scores are better engaged in their health, have better health outcomes, and lower healthcare costs.
Clients with lower PAM scores are more likely to feel overwhelmed managing their health. They are also less likely to understand and have confidence in their role in their healthcare. By understanding a client’s activation level, case managers can create individualized care plans to increase activation and engagement.
Ways to increase activation include:
- Meeting clients where they are
- Personalizing care
- Educating
- Empowering
- Increasing confidence
- Breaking actions into small, manageable steps
Content adapted from CCM Certification Made Easy, 4th Edition by Deanna Cooper Gillingham, RN, CCM, FCM (2025) and used with permission from the Case Management Institute. Purchase your copy at CCMCertificationMadeEasy.com
