Stage of Change Description
Processes of Change Interventions
Precontemplation
(Stage 1)
No intention of learning to selfinject in the foreseeable future (i.e., the next 6 months).
Patients may be in this stage because they are uninformed or under informed about the consequences of selfinjecting or they may have tried to start selfinjecting a number of times and become demoralized about their ability to do so.
Patients in this stage are often characterized as resistant or unmotivated or as not ready to become selfinjectors.
Consciousness Raising Discussion about RRMS: how it affects the body and the case for treatment.
Discussion about the pros (not cons) of selfinjection.
Written information about MS and its treatment.
Dramatic Relief Recommend Shared PerspectivesÔa
Contemplation (Stage 2) Patients are developing awareness of the need for selfinjection and are seriously considering selfinjecting in the next 6 months.
Patients in this stage are more aware of the pros of selfinjecting but are also acutely aware of the cons.This balance between the costs and benefits of changing can produce profound ambivalence that can keep patients stuck in this stage for long periods of time (i.e., chronic contemplation or behavioral procrastination).
These patients are not yet ready to become selfinjectors.
Self-Reevaluation Discussion about what is required to selfinject.
Demonstration of selfinjection.
Hands-on practice with selfinjection, encouragement, coaching.
Written educational information.
Preparation
(Stage 3)
Patients are intending to begin selfinjecting in the immediate future (i.e., the next 4 weeks).
Patients in this stage have typically taken some significant action towards selfinjecting in the past year and they have a plan of action, such as talking to their physician or nurse.
These are the people that should be recruited to become selfinjectors.
Self-Liberation Setting an appointment to initiate selfinjection.
Viewing the glatiramer acetate therapy information video.
Reading the written information in the glatiramer acetate therapy information kit.
Selfinjection training, followed by observed selfinjection, with coaching as needed.
Action
(Stage 4)
Patients have started to selfinject within the past 6 months.
In the action stage, patients have started to selfinject but selfinjection is being performed at a minimally acceptable level and the patient is not yet at ease with selfinjection.
The Action stage is the stage where vigilance against relapse is critical.
Contingency Management Review of selfinjection training and hands on practice followed by observed selfinjection, with coaching as needed.
Encouraging repeated daily selfinjection to build mastery of the technique.
Maintenance
(Stage 5)
Patients may be considered ‘long-term selfinjectors’.
Patients are consistently engaging in selfinjection and are integrating selfinjection into their daily routine.
Maintenance is the stage in which patients are less likely to relapse and increasingly more confident that they can continue selfinjection.
Helping Relationships Review of glatiramer acetate therapy information video.
Discussion about the pros and cons of selfinjection.
Professional nurse calls (Shared Solutions®).
Table 1: The Transtheoretical Model’s Stages of Change to SelfInject and Processes of Change, aPatients who were deciding whether to begin therapy were offered the opportunity to contact a peer with MS (a volunteer) who had relevant experience with injecting glatiramer acetate.