The model is based on four stages: motivation, guidance, action and maintenance.
In the formative stages, motivation prompts behavioural repetition, which in turn strengthens habit, and as habit develops, it acquires the potential to cue further repetition (Lally et al., 2010, 2011).
For example, the Transtheoretical Model is clearly not as popular as it used to be, with many papers suggesting that there are in fact only two stages: motivation and action (Brug et al., 2005).
Some authors demonstrated that the extent of clinical improvements can vary also depending on the stage of motivation achieved by patients [ 61] and that a mismatch between stage of motivation and phase of treatment can enhance resistance to treatment [ 58].
What is most important at one stage of motivation recedes in importance once satisfaction of the primary need at that level is achieved.
Patient-centred programmes were especially effective as they addressed the individual's stage of motivation for change.
More consistent with our expectations is the finding that adolescents reported a positive change in the preparation stage of motivation for treatment from admission to departure.
In addition, we will test whether socio-demographic variables (age, sex, social class), country of residence (Sweden, Germany, Belgium, Czech Republic), general psychopathology, parent child relationship, age of first use, and stage of motivation to change moderate the outcomes.
The Readiness to Change Questionnaire, designed to assess three stages of motivation to change (precontemplation, contemplation and action stages), was completed by all patients, who were then divided into "Action" (i.e. patients in action stage) and "PreAction" (i.e. patients in precontemplation or in contemplation stage) subgroups.
Empirical studies of general population groups have demonstrated that linear or simple two-stage theories (motivation and action) can be as useful as more complex five or seven stage theories for some health-related behaviours [ 42] and Weinstein et al have demonstrated that different factors influence behaviour at these two stages [ 43].
