Table 2.

Tools or Processes of Change

Tool, Processes Used to Change*DefinitionPhysician InterventionsIllustrative Quotations From Participants
Adapted from Prochaska et al.40 The 10 tools or processes of change are consciousness-raising, dramatic relief, self-reevaluation, self-liberation, counter-conditioning, stimulus control, reinforcement management, helping relationships, environmental reevaluation, social liberation.
IPV = intimate partner violence.
* In this article we focus on the 3 tools used during precontemplation and contemplation by the person trying to change behavior. Definitions and physician’s interventions are interpreted for IPV. Quotations from our data illustrate the 3 tools.
Consciousness-raisingIncreasing information about self and IPVAsk about IPVThey (prenatal clinic) hooked me up to a stress monitor because he (abuser) gave me a concussion and they wanted to make sure that my baby was still OK …. I did let them know [about the abuse].
Share observations about the relationship
Educate about the impact of stress/injuries on health
Dramatic reliefExperiencing and expressing emotions about IPVEmpathizeI had broken my finger. The physician said to me, “You can’t break your finger that way by falling. I understand being afraid.” He was real nice. I remember his name. But, he was like; “I understand fear, being afraid.” He told me his professional opinion as a doctor seeing an abused woman is that “get help, you know, get out.”
Identify emotional state
Self-reevaluationAssessing how one feels and thinks about the abusive relationshipClarify valuesI just didn’t, you know, want to have that useless, powerless feeling no more. I needed something to gain, and I knew I had to do something to change that, because where I was at was going to [nowhere] and nothing was going to change.
Experiences and feelings