CARE and Behavior Change

CARE (Computer Assisted Risk Education) is an automated counseling and planning tool that is informed by an evidence-based stages of change approach to help individuals understand and change risky behaviors. CARE has been shown to be effective at both changing behaviors and producing better health outcomes.

CARE implements a protocol to assess a patient’s:

  • Behavior
  • Knowledge and beliefs
  • Goals

It then synthesizes these inputs and creates highly personalized feedback by identifying the patient’s current stage of change and helping them create a personalized plan that moves them forward. CARE’s major innovation is an algorithm that captures complete, detailed data in an engaging and non-threatening way, and then acts upon it in real time in an effective and realistic counseling and planning experience.

The CARE system is based on a motivational interviewing approach, informed by the transtheoretical stages of change model.

Over more than 10 years, we have combined, tested and honed this approach to create scalable and effective behavior change and better health outcomes. The CARE system is designed to facilitate behavior change in any health domain with a significant behavioral component. Our current product provides HIV/AIDS-related content to elicit behavior change (Kurth and Spielberg, 2014).

Web resources – Quick links:

Overview article on the work of Ann Kurth:
University of Rhode Island transtheoretical research site:




CARE is a ready-to-use tool for HIV treatment and risk reduction.

If you have special needs, we can customize CARE to your project or organization’s requirements.

CARE is a CDC Best Practice

Stages of Change

“Stages of change” within the transtheoretical model (Prochaska and DiClemente 1992) is a widely accepted theoretical framework for understanding behavior change. Stages of change has been successfully applied to: smoking, eating, exercise, stress, depression, hypertension, drug and alcohol abuse, sexually transmitted diseases, and other health-risk behaviors.

The six stages of behavior change that patients go through:

  1. Precontemplation, where they have not yet begun to think about change.
  2. Contemplation, where they begin to think about change but have no commitment to it.
  3. Determination, where they make a specific plan to change.
  4. Action, where they try the plan to build a new pattern of behavior.
  5. Maintenance, where they work to firmly establish the new behavioral patterns.
  6. Termination, where the new patterns can now be maintained without further effort.

stages of change model.jpg

Stages of Change Model – Adapted from Prochaska and DiClemente (1992).

In a single session, CARE can bring the patient to an action stage:

  1. CARE’s My Risks section brings the patient to a contemplation stage.
  2. CARE’s Thinking It Through section transitions patients to the determination stage.
  3. CARE’s My Plan section moves the patient to action on one kind of health-adverse behavior.

CARE breaks behavior into fine distinctions. It assesses the patient’s stage of change within these fine distinctions and helps her arrive at a plan to change behaviors she is ready to address.

In additional sessions, done longitudinally, CARE continues to work the patient from contemplation to action on additional behaviors while simultaneously monitoring maintenance of behaviors she has previously attempted to address.


Web resources – Quick links:

For a list of relevant research, see:
Stages-of-change introductory articles: and



Motivational Interviewing

Motivational interviewing (Miller WR, Rollnick, 2012) is a conversational technique in which a counselor attempts to elicit change from within the patient’s own beliefs and concerns. The counselor works with the patient’s own ambivalence to surface and amplify the patient’s own motivation and commitment to change.

Motivational interviewing has gained widespread acceptance across clinical settings as a way to stimulate behavior change.

According to the approach, a conversation with the ability to motivate change must be:

  • Engaging, to create a trusting open relationship.
  • Focused, to move from general discussion to problematic behaviors.
  • Evocative, to bring the patient a sense of the importance of change, to raise their confidence about change, and to increase their readiness to make a change.
  • Planned, to move toward specific actions patients will take to change.

CARE explicitly uses each of the motivational interviewing techniques.

  1. CARE’s My Risks allows the patient to engage her own virtual counselor from a range of genders and ethnicities. The counselor then leads the entire session. The section begins with general health and demographic questions but quickly focuses on behavior-specific questions in a non-judgmental but targeted way.
  2. CARE’s Thinking It Through evokes, synthesizes, and amplifies the patient’s own beliefs to highlight key opportunities for change. It validates positive behaviors and shows the patient what her main behavior-related risks are. Thinking It Through then presents knowledge and skills-building videos to raise confidence and readiness for change.
  3. CARE’s My Plan section leads the patient to a very specific and simple plan.

Web resources – Quick links:

For a list of relevant research on motivational interviewing, see:
For a comprehensive motivational-interviewing website, see: