My pieces

Deceptive

99 Words
kiss my as
you can call me first class
producing by the mass 
attaining levels you'll never pass

I have ninety-nine words that pertain to you
Open up the bible and do what you gotta do 
to figure out what's really True
I'll be coming through the passage that was sent to you

anticipation 
 the creation of publication 
tearing down our nation
what an observation
as we sit in contemplation
forgetting innovation
desiring inspiration
inside an evocation

our directive lost
and at what kind of cost

poets non sense

A poetic text, even a rudimentary one, cannot be read linearly if the very effects that we might characterize as poetic are to be legible.[24] But this does not mean that the poetic text does not have a linear dimension. On the contrary, all texts share a common linear dimension in historical time. That is, while one may argue that hypertext transforms the diachronous processes of reading back into synchronous scenes (to put notions of hypertext’s nonlinearity in Flusser’s terms), conceiving each page or link of the hypertext document as running parallel to all others, it is not so easy to unwrite the linear historical consciousness that tells us that we encountered stories in a grade school primer long before we tackled James Joyce’s Ulysses.

Others have questioned hypertext’s claims to nonlinearity or have advanced their own modifications of same. Notably, in his seminal essay, “Nonlinearity and Literary Theory,” Espen J. Aarseth makes similar points about the nonlinearity of many traditional print texts, which may allow a high degree of flexibility and interactivity in how the reader uses them.[25] Aarseth’s alternative definition of textual linearity then draws on the topological definition as stated in Webster’s New Twentieth-Century Dictionary: “those properties of geometric figures that remain unchanged even when under distortion, so long as no surfaces are torn.”[26] Such a definition adapts itself well to a consideration of text, which, whether on the book page or the web page, is bound, however fleetingly, to the surface of its transmission medium, which the reader is nevertheless to “distort” in any number of ways. Though Aarseth goes on to present several persuasive readings of how this nonlinearity operates in both print and online texts, none is as revelatory—or as useful for my own attention to the linearity of historical time—as his commentary to the I Ching, or Book of Changes, from the third millennium BC.

Unlike historic texts with a fixed expression, such as Beowulf, I Ching seems to speak uniquely to us across the millennia, not as a distant mirror that can be understood in a philological or romantic sense but as an entity that somehow understands us and speaks for us. This almost religious effect can be partly explained by the repeated updates and the fact that the text was intended to be useful and directly relevant to events in people’s lives, but it seems to me that it is the explicit and elaborate ritual, largely unchanged through the ages, that creates the textual presence that allows us to be naïve users—not readers but agents of the text, closely related to the users of three thousand years ago, despite the epistemological interventions of time and culture.[27]

How close this “almost religious effect” of interacting with a text “intended to be useful and directly relevant” seems to our reading of the pre-Socratic poet-philosophers with whom we began! Though I would quibble with Aarseth’s idealized notion of the I Ching’s immediacy—as with Beowulf, the text would be quite incomprehensible to the vast majority of potential readers without the mediation of a dense web of scholarly and authorial interventions—he nevertheless offers a persuasive argument for qualifying the I Ching as a nonlinear text akin to hypertext. Indeed, Aarseth’s description of that work’s precisely ordered pictograms hews closely to the definition of “hypertext” first provided by T. H. Nelson in 1965: “a body of written or pictorial material connected in such a complex way that it could not conveniently be presented or represented on paper.”[28] Of course, the I Ching is generally “presented or represented on paper.” But “the explicit and elaborate ritual” by which the text is incorporated into the lives of its readers—so goes Aarseth’s argument—does not lend itself to easy diagram, nor can it be divorced from the text without changing the text’s fundamental character. This demand for participation on the part of the reader gestures toward Aarseth’s subsequent elaboration of “ergotic” literature, the term he uses to distinguish those texts—he offers the I Ching as an example here as well—that cannot be navigated without the reader making unscripted decisions that will determine the path and its meaning.[29]

The point that Aarseth glosses over, however, and that I would now like to emphasize, has to do with the linearity of time irrespective of the text itself. For while Aarseth and others address time in the act of reading or engaging with a text (whether a codex, a hypertext, or a video game), they scarcely acknowledge time as a crucial determinant of how the reader situates him- or herself relative to each encounter with the text.[30] That is, if we characterize the I Ching as an expression of ancient wisdom that still speaks to us today, then the paradox of its simultaneous antiquity and contemporaneity, “despite the epistemological interventions of time and culture,” accounts for much of its power. One may argue, as Gunnar Liestol has, that this plotting of the historical timeline does not serve a discussion of digital media, which is developing so rapidly as to neutralize “the traditional one-directional relationship of analysis (and interpretation) in most humanistic inquiry.”[31] Such an argument falls short, however, when we look back on any given specimen of digital media in general, and hypertext literature in particular, from the vantage point of our own experiential present. From this perspective, the placement of the work relative to what came immediately before and after is obscured, much like looking at strangers in an old class photograph. A bit of scholarly scrutiny might reliably situate the photograph in time and space, Iowa City in 1958 or Cleveland in 1966, but the naïve viewer might just as easily characterize the photograph as “old” and leave it at that.

Strickland’s work is particularly advantageous for considering whether hypertext circumvents or emphasizes the reader’s temporal experience of the text because she frequently produces both hypertext and traditional print versions of the same work.[32] Such is the case, for example, with Strickland’s “To Be Here as Stone Is.” When viewed on a MacBook Pro running Firefox 3.5.11, the presentation shows its age (Figure 2). This is at least in part because the poem’s design calls for us to view it in Netscape 4 (Communicator), which was discontinued in 2002. The poem’s formatting can be highly variable depending on the computer’s operating system, available fonts, web browser, and the sizing of the browser window, changes to which may inadvertently re-lineate the text.

Fig. 2. Stephanie Strickland, “To Be Here as Stone,” viewed on a MacBook Pro running Firefox 3.5.11.

The problem of hypertext that is not continuously updated to the capabilities (and thus also the demands) of the latest hardware and software echoes N. Katherine Hayles’ remarks about people still relying on computer technology that has long been out of date: “Although they can still produce documents using these versions, they are increasingly marooned on an island in time, unable to send readable files or to read files from anyone else.”[33] Despite the familiarity of this phenomenon, I am nevertheless resistant to Hayles’ characterization of digital producers and/or consumers as “marooned on an island of time.” Here, the denial of coevalness obscures the fact that these producers/consumers operate in the same information marketplace and at the same time as everyone else, which is the very reason their technology’s obsolescence is perhaps more legible than anything it produces.[34]

This is why correcting for these variables in a hypertext poem like “To Be Here as Stone Is” one nevertheless notices that the text looks like a relic of an earlier iteration of Internet technology, which it actually happens to be. The publication of the same poem in Strickland’s True North (Figure 3), by contrast, looks like it could have been published in 1987, 1997, 2007, or yesterday. In this context, there is an unexpected accuracy to the stock wording that appears on that book’s copyright page: “The paper used in this publication meets the minimum requirements of the American National Standard for Information Sciences Permanence of Paper for Printed Library Materials.”[35]

Fig. 3. Stephanie Strickland, “To Be Here as Stone Is,” as published in True North (1997).

Can we imagine any comparable standard of permanence for hypertext poetry?[36] More to the point, if we accept the thesis, advanced by Celan and others, that the poem’s failed striving toward agelessness, the poet’s Orphic struggle to lead the timeless object of desire back into daylight, is an inherent quality of poetic expression—then doesn’t hypertext make visible an ephemerality that traditional print obscures? In addition to allowing the reader to visualize verbal connections and associative leaps that otherwise appear only to the mind’s eye, don’t the design elements of hypertext help us see the poem in its ephemerality?

2. The Upward Journey: Embracing Loss

Online publishing greatly reduces the temporal separation of composition and consumption, a fact that has proven especially consequential in the areas of journalism and political action. We no longer have to wait for the evening news—let alone the morning paper!—to find out what is going on around the world. As the so-called “Arab Spring” is demonstrating even as I am writing this, Facebook and Twitter feeds have proven far more effective at organizing immediate, large-scale political protests than print media have yet achieved. The paradox of this proliferation of online information is that, while by no means immune to decay, the information is quickly superseded by new dispatches, which in turn accelerates its aging. As we have seen, a book of poems published on acid-free paper in 1997 can easily look like a book published in 2011; in the United States, it is not uncommon for a book to go through multiple printings with little or no change in design. But a hypertext poem coded in 1997 shows its age almost immediately, whether because its design elements reflect earlier stages of a rapidly changing programming environment, or perhaps because the coding requires now-obsolete software.

Strickland has insisted that the online component of her lyric projects arises from and reifies this inherent ephemerality. Such is the case, for instance, in her V project, consisting of V: WaveSon.nets/Losing L’una, a double-bound, invertible book (flipping it over allows access to each part), and V: Vniverse, an online book composed in Adobe Shockwave. Regarding the latter, Strickland has articulated the importance of the computer screen as a mediator between text and reader.

When reading online, when transformed to that kind of reader, the indispensable recognition is that you always have a co-reader in a way you do not with print. Not only are some of the display choices made only by the computer, but if the computer is not reading the code there is no poem to be had. This is a situation quite unlike torn paper, books remaining unread on a dusty shelf, a broken Ozymandian statue in ruins to reconstitute. This reading situation depends absolutely on the temporal coincidence of many human and non-human choices, many human and non-human processors, or it is nothing. As fragile as an ecosphere perhaps.[37]

Strickland’s statement, co-authored with digital media artist Cynthia Lawson (her collaborator on V: Vniverse), seems to assume that it is only with the increasingly widespread availability of computers that an intermediary now intrudes in the idealized cognitive circuit of reader and text. Yet reading a poem is always and fundamentally a process of “reconstitution” of highly mediated inputs. This is most readily apparent in public presentations, such as a poetry reading, where the individual presenting the work executes all of the “display choices,” and the “reading situation depends absolutely on the temporal coincidence” of the speaker’s voicing the poems and the audience’s listening, though even in this mundane example there are “many human and non-human processors,” including everything from chance interference (a child giggling, an old man coughing, a cell phone ringing) to the presentation’s design (how well the microphone is positioned, whether or not the speaker is standing at a podium). All of these factors, and many more, mediate between text and reader.

What makes the hypertext poem special is not that the computer’s mediation of the text makes the poem new each time the reader encounters it, but that it integrates those display choices with the text so thoroughly that the poem’s age can be seen in the age of the display. Thus when Brian Lennon notes that “creativity in the electronic arts is concentrated [. . .] in practices of programmed visual and kinetic poetry that have their roots (acknowledged or no) in the experimental typography of the historical avant-gardes (Futurism, Dada, Surrealism) and European modernism as well as the internationalist Concrete poetry of the 1950s,” his observation not only puts hypertext artists’ claims to novelty into question but also invites us to envision hypertext itself as a “historicalavant-garde,” one that is no less difficult to situate within a historical timeline.[38] Of course, Lennon did not have to limit himself to twentieth-century movements; since the advent of moveable type, the history of print has been one in which technological advances, design innovations, and reading habits are constantly reshaping each other. In this sense, Liestol’s argument about the rapidity with which computer-generated displays have been developing actually helps account for why, with hypertext, we can see as much aging in 5 years as might take 50 in print. Here, then, is where we see the hypertext poem “[a]s fragile as an ecosystem.”

In a recent essay for the Poetry Foundation website, Strickland advances what is perhaps her most radical position in what has become a decades-long conceptual evolution: “What is meant by e-literature, by works called born-digital, is that computation is required at every stage of their life. If it could possibly be printed out, it isn’t e-lit.”[39] At first glance, this assertion would seem to exclude from the genre of electronic literature most of Strickland’s own impressive oeuvre, and while she is free to support this rebranding for herself, it makes little sense for how her work has actually been read.[40] More importantly, it ignores the vital role of electronic mediation in the publishing process, the fact that many poets and publishers now make fundamental decisions about formatting, design, lineation, etc., on a computer screen, and with the full expectation that the product of that process will exist primarily in print. Finally, if the author offers up the text as an interactive experience while simultaneously prescribing the parameters of interactivity, such that the reader must always choose between conforming to or violating the author’s intent, how is the hypertext different from print? Declaring that it is only electronic literature when it was never imagined for any other medium is analogous to saying that acting is only that which occurs on a stage or, better yet, in the agora. After all, cinema and television have altered the dynamics of performer-audience interaction so dramatically (!) that it would seem as if we were now speaking of an altogether different art. I suspect that most actors would attest that doing multiple takes in front of a camera and performing for a live audience entail differing relations to space, but I cannot recall ever hearing an actor claim that one is acting, whereas the other is not.

While I have been arguing that the hypertext poem accentuates an ephemerality that has been a traditional feature of poetry itself, the ephemerality of what Strickland now defines as “e-lit” is of a different kind altogether. Poems presented in Flash animation, for example, and especially those that feature episodic or continuous animated sequences that cannot be stopped once they are started, allow the reader little choice but to follow the movement of the text as it runs through its script. What the reader misses—and this may be substantial, given the density of audiovisual information in Flash animation—disappears, at least until the reader reloads the animation. Thus the reader has a sense that the poem exists within its own time frame, which it traverses according to a visual rhythm that is the digital poem’s analogue to traditional meter. By incorporating their ephemerality into the composition itself, the Flash poem’s aging is less obvious than we find in hypertext poems.

Two examples of this play with ephemerality are Brian Kim Stefans’ “The Dreamlife of Letters” and Oni Buchanan’s three-poem cycle The Mandrake Vehicles, produced in 2000 and 2006, respectively.[41] In a note to the print publication of The Mandrake Vehicles in her 2008 book Spring, which also includes a CD containing the Flash animation, Buchanan describes the sequence as having been “scored for paper, letters, and imagination, each vehicle represented here by seven stilled frames selected from the vehicle that is itself in constant motion.”[42] Unlike Stefans’ poem, which calls on the reader only to “run poem” (and thanks him or her “for watching”), Buchanan’s compositions move in stages that have to be activated by the reader; the seven “stilled frames selected from the vehicle” in the print version are simply the stable states in each Flash-animated sequence.[43] While the animation certainly clarifies the poet’s vision for the reader, it is not indispensible, since the print version provides the reader with everything he or she needs to interpolate the “constant motion” that Buchanan intends. The reader performs the poem, as it were, as a musician might a musical score, and with the full confidence that the materials necessary to do so—in this case, “paper, letters, and imagination”—are already at hand. Buchanan, who is also a concert pianist, has worded these directions advisedly.

It is impossible to predict how these Flash animations will eventually show their age. Still, it is likely that they will do so before the print versions of the same texts. Real time is the delimiting factor of any technology. It accounts for the accelerating obsolescence of consumer goods in a global market that has long assigned great value to novelty, real or perceived.[44]

Shortly before FEED closed shop in 2001, Robert Coover, who had helped usher in the wave of hypertext composition of the 1990s, was already declaring that the heyday was over, since even this flexible recent technology, no matter how “nonlinear” in appearance, could not resist the linearity of time.

Could it be that text itself is a worn-out tool of a dying human era, a necessary aid, perhaps, in a technically primitive world, but one that has always distanced the user from the world she or he lives in, a kind of thick, inky scrim between sentient beings and their reality? Even alphabets, clever little tools in their time, are fettered now by the unlinked nature of the times of their origins, and are already giving way to new multilingual alphabets and pictograms called icons.[45]

Poetry, with its roots firmly planted in oral tradition, thrives on its portability and mutability: With every reading, and for every reader, it is simultaneously different and same, new and old. The poem in digital media is inevitably a poem about the failure to resist time, and in the long term this may prove to be its most poetic function. For it is only because Orpheus fails that the poet’s story seems to go on forever.

Communicate

THE message set out communication with earth 

that mysterious force 

earthly communicators can 'strike off' with the evil spirits

we are granted certain powers

Providence hast endowed them

spirits of vile and repulsive character

deteriorated in their thoughts

for in all lands there are

atmospheres of most classes of life

and works like a slave to keep things going

we have learned that comparatively

over by a spirit or angel

Peoples of whom I came—they had no fear of death

There was a negative confession

They resented interference from strangero

in a long succession of wise and mighty men

who had grasped all power into their own hands

Referring to differences of opinion

Jews of a wide range of ethnic backgrounds and levels of observance were connected to networks of relatives spread out nationwide, fostering frequent relocation to take advantage of educational opportunities, a new job, or an offer of marriage.

φ = 1+1/(1+1/(1+1/(1+1/(1+1/... = [1;1,1,1,1, ...]

The status of evidence and outcomes in Stages of Change research

The status of evidence and outcomes in Stages of Change research

Sandy Whitelaw,
Steve Baldwin1,
Robin Bunton1 and
Darren Flynn1


Abstract

The Stages of Change model has become a prominent feature within health promotion and most of the literature associated with the model portrays it as being `effective'. Based on an extensive review of the literature, this paper suggests that contrary to this view, there exist a relative paucity of sufficiently strong supportive evidence. The paper describes the features of the existing evidence base, and highlights problems in relation to various aspects of design and execution. Two wider issues relating to the core nature of the model and the evidence associated with it are identified as important and discussed. Two main conclusions are drawn. First, better quality quantitative outcome studies are needed. These should be complemented with significant qualitative case studies with a focus on practitioner and organizational utilization of the model. Second, the disproportionate popularity of the model may be skewing the practical and conceptual nature of health promotion. Stages of Change activities are seen to equate to `health promotion' at the expense of other activities and approaches.


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Introduction

James Prochaska and Carlo DiClemente's Transtheoretical Stages of Change model (Prochaska and DiClemente, 1983) has had a profound impact on health promotion, becoming one of the most prominent and popular conceptual resources in the field. Their remarkably elegant vision of behaviour change as a cyclical `staged' process has struck a chord with many health professionals and researchers working in topic areas ranging from smoking cessation to the promotion of physical activity. The model has been used to tailor interventions to particular `stages of change' and to harness the internal `processes' that are perceived to be at play within each of these stages.

Without doubt, a case can be made for the model being useful in some way. In a pragmatic sense, for hard-pressed field practitioners, it is clearly an advance on the crudeness of efforts to change behaviour based on a simple model of an input of knowledge leading to attitude shifts resulting ultimately in behaviour change. Likewise, in the tradition of `social marketing' there is undeniably a `common sense' attractiveness around its ability to segment populations and direct compatible interventions to them (Hastings and Haywood, 1991; Cirksena and Flora, 1995).

However, for a number of reasons, these perceived virtues cannot excuse the model from informed assessment. First, as Foucault and Popper continually suggested, the need for critique is particularly great at the very point when concepts and ideas begin to take on an established or accepted status. Second, the rapid growth in practice and research around Stages of Change cannot be left unexamined, especially when relatively profound claims are being made on its behalf. Finally, the literature tends not to explicitly discuss many important issues raised by research, leaving them unresolved. Central to this is the question of `effectiveness'. As well as being seen as broadly `useful', accounts of the model go on to explicitly portray it, for example, as: `effective' [(Prochaska et al., 1993, p. 399], achieving `favourable differences' [(Steptoe et al., 1999), p. 943] and `positive effects' [(Campbell et al., 1994), p. 786] between intervention and control groups, and as achieving `a high impact rate' [(Velicer et al., 1999), p. 26]. Whilst this literature is generally couched in an image of formality and scientific respectability, an analysis of the narrative used in the reporting of Stages of Change also shows that this form tends to be accompanied with particularly strong rhetoric and this immediately establishes the possibility that different types of evidence and persuasive strategies are at play. [Discussion of the narrative structures used to report Stages of Change work is the product of a process of discourse analysis using the tools of Fairclough (Fairclough, 1992)]. Prochaska et al. [(Prochaska et al., 1993), p. 399], for example, began an account of their work with this particularly emotive metaphor:

Of all the people alive in the world today, an estimated 500 million will die from the use of tobacco. Approximately 2.5 million will die in middle age with an average loss of 20 years of life. This group will lose a total of 5 billion life years, which ironically is the approximate age of the earth.

We accept that the optimism connected with the model may ultimately be well founded (as implied by the majority of the reporting), it may be robust [as suggested by, for example, Laforge et al. (Laforge et al., 1999) and Donovan et al. (Donovan et al., 1998)] and `useful' to practitioners [as suggested by, for example, Houlihan (Houlihan, 1999) and Haslam, (Haslam, 1999)]. The specific claims of effectiveness may also be justified. However, this paper suggests that there may be a tendency for the strength of the evidence base to be over-stated and that there is less high-quality evidence associated with the model than generally assumed. It is possible therefore that the accepted credibility that surrounds the model [Samuelson (Samuelson, 1997), for example, contends that the model is `the most important theoretical health promotion development of the decade'] is derived to a significant extent from a general faith and persuasive rhetoric.

This notion is explored in this paper using insights and data derived from an empirical review of the model, and its use in health promotion (Bunton et al., 1999) commissioned by The Health Education Board for Scotland and completed between November 1998 and April 1999.

The paper begins with introductory material containing a brief description of the model, an overview of the process by which the review was conducted and a summary of other critiques of the model. The core of the paper then considers the specific issue of concern: the general paucity of sophisticated outcome trials that assess changes in behaviour and the limitations of those that have attempted to consider such measures. The paper concludes by considering two wider issues that arise from this discussion: being conscious of the nature of the evidence that is deployed in assessing it and establishing a clear vision of the status of the model. A number of possible ways forward are then suggested.


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The nature of the Stages of Change model and expectation of models in general

Before embarking on specific examination of the Stages of Change model, as a point of subsequent reference, a brief description of its nature and the expectations associated with it is offered. The Transtheoretical Stages of Change model was developed in the early 1980s in an attempt to understand and collate a range of existing perspectives on smoking behaviour change (Prochaska and DiClemente, 1983). The framework postulated three major ideas (DiClemente and Prochaska, 1998). First, behaviour change is seen as a dynamic process that occurs in a sequenced and cyclical order, involving the following stages: `pre-contemplation' (the new behaviour is not considered), `contemplation' (the new behaviour is contemplated but not acted upon), `preparation' (efforts are made to prepare for changes involved in adopting the new behaviour), `action' (initial behaviour change is made) and `maintenance' (the new behaviour is maintained over time). Second, it is suggested that progress through these stages is driven by a series of 10 processes specific to particular stages, including `consciousness raising' (seeking information about the problem behaviour), `counter-conditioning' (substituting new alternative behaviours for problem behaviour) and `stimulus control' (controlling situations that may trigger relapse into the old behaviour). Third, the notion of levels of change recognizes that individuals can experience multiple problems that exist at different levels: symptom/situational, maladaptive cognitions, interpersonal conflicts, family/systems problems and interpersonal conflicts. So, in summary, by a process of collation, the Transtheoretical Model sought to accommodate and effectively transcend a range of existing cognitive theoretical frameworks such as the Health Belief Model, the Theory of Reasoned Action and Social Learning Theory, forming a new more comprehensive and multi-layered `supra' structure.

These intentions point to an important wider issue relating to the nature of theories and models of human behaviour, and what should be expected of them. Whilst given little explicit attention in the literature, when this matter is considered [e.g. (Earp and Ennett, 1991; Rawson, 1992)] a wide range of assumptions can be detected. Essentially, there are varied views on the extent to which models should define the scope of the phenomenon they purport to define. Whilst it is generally agreed that models are visual representations or metaphors that seek to simplify complexity, there are different views on the extent to which it is appropriate and necessary to abridge this complexity [this tension is beautifully articulated by Isaiah Berlin's essay The Hedgehog and the Fox (Berlin, 1997)]. For some, models offer a way of narrowing and simplifying our understanding of behaviour, highlighting areas in which action can pragmatically be taken. For others, there is less desire to restrict this vision, with attempts made to maintain a recognition of complexity. From these values, a range of other positions arises, summarized in Table I, and these will be deployed later in considering the Stages of Change model.



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Table I.
Summary of the features associated with models of behaviour change



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Locating the present work in the context of existing critiques

Given the intensity of debates in the published literature [e.g. between Prochaska and Velicer (Prochaska and Velicer, 1997b) and Bandura (Bandura, 1997) and Davidson (Davidson, 1992) and associated commentaries] and the strength of feeling that we have experienced in disseminating the review, before embarking on specific discussion, it is worthwhile placing this work in the context of others of a similar nature.

As far back as 1992, a critical Editorial by Robin Davidson had prompted a series of responses in the British Journal of Addiction (Davidson, 1992) and various themes can subsequently be identified from further publications. At a fundamental level, some have questioned the core internal validity of the model and this has been expressed in a range of ways. Most critically, Bandura (Bandura, 1997) has questioned whether the model is a `true' stage model at all. Ahijevych and Wewers (Ahijevych and Wewers, 1992) and Farkas et al. (Farkas et al., 1996) have also questioned the `representativeness' of the original group in Prochaska and DiClemente's 1983 work; Farkas et al., for example, suggest that `the model was developed and validated using self-selected smokers...with higher levels of consumption who intended to quit' (Farkas et al., 1996, 1278). Building on this, Pierce et al. (Pierce et al., 1998), Farkas et al. (Farkas et al., 1996) and Belding et al. (Belding et al., 1997) suggest that the model excludes a range of other variables that may have explanatory power, e.g. Pierce et al. suggest that variables not included in the model such as `level of addiction' and `quitting history' are strongly associated with cessation [(Pierce et al., 1998), p. 278]. The explanatory power of the model has also been questioned, Marcus (Marcus, 1996) and Clarke and Eves (Clarke and Eves, 1997) alluding to a concern that stage processes and behavioural outcomes are tautological or `reciprocally determined'; Marcus, for example, accepts that it is not possible to determine whether `movement in the process of change occurs before, concurrent with, or after the change in exercise stage of adoption' [(Marcus, 1996), p. 200].

These basic concerns have been reflected in a series of more specific issues related to establishing valid links between the status of individuals and the `stage' they are allocated into. In discussing the narrative expressed by smokers, McKie et al., for example, note that `the dynamic nature of assessing an individual's position on the Stages of Change model was clearly borne out...people could shift through several stages of the model in minutes as they spoke of attempts to give up' [(McKie et al., 1999), p. 9]. In a broader sense, cross-national studies have shown large variations in the distribution of populations across stages; Kearney et al., for example, note `large between-country differences (in stage distribution)...with three-fold differences in the precontemplation stage (Ireland and Italy 15% versus Greece and Portugal 46%) and in the maintenance stage (Greece 14% versus Ireland 47%)' [(Kearney et al., 1999, p. 117]. The validity of self-reported behaviour with respect to stage has also been questioned (Lechner et al., 1998; McKie, 1999). Lechner et al., for example, show that by using different models of dietary assessment, subjects can be classified into different stages, concluding [(Lechner et al., 1998), p. 8]:

...the distributions over the different stages in both studies showed that many subjects who were in action or maintenance according to the traditional classification were classified in the precontemplation stage according to the alternative classification method.

Consequently, there is evidence that significant proportions of individuals are unassignable to recognized stages (Marcus, 1996; Pierce et al., 1998; Kearney, 1999).

The external validity of the model has also been questioned with respect to its transfer into other topic domains. Clarke and Eves (Clarke and Eves, 1997) do this in relation to `negative' behaviours such as smoking and drug use to `positive' behaviours like physical activity and healthy eating, and Lauby et al. (Lauby et al., 1998) with respect to the complexities of sexual behaviour. Finally, Duncan and Cribb (Duncan and Cribb, 1996) and Piper and Brown (Piper and Brown, 1998) highlight some ethical difficulties associated with Stages of Change interventions. These include the potential for the model to exclude pre-contemplative individuals from intervention and the potential for the model to act as a subtle form of coercive control.

Despite the presence of these perspectives in the literature, there are still three broad problems. First, many of them are buried in affirmative reports or tagged on to conclusions as sources for `future research' [e.g. (Marcus et al., 1996; Steptoe et al., 1999)]. Second, except for Ashworth's review (Ashworth, 1997), Whitehead's Editorial (Whitehead, 1997) and Bandura's pointed comments (Bandura, 1997), these critiques have largely failed to find significant expression in the `mainstream' health promotion literature. Finally, with the exception of Ashworth's review (Ashworth, 1997), the critical focus has tended to be on conceptual themes at the expense of any comprehensive consideration of outcome.


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The review of the Stages of Change literature

Specific coverage of the full review processes has been reported in detail elsewhere (Bunton et al., 1999, 2000). The search was limited to the period 1985–1998, and derived from the major electronic databases including: Medline, CINAHL, EMBASE, EMBASE (Psychiatry), PsychINFO, PsycLIT, Sports Discussion, Social Citation Index and ASSIA. Using key words, `transtheoretical model', `stages of change', `motivational interviewing' and `brief intervention', 1000 publications were initially identified and for the purpose of the full review, these were narrowed to 368 that directly mentioned `stages of change' as a component of the intervention. In specifically considering outcome, this group was further reduced to 239 empirical studies with an associated data set. These were categorized according to whether they were primarily about structure (tests of the fabric or framework of the model/theory), process (tests of the ingredients, mechanisms or procedures of the model/theory) or outcome [end-point assessment or measurement after delivery of scientific health intervention(s)]. Of these, 178 (74.48%) were classed as concerned with structure, 50 (20.92%) with process and 11 (4.6%) with outcome. See Table II.



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Table II.
Summary data of structure/process/outcome analysis



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Reflection

Three specific themes arise from this work.

The general paucity of sophisticated outcome trials

The most striking feature of these data is the small number of studies that have assessed outcome. Despite the origins of the model in the early 1980s, it was not until the early 1990s that any work considering behavioural outcomes was reported. This paucity of evidence is acknowledged by Heather [(Heather, 1992), p. 829]; `the propensity of the model to catch the spirit of the times has had little to do with its scientific support but perhaps this may come later' (italics added).

Despite such confidence, much of the literature has avoided measuring behaviour change as an outcome, preferring either softer indicators such as increases in knowledge or recall of an intervention [e.g. (Campbell et al., 1994; Skinner et al., 1994; Leed-Kelly et al., 1996)] or internally generated measures of `stage progression' (e.g. moving from the `preparation' stage to `action') (Campbell, 1994; Domel et al., 1996; Cole et al., 1998; Crane et al., 1998; Grimley and Lee, 1998).

This latter type of work is particularly problematic, especially when expressed in research designs structured around intervention groups that receive stage-specific interventions against a control group who receive a non-staged intervention [e.g. (Prochaska et al., 1993; Skinner et al., 1994; Strecher et al., 1994; Voorhees et al., 1996; Schorling et al., 1997; Peterson and Aldana, 1999; Steptoe et al., 1999)]. There are two difficulties. First, stage progression does not necessarily equate to ultimate behaviour change, e.g. Clarke and Eves suggest `it is merely the intention to exercise that changes and not the behaviour itself' [(Clarke and Eves, 1997), p. 206]. Second, there is a strong possibility that the `stage progression' displayed in these studies within the `staged' intervention groups in comparison to `non-staged' match groups could be artifactual. Since specific ideas are selectively introduced to one group and not the other, and then eventually used as an outcome measure, there is a danger that subjects may, either consciously or unconsciously, absorb these prompts and comply with the suggestions.

Even in examples that attempt to consider a form of outcome, few studies include the full range of ingredients normally associated with a robust and comprehensive experimental design—the manipulation of an independent variable, the existence of a control condition, the minimizing of the effects of confounding variables and statistical measurement and analysis of a dependent variable (Harris, 1991; EPI Centre, 1996). Much of the work has been cross-sectional [e.g. (Gomel et al., 1996; Jamner et al., 1997; Kearney et al., 1999)], often containing no control groups [e.g. (Marcus et al., 1992; Marcus et al., 1996; Cole et al., 1998; Berg-Smith et al., 1999)] and using small and/or self-selected samples (Campbell, 1997; Ruggiero et al., 1997; Wilson et al., 1997). Moreover, the complex and interactive nature of stage allocation, transtheoretical processes and intervention makes the precise structuring and isolation of independent and dependent variables problematic. Therefore, it may be inherently difficult to isolate the generalized effects of an intervention from the specific influence of Stages of Change. For example, Steptoe et al. (Steptoe et al., 1999) included nicotine replacement therapy within a design that primarily was interested in behavioural counselling based on Stages of Change. These limitations are compounded by the tendency for the nature and basis of the intervention to be not explicitly described [as is suggested by Rollnick et al. (Rollnick et al., 1999)] or clouded in an array of approaches. Berg-Smith et al. (Berg-Smith et al., 1999), for example, described their work as comprising four substantial intervention models. These combined influences mean that the model tends to be, in Popper's terms, `non-falsifiable' or ascientific, a position accepted by Heather (Heather, 1992), p. 829].

Accepting these limitations, studies do exist that try to avoid these structural difficulties and attempt to assess ultimate changes in behaviour. In some, there is a degree of evidence to suggest that stage-matched interventions result in significantly higher levels of ultimate behaviour change that those that are non-stage-matched [e.g. (Prochaska et al., 1993; Campbell et al., 1994)]. However, as Ashworth [(Ashworth, 1997), p. 171] notes, this relatively small pool of literature `does not present a coherent body of evidence'.

We are also now beginning to see work that explicitly suggests that the model has been `ineffective' in achieving set health promotion aims, e.g. in relation to increasing uptake of breast screening (Crane et al., 1999), improving levels of smoking cessation (Aveyard et al., 1999; Lancaster et al., 1999; Steptoe et al., 1999), bringing about dietary changes (Green and Rossi, 1998), increasing levels of physical activity (Naylor et al., 1999), and improving biological indicators such as weight, body mass index, serum cholesterol and blood pressure (Steptoe et al., 1999).

Wider issues

As well as these specific details, the above discussion points to two wider issues relating to the nature of the Stages of Change evidence base and ultimately the very nature of the model.

The nature of evidence associated with Stages of Change

The literature highlights the tendency for supportive and critical contributions to be advanced on the basis of widely different types of evidence and that different levels of credibility are conferred to these. Occasionally, this work is built around broad conceptual development, reflection and critique (Davidson, 1992; Bandura, 1997; Cardinal, 1997; Norman et al., 1998) or practitioner knowledge (Heather, 1992; Rollnick, et al., 1997; Werch, 1997). However, the vast majority of this work can be classed as `empirical' where the model is applied to a field population [e.g. (Prochaska et al., 1993; Marcus et al., 1996; Grimley and Lee, 1998)]. Galante (Galante, 1996) characterizes this form of research as adopting an empirical, generalized and mechanical view of behaviour where the model is considered a fixed and robust resource from which objective and generalized data can be derived. This work takes on a `scientific' identity, based on grouped data, deploying various forms of survey design and using quantitative measures. For example, Prochaska and Velicer [(Prochaska and Velicer, 1997a), p. 6] suggested the need for `multi-variate measurement models and statistical methods' in Stage of Change evaluation. This type of work is traditionally considered to produce `sound' evidence and status in decision-making processes (Speller et al., 1997). Many are clearly attempting to portray Stages of Change evidence in this way and the apparent prominence of the model suggests that they have been successful.

As our review suggests, there is, however, doubt over the authority of these data and thus the assumption of valid evidence. Heather's acceptance of the model being based on `spirit' rather than `science' confirms this. Given that Stages of Change is generally portrayed as objective and scientific, this is a surprising reaction—a defence based on formal empirical research would perhaps have been expected. However, when challenged, many opt for a defence based on a fundamentally different rationale. Heather [(Heather, 1992), p. 829], for example, states:

...it is at least arguable that treatment providers must base their innovations on a sense that something is right and valuable without affording themselves the comfort of waiting for the empirical evidence to totally justify their decisions.

There are similar examples. Samuelson [(Samuelson, 1997), p. 14] calls Bandura's critique of Stages of Change `esoteric' and suggests a `pragmatic' use of the model where educators and practitioners `draw on their own observations, professional interactions, and extensive field experience'. Also, Haslam (Haslam, 1999) acknowledges then dismisses criticisms of the model, claiming that it has `intuitive' appeal. In these examples, the formal assumptions traditionally used to support the model are suspended in favour of a more intuitive, localized and holistic `sense' (Galante, 1996).

We would accept and indeed support this type of evidence having status. For example, in the field of psychotherapy research, Stiles (Stiles, 1995a,b) offers a vision of work founded on case studies and focussing on narrative accounts of processes. If the Stages of Change model is the product of softer, subjective insights (weltanschauung) which traditional scientific enquiry finds difficult to access or understand, this alternative approach is quite appropriate. Davidson (Davidson, 1992) has already opened up this avenue within Stages of Change research, favouring a form of `tacit' knowledge.

In isolation, any recourse to qualitative knowledge is not in itself inappropriate. However, concerns over the potential superficiality and incongruity of these expressions must be raised. This retreat into subjectivity clearly sits uncomfortably alongside the objective assumptions that supporters of the model invariably draw upon. Whilst tacit knowledge can be `legitimate', it is in our view not enough to declare this in a superficial way. Despite the existence of many case study-based methodologies that would allow a formal and systematic consideration of such evidence, the Stages of Change literature reflects no reporting of such work. Any recourse to subjectivity can thus be considered as rather disingenuous, reflecting a tendency within the Stages of Change movement to selectively draw on varying types of evidence to maintain an impression of worth.

The nature and status of the model

As well as variability within the evidence base, there remains a more fundamental uncertainty over the very nature of the Stages of Change model. The evaluation and cross-case comparison of any health promotion approach is to large extent dependant on the presumption that a relatively fixed and stable entity is being applied consistently across locations and time. Given the apparently variable deployment of the Stages of Change model, significant concerns can thus be raised over the validity and reliability of data across cases.

Drawing on the framework established earlier in the paper, this variability is reflected in the associated literature. Whilst Prochaska and Velicer (Prochaska and Velicer, 1997b) have stated that `the transtheoretical model has proven remarkably robust', Rollnick et al. [Rollnick et al., 1999), p. ix] suggest that `in truth, there is no such thing as it, merely a collection of different strategies for use in different situations...replicable methods simply do not exist'. There are then at least two quite different sets of assumptions of the model: one based on the presumption of a fixed and generalized pattern, the other on a more flexible and non-specific use with little effort made to differentiate between them.

Similarly, expectations of the `power' of the model vary. In particular, there has been some confusion over whether it has predictive power or is at best descriptive, which is captured in an exchange between Bandura (Bandura, 1997) and Prochaska and Velicer (Prochaska and Velicer, 1997b). Those most associated with the model have generally been reluctant to suggest that it has significant predictive power, particularly when only the Stages of Change components are deployed. Whilst many simply use only the stage component descriptively [e.g. (Wilson et al., 1997; Cole et al., 1998; Maqueen et al., 1999)] the contention would be that these approaches fail to utilize the full potential of the model, specifically the change processes. The claim is thus made that these uses are unrepresentative of the `real' model (Velicer et al., 1999). Nevertheless, many still clearly believe that the model has predictive power. Given the expectations associated with it, this may not be an unreasonable expectation—the model should contribute something prospectively to the understanding of behaviour change. This has been accepted by Prochaska and Velicer [(Prochaska and Velicer, 1997), p. 11], who state, `across a variety of problems and populations, these first three stages have been practical predictors of who signs up for health promotion programmes, who shows up, who finishes up, and who ends up better'. So, how predictive is the stage of change model?

Traditionally, the predictive capacity of a well-developed model or theory concerned with individual behaviour should be associated with its ability to define the future outcome of an intervention prior to and independent of that individual having any conscious awareness of the relevant variables and their expected effect (Rawson, 1992). Additionally, any given theoretically shaped intervention should be expected to bring about change to a degree significantly beyond any that would have happen `naturally'. This does not seem to be the case with the Stages of Change model.

As suggested already, by identifying themselves as being at a particular stage, individuals already are conscious of this status prior to any subsequent intervention. Future progress may therefore be as much a consequence of a pre-determined map and motivation. As the model itself suggests, this could be a product of inherent change processes as well as the effect of the intervention. This does not mean that the model is not useful. It does, however, raise concerns over the `power' of it and what added value it confers. Rawson [(Rawson, 1992), p. 211], for example, suggested that in comparison to uncomplicated `iconic' models (models that simply describe the isolated elements of a system), `analogic' models have greater potential in that they seek to explain `relationships and progressions between elements'. In relation to Stages of Change such higher conceptual status would be reflected in greater explicit consideration of the articulation between the main elements involved, i.e. the stage location, the promotion or activation of stage-specific processes, the intervention and an assessment of the additional contribution these elements make beyond change that would have happened despite intervention.


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Conclusion

Much is still not known about the Stages of Change model and these gaps may in time be filled. In our view, the model may be particularly useful when deployed in a way that reflects the features contained in the left column of Table I, i.e. it is used sensitively, flexibly and guardedly in association with a range of other theoretical resources. If one were given the opportunity to look at how the model is actually used in field situations (a task that has not yet been systematically undertaken), this may in fact be the most prominent type of use.

However, we feel that the literature has maintained an unnaturally assured facıade on two fronts. First, it has suggested that the Stages of Change model can be considered as a single and consistent entity. Second, it has tended to paint a relatively rosy picture of the success of the model, tending towards what Popper [(Popper, 1992), p. 38] has termed a `dogmatic attitude' whereby theorists `constantly claimed to find `verifications' for their favourite theories. This paper has thus attempted to temper this optimism by stressing the need to adopt a more critical assessment of the model whereby refutations of it are actively sought, openly discussed and genuinely assimilated. In this spirit, despite its popularity and prominence in practice and the mass of research associated with it, this paper highlights significant concerns about the status of the Stages of Change model that cannot be easily dismissed.

Most pessimistically, the excessive claims in the absence of sufficient analytical or reflective work raises the possibility that, despite the beliefs and extensive efforts of those deploying the model, it remains in the realms of `pseudoscience' (Kitzinger, 1990), an unnecessarily complex and elaborate facıade that (at best) conceals simple and self-evident ideas around targeting.

More positively, we suggest a number of possible avenues for further attention. There is a need to compliment the one-dimensional and mechanistic approach to evidence that focuses on whether the model `works' or not, with one that is more rounded and sophisticated in its orientation [see (Tudor Hart, 1997)]. This would include better quantitative studies that sought to isolate the Stages of Change component as a single independent variable, measure behaviour change as a dependent variable, ensure the use of control group and use representative samples. Given the inherently complex nature of these circumstances such approaches would only provide one particular insight. To provide a fuller picture, these should be complemented with qualitative case studies of practitioner utilization of Stages of Change. In response to the concerns raised by Steptoe et al. (Steptoe et al., 1999) about the use of Stages of Change in primary care, there is also need for explicit process-based implementation evaluation of the model in a range of settings. Given that the model is now the basis of significant commercial activities [see (Boseley, 1999)] such work with a seriously critical orientation is even more necessary.

The expression of the model may also have significance for the general development of health promotion policy and practice. The disproportionate popularity of the model may be acting as an additional pressure that is skewing the nature of health promotion—where Stages of Change activities begin to equate to `health promotion' at the expense of other activities and approaches. It is clearly difficult to provide definitive evidence that this is so and it could be reasonably argued that it is the those who deploy the model rather than the model itself that are culpable for such actions. There are, however, a series of indications that suggest that the model is contributing to the fostering of particular types of health promotion. Clearly, the model is associated primarily with individualistic approaches, DiClemente [(DiClemente, 1993), p. 101] unashamedly stating:

...our research has concentrated on intentional change, as opposed to societal, developmental, or imposed change, and appears to be touching upon dimensions of the basic structure underlying both the self-directed and treatment—facilitated modification of addictive behaviour...

and Prochaska and Velicer (Prochaska and Velicer, 1997) insist that:

...the future of health promotion programmes lies with stage-matched, proactive and interactive interventions.

Via narrative analysis of research reports, this emphasis can be confirmed in more detail by the detection of a consistent and formulaic structure [see, e.g. (Jamner et al., 1997; Lauby et al., 1998; Haslam, 1999)]. In general terms this involves the following elements: there are particular individualistic and behaviourally oriented health problems (e.g. smoking, drug use, low levels of physical activity, etc.); there are difficulties related to `uptake' and `adherence' to counter-acting messages; that a novel Stages of Change model has been developed that supersedes other less useful models; that the model has proven to be `effective'; and that this success has been displayed across a range of behavioural problems.

The construction of the problem in this way largely limits the potential solutions to individually focussed, topic-based interventions that exclude wider social and environmental approaches (Bunton et al., 1991). For example, in relation to the promotion of walking, Lumsdon and Mitchell [(Lumsdon and Mitchell, 1999), p. 271] have noted that:

...most of the evidence for techniques that help the sedentary adopt physical activity comes from quasi-experimental and experimental intervention studies, many of which examine various cognitive and behavioural strategies at an individual level...in comparison, interventions aimed at environmental, institutional and social levels remain largely unexplored.

Furthermore, as Reid [(Reid, 1999), p. 934] has suggested, the tendency for Stages of Change to be delivered mechanistically as a `magic bullet' may act to displace existing approaches to health promotion that are effective (in the case described by Reid, antismoking projects for young people based on `tried and tested' social influences theory are passed over in favour of Stages of Change). More widely this displacement may hinder a more varied and complex `systems' approach to health promotion (Nicholas and Gobble, 1991; Baum, 1995). A wider range of health promotion models that seek to define social, policy and community processes therefore need to be expressed and utilized.


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Acknowledgments

At the time of the work, S. W. was a Research Specialist, Health Education Board for Scotland. The paper does not represent the views of the Health Education Board for Scotland.

TRANSLATED KAT IN THE BIBLE

KAT FOUND IN HEBREW IN THE BIBLE

8577. תַּנִּין (tannin) -- serpent, dragon, sea monster



3803. כָּתַר (kathar) -- to surround



8598. תַּפּ֫וּחַ (tappuach) -- apple tree, apple



8574. תַּנּוּר (tannur) -- (portable) stove, firepot



8558. תָּמָר (tamar) -- palm tree, date palm



8414. תֹּ֫הוּ (tohu) -- formlessness, confusion, unreality ...



3807. כָּתַת (kathath) -- to beat, crush by beating



6985. קָט (qat) -- perhaps only



8182. שֹׁעָרִים (shoar) -- horrid, disgusting



8650. תֹּ֫רֶן (toren) -- a mast



7005. קַטָּת (Qattath) -- a city in Zebulun



3712. כִּפָּה (kippah) -- a branch, frond (of a palm tree)



8050. שְׁמוּאֵל (Shemuel) -- "name of God," a prophet of ...



935. בּוֹא (bo) -- to come in, come, go in, go



8252. שָׁקַט (shaqat) -- to be quiet or undisturbed



7526. רְצִין (Retsin) -- a king of Aram (Syria), also an ...



8160. שָׁעָה (shaah) -- a brief time, moment



7676. שַׁבָּת (shabbath) -- Sabbath



7585. שְׁאוֹל (sheol) -- underworld (place to which people ...



3645. כְּמִישׁ (Kemosh or Kemish) -- a god of the Moabites



3372. יָרֵא (yare') -- affright



4276. מַחֲצִית (machatsith) -- half, middle



620. Asenappar -- an Assyrian king



2249. חָבוֹר (Chabor) -- a river of Assyr.



854. אוֹת (eth) -- with (denoting proximity)



7673. שָׁבַת (shabath) -- to



1254. בָּרָא (bara') -- choose



8314. שָׂרָף (saraph) -- serpent



7417. רִמּוֹן (Rimmown) -- Remmon

KAT FOUND IN GREEK IN THE BIBLE

2736. κάτω; (kató) -- down, below

2596. κατά (kata) -- down, against, according to
4783. συγκατάθεσις (sugkatathesis) -- a putting down ...
2614. καταδιώκω (katadiókó) -- to pursue closely
2669. καταπονέω (kataponeó) -- to wear down
2704. καταφθείρω (kataphtheiró) -- to destroy entirely
2612. κατάδηλος (katadélos) -- quite manifest
2703. καταφεύγω (katapheugó) -- to flee for refuge
2624. κατακληροδοτέω (katakléronomeó) -- to ...
2651. καταμόνας (katamonas) -- alone.
2720. κατευθύνω (kateuthunó) -- to make straight
2605. καταγγέλλω (kataggelló) -- to proclaim
2658. καταντάω (katantaó) -- to come down to, reach
2608. κατάγνυμι (katagnumi) -- I break in pieces
2628. κατακολουθέω (katakoloutheó) -- to follow after
2617. καταισχύνω (kataischuno) -- I shame, disgrace, put ...
2640. κατάλειμμα (kataleimma) -- remnant.
2700. κατατοξεύω (katatoxeuó) -- to strike down with an ...
2715. κατεξουσιάζω (katexousiazó) -- to exercise ...
2609. κατάγω (katagó) -- to bring down
2678. κατασείω (kataseió) -- to shake
2685. κατάσκοπος (kataskopos) -- a spy
2643. καταλλαγή (katallagé) -- reconciliation
2621. κατάκειμαι (katakeimai) -- to lie down, recline
1460. ἐγκατοικέω (egkatoikeó) -- to settle down in (a ...
2604. καταγγελεύς (kataggeleus) -- a proclaimer
2691. καταστρηνιάω (katastréniaó) -- to become ...
1944. ἐπικατάρατος (epikataratos) -- accursed
2698. κατατίθημι (katatithémi) -- to lay down
2627. κατακλυσμός (kataklusmos) -- a flood

duran

DURAN

 

2:105

 

Neither those who disbelieve from the People of the Scripture nor the polytheists wish that any good should be sent down to you from your Lord. But Allah selects for His mercy whom He wills, and Allah is the possessor of great bounty

 

2:165

 

And [yet], among the people are those who take other than Allah as equals [to Him]. They love them as they [should] love Allah . But those who believe are stronger in love for Allah . And if only they who have wronged would consider [that] when they see the punishment, [they will be certain] that all power belongs to Allah and that Allah is severe in punishment

 

2:228

 

Divorced women remain in waiting for three periods, and it is not lawful for them to conceal what Allah has created in their wombs if they believe in Allah and the Last Day. And their husbands have more right to take them back in this [period] if they want reconciliation. And due to the wives is similar to what is expected of them, according to what is reasonable. But the men have a degree over them [in responsibility and authority]. And Allah is Exalted in Might and Wise.

 

2:233

 

Mothers may breastfeed their children two complete years for whoever wishes to complete the nursing [period]. Upon the father is the mothers' provision and their clothing according to what is acceptable. No person is charged with more than his capacity. No mother should be harmed through her child, and no father through his child. And upon the [father's] heir is [a duty] like that [of the father]. And if they both desire weaning through mutual consent from both of them and consultation, there is no blame upon either of them. And if you wish to have your children nursed by a substitute, there is no blame upon you as long as you give payment according to what is acceptable. And fear Allah and know that Allah is Seeing of what you do.

 

4:91

 

You will find others who wish to obtain security from you and [to] obtain security from their people. Every time they are returned to [the influence of] disbelief, they fall back into it. So if they do not withdraw from you or offer you peace or restrain their hands, then seize them and kill them wherever you overtake them. And those - We have made for you against them a clear authorization.

 

5:54

 

O you who have believed, whoever of you should revert from his religion - Allah will bring forth [in place of them] a people He will love and who will love Him [who are] humble toward the believers, powerful against the disbelievers; they strive in the cause of Allah and do not fear the blame of a critic. That is the favor of Allah ; He bestows it upon whom He wills. And Allah is all-Encompassing and Knowing

 

6:119

 

And why should you not eat of that upon which the name of Allah has been mentioned while He has explained in detail to you what He has forbidden you, excepting that to which you are compelled. And indeed do many lead [others] astray through their [own] inclinations without knowledge. Indeed, your Lord - He is most knowing of the transgressors

 

8:62

 

But if they intend to deceive you - then sufficient for you is Allah . It is He who supported you with His help and with the believers

 

8:71

 

But if they intend to betray you - then they have already betrayed Allah before, and He empowered [you] over them. And Allah is Knowing and Wise.

 

9:103

 

Take, [O, Muhammad], from their wealth a charity by which you purify them and cause them increase, and invoke [ Allah 's blessings] upon them. Indeed, your invocations are reassurance for them. And Allah is Hearing and Knowing.

 

16:71

 

And Allah has favored some of you over others in provision. But those who were favored would not hand over their provision to those whom their right hands possess so they would be equal to them therein. Then is it the favor of Allah they reject?

 

17:101

 

And We had certainly given Moses nine evident signs, so ask the Children of Israel [about] when he came to them and Pharaoh said to him, "Indeed I think, O Moses, that you are affected by magic."

 

20:63

 

They said, "Indeed, these are two magicians who want to drive you out of your land with their magic and do away with your most exemplary way.

 

28:83

 

That home of the Hereafter We assign to those who do not desire exaltedness upon the earth or corruption. And the [best] outcome is for the righteous.

 

29:51

 

And is it not sufficient for them that We revealed to you the Book which is recited to them? Indeed in that is a mercy and reminder for a people who believe

 

33:19

 

Indisposed toward you. And when fear comes, you see them looking at you, their eyes revolving like one being overcome by death. But when fear departs, they lash you with sharp tongues, indisposed toward [any] good. Those have not believed, so Allah has rendered their deeds worthless, and ever is

that, for Allah , easy.

 

36:57

 

For them therein is fruit, and for them is whatever they request [or wish]

 

48:15

 

Those who remained behind will say when you set out toward the war booty to take it, "Let us follow you." They wish to change the words of Allah . Say, "Never will you follow us. Thus did Allah say before." So they will say, "Rather, you envy us." But [in fact] they were not understanding except a little.

 

53:23

 

They are not but [mere] names you have named them - you and your forefathers - for which Allah has sent down no authority. They follow not except assumption and what [their] souls desire, and there has already come to them from their Lord guidance.

 

56:21

 

And the meat of fowl, from whatever they desire.

 

59:9

 

And [also for] those who were settled in al-Madinah and [adopted] the faith before them. They love those who emigrated to them and find not any want in their breasts of what the emigrants were given but give [them] preference over themselves, even though they are in privation. And whoever is protected from the stinginess of his soul - it is those who will be the successful.

 

61:8

 

They want to extinguish the light of Allah with their mouths, but Allah will perfect His light, although the disbelievers dislike it.

 

76:6

 

A spring of which the [righteous] servants of Allah will drink; they will make it gush forth in force [and abundance].

 

76:27

Indeed, these [disbelievers] love the immediate and leave behind them a grave Day.

 

2:282

O you who have believed, when you contract a debt for a specified term, write it down. And let a scribe write [it] between you in justice. Let no scribe refuse to write as Allah has taught him. So let him write and let the one who has the obligation dictate. And let him fear Allah , his Lord, and not leave anything out of it. But if the one who has the obligation is of limited understanding or weak or unable to dictate himself, then let his guardian dictate in justice. And bring to witness two witnesses from among your men. And if there are not two men [available], then a man and two women from those whom you accept as witnesses - so that if one of the women errs, then the other can remind her. And let not the witnesses refuse when they are called upon. And do not be [too] weary to write it, whether it is small or large, for its [specified] term. That is more just in the sight of Allah and stronger as evidence and more likely to prevent doubt between you, except when it is an immediate transaction which you conduct among yourselves. For [then] there is no blame upon you if you do not write it. And take witnesses when you conclude a contract. Let no scribe be harmed or any witness. For if you do so, indeed, it is [grave] disobedience in you. And fear Allah . And Allah teaches you. And Allah is Knowing of all things.

 

DH