Identity and stages of change as an integrated theoretical framework for a behavioral intervention to help women exit street prostitution

BACKGROUND: Despite significant health risks encountered by female street prostitutes, including physical violence, sexually transmitted infections, substance abuse and mental health problems, few theoretically informed interventions exist to help women exit the trade. The Transtheoretical Stages of Change Model (TTM) and concepts in identity theory provide a foundation for such an intervention. PURPOSE: The purpose of this research was to: a) explore the relevance of identity theory to stages of behavior change among female prostitutes; b) describe critical elements of identity theory that relate to the TTM in this population; and c) map an intervention for exiting prostitution based on an integrated model. METHODS: Purposive and snowball sampling methods were used to conduct semi-structured, face-to-face interviews with 13 key stakeholders in criminal justice and social services and former prostitutes. The interviews were recorded and text was abstracted for analysis. Using a grounded theory approach, interviews were compiled to explore how personal identity affects participation in prostitution. RESULTS: Interviews confirmed: identity is central to negotiating both entry into, and exit from, prostitution; identity and stages of behavior change are intimately tied; and they can be mapped together to provide a theoretically meaningful intervention. DISCUSSION: The integration of identity theory with the TTM provided a useful theoretical framework to map an intervention for exiting prostitution. Further work is needed to validate these results in larger samples and explore interrelationships between identity and other factors thought to fuel change. More research should assess the relevance of identity to behavior change in other conditions.