Nutrition Counseling and Education Skills for Dietetic Professionals

Chapter 5 Stages and Processes of Health Behavior Change Copyright © 2014 Wolters Kluwer

Objectives • Explain the steps in goal setting process and practice them with a

Transtheoretical Model (TTM) • TTM draws on other theories • Purpose is to guide

Stages of Change • Precontemplation – unaware of a problem and has no intention

Stages of Change (con’t) • Preparation –determined to change but has no plan of

Stages of Change (con’t) • Termination – is the ultimate goal in which changes

Process of Change • Ten activities used to progress through the stages of change

Process of Change (con’t) 1. Consciousness raising – increases awareness to the consequences 2.

Process of Change (con’t) 4. Environmental reevaluation – affects on social climate 5. Self-liberation

Process of Change (con’t) 8. Stimulus control – removes environmental cues 9. Contingency management

Matching Processes to Stages • Examples: – Precontemplation stage may include the process of

Matching Processes (con’t) • Stages continued – Preparation stage may include stimulus control, self-liberation,

Decisional Control • A method for weighing pros and cons of changing, advantages with

Goal Setting • New behaviors may be enhanced by specific goals • Based on

Step 1: Goal Identification • Goals are specific, measurable, attainable, timely • Goals should

Step 2: Goal Importance and Acceptance • Assess goal importance on numerical scale (1

Step 3: Goal Analysis and Overcoming Obstacles • Discuss problems in achieving goals •

Step 4: Goal Implementation • Discuss specific steps person will take • Provide nutrition

Some Information to Provide • Reading food labels • Adapting recipes, new recipes •

Information to Provide (con’t) • Healthful eating • Food safety • Nutrient-drug interactions •

NCP Step 4: Nutrition Monitoring and Evaluation • Review & measure progress (outcomes) at

Examples of Outcomes (Improvements) • Knowledge gained, behavioral changes • Weight changes, blood pressure

Documentation • Standards set by Joint Commission (JCAHO) • Document problems, etiology, signs/symptoms (PES)

Electronic Communication • Internet , email and telephone communication • Client’s informed consent and

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Objectives • Explain the steps in goal setting process and practice them with a client • Explain the five stages of change • Identify one process appropriate for each stage of change • Discuss the decisional balance and how it should be used • Describe the impact of self-efficacy on behavior change. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Transtheoretical Model (TTM) • TTM draws on other theories • Purpose is to guide the timing and content of interventions • Composed of a number of constructs including Stages of Change Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Stages of Change • Precontemplation – unaware of a problem and has no intention to change • Contemplation –aware that there is a problem but with no serious plan to change Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Stages of Change (con’t) • Preparation –determined to change but has no plan of action • Action –attempts to implement a plan of action for at least 6 months • Maintenance – has implemented a plan for several months and new behaviors are becoming automatic Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Stages of Change (con’t) • Termination – is the ultimate goal in which changes have been followed for several years. Some never reach this stage • Recycling – going back and forth through the stages Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Process of Change • Ten activities used to progress through the stages of change • Processes are cognitive and behavioral activities with specific task and goals to change thoughts and behaviors Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Process of Change (con’t) 1. Consciousness raising – increases awareness to the consequences 2. Dramatic Relief –increases emotional awareness 3. Self-reevaluation – includes both cognitive and affective reassessment of self-image Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Process of Change (con’t) 4. Environmental reevaluation – affects on social climate 5. Self-liberation – belief that one can change and commitment to act 6. Social liberation – increases social alternatives and opportunities 7. Counterconditioning – changing behavior in response to activities Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Process of Change (con’t) 8. Stimulus control – removes environmental cues 9. Contingency management – positive reinforcement and rewards 10. Helping relationships – support for behavior change Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Matching Processes to Stages • Examples: – Precontemplation stage may include the process of consciousness raising and selfreevaluation – Contemplation stage may include the process of continued consciousness raising and environmental reevaluation Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Matching Processes (con’t) • Stages continued – Preparation stage may include stimulus control, self-liberation, and counterconditioning – Action stage may include stimulus control and contingency management Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Goal Setting • New behaviors may be enhanced by specific goals • Based on client’s willingness to change and taking an active role in change • Four steps used in goal setting: 1. goal identification; 2. goal importance and acceptance; 3. goal analysis and overcoming obstacles; 4. goal implementation Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Step 1: Goal Identification • Goals are specific, measurable, attainable, timely • Goals should be small steps • Goals can be motivating • Start with 1 -2 easy goals for client Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Step 2: Goal Importance and Acceptance • Assess goal importance on numerical scale (1 -10) • Pick goals of high importance to client Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Step 4: Goal Implementation • Discuss specific steps person will take • Provide nutrition information • Client compares performance to goals • Attaining goals is motivating, increases selfefficacy • Falling short decreases self-efficacy Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Some Information to Provide • Reading food labels • Adapting recipes, new recipes • Menu planning • Food purchasing & preparation • Restaurant/take out meals Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Information to Provide (con’t) • Healthful eating • Food safety • Nutrient-drug interactions • Exercise • Self-monitoring, self-management Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

NCP Step 4: Nutrition Monitoring and Evaluation • Review & measure progress (outcomes) at intervals • Evaluate degree of progress, goals, outcomes • Modify recommendations if needed • Identify benefits in outcome data Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Examples of Outcomes (Improvements) • Knowledge gained, behavioral changes • Weight changes, blood pressure • Lipid/lab values, glycemic control • Dietary/lifestyle changes • Self-management, self-efficacy Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Documentation • Standards set by Joint Commission (JCAHO) • Document problems, etiology, signs/symptoms (PES) • DCP and ADI – nutrition diagnosis • Document interventions/outcomes of nutrition care • List discharge instructions, referrals Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Electronic Communication • Internet , email and telephone communication • Client’s informed consent and agreement for the use and disclosure of protected health information is needed. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins