Health Behavior Change From Theory to Action

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Health Behavior Change From Theory to Action

• Margaret Jordan, Ph.D.
• Community Oriented Primary Care
• October 2004

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Health Behavior Change

• Theory
• Self-Determination/Autonomy/Partnership
• Transtheoretical Model (Stages of Change)
• Solution Focused Therapy
• Action
• Motivational Interviewing
• Patient Empowered Readiness Model

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Prochaskas Transtheoretical Model of Behavior
Change

• Stages of readiness to change
• Decisional Balance
• Self-efficacy

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Prochaskas Stages of Readiness to Change

• PRECONTEMPLATION No Urge to Change
• CONTEMPLATION Plan to change within 6
  months
• PREPARATION Plan to change Within 1
  month
• ACTION Change has taken place within
  the last 6 months
• MAINTENANCE Change has persisted for
  more than 6 months

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Assessing Readiness to Change

• Have you made any changes in your (Smoking,
  diet) in the last 6 months?
• (If yes) What changes have you made?
• (If no) Do you feel comfortable with your
  (smoking, diet) at this time, or are you
  thinking about making any changes?
• (If plan to change) When do you think you might
  begin this change?

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Goals of Discussion with Patient in
PrecontemplationMove to Contemplation

• Dont lose patient up front
• Non-judgmental acceptance
• Emphasize autonomy
• Express personal concern
• Help patient to begin to articulate possible
  consequences of behavior and/or advantages to
  change

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Goals of Discussion with Patient in
ContemplationMove to Preparation

• Increase motivation/commitment to change
• AdvantagesgtDisadvantages
• Foster Autonomy/Increase Self-Efficacy
• Reminder of past success.
• Develop a potential plan.
• Develop strategy for dealing with roadblocks.
• Help patient begin a small action (which may lead
  to a bigger action)

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Goals of Discussion with Person in
PreparationMove to Action

• Reinforce patients perception of advantages.
• Increase patients confidence in their ability to
  make the change.
• Develop plan compatible with patients life
  situation
• Help patient predict and plan for
• difficulties
• Foster commitment Goal setting

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Factors Influencing Decisional Balance

• LISTEN to understand factors motivating patients
  behavior
• Health Beliefs
• Attitudes
• Social Pressures/Social Roles
• Resources
• Knowledge/Understanding
• Life Circumstances
• Barriers to Alternative Behaviors

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Decisional Balance

• Disadvantages
• Have to cook for myself and my family
• Dont have the time to shop and cook
• Will be hungry
• Everyone will notice
• Diet foods are expensive

• Advantages
• Will be healthier
• Will be able to play with my children
• Clothes will fit better
• My family will be proud of me
• Ill feel better about myself

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Self-Efficacy

• Measure of a patients confidence in their
  ability to meet a set goal.
• Confidence in their ability to overcome the
  barriers related to the goal.
• Confidence in understanding of what to do

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Solution-Focused Therapy Basic Assumptions

• Solutions exist for any problem.
• Patients are the experts in finding solutions
  to their problems.
• Small change leads to larger change.

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Tips for Talking About Behavior Change

• Ask for permission to discuss
• Seek First to Understand
• Consider the change within the patients context
• Respect (Autonomy, responsibility, patient
  solutions)
• Non-judgmental stance
• Acknowledge difficulty
• Express concern/educate (if necessary)
• Empathy
• Offer self as resource

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Motivational Interviewing

• Technique for engaging patient in conversation
  about relevant health behaviors
• Increase/clarify understanding of current
  behavior (readiness to change)
• Often begin change process

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Motivational Interviewing

• Id like to talk to you about the health benefits
  of weight loss, but Im not sure how you feel
  about it. Can you help me by answering to simple
  questions and then we can go from there?

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Motivational Interviewing

• Importance
• Using a scale from 1-10 can you tell me how
  important it is to you to lose weight?
• (1 is not at all important and 10 is the most
  important it can be).
• Confidence
• If you decided to lose weight right now how
  confident do you feel about succeeding? If 0
  represents not at all confident and 10 is very
  confident what number would you give yourself?

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Motivational Interviewing

• Suggestions for Next Steps
• Tackle the lower number first
• Choose importance if they are about the same
• If both are low, consider whether patient is
  ready for more discussion if not, thank for
  information youve obtained, appreciate honesty,
  reiterate autonomy, offer yourself in the future,
  and move to other priorities.

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Motivational Interviewing

• Discussing Importance
• Appreciative Inquiry
• (Why did you choose 4 and not 1?)
• Examine Pros and Cons
• Explore concerns about current status
• Hypothetical look into the future
• (Ask importance again after discussion)

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Motivational Interviewing

• Discussing Self-Confidence
• Appreciative Inquiry
• Past Experience
• What would have to change for the number to move
  up?
• Is there something I can do to help?

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Motivational Interviewing

• What next?
• Precontemplation
• Thank for conversation and move on
• Contemplation
• Come up with one or two behaviors patient can do
  (Remember, patient is the expert)
• Examplesmonitor food intake, drink more water,
  stop eating in the car, when watching TV, read a
  brochure, use stairs at work, park further away
  from building, take dog on walk, get a pedometer.
• Action
• Help patient develop REALISTIC goals ,identify
  target behavior, and help patient begin to
  develop planbehavior changes, consider trouble
  spots and think of ways to manage them, set goal,
  consider sources of support

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Ending the Conversation

• Thank, express appreciation, express your
  commitment to be continued support
• Refer for nutritional counseling if knowledge
  deficit
• Follow-up appointments, phone calls