Readiness to Change Flashcards
“Poor health or disabilities are not
inevitable consequences of ______
aging
Helping patients change behavior is an important role for the provider
1—_________ modification for disease prevention,
and disease management
2—Exercise programs, stress management and
dietary changes represent some common
interventions that require _______ __________.
Lifestyle
patient motivation
_________ ___________ is rarely a single event.
Behavior change
Studies of human behavioral changes suggest it takes
____ days to change a habit or incorporate a new one
45
Stages of Change: Transtheoretical Model of Health Behavior Change
Derived from integration of different theories of human
behavior and views of how people make change
—A dominant model of health behavior change
• Model of _____________change
—Focuses on the decision making of the individual
• Describes how people MODIFY a problem behavior
or _________ a positive behavior
• Behavioral change is a PROCESS that unfolds over time
through a sequence of stages
intentional
acquire
5 Stages of Change
- P re-contemplation
- C ontemplation
- P reparation
- A ction
- M aintenance
“OH LOOK….IT’S PC PAM!!!
Not always in a __________ progression…
• Can move backwards or stay in one stage for long time
Goal: Take steps to get back into Action and Maintenance
linear
Research has generated a rule of thumb for at-risk
populations:
1—40% in pre-contemplation
2—40% in contemplation
3—20% in preparation
****Aim for ________-________ interventions
stage-matched
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Stage Patients Position: • “Ignorance is bliss” • Lack of information • Demoralization from past attempts • Ex.: Patient with high cholesterol levels may feel “\_\_\_\_\_\_\_” to the health problems that strike others
Clinical Goal:
• Move patient from “NO!” to “I’ll think about it…”
Pre-contemplation
immune
Pre-contemplation Stage
Goals:
- Help patient develop a reason for changing
- VALIDATE the patient’s experience
- _____________ further selfexploration
- Leave the DOOR OPEN for future conversations
Encourage
___________________ STAGE
Patients Position:
• “Sitting on the fence”
• Possible intention to change in the near future
• Assess barriers (e.g., time, expense, hassle, fear, “I
know I need to, doc, but …”) and the benefits of
change
Clinical Goal:
• Provide direction and support
Contemplation
_______________ STAGE
Patients Position:
• “Testing the waters”
• Intention to take action in the immediate future
• Preparing plan of action
• May experiment with small change
—— i.e. sampling healthier foods may be an experimentation or a move toward greater dietary modification.
Clinical Goal:
• Provide direction and support
Preparation
_________ STAGE
Patient’s Position:
• Overt action has been taken
–working towards goal
Clinical Goal:
• Provide direction and support
• Guide patient in the creation of a specific action plan
Action
Set S.M.A.R.T. goals
• Agreed on by doctor and patient
1—Short term goals spanning ____-____ weeks are generally more effective than long term goals over months
2–_______ _________ are a great tool
– commitment to change
1-2
-Self contracts
SMART =
S PECIFIC M EASUREABLE A TTAINABLE R ELAVANT T IME BOUND
KNOW THIS D.U.M.B. A.S.S!!
\_\_\_\_\_\_\_\_\_\_\_ STAGE Patient’s Position: • Working to prevent lapse – Temporary fall or reemergence of an old habit • Working to prevent relapse – Resuming an unwanted habit • Less temptation and more confidence
Clinical Goal:
• Continue to provide direction and support
Maintenance
Needs: Empathy, Acceptance, “Plant Seeds,” Information/ Education = ??
PRECONTEMPLATION
Needs: Information, “Baby steps”, Develop relationships, Review barriers/ obstacles =??
CONTEMPLATION
Needs: Investigation, Specifics, Plan, Scheduling = ??
PREPARATION
Needs: Inspiration, Analyze Challenges, Rewards, Support =??
ACTION
Needs: Role-model, Rewards, Creativity, Relapse Prevention =??
MAINTENENCE
Assessing IMPORTANCE
Today, on a scale of 1 – 10, how important is it
to _____________?
Assessing CONFIDENCE in
ability to change
Today, on a scale of 1 – 10, how confident are you
that you will be able to ________________________?
KNOW
Motivational Interviewing (MI)
O A R S:
- O PEN ended questions
- A FFIRMATIONS
– Help pt feel change is possible - explore past successes
– Focus on positive aspects of changing - _________ Listening
– Repeat or rephrase what the pt says - Listen to pt - they
will tell you what worked and what did not - Summarization
—- Announce you are going to summarize, list selected
points, invite the pt to correct anything missed
Reflective
Resistance to change
Shift topics to reduce resistance
—- Do NOT respond to resistant statements
—Help pt develop new insights on situations
—Establish a no-fault policy
—-Demonstrate empathy
XX
Most important part of
motivational
interviewing… =???
Talk less than the patient and listen more.
Motivational Interviewing
- Assess and Personalize Patient’s Risk Status
- Stages of Change Evaluation
- Educate About ______ & Advise About Weight Goal
- Assess Patient’s Understanding and Concerns
Risks
When a patient is ready to change:
Help provide supportive tools and create a plan of
action
• ________ _________ is key to success
Goal setting
Cultural Sensitivity
• Respecting and understanding attitudes, values, and
beliefs of others
• __________ to use cultural knowledge while interacting with patients
• Considering cultural preferences and customs during
discussions and with regard to recommendations for
treatment
Willingness
Diet is often a significant aspect of cultural identity
• Select cultures perceive excessive body weight as
desirable
—Helpful to reassure patients that they need not achieve
a BMI of
fat loss
5%-10%
Patients may perceive attempt to change a lifelong habit
or practice s/he enjoys or is comfortable with as a
potential threat
• May become defensive
• Can be prevented or minimized by using _______
communication
***Describe behavior rather than evaluating it
supportive
Avoid using medical terminology – make sure the
patient understands
• Allow them time to ask questions
– without
______________
• Listen – analyze and understand the patient verbal and
non verbal messages
interruption
Reflection Technique:
If patient makes a statement: i.e. “I feel depressed
about my lack of progress” then,
________ patient’s words: “You say you feel depressed”
Restate
Recognize your ___________ and when you need to REFER a patient in need of more experienced help
• Despite best efforts, some patients may not be willing
or ready to change
limitations
Don’t just talk the talk…..
• BE a role-model of good health habits
Healthier Doctors Have Healthier Patients
KNOW THIS
