Health Behavior Change: Goal Setting and Process Matching

1. Nutrition Counseling and Education Skills for Dietetic Professionals 6th Edition

2. Chapter 5Stages and Processes of Health Behavior Change

3. 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.

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. Matching Processes to Stages • Examples: • Precontemplation stage may include the process of consciousness raising and self-reevaluation • Contemplation stage may include the process of continued consciousness raising and environmental reevaluation

13. 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

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

15. 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

16. 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

17. Step 2: Goal Importance and Acceptance • Assess goal importance on numerical scale (1-10) • Pick goals of high importance to client

18. Step 3: Goal Analysis and Overcoming Obstacles • Discuss problems in achieving goals • Discover and help overcome obstacles

19. Step 4: Goal Implementation • Discuss specific steps person will take • Provide nutrition information • Client compares performance to goals • Attaining goals is motivating, increases self-efficacy • Falling short decreases self-efficacy

20. Some Information to Provide • Reading food labels • Adapting recipes, new recipes • Menu planning • Food purchasing & preparation • Restaurant/take out meals

21. Information to Provide (con’t) • Healthful eating • Food safety • Nutrient-drug interactions • Exercise • Self-monitoring, self-management

22. 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

23. Examples of Outcomes (Improvements) • Knowledge gained, behavioral changes • Weight changes, blood pressure • Lipid/lab values, glycemic control • Dietary/lifestyle changes • Self-management, self-efficacy

24. 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

25. Electronic Communication • Internet , email and telephone communication • Client’s informed consent and agreement for the use and disclosure of protected health information is needed.