Effective Communication Skills for Health (PCH 306) PDF

EFFECTIVE COMMUNICATION SKILLS FOR HEALTH (PCH 306) 5. Stages and Processes of Health Behavior Change Bianca Sallum | PhD Candidate, MPH, BSN Fall 2024 - 2025 TRANS THEORETICAL MODEL/STAGES OF CHANGE (TTM)  TTM draws on different theories  Identifies st...

EFFECTIVE COMMUNICATION SKILLS FOR HEALTH (PCH 306) 5. Stages and Processes of Health Behavior Change Bianca Sallum | PhD Candidate, MPH, BSN Fall 2024 - 2025 TRANS THEORETICAL MODEL/STAGES OF CHANGE (TTM)  TTM draws on different theories  Identifies stages of change that individuals pass through before actualizing a change  The purpose of TTM is to guide the timing and content of interventions  TTM is composed of a number of constructs including stage of change, process of change, decisional balance, and situational self-efficacy  All constructs are organized around stage of change  It is used to guide behavior change to promote health 2 ASSESSING STAGES OF CHANGE  It is a framework for understanding client’s readiness to change to healthier practices  Change is not viewed as a single event  People who need to make changes progress through six identified stages:  Pre-contemplation: no intention of changing in the next 6 months  Contemplation: intending to change but not soon  Preparation: intending to change in the next months  Action: made recent changes in health choices  Maintenance: changes maintained to 6 months 3  Termination: changes maintained for 5 years ASSESSING STAGES OF CHANGE  People don’t change their health choices just because we tell them to or because they know they should  The key to successful counseling and education is  To assess and identify the person’s stage of readiness for change  To match the intervention to it  Different counseling strategies are needed  This should increase the effectiveness of the intervention and assist client in progressing to the next stage 4 ASSESSING STAGES OF CHANGE  Health intervention and educational programs are action oriented, assuming that people are making changes or are ready to do it.  40 to 50% are in pre-contemplation stage  20% are in the preparation stage  20 to 25% are in the action stage 5 STAGES OF THE CHANGE MODEL 6 STAGES OF THE CHANGE MODEL 7 STAGES OF THE CHANGE MODEL  Pre-contemplation  Person unaware or under-aware of the problem  Denies there is problem  Not interested in changes  Has no plans to change health practices  Person may have previously tried a change and may be resistant  The client needs to own or acknowledge the problem and its negative aspects  Contemplation  Person is aware of the problem  Intends to do better  Has no serious thought or commitment to making change 8  Discouraged by previous experience STAGES OF THE CHANGE MODEL  Preparation  Person is more determined to change  Intends to take initial action in about 30 days but not today  Action  Person attempts to overcome the problem by actively modifying food choices, behaviors  Not all clients are in the action stage  Considerable commitment is required  Maintenance  Person consolidated and stabilized gains made over months to maintain the new behavior change 9 STAGES OF THE CHANGE MODEL  Termination  Changes should be maintained for 5 years  Some changes may require a life time of maintenance such as weight management  Lapses and relapse are common problems  In the early stages, focus on the benefits of making changes and how that change can improve health  Cognitive and affective self reevaluation, raising awareness is suggested in the contemplation stage  Self-liberation and behavioral goals are important in the preparation stage 10  Behavioral techniques are useful in the action and maintenance stages STAGES OF THE CHANGE MODEL  Recycling  Most people do not maintain behavioral changes successfully on the first attempt  Recycling to an earlier stage: from action to preparation or from preparation to contemplation, may be expected several times as people struggle to modify or cease behaviors  Moving back and forth through the stages represents a learning process for the client  People can learn from their mistakes with the help of the counselor and continue trying 11 STAGES OF THE CHANGE MODEL 12 STAGES OF THE CHANGE MODEL 13 PROCESS OF CHANGES  Activities people use to progress through the stages of change when there are shifts in behaviors, attitudes and intentions  The 10 processes are cognitive and behavioral activities that promote behavioral change  At each stage, there are specific tasks and goals to be accomplished to alter client thoughts and behaviors in moving on the next step  The 10 processes should be integrated into the stages of change so that the treatment intervention matches the client’s stage of change 14 PROCESS OF CHANGE 1. Increasing awareness about the healthy behavior  Interventions: providing educational materials, media , feedback from the counselor 2. Dramatic relief: the client has experience emotional arousal and feelings about the unhealthy behavior that may be relieved if appropriate action is taken  Techniques used: personal testimonies, media 3. Self-reevaluation includes reassessment of the client’s self image to realize that the healthy behavior is part of who they want to be 15  Techniques used: healthy role models, imagery PROCESS OF CHANGE 4. Environmental reevaluation includes cognitive and affective assessment how the personal behavior or problem affects others 5. Self liberation: Commitment to change behavior based on the belief that achievement of the healthy behavior is possible. 6. Social liberation: Environmental opportunities that exist to show that the society is supportive of the healthy behavior. 7. Counter conditioning: Substituting healthy behaviors and16 thoughts for unhealthy behaviors and thoughts. PROCESS OF CHANGES 8. Stimulus control removes environmental cues to unhealthy behavior which can support changes 9. Contingency management: Rewarding the positive behavior and reducing the rewards that come from negative behavior. 10. Helping relationships: Finding supportive relationships that encourage the desired change. 17 MATCHING PROCESSES TO STAGES  Particular processes are more effective during certain stages of change  Counselor needs to match the process with the person’s identified stage of change  Pre-contemplation stage  Awareness raising methods by providing nutrition education materials can help clients become more aware.  Self reevaluation of thoughts, feelings, values, problems is appropriate. The client needs to weigh the pros and cons of change 18 MATCHING PROCESSES TO STAGES  Contemplation stage  Awareness raising  Self reevaluation of the client’s values  Environmental reevaluation will consider the effect of behaviors of people they care about.  Preparation stage  Stimulus control  Counterconditioning  Self liberation 19 MATCHING PROCESSES TO STAGES  Action stage  Stimulus control, counterconditioning and contingency management can help against lapsing 20 MATCHING PROCESSES TO STAGES  The client’s effective health behavior change depends on doing the right things (processes) at the right time (stages)  The best strategies at one stage may be ineffective at another.  Keep in mind that the client may be at an early stage for one change, and at another stage for a different behavior 21 DECISIONAL BALANCE  It is a method of weighing the client’s pros and cons for changing, or advantages and barriers.  Clients need to be encouraged to discuss the cons because they must be recognized and addressed  By the contemplation stage, the pros need to start outweighing the cons  Changes in pros across the stages occurred more frequently than changes in cons  The pros may change more easily because the benefits are more immediate  Some of the cons may be beyond the individual’s control such as 22 cost and availability of health foods. DECISIONAL BALANCE – EXAMPLE 23 SELF-EFFICACY  It is defined as the confidence that the client has in adopting the new healthful behaviors in high risk situations and across all situations encountered.  Temptations could be negative feelings, motional problems, cravings for food, attending social events etc… 24 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 25 STEP 1: GOAL IDENTIFICATION  Goals are SMART: specific, measurable, agreed to, realistic and timely  Goals can be motivating  Start with 1-2 easy goals for client  Ex: “I will buy a low salt snack for tomorrow” or “I’ll look for low salt snacks when I visit the grocery store today”  Goals should focus on the near future such as doing something today or this week. When people think of doing something in the distant future, then it’s easy to put off the 26 goal and start some other day STEP 2: GOAL IMPORTANCE AND ACCEPTANCE  Assess goal importance for the client on numerical scale (1-10)  Pick goals of high importance to client; goals need to score > 5 27 STEP 3: GOAL ANALYSIS AND OVERCOMING OBSTACLES  Discuss problems in achieving goals.  Counselor may ask: ”What problems do you see in achieving this goal? OR “What may interfere?”  Discover and help overcome obstacles  Telling the client in advance to expect some problems/obstacles as this will help the client not give up after the first obstacle encountered. 28 STEP 4: GOAL IMPLEMENTATION  Client should have specific steps to do  Client compares performance to goals  Attaining goals is motivating, increases self-efficacy  Falling short decreases self-efficacy Once the nutrition intervention (perceived as goal) is decided on, the counselor has to support this goal with information, knowledge and skills that the client needs to attain this goal. 29 SOME INFORMATION TO PROVIDE – HEALTHY EATING  Reading food labels  Adapting recipes, new recipes  Menu planning  Food purchasing & preparation  Restaurant/take out meal  Food safety  Nutrient-drug interactions  Self-monitoring, self-management 30 MONITORING AND EVALUATION  Review & measure progress (outcomes) at intervals  Evaluate degree of progress, goals, outcomes  Modify recommendations if needed  Identify benefits in outcome data 31 EXAMPLES OF OUTCOMES (IMPROVEMENTS)  Knowledge gained, behavioral changes  Weight changes, blood pressure  Lipid/lab values, glycemic control  Dietary/lifestyle changes  Self-management, self-efficacy 32 DOCUMENTATION  Depends on the profession/ country…  Standards set by Joint Commission o Accreditation of Healthcare Organizations (JCAHO)  Traditional method of charting is SOAP  Using NCP, an ADIME format is used – assessment, diagnosis, intervention, monitoring & evaluation  As client comes for follow-up appointments, results of health outcomes and goals achieved should be noted along with new goals and interventions. 33 ELECTRONIC COMMUNICATION  Internet, email and telephone communication  Client’s informed consent and agreement for the use and disclosure of protected health information is needed. 34 VIDEO - TTM https://www.youtube.com/watch?v=oO80XyBDrl0 35 REFERENCES  Parvanta, C., et.al. (2011). Essentials of Public Health Communication. Jones & Bartlett Learning.  Sood, S., & Riley, A. H. (2024). Health Communication Fundamentals: Planning, Implementation, and Evaluation in Public Health. Springer’s Publishing Company.