1. Supporting Women in Behavior Change: Adult Lifestyle Change Viola F. Holmes, MS, RD, CDE Registered Dietitian & Certified Diabetes Educator University of Virginia Diabetes Education & Management Program

3. Two major factors affect a person's readiness to change: 1.) "importance" - determined by what value a person places on making change 2.) "self efficacy" - a person's belief or confidence in their ability to succeed at making change

4. The Role of Importance: A piece to the counseling style motivational interviewing ▫ Exploring what matters to the client ▫ Focusing on the client’s perspective

5. The use of scales to engage the client: A common way of assessing as well as cultivating importance and confidence is the use of scales. Scales can help clients/patients to verbalize and process A common way of assessing as well as cultivating importance and confidence is the use of scales. Scales can help clients/patients to verbalize and process “On a scale of 1 to 10, how important is it to you to lose weight right now?” “On a scale of 1 to 10, how important is it to you to lose weight right now?” “On a scale of 1 to 10, how confident are you that you can lose weight?” “On a scale of 1 to 10, how confident are you that you can lose weight?”

6. Scaling - role play The scenario: Elaine has been referred by her doctor for weight loss counseling. During this initial visit Viola explores and engages to determine what is important to Elaine.

7. Goals for the lifestyle change session: Find out which stage of change the client is in, and address the concerns specific to their stage Have the client articulate their “pros” and “cons” of making change so they can better process and ultimately resolve their conflicts Empathize with and empower the client to take steps forward, if they are ready

8. Attention to the Stages of Change Prochaska & Di Clemente: Transtheoretical Model of Behavior Change

9. Expressing empathy – an essential: The ability to understand the client’s situation, perspectives, feelings Being able to communicate that understanding to the client

10. Strategies for building confidence: Review past successes Define small steps that can lead to success Problem solve to address barriers Provide tools & resources, teach skills Attend to the progress use a lapse as occasions to further problem solve rather than failure

11. Remember these 4 “E”s: Engage Empathize Empower Encourage

12. Thank you! Viola F. Holmes, MS, RD, CDE Registered Dietitian & Certified Diabetes Educator vjf7j@virginia.edu