1. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Nutrition Counseling and Education Skills for Dietetic Professional s 6 th Edition

2. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 5 Stages and Processes of Health Behavior Change

3. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins 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. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins 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. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins 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. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins 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. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins 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. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins 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. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins 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. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins 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. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins 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. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins 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. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins 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. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Decisional Control A method for weighing pros and cons of changing, advantages with barriers

15. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins 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. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins 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. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Step 2: Goal Importance and Acceptance Assess goal importance on numerical scale (1-10) Pick goals of high importance to client

18. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Step 3: Goal Analysis and Overcoming Obstacles Discuss problems in achieving goals Discover and help overcome obstacles

19. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins 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. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Some Information to Provide Reading food labels Adapting recipes, new recipes Menu planning Food purchasing & preparation Restaurant/take out meals

21. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Information to Provide (con’t) Healthful eating Food safety Nutrient-drug interactions Exercise Self-monitoring, self-management

22. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins 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. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins 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. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins 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. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Electronic Communication Internet, email and telephone communication Client’s informed consent and agreement for the use and disclosure of protected health information is needed.