STAGES OF CHANGE

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STAGES OF CHANGE

• IMPLICATIONS FOR TEACHING
• AND LEARNING

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The Lesson Plan FNP Apr. 2006 Training
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LESSON PLAN continued
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LEARNING OBJECTIVES

• Analyze stages of change as they apply to a
  behavior you have changed.
• Plan ways to include the stages of change model
  in your nutrition lessons.

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HEALTH BELIEF MODEL

• Before a person will adopt a preventative health
  action
• Feel personally threatened by a disease
• Believe that the benefits of taking the action
  outweigh the barriers or costs.

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5 STAGES OF CHANGE

• Changing healthy behaviors means progressing
  through a series of Stages of Change.
• Each stage has its own challenges and its own
  Keys to Success.

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5 STAGES OF CHANGE

• Not Ready for Change (Precontemplation)
• Thinking About Change (Contemplation)
• Ready to Change (Preparation)
• Taking Action (Action)
• Maintaining a Change (Maintenance)
• Dr. James Prochaska

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5 STAGES OF CHANGE

• Ideas on determining a current stage of change.
• Directions on how to get to the next stage of
  change.
• Keys to success for the best ways to get to the
  next stage.
• Personal thoughts on change.

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Not Ready for Change StageIs there a problem?

• You dont intend to change your behavior in the
  near future.
• Under-estimate the benefits of changing (the
  pros) and over-estimate the problems or costs of
  changing (the cons).
• Start to think about the benefits of changing.
• May lack information.

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An awareness quiz
Not ready for change stage.

• Do you have a problem with your weight? Yes No
• Do you have a problem with your skin? Yes No
• Does anyone in your family have diabetes? Yes
  No
• Has anyone in your family had a heart attack or
  stroke? Yes NO
• Does anyone younger look up to you? Yes No

Disease preventionbetter appearancemore
energycan be a motivator to move someone to the
next stage of change.
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THINKING ABOUT CHANGE STAGE Does this problem
mean I should change my behavior?

• Intend to do something about your unhealthy
  behavior within the next 6 months.
• Make a decision to change and a promise to
  yourself that you will change soon.
• Getting ready, but not prepared enough yet.
• You are more aware of the benefits (pros) of
  changing, but you may still be over-estimating
  the problems (cons) of changing.

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• Ambivalence is common and many people who have
  a good enough reason to change right now, get
  stuck and never move beyond considering a change.

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How hard is it to change?
Not ready for change stage.

• Keys to Success
• Learn about it. You dont have to change, just be
  open to more information.
• Increase the pros. Think about the benefits
  before they are ready to make a change.
• Get scared and do something. Use bad health of
  family to help motivate. Start taking small
  steps.

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Take some small steps
Thinking About Change

• Begin to eat more fruits and vegetables.
• Begin to exercise more or in a new way.
• Small steps can make a difference over time.

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Do your PROS outweigh your CONS?
Thinking About Change

• Keys to Success
• Pros greater than cons. Grow your pros and
  shrink your cons to make progress. Learn ways
  to overcome barriers of time, taste, and cost.
• Look around you. Notice how people are eating
  more healthily and exercising more. Notice how
  easy it is.

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Do your PROS outweigh your CONS?
Thinking About Change

• Keys to Success
• 3. Small steps. Start eating a little more
  healthily. Start increasing your exercise a
  little.
• 4. Make a promise to yourself. Promise yourself
  to make a specific change (5 servings of fruits
  and vegetables.)

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Ready to Change StageWhat is my plan of action?

• Ready to do something about changing soon.
• Started taking small steps to change behavior.
• Goal is to keep on taking small steps until you
  have achieved your change.
• Need encouragement and social support from
  others.

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PROS VERSUS CONS
Ready to change stage

• The individual will look at the pros and cons of
  making a behavior change.
• If the pros significantly outweigh the cons then
  they will move toward Action.
• The individual must also have confidence that
  they can take action.
• Things that increase confidence (self-efficacy)
  are self-mastery, modeling, reframing, and
  persuasion.

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Which strategies are you using?
Ready to change stage

• Keys to Success
• Using the strategies. Develop a list of tips to
  improve your eating or activity. Keep trying
  things until you find what works for you.
• Use substitutes. Go slow. Try different ideas.
  Take small steps.
• Look at yourself. Think about your habits. How
  many strategies are you using? Change your
  self-imageyou are already making healthy
  changes.

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TAKING ACTION STAGEIs this new behavior
working?

• If you are in this stage, you are making changes.
  
• Here we need tips to keep it up.
• We also need to be shown ways to deal with
  temptations to move back to old habits.
• If you stick with it long enough, it will become
  second nature.

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MANAGING SETBACKS
Taking Action Stage

• To continue lifelong changes in healthy habits
  you will need to view setbacks or relapses as
  opportunities for learning rather than reasons
  for feeling bad about yourself of guilty.
• Very few people make it through major changes
  without at least one serious setback.

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Tips for making progress after a setback.
Taking action stage.

• Move quickly back to healthy behaviors.
• Maintain your can do image. You are someone
  who is improving the quality of your life with a
  healthier diet.

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Dont stress about it.
Taking action stage.

• Not everything in life is planned. There may be
  times when you cant follow through on your
  commitment to change.
• Take a break. Plan to get back on track soon.
• Plan ahead to avoid getting off track too often.

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Some challenges
Taking action stage.

• A super busy schedule
• Going shopping
• Forgetting to exercise or eat right
• Eating at a restaurant

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Keys to Success
Taking action stage.

• Get help. Tell your family and friends your
  health goal. Ask them to help. Thank them.
• Use cues. Keep your healthy option in sight and
  close at hand.
• Plan ahead. Make it easy to follow your new
  health behavior.
• Take a break. Dont fight it! Dont feel bad
  about yourself! See yourself as a Can do person.

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MAINTAINING A CHANGEIs there a problem?

• Confidence in your ability is increasing.
• Strive for even more changes.
• Learn more about your health.
• Relapse is likely but one seldom goes all the way
  back to where they began.

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Keys to Success
Maintaining a change stage.

• Be proud of yourself. Give yourself a pat on the
  back. Set goals and reward yourself for meeting
  them.
• See yourself as a role model. Others around you
  are probably exercising or eating better because
  of your changes.

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Applications of the Model

• Health fairs and screenings address the Thinking
  About Change stage.
• Providing information is helpful at this stage.
• Classes might help in the Ready to Change stage
  to learn how to make their changes.
• Peer and customer support is helpful at all
  stages.
• Skill building courses will help with the Taking
  Action and Maintaining Change stage. (support
  groups and ongoing exercise programs)

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Health Programming Grid
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• STEPS http//web.aces.uiuc.edu/step/
• Web-based nutrition program to help people
  improve their diet stage by stage.
• Its really a lifelong process. You need to take
  baby steps. Welshimer
• Interactive technology allows the consumer to
  pick and choose what meets their needs.
• Nutrition Analysis Tools and System (NATS).
  Illinois council on Food and Agricultural
  Research. Strategic Research Initiative in
  Information Systems and Technology.
• Kathleen Welshimer Cathy Ludwig Bell

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http//www.nutricsi.wisc.edu/fav/
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What did you learn?Closure/Processing

• Analyze your current stage of change on eating 5
  colors of fruits/vegetables every day.
• Think of ways to help yourself and support each
  other.

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RESOURCES

• Novembrino, D. Greene, G. (2003). The FV
  Connection. UNI NFS Department.
• Eat Smart Play Hard Michigan Team Nutrition.
  (2004). Michigan State University Extension
  Michigan Department of Education.
  http//www.tn.fcs.msue.msu.edu/
• Fishbein, M. (2002). Syllabus Foundations in
  Health Education. Iowa State University Library.
  http//www.lib.iastate.edu/common/hs255/01spr/bct.
  pdf
• Davis, M. (2002). The Long and Winding Road
  Newsletter. Southern Illinois University.
  http//www.sui.edu/perspect/02_sp/change.html
• Welshimer, K Ludwig Bell, C. Step Up to Good
  Health Website. Analysis Tools and System (NATS).
  Illinois council on Food and Agricultural
  Research. Strategic Research Initiative in
  Information Systems and Technology.
  http//www.aces.uiuc.edu/step/
• Velicer, W. F., Prochaska, J. O., et al.
  Transtheoretical Model Website. Cancer Prevention
  Research Center. http//www.uri.edu/research/cprc/
  TTM/detailedoverview.htm