Page 101 - Nutrition Counseling and Education Skills: A Guide for Professionals

Stages of Change

Change is not viewed as a single event, such as “I will eat less sodium starting today,” but as an unfolding
process over time requiring more than one attempt. The model in Table 5-1 shows the how, not the why,
people change either with counseling or without it on their own. To make changes, people progress through
six identified stages. The tasks at each stage vary, and movement through the stages represents personal
progress for the client.

Precontemplation

In stage 1, Precontemplation, a person is unaware or underaware that a health problem exists, denies that there
is a problem, or has no intention to take action to change. Thus, the individual has no plans, for example, to
modify eating practices to lose weight or start exercising in the next 6 months.3,4 The person may have tried a
change previously and failed, such as to lose weight, and may be resistant to the health professional’s efforts to
suggest possible changes. Perhaps a visit to the doctor initiated a referral to see the nutrition and dietetics
counselor for weight loss, even if the patient was not concerned with his or her weight.

Because these clients are unaware, uninformed, or unconcerned about the health problem, the counselor
needs to assess the client’s views on making a change and address the reasons for not wanting to change rather
than providing dietary information.3 Educating the client about food changes is not appropriate at this stage.
To identify this stage, the counselor may ask: “Are you seriously intending to change (name the problem
behavior) in the next 6 months?”

1. Precontemplation No intention of changing in the next 6 mo.
2. Contemplation Intending to change, but not soon.
3. Preparation Small changes are made, intending to change in 30 d.
4. Action Changes are made in food choices regularly.
5. Maintenance Behavior changes maintained for 6 mo.
6. Termination Occurs only if changes are maintained for a year or more.

Table 5-1 ■ Stages of Change

For people ignoring the relationship between a high-fat diet and coronary heart disease, for example, one
may ask: “Have you thought about eating less fat (or more fruits and vegetables) in the near future?” At this
stage, a person with a heart problem may need to know the health benefits of change as well as the risks of not
addressing the problem.

The client needs to “own” or acknowledge the health problem and its negative aspects.3,4 These individuals
are not ready for action-oriented interventions. Knowing the person’s SOC helps the counselor identify the
appropriate type of intervention. Table 5-2 lists sample questions and interventions at each stage.

Stage Question for Client Intervention
Precontemplation “What can I do to help?” Consciousness raising

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