Page 103 - Nutrition Counseling and Education Skills: A Guide for Professionals

Termination Self-management, self-efficacy

Table 5-2 ■ Stages of Change Interventions

Contemplation

In stage 2, Contemplation, a person is aware that the health problem exists and intends to do better eventually,
such as eating differently or exercising more. He or she has no serious thought of or commitment to making a
change, however, and keeps putting it off.3,4 The person may be mentally struggling with the amount of time,
energy, effort, and cost of overcoming a health problem or may be discouraged by previous failures. When the
cons of changing a behavior are large and the pros are small, the result may be ambivalence that keeps people
stuck at this stage for long periods of time, even months or years.3 The person needs to make a decision.

The counselor may ask, for example:

“What have you been thinking about in terms of making a change?”
“What are the pros and cons of doing it?”
“How can you change your environment?”
“What do you think about eating less fat? What are the barriers or obstacles to doing it?”

Preparation

In stage 3, Preparation, a person is more determined to make a change and intends to take initial action soon,
perhaps in about 30 days.4 He or she may report small changes in addressing the problem behavior, such as
reading a few food labels or buying low-fat foods. Clients need to make a commitment to change, set
priorities or goals, and develop a plan of action.3,4

The counselor may inquire about possible interest in losing weight, becoming more physically active,
making healthier choices, and keeping records of food intakes. A study of parents of obese children needing
weight loss found that about 62% of parents were in the action SOC for child dietary behaviors, but only 41%
were for physical activity child behaviors. Parents who thought their own weight was a problem were less
likely to make changes in their overweight children’s behaviors.5

Action

In stage 4, Action, a person takes action to implement a plan and overcome the health problem by actively
modifying food choices, behaviors, environments, and experiences.3 Keep in mind that most clients are not in
the action stage when first referred for counseling. People are classified in this stage if they have altered a
behavior successfully for a certain period or up to 6 months, such as purchasing different groceries or
exercising three times a week.

Considerable commitment of time and energy is required in the action stage when people are trying to
change.3 The counselor may ask: “What are you doing differently already?” At this stage, clients need
knowledge and skills and should know how to respond to a lapse or relapse.3 New behaviors are not firmly
established in a week or a month, and old patterns may resurface.

With overweight adults using TTM with SOC, there was some evidence in an intervention that there were
improvements in dietary habits and in physical activity. Examples were increased exercise frequency and
duration, increased fruit and vegetable consumption, and reduced dietary fat intake.6

103