Page 99 - Nutrition Counseling and Education Skills: A Guide for Professionals

Breakfast: Orange juice, bacon, two slices of toast with peanut butter, and coffee.
Mid-AM Snack: Coffee and doughnut.
Lunch: Beef sandwich or bacon cheeseburger, French fries, and cola.
Dinner: 8 oz steak, baked potato with butter and sour cream, green vegetable, salad with blue cheese

dressing, cookies, and wine.
Evening snack: Beer and pretzels.

One change leaves the way open for others.

—Niccolo Machiavelli

Introduction

There is no single gold standard method or unifying theory of counseling patients and clients that can account
for all of the complexities of behavioral change and ensure success in changing people’s food choices, eating,
and exercise behaviors. Instead, the nutrition and dietetics counselor needs to be proficient in using several
approaches and interventions yet adapting them to the person being counseled. Food and health behaviors are
influenced by many factors including family, culture, physical, and social environments.1

This chapter explores the Transtheoretical Model of behavior change and the goal-setting process. The
model emphasizes that people progress through various stages in modifying diet, exercise, and other health
behaviors and that the counseling intervention strategies should be modified according to the client’s Stage of
Change.2 Later chapters emphasize other counseling approaches, including motivational interviewing, the
Health Belief Model, behavior modification, counseling for cognitive change, the role of self-efficacy in
making lifestyle changes, and preventing or dealing with lapses and relapse.

Transtheoretical Model/Stages of Change

Prochaska and colleagues developed the Transtheoretical Model (TTM), also referred to as Stages of Change
(SOC).3,4 (See Figure 5-1.) The purpose of the TTM is to guide the timing and content of interventions for
better health. It is composed of four constructs: (1) Stages of Change, (2) processes of change or how people
change, (3) decisional balance, and (4) situational self-efficacy. The model has guided interventions for a
variety of health behaviors.2

CASE ANALYSIS 1

What is Mr. Howard eating that is desirable and that you can encourage him to continue doing? (foods
reduced in cholesterol and saturated fatty acids)

The TTM is used to promote behavior change to improve health. After understanding the client’s
continuum of motivation to change, the framework helps the counselor with planning and implementing an
appropriate intervention. Individuals progress through the six stages, often making many attempts to change
problem health behaviors, such as eating too much, consuming less desirable foods, or not exercising. Within

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