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Behaviour Modification
A 'Stages of Change' Approach to Helping Patients Change Behaviour
Helping patients change behavior is an important role for care provider. Change interventions are especially useful in addressing lifestyle modification for disease prevention, long-term disease management and addictions.
Care provider involved in behaviour modification need to develop techniques to assist patients who will benefit from behavior change. Traditional advice and patient education does not work with all patients.
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The change can be applied to any desirable behavior (e.g., smoking or drinking cessation, losing weight, exercise etc.)
Interventions aimed at making changes in the behavior will be effective only if they are based on the stage of motivation of the patient.
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Understanding Change
The Stages of change model shows that, for most persons, a change in behavior occurs gradually, with the patient moving through the stages mentioned below. Relapses are almost inevitable and become part of the process of working toward life-long change.
- Understanding patient readiness to make change, appreciating barriers to change and helping patients anticipate relapse can improve patient satisfaction and lower physician frustration during the change process.
- Repeatedly educating the patient or promising patients an improved outcome does not guarantee their motivation for long-term change.
- Relapse during any treatment program is sometimes viewed as a failure by the patient and the physician. It may cause patients to give up treatment and avoid contact with their physician.
- Physicians can help by explaining to patients that even though a relapse has occurred, they have learned something new about themselves and about the process of changing behavior. Focusing on the successful part of the plan shifts the focus from failure, promotes problem solving and offers encouragement. Their positive steps toward behavior change should be acknowledged.
- Most people find themselves "recycling" through the stages of change several times ("relapsing") before the change becomes truly established.
- The Stages of Change model is useful for selecting appropriate interventions. By identifying a patient's position in the change process, physicians can tailor the intervention. Thus, the focus of the office visit is not to convince the patient to change behavior but to help the patient move along the stages of change.
- Physicians should encourage patients to address the barriers to full-fledged action. While continuing to explore patient ambivalence, strategies should shift from motivational to behavioral skills. During the action and maintenance stages, physicians should continue to ask about successes and difficulties--and be generous with praise and admiration.
- Involving Others: Physicians can enlist the help of other health care professionals (e.g., nutritionists, nurses, mental health personnel) to reinforce the message that a change in behavior is needed and to provide additional education and skill information to the patient.
- Physicians should document the content and outcome of patient conversations, including specific tasks and plans for follow-up.
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STAGE
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DESCRIPTION
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Pre contemplation
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Is the stage in which an individual has no intent to change the behavior in the near future for at least next 6 months & are often resistant & unmotivated.
Individual should be made aware of consequences through counseling. e.g. Ask the client's current perception on smoking & encourage a balanced view of pros & cons.
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Contemplation
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Is the stage in which the individual intents to change within next 6 months. At this stage they are ambivalent about change.
Individuals should be motivated to change the behavior by discussing the benefits of a behavior change. e.g. evoke reasons for change & risks of not changing.
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Preparation
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Is the stage in which individuals intend to take steps to change, usually within the next month
They should be given behavioral skills training e.g., Brainstorm to identify various coping strategies & refer client to support services
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Action
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Is one in which an individual has made an overt, perceptible lifestyle modifications for fewer than 6 months.
Support & teach client in learning cessation techniques & skills.
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Maintenance
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In this stage a positive behavior change has already taken place. Individuals show high level of self-efficacy & are less tempted to relapse.
Help client identify & use relapse prevention strategies.
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Relapse/Recycling
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Slipping back to previous behavior / reentering the cycle of change
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