Health Coach newsletter spring 2018

Hennepin County, Minnesota sent this bulletin at 04/04/2018 08:36 AM CDT

March 2017

This quarterly newsletter will provide tips and resources about health coaching to help you keep patients engaged in their care.

Stages of change -- meeting the patient where they are

Health coaching is a patient-centered approach to care. Our role as coaches is to help patients take steps to improve lifestyle behaviors that affect their health and well-being. Behavior change is difficult. People may fluctuate back and forth between the various stages of change for many months or years before they achieve long-lasting change in their behavior.

The stages of change initially focused on risky behaviors such as excessive smoking, drinking, drugs, gambling, or engaging in unsafe sexual practices. However, stages of change can also be applicable to self-management of chronic conditions, such as diet, physical activity, and medication adherence.

The Transtheoretical Model (TTM) also known as the stages of change was developed in the late 1970s by James Prochaska and Carlo Di Clemente and colleagues on the basis of research that was published in peer-reviewed journals and books. The research determined that there are five stages to changing lifestyle behavior in order to achieve positive, lasting changes in one’s life:

Pre-contemplation
Contemplation
Ready for action or preparation
Action
Maintenance

Understanding the stages of change can be helpful in the health coach’s approach to move patients along the continuum. Of note, the stages are dynamic. This means that the lines between the stages are arbitrary. There is no set length of time for each stage, and the patient can relapse in the decision-making process.

In this issue of the newsletter, we will discuss pre-contemplation and contemplation.

Stage 1: Pre-contemplation

In the pre-contemplation stage, people do not think seriously about changing and are not interested in getting help. People in this stage tend to defend their current behaviors and do not feel it is a problem. They may be defensive when others pressure them to change.

Stage 2: Contemplation

In the contemplation stage, people acknowledge the health consequences of their lifestyle behavior(s), and they spend time thinking about making a change. Although they are able to consider the possibility of changing, they can be ambivalent about it. In this stage, people are on a teeter-totter, weighing the pros and cons of modifying their behavior. Although they think about the negative aspects of their lifestyle and the positives associated with making change, they may doubt that the long-term benefits will outweigh the short-term challenges.

It might take as little as a couple weeks or as long as a lifetime to get through the contemplation stage. In fact, some people think and think and think about making a change and may die never having gotten beyond this stage. On the plus side, people at this stage are more open to receiving information about how to improve their lifestyle, and are more likely to actually use educational interventions and reflect on their own feelings and thoughts concerning their lifestyle behaviors.

Health coach approach for pre-contemplation and contemplation

Stage 1: Pre-contemplation

The health coach can:

Recognize and validate the patient’s lack of readiness to commit to a behavior change
Clarify that the decision is the patient’s and not a directive of the care team
Encourage the patient to evaluate their current behavior and personalize the risks

Stage 2: Contemplation

The health coach can:

Recognize and validate the patient’s present lack of readiness for change
Clarify that the decision is the patient’s
Encourage evaluation of pros and cons of a behavior change
Help the patient identify their positive health outcome expectations

(Stage descriptions and approaches from Virginia Tech—Continuing and Professional Education)

An example of a conversation with a patient—contemplation stage

Coach: Hello Ms. Johnson. As part of your preventive visit today, we will gather information regarding your health. One question is tobacco use. Can you tell me about your tobacco use history?

Ms. Johnson: I have smoked cigarettes for many years. I know, you’re going to tell me I should quit. I am getting a little more winded when I do my housecleaning. It’s so hard to quit, though. I’ve tried many times.

Coach: Yes, smoking can make it harder to breathe when you move. You say you’ve tried to quit before. Can you tell me more about that?

Ms. Jones: I’ve tried cold turkey many times, but can’t go past three days without a cigarette.

Coach: Quitting is hard for anybody. Would you like to hear about some ideas on how we can help?

Ms. Johnson: I guess so. I want to be around for my grandbabies.

Coach: That’s a great motivation for you! I can support you along the way when you decide. In addition, nicotine replacements, medications, and other interventions are available to help you quit [use teaching materials to explain all the resources available for smoking cessation]. What are your thoughts about what I’ve said?

Ms. Johnson: Maybe I do need more help with the medications to help me get past the three-day wall I hit. I’ll think about it.

Coach: Great! Call the clinic if you decide to quit, and we’ll help you get started, or we can talk more at your next visit. I appreciate your willingness to talk about this, Ms. Johnson. It says a lot about you!

Ms. Johnson: Thank you. I’ll let you know.

Ask the health coach

Question

What if my patients never want to change?

Answer

As a coach, it can be discouraging if patients do not want to make positive changes to improve their health and well-being. It’s important to recognize that some people never move out of pre-contemplation. In spite of our best efforts, the decision to make lifestyle changes rests with the patient. As coaches, we can educate patients and offer support. Talking about these situations with your co-workers can be an opportunity to explore other approaches and/or get your co-workers’ support and encouragement for your work. It’s important for coaches and all health care professionals to practice good self-care to keep from burning out.