Nutrition Counseling: Stage Of Change Algorithm

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Nutrition Counseling: Stage Of Change Algorithm

Nutrition Counseling: Stage Of Change Algorithm

Develop a Stage of Change Algorithm for a specific dietary behavior. The purpose of the algorithm is to determine which stage of change (Transtheoretical Model) an individual is in. Complete the algorithm with 2 people.

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Submit the algorithm and a brief summary of your experience using it with other people. Include the stage of change you identified for each of the 2 people.

Refer to the “Meeting your Client Ch 4 Lecture” under Modules for an example.

you have to follow similar 5 quistion ( the questions i uplod ) and do it for two patient

Let client make decisions about weighing

– Weighing in works for some but not for others • Who performs the weigh-in? Where? When? How often?

6. Setting the Agenda – First Session: Explain the flow of the session

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INVOLVING PHASE, CONTINUED 6. Setting the Agenda

– Other Sessions: come to an agreement with the client after • Asking the client about any issues they want to address

• Explaining your intentions for the session (education, exploration, etc.)

• Sharing any additional assessment data that might bring up other issues

7. Transitioning into the Next Phase – Proper facilitation includes

voicing direction of the session • Make a statement indicating that you

both are moving on Nutrition Counseling: Stage Of Change Algorithm

S TA G E 2 : E X P LO R I N G & E D U C AT I N G

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EXPLORATION-EDUCATION PHASE 1. Education

2. Assessment

3. Providing Nonjudgmental Feedback

4. Client’s Thoughts on Assessment vs. Standards

5. Summarize

6. Assess Readiness to Make a Change

EXPLORATION-EDUCATION PHASE 1. Education

– Main focus: address health risks associated with your client’s eating pattern

2. Assessment – Some of the basic assessment techniques are discussed in Ch. 5

– Have client fill out assessment forms prior to session

• Have client discuss how they felt when filling them out and what they think about them

– Do not be redundant

• Client Assessment Questionnaire (LMF 5.1 on pp. 402-404)

• Food Frequency Questionnaire (LMF 5.4 on p. 408)

• Medical Release Form if necessary for weight loss (LMF 8.5 on p. 432)

– See example phrasing on p. 86

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• Use assessment and discussion to determine which topics to explore

• Assessment can also include the description of a typical day

– Refer to Exhibit 4.2 on p. 87

– A typical day of your life and mention where food fits in

EXPLORATION-EDUCATION PHASE

PRACTICE – TYPICAL DAY STRATEGY

• Partner up with someone • Nutrition Counseling: Stage Of Change Algorithm One person is the client and one is the counselor

– Counselor – request the typical day information

• Make note of important concepts (not every detail)

• Simple, open questions – “And then what?” “How did you feel then?”

• Avoid providing hypotheses, ideas, or intricate questions

• Listen and get an idea of what this person goes through everyday

– Client – comply and provide typical day routine

• Discuss daily routines, encounters, and mention foods as part of it

– Typically takes 10-20 minutes

• Switch roles if time permits

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TYPICAL DAY STRATEGY • Explain the overall information that you obtained as

the counselor. – Outside of diet, how did you learn about this person’s life?

Personal interactions? Routines? Stresses? Attitude? Schedule?

• Give specific examples

• Compare this assessment technique to a standard dietary recall.

– How are these two different in terms of what you learn about the client? Would you use one over the other? Why?

– How would you use this strategy in your counseling sessions?

3. Nonjudgmental Feedback – Assessments need to be reviewed point-by-point in a neutral

manner

– “Just the facts, ma’am!”

– Provide the standard norms for comparison

4. Client’s Thoughts about Assessment vs. Standards – Encourage exploration of the results

– Do not use “you” when clarifying the information • “People with high cholesterol levels are at higher risk for CVD.”

EXPLORATION-EDUCATION PHASE

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5. Summarize • What is the client doing well?

• What problems were identified in the assessment?Nutrition Counseling: Stage Of Change Algorithm

• If any, what were the self-motivational statements made by the client?

• Where there any ideas of change that the client stated?

– Does the client have anything to add or clarify?

– How would the client like to proceed?

6. Assess Readiness to Change – If your client would like to start making changes, then

• What stage of the TTM would they be found in?

EXPLORATION-EDUCATION PHASE

ASSESSING READINESS TO CHANGE • Stage of Change Algorithm

– Readiness-to-change open ended questions

• How ready to you feel to make a change in this behavior?

• Readiness-to-change scale question • On a scale from 1 (not at all) to 10 (very ready)

• Readiness-to-change graphic

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STAGE OF CHANGE ALGORITHM Can be modified to assess stages for other dietary factors Purpose: Determine TTM stage Assignment: select another lifestyle behavior and use it in algorithm • Complete with 2

people

EXAMPLE STAGE OF CHANGE ALGORITHM

1. What level of fiber would you say is in your overall diet? – Low, Very low, In the middle, High, Very High

– Go to #2 How long have you followed a diet high in fiber? • < 1 month to 5 months = ACTION

• 6 months to > 1 year = MAINTENANCE

2. In the past 6 months, have you tried to eat more fiber? – Yes How successful were you? No Go to #3

• Very and somewhat successful = PREPARATION • Not successful Go to #4

3. Are you seriously thinking about eating more fiber in the next 6 months?

• Yes Go to #5 No = PRECONTEMPLATION

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EXAMPLE CONTINUED

4. Do you plan to continue try to eat more fiber in the next 6 months? • Yes = PREPARATION No = CONTEMPLATION

5. How confident are you that you can change your diet to eat more fiber? • Very and Somewhat confident = PREPARATION

• Not very and Don’t know = CONTEMPLATION

RESOLVING PHASE • The two previous phases focused on

– Clarifying the problem & identifying the strengths within themselves

• The focus of this phase is dependent on the motivation level of the client

– Level 1: Not ready to change (precontemplative)

– Level 2: Unsure, low confidence (contemplative to preparation)

– Level 3: Motivated, confident, and ready (preparation to action)

• Refer to Table 4.2 on p. 89

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CLOSING PHASE • Review the session

– Summary of the issues

– Identification of the strengths

– Clear restatement of the goals

• Express optimism about the future

• Statement of appreciation – enhance self-efficacy – For any obstacles overcome

CHAPTER 4 CASE STUDY • Nancy was just recently diagnosed with HTN

– 26 y.o.f., overweight

– Lives with her 3 small children, husband, and mother

– Works nights

• Read this example (pp.96-98) – To prepare you for typical counseling sessions

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NUTRITION RESOURCES • Healthy Dietary Information Nutrition Counseling: Stage Of Change Algorithm

– www.choosemyplate.gov

• Healthy Weight Management – http://www.eatright.org/Public/landing.aspx?TaxID=6442451978

• Food and Nutrition Handouts – http://www.eatright.org/HealthProfessionals/content.aspx?id=2

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CHAPTER 14 GUIDED COUNSELING

• Preparation for Session 1 – See checklist on p. 355

• Informed consent (instead of LMF 14.1 and 14.2)

• Client Assessment Questionnaire (LMF 5.1)

• Food Frequency Questionnaire (LMF 5.4)

• Medical Release (LMF 8.5) – if client is at risk of health condition

– Contacting the client before session 1 • Email or phone call

– See example on p. 352

– Provide the above forms to be completed prior to the session

– Schedule the session date, time, and place

– Provide contact information – in case change of plans

http://www.choosemyplate.gov/
http://www.eatright.org/Public/landing.aspx?TaxID=6442451978
http://www.eatright.org/HealthProfessionals/content.aspx?id=250
http://www.eatright.org/HealthProfessionals/content.aspx?id=250
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PRACTICING YOUR FIRST COUNSELING SESSION

• Write your 1st contact statement – See example on p. 352 and make appropriate adjustments

– Obtain the forms you need from Canvas and make adjustments as needed

• Complete the Assessment Forms for yourself as practice

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PRACTICE – MOCK SESSION 1 • Write a mock dialog of your first session

– Follow the Interview Checklist

– Include actual statements that you and the client would make

– Following the involving, exploration, resolving, & closing phases in succession

• Explain when and how you would use attending and relationship-building skills in this session

• You may want to use a class partner to act as your client • You may want to complete the Typical Day Strategy &

Stage of Change Algorithm activities at the same time. Nutrition Counseling: Stage Of Change Algorithm

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