Utilizing the Stages of Change to Motivate Patients

Have you ever started a new job or routine where you had to wake up earlier than you previously had? I bet it wasn't easy at first! You had to consciously change your routine and set your alarm without hitting the snooze button. Change can be challenging, especially if we are used to a certain way of life.

I encounter this struggle with most, if not all, of my nutrition consulting clients. In order to begin to change, there has to be a willingness to do so. There can be a health challenge present, but if the patient does not see their condition or habit as detrimental to their health, they will not make an effort to change. Adapting healthy behaviors, such as exercising, selecting healthful foods, quitting smoking, and taking medications, is key for patient well-being.

There are various stages of readiness to change. The TransTheoretical Model (TTM) of Change states that there are 6 stages:

• Pre-contemplation phase—Person has no intention to change, and is reluctant to admit they have a problem. They may rationalize why the behavior is okay to continue.
• Contemplation phase—The person is willing to consider treatment, and acknowledge that they have a problem. However, they are still on the fence about starting treatment.
• Preparation phase—The decision is made to stop the behavior. Commitment and determination to change requires a realistic plan and support. People will usually take action in the next month. A motivating belief usually propels people to enter into the next phase.
• Action phase—Individuals at this stage will enter treatment or seek counseling. They seek an external support network to keep them accountable, and to cheer them on.
• Maintenance phase—This phase takes 3 to 6 months. The threat of old patterns becomes null or insignificant, and confidence increases.
• Relapse—There is always a possibility for relapse, but keeping a strong positive support network is key to prevent and deal with relapse. This stage does not happen for everyone.

The TTM is a tool that can be utilized in Motivational Interviewing (MI). MI originated when psychologists were helping people with alcohol and drug addictions, however it can be used to change any behavior, such as to quit smoking or losing weight. MI is a method that works on facilitating, and engaging intrinsic motivation within the client in order to change behavior.

MI is based on the idea that 'knowledge X motivation = change.' General principles of MI include:

• Express empathy
• Develop discrepancy
• Avoid argumentation
• Roll with resistance
• Support self-efficacy

These principles are threaded into each patient interaction, no matter where that patient is. However, specific tools can be utilized depending on the stage of change.

When a pharmacist is utilizing change talk, they will assess which stage the patient is at, and use certain language to help move them to the next stage of change. It is important to get to the why—or the motivating factor underlying the need to change a behavior. What motivates them? Perhaps it is seeing their grandchildren graduate or to fully enjoy retirement. Bringing these motivators to the forefront of the patient’s mind will get them engaged in adapting healthy behaviors.

Another strategy to elicit change behavior is to have the patient weigh the pros and cons of staying with the behavior. Every behavior, whether maladaptive or constructive, has a positive and negative reward. For example, overeating creates a sense of comfort for many people, even if it does lead to weight gain, and subsequent health challenges. When the patient weighs the pros and cons, they will see the impact of staying where they are. This will move them to the next stage of change.

Having the client reflect on what has not worked in the past, and reflecting on future vision and goals are other examples of techniques a pharmacist can use. Keep in mind that this is a process, and it may take multiple conversations until someone moves from one stage to the next. As that patient's healthcare professional, you are there for support and encouragement. Allowing the patient their autonomy and choice, while providing that steady encouragement, will be a recipe for success.

Pharmacists trained in MI techniques can be extremely valuable for any practice setting. Pharmacists can get trained in MI through Continuing Education courses online or in live CE sessions.