Stages of Changes - Navy Medicine

Stages of Changes - Navy Medicine

Stages of Change Assistance and Navigation for Others The views expressed in this presentation are those of the author and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, or the U. S. Government. Objectives Discuss the Stages of Change Model Describe how to assist others in moving through the Stages of Change Explain practical applications of the Stages of Change Model

Navy and Marine Corps Public Health Center Introduction Transtheoretical Model (TTM)- developed by James Prochaska and Carlo DiClemente, consists of 4 constructs which focuses on promoting behavior change by identifying how and why people change. It also looks at a persons readiness to adapt to a new behavior. Stages of Change is one of the four TTM model constructs. It was tested, in-depth, with many different populations and addictive behaviors. It focuses on the decision making process and how individuals

move from one stage to the next. Navy and Marine Corps Public Health Center Stages of Behavior Change Precontemplation Contemplation Precontemplation Preparation Maintenance

Action Contemplation Relapse Maintenance Relapse Navy and Marine Corps Public Health Center Action

Preparation Precontemplation Person has no intention to adopt change within the next 6 months Person is unaware of their issues Person is not ready Person is not serious about change Navy and Marine Corps Public Health Center Contemplation Person acknowledges there is a problem and is thinking about

making a change Intends to make changes within the next six months Weighing the pros and cons of change Person may be in this stage for a long period of time Person not committed to make a change Navy and Marine Corps Public Health Center 6 Preparation Person is planning on making behavior change within the next

month Person is not sure how to make changes and may doubt their abilities Person may begin a plan of action Person collects information Testing the waters Navy and Marine Corps Public Health Center 7 Action

Person is actually making the changes to modify their behaviors, environment, and experiences on a daily basis These changes have occurred within the last day to six months This phase includes a lot of time, energy, and recognition This person is achieving their goal Navy and Marine Corps Public Health Center 8 Maintenance Sustained change for 6 months or more

The focus is to prevent relapse Maintain the progress that has occurred during the action stage Person is very confident that they will maintain the changes Avoid temptations and old/new triggers Navy and Marine Corps Public Health Center 9 Relapse In many cases a person may experience relapse Person may feel like a failure, resume old behaviors, feel like they

are no good and experience disappointment This is an opportunity to regroup and continue to learn and grow from the experience Navy and Marine Corps Public Health Center 10 Understanding the Stages of Change Relapse can occur during any stage Precontemplation

Each stage calls for different strategies Maintenance Relapse Be aware of subtle signs The goal is to move to the next step/stage Navy and Marine Corps Public Health Center

Contemplation Action Preparation 11 Stages of Change Assistance and Navigation for Others (Part 2) The views expressed in this presentation are those of the author and do not necessarily reflect the official

policy or position of the Department of the Navy, Department of Defense, or the U. S. Government. Assisting Others to Move Through the Stages of Change Precontemplation Precontemplation Contemplation Preparation Maintenance

Contemplation Relapse Action Maintenance Relapse Navy and Marine Corps Public Health Center Action Preparation

13 Precontemplation Leave the door open for communication Person may seem: Naive Impatient Closed minded Providers need to: Ask questions Listen

Provide unbiased information Guide individuals in awareness and to acknowledge the issues Navy and Marine Corps Public Health Center 14 Contemplation Provide information Person may seem: Reluctant Unsure / go back and forth Willing to listen but provide obstacles

Providers need to: Give take home information Review pros and cons Help to highlight the pros Assist in making a decision Navy and Marine Corps Public Health Center 15 Preparation Provide help / referrals, support, etc. Person may:

Start planning Set dates Look for support Providers need to: Assist in implementing a plan Discuss barriers Provide support Navy and Marine Corps Public Health Center 16

Action Person may: Struggle with habits and change process Complete goals but may need help mastering them Providers need to: Provide encouragement Congratulate success Remind individual of the end goal Address tempting situations and help with coping skills Navy and Marine Corps Public Health Center

17 Maintenance Person may: Feel like they have everything under control Have an improved quality of life Providers need to: Remind individual of support systems and address possible relapse Encourage individual to stick with their plan Allow individual to discuss successes and challenges Listen and provide support

Navy and Marine Corps Public Health Center 18 Relapse Relapse does not mean that you or the individual have done anything wrong Relapse is a part of behavior change During this phase the individual usually feels disappointed, experiences low self-esteem, and needs reinforcement and support

Some individuals need to discuss what happened Others may need to go back into a behavioral change program Navy and Marine Corps Public Health Center 19 Identifying a Slip Slips do not necessarily indicate a relapse Examples: I missed a dose of my medication I puffed a cigar at the wedding I ate an extra slice of cheese cake

I did not complete my exercise routine this week Navy and Marine Corps Public Health Center 20 Relapse Situations Relapse can occur in any phase Each person is different Precontemplation Be open and understanding

Maintenance Ask open-ended questions Contemplation Relapse Determine current stage Action Preparation

Assist in progressing from current stage Navy and Marine Corps Public Health Center 21 Tobacco Scenario Tobacco Scenario Marie has come in to see you because her supervisor asked her to talk to someone about her smoking. She has been smoking for 10 years. She states she has been sent to you because she is

spending too much time for smoke breaks. The command recently moved the tobacco use area outside of the gate; it now takes her over 15 minutes in travel time to get there and back. She feels that her productivity is being affected by the new smokefree base rules and not by her smoking. What stage of change is Marie experiencing and how can we address this scenario? Navy and Marine Corps Public Health Center 23 Nutrition Scenario

Nutrition Scenario LT Smitty failed his PRT for the first time. He has a diet that is high in caffeine and fat (primarily coffee, energy drinks and snacks, as he feels hungry). He has little time to cook and elects to eat convenience and junk food. He realizes the need to make changes to his diet and would like some information on what he can do in the next few months to help him prepare for a lifestyle change. What stage of change is LT Smitty experiencing and how can we address this scenario? Navy and Marine Corps Public Health Center

25 Fitness Scenario Fitness/Nutrition Scenario Petty Officer Alexis is recovering from a pulled muscle injury along with sciatic nerve pain. She was told she can begin exercising and has joined a gym. She also bought new workout clothing and is working with a personal trainer to hasten her recovery process. She increased her consumption of foods high in vitamins A, C, and protein. Petty Officer Alexis has indicated she

is having trouble managing her work and exercise schedule. What stage of change is Petty Officer Alexis experiencing and how can we address this scenario? Navy and Marine Corps Public Health Center 27 Psychological Well-Being Scenario Psychological Well-Being Scenario Jonathan Deer has been diagnosed with and treated for PTSD.

Initially he refused to take medication because he felt it was a sign of weakness. Over the past five months he has been consistently taking his medication as scheduled. He does not attend his support group any longer but sees his doctor regularly. What stage of change is Jonathan Deer experiencing and how can we address this scenario? Navy and Marine Corps Public Health Center 29 Drug Use and Alcohol Misuse Scenario

Drug Use and Alcohol Misuse Scenario Chief Lee previously went to treatment for a single DUI. He has been sober for 18 years. He goes to meetings regularly and shares how he did not allow his past alcohol problem to affect his current life. He uses his own situation to encourage junior enlisted members on how to deal with alcohol related problems they may be experiencing. What stage of change is Chief Lee experiencing and how can we address this scenario? Navy and Marine Corps Public Health Center

31 Injury Free / Active Living Scenario Injury Free / Active Living Scenario Glenn Smith had a sedentary lifestyle and understood he needed to increase his physical fitness level in order to qualify for active duty service. He significantly increased his physical activity by participating in strength training and aerobic activity six days a week with good success. He was hurt while playing basketball; subsequently his time now consists of watching TV or hes on the

computer. He is disappointed that he was injured and feels the only way to avoid re-injury is to refrain from going to the gym. What stage of change is Glenn Smith experiencing and how can we address this scenario? Navy and Marine Corps Public Health Center 33 Conclusion Utilization of different strategies and interventions depend upon an individuals stage of change.

Lifestyle changes are not an effortless task, thus a sense of accomplishment is achieved with each progressive stage. The process of change is on-going. Navy and Marine Corps Public Health Center 34

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