Counseling – Using the "Stages of Change" Model
Keep in mind when you are counseling that your recommendations to take folic
acid may not motivate someone to take multivitamins immediately, but it may make him/her
consider taking folic acid.
Change
is not an event. It is a process. |
Consider using DiClemente and Prochaska's "Stages of Change" model for folic acid
counseling and help your clients to take action and maintain it. The theory’s
basis is that a person goes through a series of stages from gaining knowledge, increasing
confidence, preparing for the action, taking the action and maintaining it. Your goal
in counseling is to merely assess where the patient is within the change continuum and try
to move them to the next step by offering support and information that empowers.
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Stage |
Characteristics |
Strategies |
Folic
Acid Counseling |
| Pre-contemplation |
- Unable/unwilling to change
- Not interested in changing
- Denial
|
- Provide non-threatening information
- Raise awareness
|
- Discuss benefits of folic acid
- Distribute educational materials, including brochures
|
| Contemplation |
- Ambivalent about change
- Substitute thinking for action
|
- Translate thinking into doing
- Give alternative choices
|
- Give recipes for foods high in folate
- Distribute "Advantages and Disadvantages of Folic
Acid" chart
|
| Preparation |
- Show need and desire for assistance to change
- Don't know how to change
|
- Small steps for change
- Focus on interventions
- Find out what works for them
|
- Encourage to buy multivitamins or supplements, and foods
high in folate
- Give out samples of multivitamins or supplements if
available
- Refer to WIC or Food Stamps
- Refer to perinatal care to obtain perinatal vitamins
|
| Action |
- Experiencing success in change
- Relapse is common
|
- Reinforce successes with change
- Build confidence
|
- Praise and encourage the small successes (i.e., purchasing
vitamins, consuming more fruits and vegetables, going to perinatal visits)
|
| Maintenance |
- Low risk for relapse
- Temptation low
|
- Encourage continued behavior change
- Build upon successes they have experienced
|
- Include folic acid message on annual exam reminder postcards
|
Keep
in mind that people need different kinds of assistance, depending on where they are on the
continuum. When you look upon change as a process, your goals become more
realistic. Helping a patient progress from not thinking about folic acid to
thinking about it, constitutes a successful intervention. Start with knowledge and
lead them to motivation and cues to action. Constant reinforcement from different sources
is also beneficial.
|
