As tradition dictates, resolutions abound at the beginning of each year. Many people make New Year’s resolutions that involve lifestyle modification to improve health. From my perspective, people who do this are ready to make changes, and offering interventions at this time can be quite fruitful.
But despite an eagerness to make positive health changes among certain subsets, we, as healthcare providers more often experience a wide range susceptibility to change among our patients. Many times when I open discussions regarding lifestyle modifications, particularly smoking cessation, patients simply stare blankly and completely ignore the topic. They then quickly change the subject to something they feel is more suitable for discussion.
Sometimes patients tell me they plan to quit smoking on a certain date or after a specific life event. I am always quick to document this, so I can follow up with them after that date comes or that life event occurs. In doing this, I’m following the transtheoretical model of change, which I’ve found to be quite helpful for offering targeted advice, recommendations and interventions when addressing smoking cessation and any other behavioral change to improve overall health.
In the transtheoretical model there are five stages of change: precontemplation, contemplation, preparation, action and maintenance.
Patients in the precontemplation stage are usually the ones that stare blankly and change the topic. These patients have not yet considered making a change and can be the most complicated to approach. It is best for the provider to focus on building rapport and establishing trust during this stage.
During the contemplation stage, patients have recognized the need for changes and are preparing to make them. It is in this stage that the healthcare provider has the greatest influence, as these patients are open to conversation and want recommendations.
Then comes the preparation stage, in which patients have taken the initial steps towards change and are seeking advice from health-care providers. It is your responsibility to provide resources to the patient during this stage. Your role in the last two stages, action and maintenance, is to support and encourage patients in order to help them stick with the undertaken behavior change.
I hope this approach to understanding and evaluating your patients is helpful, not only for ensuring that those with New Year’s resolutions succeed, but also to ensure that patients who are not yet ready to change continue to be reevaluated.
Leigh Montejo, MSN, FNP-BC, provides health care to underserved populations at the Metropolitan Community Health Service’s Agape Clinic in Washington, North Carolina.