Behavior Change

Dr. Oryzati Hilman Agrimon, MSc.CMFM, PhD (C) PhD Candidate in General Practice/ Family Medicine, the University of Adelaide, Australia Lecturer Department of Public Health and Family Medicine Faculty of Medicine and Health Sciences Universitas Muhammadiyah Yogyakarta

Discussion Topics Background for Behavior Change

The Behavior Change Model

The Ladder of Change

Lifestyle Modification Counseling

Is changing (unhealthy) behaviors easy or difficult to do...?

What can a doctor do to help the patient change his/her unhealthy behaviors...?

Background for Behavior Change .The health profession must find the most effectivemeans of extending the benefits of good health for allIt is necessary to find ways to extend the benefits ofgood health to the most vulnerable and promote responsible behavior and the adoption of lifestylesthat are conducive to good health

. Helping patients change behavior is an important role for family physicians. Change interventions are especially useful in addressing lifestyle modification for disease prevention, long-term disease management and addictions. The concepts of "patient noncompliance" and motivation often focus on patient failure Understanding patient readiness to make change, appreciating barriers to change and helping patient anticipate relapse can improve patient satisfaction and lower physician frustration during the change process.

Behavior Change .Behavior change is rarely a discrete, single event; the patient moves gradually from being uninterested (pre-contemplation stage) to considering a change (contemplation stage) to deciding andpreparing to make a change. Most people find themselves "recycling" through the stages of change several times ("relapsing") before the change becomes truly established.

Behavior Change Model(Prochaska & DiClemente, 1992) .

Pre-Contemplation Stage . During the pre-contemplation stage, patients do not even consider changing Smokers who are "in denial" may not see that the advice applies to them personally. Patients with high cholesterol levels may feel "immune to the health problems that strike others. Obese patients may have tried unsuccessfully so many times to lose weight that they have simply given up.

Contemplation Stage . During the contemplation stage, patients are ambivalent about changing. Giving up an enjoyed behavior causes them to feel a sense of loss despite the perceived gain During this stage, patients assess barriers (e.g., time, expense, hassle, fear, "I know I need to, doc, but ...") as well as the benefits of change.

Preparation Stage . During the preparation stage, patients prepare to make a specific change. They may experiment with small changes as their determination to change increases. For example, sampling low-fat foods may be an experimentation with or a move toward greater dietary modification. Switching to a different brand of cigarettes or decreasing their drinking signals that they have decided that the change is needed.

Action Stage . The action stage is the one that most physicians are eager to see their patients reach. Many failed New Year's resolutions provide evidence that if the prior stages have been glossed over, action itself is often not enough. Any action taken by patients should be praised because it demonstrates the desire for lifestyle change.

Maintenance & Relapse Prevention

Maintenance and relapse prevention involve incorporating the new behavior "over the long haul." Discouragement over occasional "slips" may halt the change process and result in the patient giving up. However, most patients find themselves "recycling" through the stages of change several times before the change becomes truly established.

Stages of Change Model .Stage in transtheoretical Patient stage Incorporating other explanatory/ model of change treatment models.

Pre-contempla-tion Not thinking about change May be resigned Feeling of no control Denial: does not believe it applies to self Believes consequences are not serious Locus of Control Health Belief Model Motivational interviewingContemplation Weighing benefits and costs of behavior, proposed change Health Belief Model Motivational interviewingPreparation Experimenting with small changes Cognitive-behavioral therapyAction Taking a definitive action to change Cognitive-behavioral therapy 12-Step programMaintenance Maintaining new behavior over time Cognitive-behavioral therapy 12-Step programRelapse Experiencing normal part of process of change Usually feels demoralized Motivational interviewing 12-Step program

The Ladder of Change (Bohtello, 2004) .

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Step 1: Building a partnership:Developing empathy, clarifying roles & responsibilities and using relational skills effectively Step 2: Negotiating an agenda: Using preventive or problem-based approaches to negotiate a shared agenda

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Step 3: Assessing resistance & motivation:Asking about patients readiness to change, their reasons for staying the same (resistance) and their reasons for change (motivation), and their levels of resistance & motivationStep 4: Enhancing mutual understanding: Understanding & addressing how you & your patients have differences in perceptions & values about reasons for staying the same and for changing; or, reducing patients resistance, increasing their motivation, and thereby helping them to take charge of their health

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Step 5: Implementing a plan for change:Negotiating an appropriate plan with your patients based on your mutual understanding; for example, thinking more about change, preparing to change and taking baby steps or giant leaps toward changeStep 6: Following through: Negotiating about the need and timing for futureclinical encounters

Lifestyle Modification Counseling

Hal-hal yang Diperlukan untuk Konseling Perubahan Perilaku

A. Gabungan Komunikasi Verbal & Komunikasi Non-Verbal B. Sikap Empati & Dapat Dipercaya C. Ketrampilan Mendengar AktifD. Memahami konsep the Behavior Change Model & the Ladder of Change

A. Komunikasi Verbal dan Non-Verbal 1. Komunikasi Verbal Kata-kata yang diucapkan secara lisan2. Komunikasi Non-Verbal Menjaga tatapan mata Ekspresi wajah ramah, tersenyum Postur tubuh terbuka Artikulasi suara jelas & intonasi tepat Penampilan bersih & rapi

B. Sikap Empati dan Dapat Dipercaya 1. Empati Kemampuan untuk mengenali, memahami dan merasakan secara langsung emosi orang lain2. Dapat Dipercaya Bisa menunjukkan integritas profesi sesuai dengan kompetensi dokter Memelihara dan menjaga harga diri pasien, hal-hal yang bersifat pribadi, dan kerahasiaan pasien sepanjang waktu

C. Ketrampilan Mendengarkan Aktif Ketrampilan mendengarkan secara aktif dengan melakukan: Refleksi Isi Refleksi Perasaan

D. Memahami konsep the Behavior Change Model & the Ladder of Change

Thank you for your attention!Questions are most welcome!

Wassalamu alaikum Wr.Wb

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