ASSIGNMENT 1a.

Behavior Modification: Stages of Change

Instructions:

Indicate which response most accurately describes your stage of change for two different
behaviors (in the blank space identify the behavior: physical activity, weight control, nutrition,
stress, smoking).

Next, select the statement (select only one) that best represents your current behavior pattern.

To select the most appropriate statement, fill in the blank for one of the statements if your current
behavior is a problem behavior. (For example, you might say, “I currently smoke and I do not
intend to change in the foreseeable future.” or “I currently do not exercise but I am contemplating
changing in the next 6 months.”

If you have already started to make changes, fill in the blank in one of the last two statements.

(In this case, you might say: “I currently eat a low-fat diet but I have done so only within the last 6
months,” or “I currently practice adequate stress management techniques and I have done so for
more than 6 months.”) You may use this technique to identify your stage of change for any type of
health-related behavior.

Example:

Behavior 1: Physical activity__

1. I currently _____________________, and I do not intend to change in the foreseeable future.

2. I currently _____________________, but I am contemplating changing in the next 6 months.
3. I currently _____________________, regularly but intend to change in the next month.
4. I currently _____________________, but I have done so only within the last 6 months.
5. I currently _____________________, and I have done so for more than 6 months.

Answer:

Selected statement: Number 5 with the following complete statement:

5. I currently take a walk from my house going to Brgy. road way to ride a jeepney transportation
with route going to school campus and from outside the campus at where I intend the jeepney to
stop & drop by, I take a walk again going inside to the school campus and department office for
duty, and I have done so for more than 6 months.

Stage of change: _Maintenance__

Specific goal and date to be accomplished: _Daily routine for cardiorespiratory endurance exercise
Example:

Behavior 2: _Nutrition__

1. I currently _____________________, and I do not intend to change in the foreseeable future.

2. I currently _____________________, but I am contemplating changing in the next 6 months.

3. I currently _____________________, regularly but intend to change in the next month.

4. I currently _____________________, but I have done so only within the last 6 months.

5. I currently _____________________, and I have done so for more than 6 months.

Answer:

Selected statement: Number 3. with the following complete statement:

3. I currently seldom eat preferred cook meal at home, I opted to visit fast food chain for a meal,
regularly but intend to change in the next month.

Stage of change: __Preparation__

Specific goal and date to be accomplished: To rely on a meal not always on the fast-food chain but
to consider food preparation specially fruits & vegetable included for meal at home.

Stages of Change

1 = Precontemplation 4 = Action

2 = Contemplation 5 = Maintenance

3 = Preparation 6 = Termination/Adoption
Now, it’s your turn!

Physical Behavior
Behavior 1: _________________

1. I currently _____________________, and I do not intend to change in the foreseeable future.

2. I currently _____________________, but I am contemplating changing in the next 6 months.
sleep late
3. I currently _____________________, regularly but intend to change in the next month.
4. I currently _____________________, but I have done so only within the last 6 months.
5. I currently _____________________, and I have done so for more than 6 months.

3 with the following complete statement:

Selected statement: Number ___

3. I currently sleep late, regularly but intend to change in the next month.
______________________________________________________________________________
______________________________________________________________________________
___________________________________________

Preparation
Stage of change: ______________

Specific goal and date to be accomplished:

To reset my sleeping routine by self discipline such as having a schedule, setting an alarm until 9 pm to
______________________________________________________________________________________
finish my school works and reducing my use of gadgets before sleeping.
____________________________________________

Nutrition
Behavior 2: _________________

1. I currently _____________________, and I do not intend to change in the foreseeable future.

2. I currently _____________________, but I am contemplating changing in the next 6 months.

drink coffee
3. I currently _____________________, regularly but intend to change in the next month.

4. I currently _____________________, but I have done so only within the last 6 months.

5. I currently _____________________, and I have done so for more than 6 months.

3 with the following complete statement:

Selected statement: Number ___
I currently drink coffee, regularly but intend to change in the next month.
______________________________________________________________________________
______________________________________________________________________________
___________________________________________

Preparation
Stage of change: ____________________

Specific goal and date to be accomplished:

To cut back gradually by drinking fewer or smaller cup of coffee each day until my body is able to
______________________________________________________________________________________

adjust from my caffeine intake.

_________________________________________________________
 ASSIGNMENT 1b.

SMART Goal Sheet for Physical Activity

Specific: What are you going to do?

Measurable: How much or how long? How often? How will I know if I have achieved it?
Attainable: What are you going to do to reach your goal?
Realistic: Why is this important to you? Do you believe you can achieve this?
Time-specific: When will you start? How will you monitor your progress towards your goal?

Sample SMART goal: By the end of the month, I will be walking 20 minutes per day, three times a
week.
Action Steps Anticipated Barriers Contingencies
Identify the walking route. Rain Walk indoors (e.g. treadmill);
Follow a group exercise video

Walk with mp3 player during

Find a walking partner. Friend is busy
solo walks

Start studying for an exam days

Schedule this after my class Study for an exam
before the date

Now, it’s your turn!

Write your SMART goals that will aid with the process of change for physical activity.

SMART Goal Sheet for Physical Activity

Specific: For the next month, I will save 10% of my allowance, which is between P100-P200
___________________________________________
Measurable: I will keep record of my expenses and ensure I spend less than 500
____________________________________________
Attainable: My average monthly expense is P200, hence I will try my best to spnd my money wisely.
____________________________________________
Reducing my expenses on irrelevant things will prevent me from spending my money on trivial items.
Realistic: thus, will also help me save more, become more responsible, and practice budgetting.
____________________________________________
The goal is to set aside 10% of my savings throughtout the year.
Time-specific: ____________________________________________

Every week I will set aside 10% of my allowance for my savings.

Action Steps Anticipated Barriers Contingencies

Set a day to review current
Create a budget plan Lack of time financial situation every week

Maintain expenses budget Prioritize what to spend and

High expenses where to spend it.

Stay on track with my savings Impulsive buying

goal Record my expenses
Submit your assignment 1a & 1b answers by encoding it in the ‘word’ document, with your name &
PE12 section in eLearn.

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Read each statement in the Health Appraisal Questionnaire, fill up & submit by clicking the URL
icon posted in eLearn to access the form.