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 effective
means of extending the benefits of good health for all
It is necessary to find ways to extend the benefits of
good health to the most vulnerable and promote
responsible behavior and the adoption of lifestyles
that 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 and
preparing 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

model of change

Incorporating other explanatory/

treatment models.

Pre-contemplation

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
interviewing

Contemplation

Weighing benefits and costs of

behavior, proposed change

Health Belief Model

Motivational
interviewing

Preparation

Experimenting with small changes

Cognitive-behavioral
therapy

Action

Taking a definitive action to change

Cognitive-behavioral
therapy
12-Step program

Maintenance

Maintaining new behavior over time

Cognitive-behavioral
therapy
12-Step program

Relapse

Experiencing normal part of process of

change
Usually feels demoralized

Motivational
interviewing
12-Step program

The Ladder of Change

(Bohtello, 2004)

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

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 &
motivation

Step 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

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 change

Step 6: Following through:

Negotiating about the need and timing for future
clinical 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 Aktif
D. Memahami konsep the Behavior
Change Model & the Ladder of Change

A. Komunikasi Verbal dan Non-Verbal

1. Komunikasi Verbal
Kata-kata yang diucapkan secara lisan
2. 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 lain
2. 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