Is your patient ready to change?
Finding out may be easier than you think
HealthPartners in Minneapolis integrates the Transtheoretical Model of Health Behavior Change into all of its health promotion programming. "We use the stages of readiness to find a leverage point to move members up the ladder from pre-action to action stages," says Nico Pronk, PhD, senior director of the Center for Health Promotion for HealthPartners.
HealthPartners determines a member’s stage of readiness with a few simple questions asked over the telephone, he explains. "The questions link the behavior we’re targeting, such as establishing an exercise routine, to the time frames suggested by the model. For example, we might ask, How likely are you to begin exercising in the next six months?’ The objective is to put the patient in a certain stage and target your interventions based on that stage."
Pronk adds that willingness to communicate is an accurate predictor of a health plan member’s willingness to change. "We’ve found that if a member is willing to talk about health improvement, it’s a great gateway to readiness to change."
HealthPartners has also found the stage of readiness model is an effective tool for changing managed care members’ health behaviors. (For a description of the five stages of readiness, see box, p. 19.) Here are some results from a random sample of telephone counseling sessions used to assess if a member was ready to start regular exercise:
• In the course of eight telephone calls during the six-month intervention period, 38% of precontemplators moved into action.
• Of 53% of members beginning in the action stage, 91% remained in action stages at six-month follow-up.
• Members in a control group moved in and out of readiness changes with no across-the-board changes maintained.
"We not only moved members from pre-action stages to action stages, but more importantly, we prevented members in action stages from relapsing," says Pronk.
Resources: Transtheoretical Model
• Prochaska JO, Velicer WF. The transtheoretical model of health behavior change. American Journal of Health Promotion 1997; 12:38-48.
• Prochaska, JO. Strong and weak principles for progressing from precontemplation to action on the basis of 12 problem behaviors. Health Psychol 1994; 13:47-51.
• Prochaska JO, Rossi JS, Velicer WF, et al. Stages of change and decisional balance for twelve problem behaviors. Health Psychol 1994; 13:39-46.
• DiClemente CC, Norcross JC, Prochaska JO. In search of how people change: Applications to addictive behaviors. Am Psychol 1992; 47:1,102-1,114.
Researchers at the Cancer Prevention Research Center at the University of Rhode Island at Warwick developed and continue to conduct ongoing research on the five stages of readiness. Descriptions of current research programs on the stages of readiness and a review of literature on the model are available at www.uri.edu/research/cprc.