Learn to recognize the stages of readiness

Most asthma management programs operate on the assumption that patients know why they should follow the asthma management plan their physician has devised for them. However, patients aren’t always ready to adopt a formal regimen to regain and maintain control over their asthma.

"People in general are bad at regular routines," says Mark L. Robbins, PhD, a fellow in clinical and health psychology at the Cancer Prevention Research Center at the University of Rhode Island in Warwick. "We vary in our readiness, or motivation, to change. If clinicians understand their patients’ stage of readiness, they can guide their interventions and increase their chances of success."

Robbins and his colleagues at the University of Rhode Island have applied the Transtheoretical Model of Health Behavior Change to several substance abuse and health promotion programs. The model includes these five stages:

1. Precontemplation.

This is noted when the patient:

— is not ready to act and has no intention of taking action in the next six months;
— avoids reading, talking, and thinking about the behavior that needs to be changed;
— is pressured by others to take action, but often has developed defenses to cope with those pressures.

"These patients may avoid reading, talking, or thinking about the changes they need to make," says Robbins. "Pressuring them to changes probably will backfire. Instead, encourage them to think about change and read about their condition."

2. Contemplation.

This is determined when the patient:

— intends to take action within the next six months;
— substitutes thinking for action;
— appears to be waiting for the right time to take action;
— is unprepared to change;
— remains ambivalent about changing.

"Patients at this stage should be encouraged to weigh the pros and cons of their treatment plan and encouraged to make small action steps," he notes.

3. Preparation.

This stage is present when the patient:

— begins practicing the behavior;
— intends to start changing behavior in the next 30 days;
— is more confident and less tempted;
— is most likely to participate in a program and most likely to benefit from that program.

"Encourage patients at this stage to plan adequate time, energy, and support for change and help them set reasonable goals," suggests Robbins.

4. Action.

The patient recently started to change behavior.

5. Maintenance.

The patient has changed behavior consistently for more than six months.

Patients in both action and maintenance stages may benefit from stimulus controls, Robbins says. For example, you might provide beepers to remind patients to take their medications.