Facilitators of Change Nutrition/Behavior Counseling

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State of readiness

Key strategies for moving to next stage

Counseling do’s at this stage

Counseling don’ts at this stage


Increased information and awareness, emotional acceptance

  • Provide personalized information

  • Allow client to express emotions about his or her disease or about the need to make dietary changes

Don’t assume client has knowledge or expect that providing information will automatically lead to behavior change.

Don’t ignore client’s emotional adjustment to the need for dietary change, which could override ability to process relevant information.


Increased confidence in one’s ability to adopt recommended behaviors

  • Discuss and resolve barriers to dietary change.

  • Encourage support networks.

  • Give positive feedback about a client’s abilities.

  • Help to clarify ambivalence about adopting behavior and emphasize expected benefits.

Don’t ignore the potential impact of family members and others on client’s ability to comply.

Don’t be alarmed or critical of a client’s ambivalence.


Resolution of ambivalence, firm commitment, and specific action plan

  • Encourage client to set specific, achievable goals.

  • Reinforce small changes that client may have already achieved.

Don’t recommend general behavior changes (Eat less fat.)

Don’t refer to small changes as “not good enough.”


Behavioral skill training and social support

  • Refer to education program for self-management skills.

  • Provide self-help materials

Don’t refer clients to information-only classes.


Problem-solving skills and social and environmental support

  • Encourage client to anticipate and plan for potential difficulties.

  • Collect information about local resources.

  • Encourage client to “recycle” if he or she has a lapse or relapse.

  • Recommend more dietary changes of client is motivated.

Don’t assume that initial action means permanent change.

Don’t be discouraged or judgmental about a lapse or relapse.

Story M, Holt K, Sofka, D. Bright Futures in Practice: Nutrition, US Dept of Health and Human Services. 2002;257.

Folic Acid

Stages of Change

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