Working with parents at different stages of change
What if someone isn’t ready to change? When setting goals with parents it is important to consider how ready the parent is to change and to set goals that are aligned with their current attitudes and behaviours. For example, if a parent has not even considered changing their physical activity behaviours, setting an action plan with them to go running three times a week will have little effect.
Stages of change model
A model that is helpful for understanding how ready parents are to change is the “stages of change” model4. A brief overview is provided below and a more in-depth explanation is available in the Royal College of Nursing’s stages of change in practice module.
The stages of change model suggests there are five stages of change:
- pre-contemplation – not thinking about change
- contemplation – thinking about change but not yet done anything about it
- preparation – made some concrete step towards change but not yet where you’d like to be
- action – engaging in the desired behaviour but been doing so for less than 6 months
- maintenance – the desired behaviour has been maintained for longer than 6 months.
You can identify a parent’s stage of change by asking open questions about their physical activity and dietary behaviours, how long they have been doing these things and - in cases where change might be beneficial - have they considered changing any of these behaviours? Identifying what stage of change someone is at means you will be able to talk to parents at this level rather than, for example pushing someone into action while they are still at the pre-contemplation stage.
Movement between the five stages is not linear, at any point someone might “relapse” to a previous stage. It is important if someone relapses to encourage them not to be too hard on themselves and acknowledge that relapse is common. Help the individual to identify the benefits they and their family have already achieved from their behaviour change and set a plan to move on.
The ideas below outline how you might work differently with parents at different stages of change.
A parent who is in the pre-contemplation stage may appear uninterested, may present a lot of barriers or may be resistant or defensive (for further information about working with parents who are resistant see module 1).
The aim in the pre-contemplation stage is to work with the parent to help them think about how their behaviours are impacting on theirs and their child’s health (using the communication techniques outlined in the communicating weight module). This can be done through asking questions such as ‘have you thought about..?’, ‘how would you feel if..?’. If a parent isn’t receptive, don’t be put off, an individual doesn’t see that there is a problem in this stage. You might give the parent an information leaflet and let them know they can contact you if they want to discuss this at another time.
The important message is that you can still support someone who is not yet ready to change.
Useful action plans at the pre-contemplation stage:
- reading information leaflets (e.g. about the consequences of unhealthy weight as outlined in the unhealthy weight at pre-school age module)
- simply asking parents to reflect on your discussions and booking in a follow-up appointment to discuss further
- asking parents to monitor the child’s current physical activity or dietary behaviour. Self-monitoring used in this way can be a good starting point, as seeing things in black and white can be quite an eye-opener for parents.
At the contemplation stage the parent may begin to show interest, ask you questions and begin to recognise there is a problem. E.g. why is that important? how could I go about that? This is a good opportunity to use your professional knowledge and provide encouragement and support the individual to begin to change. Motivational interviewing techniques are particularly useful at the contemplation stage, where parents might be undecided whether to change or not.
Useful action plans at the contemplation stage:
- writing down or reading about why change would be beneficial (e.g. consequences of unhealthy weight)
- small, concrete steps to help get parents ready to change (e.g. a simple dietary change such as introducing some fruit into the house).
The parent in the preparation stage will have taken some conscious action to indicate they feel ready to change, although they might still be unsure how to go about it. E.g. it might have been their decision to come and see you and ask for help. The techniques in this online resource are potentially most helpful for parents in the preparation stage of change, since they are looking for support, are likely to be open to receive information and you can use your professional knowledge to guide and support them in this process. It is a good chance to discuss outcome goals (i.e. what the parent would like to achieve) and discuss action plans to work towards the dietary and physical activity recommendations outlined in the physical activity and sedentary behaviour and nutrition modules.
Useful action plans at the contemplation stage:
- focussed on concrete behavioural changes to physical activity and diet (e.g. increasing fruit and vegetables, increasing outdoor play or walking, reducing TV time)
The parent in the action stage will already have begun changing and you can use the skills you have learned in this module to help them focus their goals and set action plans to help them stay on track. Make sure the parent focuses on making small manageable changes, offer continuing support and arrange a follow up meeting/appointment to check on their progress at a later time. It might also be useful at this stage to discuss any challenges the parent is facing and discuss ways they might overcome these (see the attached barrier identification worksheet).
The parent in the maintenance stage may need little professional support as their healthy behaviours will be well established. Provide parents with specific praise and positive reinforcement to help them stay on track, and let them know how to contact you if they do face any challenges or have any questions.
4 Prochaska, James O., and Carlo C. DiClemente. "Toward a comprehensive model of change." Treating addictive behaviors. Springer US, 1986. 3-27.
Below is a short quiz containing questions on what you have learnt throughout this module. If it takes a number of goes to get all of the questions correct, please note down each score in your logbook in the space provided. The main purpose of this quiz is to embed learning, and provide you with the opportunity to evaluate your learning. Please remember that we are focusing on the effectiveness of this website and not auditing your practice.
Once you have all the questions correct you will be provided with a certificate of module completion.
Behaviour change techniques
Start the quiz
1. Why is it important to use behaviour change techniques?
a) Education and information alone do not change behaviour
b) People’s behaviours have an impact on their health and well being
c) It is difficult to change our own behaviour and behaviour in other people
d) All of the above
2. What is a behaviour change technique?
a) A strategy that helps an individual change their behaviour
b) A way of telling someone to change their behaviour
c) Something you do that forces someone else’s behaviour to change
d) All of the above
3. If an individual sets a goal to reduce their portion sizes so that they can lose weight, which is their outcome and which is their process goal?
a) Both are outcome goals
b) Both are process goals
c) Losing weight is the outcome goal, reducing portion sizes is the process goal
d) Reducing portion sizes is the outcome goal, losing weight is the process goal
4. Why might you use a “bubble task” with parents?
a) To help give a parent ideas if they do not know what they would like to change
b) To tell a parent what they need to change
c) To help give some focus for a parent who wants to change everything at once
d) a & c only
5. Which behaviour change technique involves setting a detailed and specific behavioural plan?
c) Action planning
d) Environmental re-structuring
6. If you are helping a parent to set an action plan, which of the following would be most likely to result in action?
a) Eat cucumber sticks for snacks on Monday, Wednesday and Friday and carrots with hummus as a snack on Tuesday and Thursday
b) Increase vegetable intake
c) Eat more cucumbers and carrots
d) Replace unhealthy snacks with cucumber sticks or carrots with hummus
7. What are the benefits of self-monitoring when trying to change behaviours?
a) Helping parents see in black and white what their current behaviour is like
b) Helping parents feel a sense of achievement as they “tick” off their progress
c) Providing an account to help you review progress with the parent at the next meeting
d) All of the above
8. Imagine you are working with a parent in the pre-contemplation stage of change who has a pre-school child who is physically inactive. Which of the following action plans would be most appropriate?
a) Be active for an hour every day
b) Reduce TV viewing to 2 hours a day
c) Read an information leaflet about why it is important for pre-school children to be physically active (and the dangers of physical inactivity)
d) Read an information leaflet about how to change physical activity behaviours
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