Readiness for Change: No Easy Answers

The concept of patient readiness to make positive lifestyle changes has been on my mind lately. I’ve often used Prochaska and DiClemente’s Stages of Change Model to evaluate the stage of change of a person and to guide my approach to health promotion activities for such things as counseling people to stop smoking or implement exercise into their daily lives. It includes pre-contemplation, contemplation, preparation, action, maintenance, relapse.  http://stepupprogram.org/docs/handouts/STEPUP_Stages_of_Change.pdf

It looks straightforward, but it’s anything but.  Of all the steps, the one that seems to be the most difficult for people is from preparation to action, or actually implementing the positive lifestyle change.

A quick search for research about factors related to readiness to change an aspect of lifestyle show that while there are a great number of articles about evaluating the stages of change, there is little about factors that influence readiness of an individual to make this change. The articles that do identify factors related to readiness for change demonstrate the complex nature of readiness as well as the numerous individual factors associated with each situation.

The role of nurses in readiness for change isn’t entirely clear to me.  We educate, coach, or guide people to make positive lifestyle changes, but how many people actually make the changes?  What needs to be in place to move people to a state of readiness for change?  I recently participated in research that offers one interesting insight.  In a survey of patients at a family practice clinic, people who were able to see their primary health care provider on the day that they requested an appointment were significantly more likely to indicate that they had made a lifestyle change. Perhaps then, accessibility to care at a time that a person wants to see their provider, is also a time when they are ‘more ready’ to receive information, education and support for lifestyle changes.  This association needs to be confirmed, but it’s certainly worth further exploration.

Nurses work to help people achieve a healthy lifestyle and optimum health.   It’s important for us not only to develop programs that meet people’s need for information and provide the resources to do so, but also to consider the intangible element of readiness for change.

Roberta Heale, Associate Editor of EBN, @robertaheale @EBNursingBMJ

 

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