**Stages of Change Handout 1**

**Stages of Change Opportunities for Intervention Chart**

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| **Precontemplation Stage**                                            |
|                                                                       |
| ***Goal: participant will begin thinking about change***              |
|                                                                       |
| Use relationship-building skills                                      |
|                                                                       |
| Personalize risk factors                                              |
|                                                                       |
| Give data about the participant's eating patterns/intake, lab         |
| results, etc. as compared with the norm (Dietary Guidelines, WIC      |
| parameters)                                                           |
|                                                                       |
| Rather than using scare tactics, express your caring concern          |
|                                                                       |
| Use teachable moments (the symptom as a message)                      |
|                                                                       |
| Allow participant to express emotions about the need to make dietary  |
| changes                                                               |
|                                                                       |
| **Recommended questions:**                                            |
|                                                                       |
| "How would you know if ... was a problem for you?"                    |
|                                                                       |
| "What would have to happen for you to know that this is a problem?"   |
|                                                                       |
| "What warning signs would let you know that this is a problem?"       |
|                                                                       |
| "Have you tried to change in the past?"                               |
|                                                                       |
| "If you were to decide to change, what do you imagine might be some   |
| advantages?"                                                          |
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| **Contemplation Stage**                                               |
|                                                                       |
| ***Goal: participant will examine benefits and barriers to change***  |
|                                                                       |
| Elicit from the participant reasons to change and the consequences of |
| not changing                                                          |
|                                                                       |
| Explore ambivalence, praise the participant for considering the       |
| difficulties of change                                                |
|                                                                       |
| Restate both sides of ambivalence                                     |
|                                                                       |
| Question possible solutions for one barrier at a time                 |
|                                                                       |
| Pose advice gently as "a solution that has been effective for some    |
| participants and might be adaptable to you" to avoid participant's    |
| natural resistance                                                    |
|                                                                       |
| **Recommended Questions:**                                            |
|                                                                       |
| "Why do you want to change at this time?"\                            |
| "What would keep you from changing at this time?"\                    |
| "What are the barriers today that keep you from change?"\             |
| "What might help you with that aspect?"                               |
|                                                                       |
| "What things (people, programs and behaviors) have helped in the      |
| past?"                                                                |
|                                                                       |
| "What would help you at this time?"                                   |
|                                                                       |
| "What do you think you need to learn about changing?"                 |
+-----------------------------------------------------------------------+
| **Preparation Stage**                                                 |
|                                                                       |
| ***Goal: participant will discover elements necessary for decisive    |
| action***                                                             |
|                                                                       |
| Reinforce small changes participant may already have made             |
|                                                                       |
| Encourage the participant to set specific, achievable goals; ask for  |
| a change date                                                         |
|                                                                       |
| Ask which strategies the participant has decided on for risk          |
| situations                                                            |
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| **Action Stage**                                                      |
|                                                                       |
| ***Goal: participant will take decisive action***                     |
|                                                                       |
| Reinforce the decision                                                |
|                                                                       |
| Delight in even small successes                                       |
|                                                                       |
| View problems as helpful information                                  |
|                                                                       |
| Ask what else is needed for success                                   |
+-----------------------------------------------------------------------+
| **Maintenance Stage**                                                 |
|                                                                       |
| ***Goal: participant will incorporate change into daily lifestyle***  |
|                                                                       |
| Continue reinforcement                                                |
|                                                                       |
| Ask what strategies have been helpful and what situations problematic |
+-----------------------------------------------------------------------+

Adapted from Miller WR. Rollnick S. Motivational interviewing. Preparing
people to change addictive behavior. New York: Guilford, 1991 191-202.