Stage Goal Strategy Questions to Ask Tools to Use Pre-contemplation • Patient doesn’t see the problem • Patient forced to go to appointments • Establish rapport and support • Assess motivation • Assess nutrition knowledge and beliefs, thoughts, fears • Assess nutrition status • Explore costs and of change • Provide information in the third person • Offer factual information • What are of following your diet? • What are the reasons you don’t want to follow your diet? • Would you be interested in understanding some of the newest research on ___ (the disorder)? • Reasons for and against change • Knowledge quiz Contemplation • Increase • Develop Discrepancy • Discuss barriers to change • Prioritize pros and cons of change • Explore barriers to change • Provide information in the third person • What makes it for you to follow your diet? • What helps make it easier to follow your diet? • On a scale of one to ten, how important is it for you to follow your diet? • Reasons for and against change • Identifying barriers • Overcoming barriers Preparation • Initiate change • Explore options for change • Elicit strategies that have been successful in the past • Explore the barriers of following the diet • Provide education • Set behavioral goals • Explore self-talk • Provide ideas for variety • Here are some ideas that have made it easier for other people I see. What do you think of these ideas? • What do you think will get in the way of following this diet? • On a scale of one to ten, how are you to follow the goal you set? • Identifying and overcoming barriers • Meal planning • Role play • Goal setting • Preparation stage strategies Action • Commitment to change • Ask to offer information and advice • Discuss high risk situations, teach strategies and rehearse • Encourage, support and reinforce changes • Of all the strategies you have tried, which ones have worked best for you? • How will the upcoming vacation affect staying on the diet? • Identifying high risk situations • Planning for vacations, eating out, compan y, holidays Maintenance/Lapse • Continued Commitment • Acknowledge positive changes • ability to change • Identify red and action plan for lapse • Rehearse lapse strategies • Schedule follow-up to maintain contact and reinforce changes • You have managed to follow your diet in many tough situations. Let’s list and write them out. How were you able to handle each one? • Next month you are off to camp. How might camp affect your diet? • How will you know when you are losing your motivation to follow the diet? • Barriers assessment and worksheets • Red Flags handout Pocket Guide to Using Motivational Interviewing