WISEWOMAN Intervention Level Training

Intervention Levels

Training Objectives

• At the end of the training, the WISEWOMAN staff member will be able to:– Explain the Michigan WISEWOMAN intervention levels

– Describe ways to determine whether a participant is ready to make lifestyle behavior changes

– Apply the information to assist a participant with setting a small step or a goal

Each Michigan WISEWOMAN participant is placed in Intervention Level 1, 2, or 3, depending on:

– Her readiness to change

– Her chronic disease risk factors

Intervention Levels

Questions to Keep in Mind

• Is she ready to make a change?• How many risk factors does she have?• What services does she receive?

Level 1

• Is she ready to make a change?– No

• How many risk factors does she have?– 0– 1

• What services does she receive?– Risk Reduction Counseling– Small Step – Can use Goals form or My Health Information

Pamphlet– Referral to MSU Extension– No follow-up calls

Level 2

• Is she ready to make a change?– No

• How many risk factors does she have?– 2 or more

• What services does she receive?– Risk Reduction Counseling– Small Step – You can use the Goals Form or My Health

Information Pamphlet– Referral to MSU Extension– One follow-up contact in one or two weeks

Level 3

• Is she ready to make a change?– Yes

• How many risk factors does she have?– It does not matter

• What services does she receive?– Risk Reduction Counseling– Small Step/Goal – Use Goal form– Referral to MSU Extension– First follow-up contact 7 – 30 days from screening– Second follow-up contact less than 60 days from screening– Up to three more contacts

What is the most important question in determining a participant’s

intervention level?

Is she ready to make a change?

How do I know if she is ready to make a change?

Don’t assume she is ready

• According to research only 10% - 15% are ready to make a change at the first screening

How do I know if she is ready to make a change?

• What Stageof Change is she in?

Contemplation

Preparation

Pre-Contemplation

Action

Maintenance

Not Ready

Still Deciding

May want Follow-up

Probably Ready

How do I know if she is ready to make a change?

Not ready Still Deciding

Probably ready

May Want Follow-up

• Look at her WISEWOMAN Health Risk Questions

How do I know if she is readyto make a change?

• Ask her

• Listen to what she says

• If you are not sure how to ask her, use the Readiness Ruler

– Participant talks – 80%

– You talk – 20%

READINESS RULER

Below, mark where you are now on this line that measuresyour change in __________________________________.

Are you not prepared to change, alreadychanging or somewhere in the middle?

0 101 5 6 7 8 9432

Not Ready Still Deciding Probably Ready

READINESS RULER

Below, mark where you are now on this line that measuresyour change in __________________________________.

Are you not prepared to change, alreadychanging or somewhere in the middle?

0 101 5 6 7 8 9432

Not Ready Still Deciding Probably Ready

How confident are you that

you can make this change?

You can also use this tool to measure confidence

Listen for Change Talk

• Desire– I want to eat better

• Ability– I have some time to walk after dinner

• Reasons– I would feel better if I quit smoking

• Need– I really need to get my blood pressure under control

• Commitment – I am ready to start eating better

Small Steps/Goal Setting

Small Steps

• Are Achievable– Add 1 Piece Of Fruit Or Vegetable– Add 10 Minutes Of Walking 3 Days

Per Week

• Encourage Success In The Future

Many of our participants have not

been successful making health

changes

Being successful with one small change, will help them continue to make changes in the

future

Small Step/Goal Setting

• In what areas can a participant set a small step/goal? – Nutrition– Physical Activity– Smoking Cessation– ANY!

Meet her where she is – Do not try to take her

where you think she should be

Small Step/Goal Setting Tips

Focus On One Thing

• Life is already difficult for her, try not to make it more complicated

Make It Personal

• Remember, she is the one who has to do the work

• It has to be something she wants to do

– Participant talks – 80%

– You talk – 20%

Make It Measurable

• Use numbers

– Add 1 piece of fruit . . .

– Walk 10 minutes . . .

– Smoke 5 fewer cigarettes . . .

Make It Manageable

• If she eats one fruit or veggie each day, she can go to two, but not five

• Remember, these are small steps

Set A Timeline

• Have her pick something she can do every day, or most days for the next two weeks

Make A Plan

• What is she going to do?

• When is she going to do it?

• How often is she going to do it?

• Where is she going to do it?

• Who will support her?

My goal is to be active 10 minutes a day most days of the week

My plan is to walk around the parking lot with my friend for 10 minutes during my lunch break at least 5 days a week for the next two weeks

Scenarios

• The following scenarios were created for this training exercise

• Any resemblance to persons living or dead is purely coincidental

Dora – 56

• High BP; Prediabetes; Obese; Family History of Premature CVD; Physically Inactive

• Not interested in healthy foods – A little interested in finding out more about being physically active

• When you talk to her, she has a whole list of reasons why now is not a good time to make changes

• What is Dora’s intervention level?

LeeAnn – 48

• Smokes; Low HDL; Physically Inactive

• Very interested in healthy foods; Very interested in being physically active; Has been trying to quit smoking lately

• When you talk to her, she tells you she does not like waking up coughing every morning, so she has cut back to ½ a pack a day

• She knows she would feel better if she quit smoking

• What is LeeAnn’s intervention level?

Betty – 54

• Family History of Premature CVD

• Has been trying to eat healthier lately; Has been trying to be more active lately

• Her older sister just had a stroke two weeks ago.

• Her sister eats a lot of fried foods and a lot of salty foods.

• Since her sister’s stroke, Betty started jogging, and she has been trying to cut out all fried foods and salt, but it is hard.

• What is Betty’s intervention level?

• What small step should Betty work on?

What is one thing you will do differently as a result of this training?