OK, so we are a few weeks into 2016, and many of us may already be wavering from our New Year’s resolutions, if not completely forgotten them. Why is it so hard to make changes? James Prochaska, from the University of Rhode Island, has studied this question for more than thirty years, and has applied his theory to many health behaviors, including behaviors important in diabetes management.
Prochaska has found that people who have successfully made positive change in their lives go through five specific stages: precontemplation, contemplation, preparation, action, and maintenance.
- “Precontemplation is the stage at which there is no intention to change behavior in the foreseeable future. Many individuals in this stage are unaware or under-aware of their problems.” Some people call this phase “denial.”
- “Contemplation is the stage in which people are aware that a problem exists and are seriously thinking about overcoming it but have not yet made a commitment to take action.” Many people in this stage can be described as ambivalent. They want to improve their blood sugar, but are not yet ready to cut back on eating sweets.
- The Preparation stage can be considered the information gathering and planning stage. The preparation stage is the most important. Fifty percent of the people who attempt behavior change and skip this stage will relapse within 21 days, according to Prochaska in his book, Changing for Good.
- “Action is the stage in which individuals modify their behavior, experiences, or environment in order to overcome their problems. Action involves the most overt behavioral changes and requires considerable commitment of time and energy.” During the action stage, one implements the plans developed and information gathered in the preparation stage.
- “Maintenance is the stage in which people work to prevent relapse and consolidate the gains attained during action. For addictive behaviors this stage extends from six months to an indeterminate period past the initial action.”
Most people I work with, who have diabetes, could be categorized in the contemplation stage. They are seriously thinking about life changes, but have not yet made a commitment to take action. Therefore, I think it valuable to further explore this stage.
Within each stage, specific actions called, “processes of change,” help someone mentally move through each stage successfully. In the contemplation stage, the processes of change are “consciousness raising” and “self-reevaluation.”
Consciousness raising is the process of actively becoming more aware, mindful or conscious of the current situation. Some activities include, keeping a food diary to learn more about how much I am eating, monitoring blood sugar to learn how well or if my treatment plan is working, or reading food labels to learn about how much carbohydrate is in different foods.
Self-reevaluation flows naturally from consciousness raising. Self-reevaluation means taking stock or appraisal of the behavior that needs to be changed, and reveals how your values conflict with the problem behaviors.
An activity which will help clarify your values, or “why” you want to change is called “decisional balance”. The decisional balance takes into consideration the pros and cons of behavior change. Understanding pros and cons helps one acknowledge that behavior change has good consequences, but requires sacrifice.
Take a piece of paper. Divide the paper into two columns. Label one “pros” and the other column “cons”. Under each column answer each question: What will be the consequences of my behavior change be for me?
- What will the consequences of my behavior change be for others (family, friends, coworkers)?
- What will my reactions be to my new self?
- What will the reactions of others (family, friends, coworkers) be to my new self?
- If the pros of change outweigh the cons, then one is ready to move into the preparations stage! This sets the foundation for the preparation, action and maintenance stages.
I once heard a radio interview with James Prochaska. He said that making a behavior change should be approached as if you were getting ready for a major surgery. How much pre-planning would you do? How much support would you solicit from friends and family? How much mental attention would you put towards it? It would be your number one priority, and you would choose a time when there would be nothing else within your control that would take precedence. You would not choose a time when you are making a marital change, job change, major vacation, getting ready to move to a new house, etc. Healthy behavior change is that difficult, and it is that important.
By: Donna Webb, RD, LD, CDE
Cecelia Health Diabetes Health Coach
Cancer Prevention Research Center. University of Rhode Island, 2016. Web. 10 Jan. 2016. <http://web.uri.edu/cprc/about-ttm/>
Prochaska, J. O. and W. F. Velicer (in press). “The transtheoretical model of health behavior change.” American Journal of Health Promotion.
Prochaska, PH.D., James O., John C. Norcross, PH.D., and Carlo C. Diclemente, PH.D. Changing For Good. New York, NY: Harperollins Publishers, 1994. Print.
Kwa hivyo, tuna wiki chache tu katika 2016, na wengi wetu tayari tunaweza kuwa tukizunguka kutoka kwa azimio letu la Mwaka Mpya, ikiwa hatujawasahau kabisa. Kwa nini ni vigumu sana kufanya mabadiliko? James Prochka, kutoka Chuo Kikuu cha Rhode Island, amekuwa akichunguza swali hili kwa zaidi ya miaka thelathini, na ametumia nadharia yake kwa tabia nyingi za afya, ikiwa ni pamoja na tabia muhimu katika usimamizi wa kisukari. Prochazka amegundua kuwa watu ambao wamefanikiwa kufanya mabadiliko mazuri katika maisha yao hupita katika hatua tano maalum: pre-contemplation, contemplation, preparation, action, na maintenance. - Precontemplation ni hatua ambayo hakuna nia ya kubadilisha tabia katika siku zijazo. Watu wengi katika hatua hii hawajui au hawajui matatizo yao.Watu wengine huita hatua hii kukataa.Mtazamo ni hatua ambayo watu wanajua kuwa tatizo lipo na wanafikiria kwa uzito juu ya kuishinda lakini bado hawajafanya ahadi ya kuchukua hatua.Watu wengi katika hatua hii wanaweza kuelezwa kama ambivalent. Wanataka kuboresha kiwango cha sukari ya damu yao, lakini hawajajitayarisha kupunguza kula peremende. - Hatua ya Maandalizi inaweza kuchukuliwa hatua ya kukusanya habari na mipango. Hatua ya kujitayarisha ndiyo muhimu zaidi. "Kama vile Prochaska anavyosema katika kitabu chake ""Kubadilisha kwa Uzuri,"" asilimia 50 ya watu wanaojaribu kubadilisha tabia zao na kuruka hatua hii watarudi tena ndani ya siku 21." - <unk>Hatua ni hatua ambayo watu binafsi kurekebisha tabia yao, uzoefu, au mazingira ili kushinda matatizo yao. Hatua inahusisha mabadiliko ya wazi ya tabia na inahitaji kujitolea kwa muda na nishati. <unk> Wakati wa hatua ya hatua, mtu hutekeleza mipango iliyoundwa na habari zilizokusanywa katika hatua ya maandalizi. - <unk>Uhifadhi ni hatua ambayo watu kazi ili kuzuia relapse na kuimarisha faida kupatikana wakati wa hatua. Kwa tabia ya kulevya hatua hii inaenea kutoka miezi sita hadi kipindi kisicho na uhakika baada ya hatua ya awali. <unk> Watu wengi ninaofanya kazi nao, ambao wana ugonjwa wa kisukari, wanaweza kuorodheshwa katika hatua ya kutafakari. Wanafikiria kwa uzito juu ya mabadiliko ya maisha, lakini bado hawajafanya ahadi ya kuchukua hatua. Kwa hiyo, nadhani ni muhimu kuchunguza zaidi hatua hii. Ndani ya kila hatua, vitendo maalum vinavyoitwa, "mchakato wa mabadiliko", husaidia mtu kusonga kiakili kupitia kila hatua kwa mafanikio. Katika hatua ya kutafakari, mchakato wa mabadiliko ni "kuinua ufahamu" na "kujipima upya". Kuinua ufahamu ni mchakato wa kuwa na ufahamu zaidi, ufahamu au ufahamu wa hali ya sasa. Kuhifadhi diary ya chakula ili kujua zaidi kuhusu kiasi cha chakula unachokula, kufuatilia sukari ya damu ili kujua jinsi mpango wako wa matibabu unavyofanya kazi, au kusoma lebo za chakula ili kujua kiasi cha wanga katika vyakula tofauti. Kujitathmini upya hutoka kwa asili kutokana na kuongezeka kwa ufahamu. Kujitathmini upya ni kuchukua hesabu au tathmini ya tabia ambayo inahitaji kubadilishwa, na inaonyesha jinsi maadili yako yanayopingana na tabia za tatizo. Shughuli ambayo itasaidia kufafanua maadili yako, au <unk>kwa nini<unk> unataka kubadilisha inaitwa <unk>mabadiliko ya usawa<unk>. Usawa wa uamuzi hufikiria faida na hasara za mabadiliko ya tabia. Kuelewa faida na hasara husaidia mtu kutambua kwamba mabadiliko ya tabia yana matokeo mazuri, lakini yanahitaji dhabihu. Chukua kipande cha karatasi. Gharama karatasi katika safu mbili. Weka alama moja "faida" na safu nyingine "dharafu". Katika kila safu, jibu swali hili: Ni nini matokeo ya mabadiliko ya tabia yangu? - Mabadiliko ya tabia yangu yatakuwa na matokeo gani kwa wengine (familia, marafiki, wafanyakazi wenzangu)? - Nitaitikiaje nafsi yangu mpya? - Watu wengine (familia, marafiki, wafanyakazi wenzangu) watakuwa na maoni gani kuhusu mimi mwenyewe mpya? - Ikiwa faida za badiliko zinasababisha hasara, basi mtu yuko tayari kuingia katika hatua ya maandalizi! Hii huweka msingi kwa ajili ya hatua za maandalizi, hatua na matengenezo. "Mwanzoni mwa mwaka wa 1990, nilipokea mahojiano ya redio na James Prochaska.""" "Mwanamume huyo alisema: ""Kubadili tabia yako ni kama kujitayarisha kwa upasuaji mkubwa." Ungefanya mipango mingapi mapema? Ungetaka kupata msaada gani kutoka kwa marafiki na familia? Ungekazia fikira jambo hilo kwa kadiri gani? Hii itakuwa ni kipaumbele chako cha kwanza, na utachagua wakati ambapo hakuna kitu kingine kinachoweza kudhibitiwa ambacho kitakuwa cha kwanza. "Huwezi kuchagua wakati wa kufanya mabadiliko ya ndoa, mabadiliko ya kazi, likizo kubwa, kujiandaa kuhamia nyumba mpya, na kadhalika.""" Mabadiliko ya tabia ni muhimu na ni muhimu. Donna Webb, MD, MD, MD, MD, MD, MD, MD, MD, MD, MD, MD, MD, MD, MD, MD, MD, MD, MD, MD, MD, MD, MD, MD, MD, MD, MD, MD, MD, MD, MD, MD, MD, MD, MD, MD, MD, MD, MD, MD, MD, MD, MD, MD, MD, MD, MD, MD, MD, MD, MD, MD, MD, MD, MD, MD, MD, MD, MD, MD, MD, MD, MD, MD, MD, MD, MD, MD, MD, MD, MD, MD, MD, MD, MD, MD, MD, MD, MD, MD, MD, MD, MD, MD, MD, MD, MD, MD, MD, MD, MD, MD, MD, MD, MD, MD, MD, MD, MD, MD, MD, MD, MD, MD, MD, MD, MD, MD, MD, MD, MD, MD, MD, MD, MD, MD, MD, MD, MD, MD, MD, MD, MD, MD, MD, MD, MD, MD Chuo Kikuu cha Rhode Island, 2016. Mtandao. 10 Januari 2016 <p><p><p><p><p><p><p><p><p><p><p><p><p><p><p><p><p><p><p><p><p><p><p><p><p><p><p><p><p><p><p><p><p><p><p><p><p><p><p><p><p><p><p><p><p><p><p><p><p><p><p><p><p><p><p><p><p><p><p><p><p><p><p><p><p><p><p><p><p><p><p><p><p><p><p><p><p><p><p><p><p><p><p><p><p>< <unk>Mfano wa transtheoretical wa mabadiliko ya tabia ya afya.<unk> American Journal of Health Promotion. Prochaska, Ph.D., James O., John C. Norcross, Ph.D., na Carlo C. Diclemente, Ph.D. Kitabu Changing For Good. New York, NY: HarperCollins Publishers, 1994. Uchapishaji.