Building Competency in Diabetes Education THE ESSENTIALS

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that the: “Power [of therapy] could be enhanced if we could integrate the profound insights of psychoanalysis, the powerful techniques of behaviourism, the experiential methods of cognitive therapies, the liberating principles of existential therapy and the humane values of humanistic therapy” (178). Stages of change The TTM describes five “stages of change” that were identified by studying the strategies used by successful self-changers (179-181) (Figure 10). A central hypothesis of the TTM is that not every patient is ready for change, even when confronted with a diagnosis, such as diabetes, that may require behaviour changes to optimize health. The model describes the characteristics of people at the different stages in terms of their readiness (or intention) and confidence to make the change in question. It then goes on to suggest the types of interventions that are most appropriate for each stage (179-181).

Figure 10. Stages of change

Stage I. Pre-contemplation: Not considering change >6 months

Stage II. Contemplation: Considering – but not soon

Stage III. Preparation: Getting ready – soon

Stage IV. Action: Trying it out

Stage V. Maintenance: Doing it more than 6 months

Reprinted with permission from Jones et al (182)

• Precontemplation : There is little or no intention to change behaviour; lack of awareness of a problem or resistance to change is the hallmark of this stage. Barriers outweigh the positive outcomes of making a change. Recommendations may be met with open rebellion. The health professional’s role here is to help the patient identify the importance of his/her own issues/problems and need for behaviour change (collaboratively identify the problem).