ASSESSING THE KNOWLEDGE OF TRADITIONAL USES OF TINOSPORA CARDIFOLIA AND DEVEL...
Diet Counseling - Is it an Under-rated skill?
1. Diet Counseling – Is it an
under-rated skill?
Padmashri Shanmugaraj
Managing Partner
www.PrimeHealthConsultants.co.in
2. A good counselor should
Excel at ‘social marketing’
Successfully ‘sell’ healthy behavior
3. Stages of change-Transtheoretical model
Precontemplation- Not considering change
Contemplation- Thinking if change is necessary
Preparation- Thinking of ideas to implement the
change
Action- Implements the change
Maintenance – Change becomes a part of the routine
Relapse – Considering difficulties
involved bcos of change
4. Stages of change
Can also be listed as:
Not ready-to-change
Considering meeting goals
Ready-to-change
5. To facilitate behavior change:
Express empathy- Accept patient’s concerns
Understand cultural factors
Be familiar with cultural norms
Be aware of accepted body language
Develop discrepancy – Identify advantages &
disadvantages of behavior modification
6. Contd….
Avoid arguments- May lead o defensiveness in
patient about his ideas
Roll with resistance
Invite new perspectives about the same idea
Don’t impose – Instead of saying “Eat this!”, say
“Its good for you if you eat this”
Support self-efficacy
Words of hope, affirmation, confidence
Make patient feel responsible for his change
Help him choose & implement his personal
change
7. Stages of Intervention
Interviewing
Purpose: To obtain necessary information
Question in non-threatening manner
Begin session with introduction of yourself
Begin with open-ended questions. [For eg:
Questions starting with What, How, Why &
Could]
End with close-ended, follow-up questions
Establish rapport- show interest in important
aspects of patient’s life
Assess current eating behavior
Emphasize self-monitoring tools
Diet diary
Adherence ruler, so that patient can rate his
level of adherence to diet
8. First session is the deciding factor!!
During the first session
Ensure privacy
Reduce interruptions- No telephone calls, no staff or patients knocking
on the door etc
Body language [Discussed in detail later]
Begin with introducing goal / subject of the session – “We are
here to discuss your CHO intake with regards to your insulin dosage”
Assess ‘stage of change’ & document it – Helps in
facilitating the change
9. Body language / Non-verbal communication
Your manner of sitting should reflect interest
Lean forward slightly facilitating better hearing
Sit across each other with no barriers in between
Maintain respectful but close distance
Introduction should accompany firm handshake
Establish direct yet varied eye-contact
Nod often to show agreement
Brief periods of silence - enables patient to think & accept
changes suggested
10. Verbal Communication
Positive, confidence-building statements
“Its great that……..
“I am really impressed that……
Show the patient example of his/her progress
“ Its wonderful that you have lost 1 kg in the last fortnight”
“I am happy that you are very disciplined about your diet”
Paraphrasing
Concise & to-the-point repetition of patient’s history
Helps patient in re-thinking about his & dietitian’s views
Summarizing
Similar to paraphrasing but is more detailed
Enables better communication during follow-up
11. ‘Not-ready-to-change’
patients
Ask key open ended questions
Reflective listening - Involves guessing how the patient is
feeling & phrasing it as a statement and not as a question. Helps patient
realize that the dietitian understands his feelings
Affirm – Enables alignment & normalization of patient’s barriers to
change. {“Its very normal that you are finding it difficult to resist sweets”}
Summarize – Periodically summarize key points
Elicit self-motivational statements – Enables patient to
realize problems exist & that solutions can also be worked out
12. Overcoming resistant behavior
Reflective listening [Discussed earlier]
Double-sided reflection: Point out discrepancies, if any, in
patient’s views [“On one hand you say its possible but on the other
hand you say you don’t have enough time”]
Shift focus: Enable optimistic outlook
Agree with a twist: Agree with him but redirect conversation
casually to a key topic
Emphasize personal choice – Advice given can be taken or
avoided: It’s a patient’s choice!!
Reframe: Enable looking at things with a fresh, positive
perspective
13. ‘Unsure-about-change’ patients
First step
Build readiness to change
Summarize patient’s perceptions
Help him explore his ‘ambivalence’ by asking him to list pros &
cons of the change suggested
Talk about how life would be after implementing the change- Tip
the balance away from ambivalence
Second step
Help him choose healthier options
Third step
Arrive at a plan, TOGETHER!!
14. ‘Ready-to-change’ patients
Collaborate with the patient to set goals
Provide tools to use in meeting nutritional goals
Help him justify the decision to make a change
Map out the specifics of plan of action
Help him recognize his success at achieving
a goal
15. Ending a session
Need not end with ‘agreeing’ to change
Acceptance that change is necessary is good
enough!!
Express hope & confidence in patient’s ability to
make change
Arrange for next visit : Shows that dietitian is
interested!!