Sample Group Activity

Excerpt from Care Management Skills: Stages of Change

	Display Group Activity (Slide 11).
Setup Group Activity ? Ask	Stages of Change Activity Overview: Participants match patient statements to the correct stage of change. For small classes (under 10 participants), each participant works alone. For larger classes, break the class into groups of two or three participants. Note: The trainer may choose to exclude specific examples if they are not relevant to the group. Setup: The trainer should make and place five signs in the front of the classroom. Each sign represents a stage in the change process (Precontemplation, Contemplation, Preparation, Action, and Maintenance). Cut apart the Stages of Change Statements (Supplement #1) into individual strips of paper containing one statement each. Distribute strips of paper that have a single statement from patients regarding a lifestyle change to the participants. The participants physically match the sentences with the appropriate stage of change by placing the sentence handout under the appropriate stage of change sign. Review the placement of the statements with the participants after the activity is complete. Ask possible debriefing questions: § Are there any statements that someone wants to move to a different stage of change? Discuss as a group. § What are some of the cues you used to match the statements with the stage of change? Discuss the importance of listening to the cues patients give you regarding their readiness to change. Reinforce that the patients don’t always fit neatly into one category or another¾there is sometimes overlap. Also, patients do not always move in a linear fashion along the continuum, and they may move in either direction. See Answer Key (Supplement #2).
Summary and Transition	Ask for and answer any related questions before moving on to the next section of training. Explain that being able to identify patients’ stages of change allows the Care Manager to meet them where they are on the readiness to change continuum. The Care Manager can then tailor the interventions to those that will be most helpful in empowering patients to move to the next stage. Now, let’s take a look at interventions for managing the change process.

Activity: Stages of Change

Supplement #1: Stages of Change Statements

Instructions: Make a copy of the following statements (3 pages).

Cut the paper into strips so that there is one statement on each strip of paper.

These statements are to be handed out to the participants in the group activity.

“I have smoked since I was a teenager. Smoking is just me and I’m not changing.”

“The doctor wants me to stop drinking wine. My grandfather loved wine, my father loved wine, and I love wine. They each lived a good long life; I’ll live a good long life too.”

“My doctor says I have to watch what I eat, but I’m not going to count calories or read books about nutrition, it’s all too much work.”

“All of my family is big. We’re just born that way. It’s just who we are. My grandma was big and lived to be 80.”

“The doctor says my cholesterol is too high, but I eat well and I feel good.”

“I know I need to bring my cholesterol down, but it’s hard to even think about giving up my favorite foods¾especially not forever.”

“I’ve looked into the local health/exercise facility, but I just don’t feel comfortable. And the only time I have available to exercise is in the early morning and I’m too tired to get out of bed.”

“I’d like to stop smoking, I really would, but I’ve tried before and I just can’t do it.”

“I need more physical activity, so I signed up for exercise classes. The classes begin next week.”

“I’ve read the first chapter of a book that was suggested about nutrition, but there was so much to remember and I don’t think I’d ever be able to track what I eat so closely.”

“I am reading the brochure about lowering cholesterol that you suggested. And, I am making notes for what foods to buy on my grocery list.”

“I’ve talked to the doctor about trying to stop smoking. He has given me a prescription for something to help with the cravings.”

“My neighbor and I have made plans to start walking together in the mornings three days a week.”

“I’ve been shopping for groceries twice¾and I’ve stuck to my list, buying items that are good for my cholesterol.”

“I’ve been on my diet for two weeks and I feel good. I am excited about losing weight.”

“I’ve attended classes at the health club for three weeks now. It was hard to keep up in the beginning, but now it is getting easier.”

”I haven’t smoked all day. I’ve circled the day on my calendar. I also have the medication the doctor prescribed to help.”

“I haven’t smoked for two weeks, but last night was tough. I went out to a restaurant with some friends and I could hardly resist. I don’t know if I can stick to it.”

“My wife’s a great cook, and I’m eating her food no matter what the doctor says.”

“I enjoy my wine and cigarettes, but I would like to be around long enough to see my grandchildren grow up.”

“I was doing so well on my diet¾I lost six pounds, but then I went on vacation. There was so much good food. Now I’m having a hard time starting over.”

“I was doing really well working out until I pulled a muscle. Now it hurts too much to work out. I’m just too old to do all this exercise.”

“I did what I was supposed to do. I watched what I was eating, I brought down my cholesterol, and I lowered my blood pressure. Now that I’m healthy, I can go back to eating what I like, right?”

“I need to walk up two flights of steps to get to my apartment. Lately, I’m out of breath by the time I’ve reached my door. I guess it’s time to stop smoking.”

“My wife and I have talked about it, and she’s going to start cooking with less fat. And, we’re talking about other ways to help me lose weight.”

“My sister needs to watch her cholesterol too. We are getting together tomorrow and shopping together for healthier food. We’re going to do this together.”

“I’ve started walking every morning. I really feel better, and it’s much easier to climb the stairs to my apartment.”

“It is easier to cook healthy foods than I thought. And, I actually like what I am eating.”

“I’ve lost the weight I wanted to lose. I feel so much better.”

“I’ve been biking four mornings a week for two months now. I feel great!”

Activity: Stages of Change

Supplement #2: Answer Key

Precontemplation: “I won’t”

§ “I have smoked since I was a teenager. Smoking is just me and I’m not changing.”

§ “The doctor wants me to stop drinking wine. My grandfather loved wine, my father loved wine, and I love wine. They each lived a good long life; I’ll live a good long life too.”

§ “My doctor says I have to watch what I eat, but I’m not going to count calories or read books about nutrition, it’s all too much work.”

§ “All of my family is big. We’re just born that way. It’s just who we are. My grandma was big and lived to be 80.”

§ “The doctor says my cholesterol is too high, but I eat well and I feel good.”

§ “My wife’s a great cook, and I’m eating her food no matter what the doctor says.”

Contemplation: “I might”

§ “I know I need to bring my cholesterol down, but it’s hard to even think about giving up my favorite foods¾especially not forever.”

§ “I’ve looked into the local health/exercise facility, but I just don’t feel comfortable. And the only time I have available to exercise is in the early morning and I’m too tired to get out of bed.”

§ “I’d like to stop smoking, I really would, but I’ve tried before and I just can’t do it.”

§ “I’ve read the first chapter of a book that was suggested about nutrition, but there was so much to remember and I don’t think I’d ever be able to track what I eat so closely.”

§ “I need to walk up two flights of steps to get to my apartment. Lately, I’m out of breath by the time I’ve reached my door. I guess it’s time to stop smoking.”

§ “I enjoy my wine and cigarettes, but I would like to be around long enough to see my grandchildren grow up.”

Preparation: “I will”

§ “I need more physical activity, so I signed up for exercise classes. The classes begin next week.”

§ “I am reading the brochure about lowering cholesterol that you suggested. And, I am making notes for what foods to buy on my grocery list.”

§ “I’ve talked to the doctor about trying to stop smoking. He has given me a prescription for something to help with the cravings.”

§ “My neighbor and I have made plans to start walking together in the mornings three days a week.”

§ “My wife and I have talked about it, and she’s going to start cooking with less fat. And, we’re talking about other ways to help me lose weight.”

§ “My sister needs to watch her cholesterol too. We are getting together tomorrow and shopping together for healthier food. We’re going to do this together.”

Action: “I am”

§ “I’ve been shopping for groceries twice¾and I’ve stuck to my list, buying items that are good for my cholesterol.”

§ “I’ve been on my diet for two weeks and I feel good. I am excited about losing weight.”

§ “I’ve attended classes at the health club for three weeks now. It was hard to keep up in the beginning, but now it is getting easier.”

§ ”I haven’t smoked all day. I’ve circled the day on my calendar. I also have the medication the doctor prescribed to help.”

§ “I’ve started walking every morning. I really feel better and it’s much easier to climb the stairs to my apartment.”

§ “It is easier to cook healthy foods than I thought. And, I actually like what I am eating.”

Maintenance: “I have”

§ “I haven’t smoked for two weeks, but last night was tough. I went out to a restaurant with some friends and I could hardly resist. I don’t know if I can stick to it.”

§ “I was doing so well on my diet¾I lost six pounds, but then I went on vacation. There was so much good food. Now I’m having a hard time starting over.”

§ “I was doing really well working out until I pulled a muscle. Now it hurts too much to work out. I’m just too old to do all this exercise.”

§ “I did what I was supposed to do. I watched what I was eating, I brought down my cholesterol, and I lowered my blood pressure. Now that I’m healthy, I can go back to eating what I like, right?”

§ “I’ve lost the weight I wanted to lose. I feel so much better.”

§ “I’ve been biking four mornings a week for two months now. I feel great!”

B.Schalk, developed in collaboration with Training Systems Design