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Setting Behaviour Change Goals

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Goal SettingThis section moves on from earlier content about motivating client’s to resolve to make changes to how to support client’s to implement changes.

Once they are clear they want to make changes, the process moves on to look at how we effect change in their behaviour. They need to make those choices – supported by you.

Goal setting is an important part in changing behaviour – client’s need to identify what we want to achieve before they can begin to achieve it.

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Setting the scene

The first part of the process is to look at the client’s current behaviour – this gives a baseline from which you can work together to identify and support change. A useful tool to do this is the health behaviour check which should be used as part of a discussion about current behaviours.

The Health Behaviour Check gives a structured approach to reviewing what the client eats, drinks, how active they are and whether they smoke (or not) and if they do, how much.

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Health Behaviour CheckThe first part of the behaviour check is a review of the client’s knowledge and understanding of key health messages. This is partly to assist you in gauging their level of understanding, but will also act as a tool to review how much their views/understanding changes over time as a similar questionnaire is undertaken at the end of pregnancy. Refer to Learning Resources to view a copy of the Health Behaviour Check.Key questions are around understanding of benefits of breastfeeding, safe activity levels, suggested weight gain in pregnancy as well as assessing their confidence to approach some of the issues the service supports.

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Health Behaviour CheckThe second part of the behaviour check reviews client’s current behaviour – including how active they have been in the previous week, what sorts of foods they have eaten, alcohol consumption and smoking status. This information provides a level of knowledge for you to encourage them to identify areas for change. In completing the health behaviour check, encourage the client to be as honest as possible with their answers. It is not a test not will you judge their responses – it gives you an opportunity to work together to make changes.

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Health Behaviour CheckYou should complete the check together – sitting alongside the client if possible so that answers can be discussed as you go along and you can also raise health messages along the way. For example, if they put that they do 30 minutes exercise, three times a week – you could say “That’s over half way to the 5 x 30 minutes that is recommended” or if they don’t eat any fruit and vegetables, you could ask if they know that fruit juice and tinned/frozen fruit/vegetables all count and how big a portion actually is. The same can be raised around portion sizes of other foods.

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Health Behaviour CheckOnce the check has been completed, review the client’s answers with them. For some clients, there will be clear areas to take action – for example if they do no physical activity at all or well below the recommendation. It might be that they do not eat any fruit and vegetables or they eat several portions of fatty foods a day. Your role is to help the client to identify areas to focus their change – promoting the fact that they will be setting small goals as they go along, so that eventually they will have worked on all the areas that could be improved.

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Health Behaviour CheckEtivityComplete a Health Behaviour Check on a family member, colleague or friend.

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Health Behaviour CheckIt may be more challenging with some clients to identify clear areas for action – for example, if they are already active beyond the recommended 5x30, or they appear to eat a healthy, balanced diet. It may be that there are clear areas for action, but the client is ambivalent about making changes. For example, in a discussion around physical activity, they raise multiple barriers to undertaking any increases in their activity levels. Discussing the benefits of making changes with clients may be helpful in motivating them to identify areas for action/set goals.

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Health Behaviour CheckEtivityConsider the case study examples of a completed Health Behaviour Check. Consider what health benefits you could discuss with clients when supporting their decision-making.Health Benefit cards are included in the manual to give written examples. An example follows on the next slide.

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Benefit Cards

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Health BenefitsIt may be more challenging with some clients to identify clear areas for action – for example, if they are already active beyond the recommended 5x30, or they appear to eat a healthy, balanced diet. It may be that there are clear areas for action, but the client is ambivalent about making changes. For example, in a discussion around physical activity, they raise multiple barriers to undertaking any increases in their activity levels. Discussing the benefits of making changes with clients may be helpful in motivating them to identify areas for action/set goals.

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Setting GoalsOnce you have established where a client is in relation to making changes, and they have identified, with support, areas to take action, you should support them to identify specific goals. The introduction to this session described the importance of setting small goals in supporting changes to behaviour – building on the principle of eating an elephant – impossible in one go, but entirely possible in a number of small bites!

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Setting GoalsThere are a number of key principles in goal setting, you may already be familiar with the idea of SMART goals.

•Specific•Measurable•Achievable•Relevant•Timely

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SMART Goals• Specific – the goal needs to be clearly defined and detailed, not vague.

For example, a vague goal would be “getting fit and healthy”, a specific goal would be “I will hit my 6000 steps a day target”

• To define the goal, encourage the client to think about: What they’ll do? When they’ll do it? Where they’ll do it and who with?

• Measurable – making the goal specific enables it to be easily measured. For example, how many steps they actually did, and on how many days. It helps in being able to measure progress and look at areas for additional work.

• Achievable – it’s important for you to explain to the client about setting goals that are achievable – so if they are currently doing 2000 steps a day, it’s a big jump to set a 6000 step target. It might be more sensible to set a gradual increase – so there are opportunities to celebrate and boost confidence along the way.

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SMART Goals• Relevant – the goal needs to be something that’s important to the client

– something they really want to change. Otherwise, they may find it difficult to be motivated to succeed. They will also be more likely to succeed if they can see the important difference it will make to their health.

• Timely – you need to work with the client to ensure it is the right time to set this goal, and give themselves a time limit to achieve it. Target dates for goals should tie in with the appointments they have with you – it will assist the client in recorded and continuing to make progress. If the goal would take longer, then it could be broken down further – so 1000 extra steps each week towards the goal.

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SMART goals

EtivityThink about the two clients, Suzanne and Ayshia.

Can you suggest some smart goals for them to set?

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Self monitoring of behaviourOne of the most important aspects of behaviour change is to encourage clients to monitor their behaviour and the changes they make. Measuring and recording progress can act as a key motivating factor, or tell them something might be wrong with their plan if they’re having difficulties. Without monitoring behaviour using a tool – and there are a number of tools available – it can be easy for the client to over estimate – or underestimate how successfully they are in changing their behaviour.For example, if you try to remember what you had to eat yesterday, or the day before, you might forget that you had a chocolate biscuit, or ate the leftovers of your children’s dinner!

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Using behaviour change diariesThere are 3 main reasons to use a behaviour change dairy.1.To enable the client to map their current behaviour before making a change. This can be particularly helpful in aiding clients who are not sure what behaviour to change. In addition, just keeping track of behaviour can be a powerful tool in motivating change. For example, if you have to write down each biscuit you have eaten, you would be more likely to eat one pr two rather than half a packet.2.When a goal has been set, using a diary to track progress towards that goal and see if behaviour is changing in the right direction.3.Using a diary can help clients identify areas for further work to increase opportunities for success – for example, when they ate three chocolate bars, how did they feel – before and after, or when they hit their target, how did they feel.

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Behaviour Change Diary

Below is an example of a behaviour change diary. See if you can find some other examples of tracking behaviours, such as charts or graphs.

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Recording GoalsWhen clients have set their goals, it is important that you both record a copy of what they are intending to achieve. It could be a simple note on the fridge or fruit bowl to motivate them to eat less or eat more fruit. One tool in the manual is a Personal Health Plan – this helps the client write down their goal and think around how they will achieve it.It is helpful to find a tool that works for each client – if they like the PHP, then use that to record goal setting. Other clients might like a picture to describe what they intend to achieve.

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Rewards and relapseOnce a client has deciding on their behaviour to change and has set themselves clear goals, your role is to support them in achieving their goals. You have three clear roles:1.Celebrating success and encouraging them to recognise and reward their own success2.Questioning areas they have experienced difficulties and aiming to work through overcoming those difficulties – but most focus should be on celebrating success3.Preventing lapses or relapse

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Reviewing progressAt the next meeting, following goal setting, your role is to explore with the client how they have got on. You will be seeking the answers to some of the questions below (remembering that all the questions below need to be phrased openly in discussions with clients). The questions are to support your focus, rather than forming a ‘tick list’ of points to cover:What was tried – what was the goal?What was the result – success? What were the benefits?Were there any difficulties?Has the client got enough support – from friends/family or from you?Does the goal need to be changed?

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Reviewing progressDuring the discussion, it is important to praise the client – for any small achievement – for example, even completing a food diary is an achievement (even if they didn’t manage to successfully change all their behaviours). It is also important to remind the client that change takes a long time – so any small steps are great progress towards their goal and building on each success – and learning from any setbacks, all support achievement of the goal.

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RewardsConsidering how the client will recognise and reward their own success is a key part of the process. We are often very quick to judge ourselves when something doesn’t got right, or we fail to meet our expectations. It is not often that we as individuals stop to celebrate our successes. When talking about setting goals, it is important to discuss what the client will do to reward themselves when they achieve something. Often though, we use food as a reward – so if they’ve eaten more fruit, they might be tempted to reward themselves with a less healthy ‘treat.’ So try to encourage rewards that don’t impact on the bigger goal.

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RewardsYour role in relation to rewards is to support the client – through discussion and suggestion – to identify a reward scheme that will work for them. Find out what motivates them and what they would consider to be a real treat – these don’t have to cost money – it could be a bubble bath in peace and quiet, half an hour relaxing with a book, a gold star or a chart to record successes with a larger reward after 5 or 10 stars. You are also important in relation to praising achievements and celebrating and sharing their successes. Consider some examples you might suggest as possible rewards and post these examples on the Forum.

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Preparing for difficultiesWhen supporting clients in goal setting, it is also useful to help them consider when it might be difficult to keep on track. Behaviour change is often a bumpy process – rather than a straight line and it is common to have lapses in behaviour, for goals not to be met and for clients to encounter difficulties along the way. If it really were that easy to change without help and as soon as you set a goal, then no-one would need support to do itIt is important to make sure client’s also understand that they may experience difficulties or set-backs along the way. For some clients, who are client is highly motivated/confident, they may find it easier to overcome difficulties without support and you may not need to spend a lot of time discussing this area. Reinforce that if they have a set back, to spend time learning from it rather than becoming disillusioned or angry for having ‘failed’

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Preparing for difficultiesFor other clients, who are already less confident, it is worth spending a little more time on techniques for reducing the likelihood of difficult situations – and also planning what to do if they do experience difficulties.Work with your client to consider what might be ‘high risk’ situations – for example, grocery shopping on an empty stomach at 11am. This might result in her grabbing something unhealthy as a quick fix.There are two possible solutions here – one is to avoid the situation by having eaten before going, or writing a list and only buying from the list. The second one would be to have a healthy snack in her bag – or go and get a snack before starting the shop. You role is to help clients identify any areas that might be difficult – or review these when progress has been slow – and support them to identify solutions.

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Coping with difficultiesWhen working with clients who have experienced difficulties or haven’t reached their goals, it is important to help them recognise that it is an important part of the process. They can learn from the mistake and be more prepared next time. You can also usually find some area that they have been successful – don’t let them consider one bad day or lapse to have de-railed progress towards the goal.Talk through the difficulties with your client – help them to understand why they lapsed, what was happening? How did they feel? Were they still using a diary to record they behaviour? Did they have enough support? Was the goal realistic – does it need to be reviewed?

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Coping with difficultiesWhen you’ve covered all of these areas, it may be that they can identify where it went wrong and you can begun to plan a strategy for avoiding that lapse next time – and identifying any other potential risky areas.

Consider the Case Studies attached and think about what suggestions you would have for Sarah, Claire and Joanne.