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Intervention Levels

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Each Michigan WISEWOMAN participant is placed in Intervention Level 1, 2, or 3, depending on:

– Her readiness to change

– Her chronic disease risk factors

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Training Objectives

• At the end of the training, the WISEWOMAN staff member will be able to:– Explain the Michigan WISEWOMAN intervention levels

– Describe ways to determine whether a participant is ready to make lifestyle behavior changes

– Apply the information to assist a participant with setting a small step or a goal

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Intervention Levels

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Questions to Keep in Mind

• Is she ready to make a change?• How many risk factors does she have?• What services does she receive?

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Level 1

• Is she ready to make a change?– No

• How many risk factors does she have?– 0– 1

• What services does she receive?– Risk Reduction Counseling– Small Step – Can use Goals form or My Health Information

Pamphlet– Referral to MSU Extension– No follow-up calls

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Level 2

• Is she ready to make a change?– No

• How many risk factors does she have?– 2 or more

• What services does she receive?– Risk Reduction Counseling– Small Step – You can use the Goals Form or My Health

Information Pamphlet– Referral to MSU Extension– One follow-up contact in one or two weeks

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Level 3

• Is she ready to make a change?– Yes

• How many risk factors does she have?– It does not matter

• What services does she receive?– Risk Reduction Counseling– Small Step/Goal – Use Goal form– Referral to MSU Extension– First follow-up contact 7 – 30 days from screening– Second follow-up contact less than 60 days from screening– Up to three more contacts

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What is the most important question in determining a participant’s

intervention level?

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Is she ready to make a change?

How do I know if she is ready to make a change?

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Don’t assume she is ready

• According to research only 10% - 15% are ready to make a change at the first screening

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How do I know if she is ready to make a change?

• What Stageof Change is she in?

Contemplation

Preparation

Pre-Contemplation

Action

Maintenance

Not Ready

Still Deciding

May want Follow-up

Probably Ready

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How do I know if she is ready to make a change?

Not ready Still Deciding

Probably ready

May Want Follow-up

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• Look at her WISEWOMAN Health Risk Questions

How do I know if she is readyto make a change?

• Ask her

• Listen to what she says

• If you are not sure how to ask her, use the Readiness Ruler

– Participant talks – 80%

– You talk – 20%

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READINESS RULER

Below, mark where you are now on this line that measuresyour change in __________________________________.

Are you not prepared to change, alreadychanging or somewhere in the middle?

0 101 5 6 7 8 9432

Not Ready Still Deciding Probably Ready

How confident are you that

you can make this change?

You can also use this tool to measure confidence

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Listen for Change Talk

• Desire– I want to eat better

• Ability– I have some time to walk after dinner

• Reasons– I would feel better if I quit smoking

• Need– I really need to get my blood pressure under control

• Commitment – I am ready to start eating better

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Small Steps/Goal Setting

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Small Steps

• Are Achievable– Add 1 Piece Of Fruit Or Vegetable– Add 10 Minutes Of Walking 3 Days

Per Week

• Encourage Success In The Future

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Many of our

participants have not

been successful

making health

changes

Being successful with

one small change, will

help them continue to

make changes in the

future

Small Step/Goal Setting

• In what areas can a participant set a small step/goal? – Nutrition– Physical Activity– Smoking Cessation– ANY!

Meet her where she is – Do not try to take her

where you think she should be

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Small Step/Goal Setting Tips

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Focus On One Thing

• Life is already difficult for her, try not to make it more complicated

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Make It Personal

• Remember, she is the one who has to do the work

• It has to be something she wants to do

– Participant talks – 80%

– You talk – 20%

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Make It Measurable

• Use numbers

– Add 1 piece of fruit . . .

– Walk 10 minutes . . .

– Smoke 5 fewer cigarettes . . .

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Make It Manageable

• If she eats one fruit or veggie each day, she can go to two, but not five

• Remember, these are small steps

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Set A Timeline

• Have her pick something she can do every day, or most days for the next two weeks

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Make A Plan

• What is she going to do?

• When is she going to do it?

• How often is she going to do it?

• Where is she going to do it?

• Who will support her?

My goal is to be active 10 minutes a day most days of the week

My plan is to walk around the parking lot with my friend for 10 minutes during my lunch break at least 5 days a week for the next two weeks

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Scenarios

• The following scenarios were created for this training exercise

• Any resemblance to persons living or dead is purely coincidental

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Dora – 56

• High BP; Prediabetes; Obese; Family History of Premature CVD; Physically Inactive

• Not interested in healthy foods – A little interested in finding out more about being physically active

• When you talk to her, she has a whole list of reasons why now is not a good time to make changes

• What is Dora’s intervention level?

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LeeAnn – 48

• Smokes; Low HDL; Physically Inactive

• Very interested in healthy foods; Very interested in being physically active; Has been trying to quit smoking lately

• When you talk to her, she tells you she does not like waking up coughing every morning, so she has cut back to ½ a pack a day

• She knows she would feel better if she quit smoking

• What is LeeAnn’s intervention level?

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Betty – 54

• Family History of Premature CVD

• Has been trying to eat healthier lately; Has been trying to be more active lately

• Her older sister just had a stroke two weeks ago.

• Her sister eats a lot of fried foods and a lot of salty foods.

• Since her sister’s stroke, Betty started jogging, and she has been trying to cut out all fried foods and salt, but it is hard.

• What is Betty’s intervention level?

• What small step should Betty work on?

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What is one thing you will do differently as a result of this training?

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