Help your clients succeed in 2024
By Carolien Koreneff, CDE-RN
Did you or your clients set some New Year’s resolutions this year? New Year’s resolutions are notoriously difficult to keep because people tend to make their resolutions either too intense or too far-reaching. In fact, around 15% of people break their resolution in as little as three months, and less than half of us achieve the goals we set for ourselves.
People who achieve their goals generally know their own strengths and weaknesses, thereby they can recognise where and when they may require additional support. One study that looked at what made people more likely to stick with their New Year’s resolutions found that those who were more successful tended to be more mentally prepared, ready to start that change, and were more confident in their own ability to make progress towards their goal (and continued to do so).
As healthcare professionals working with people with diabetes, we may not always help our clients set their New Year’s resolutions, but recommending behaviour change goals is an important part of our interactions with our clients to help improve their quality of life. You can help your clients achieve their goals, by exploring their underlying reasons and rationale for wanting to change certain behaviours, and by providing the support they need.
We discussed the benefits of Health Coaching in a previous issue of this e-newsletter; but in case you missed it, you can find that article here. In this article we focus on strategies that can help you help people succeed at behaviour change.
Motivational Interviewing (MI) is an evidence-based approach to behavioural change. It is a guiding style of communication that honours client autonomy, and is designed to empower people to change by drawing out their own meaning, importance and capacity for change.
“MI is a collaborative, goal-oriented style of communication with particular attention to the language of change. It is designed to strengthen personal motivation for and commitment to a specific goal by eliciting and exploring the person’s own reasons for change within an atmosphere of acceptance and compassion.”(Miller & Rollnick, 2013, p. 29)
Core skills in MI are referred to as the OARS, which is an acronym for Open-ended questions, Affirmation, Reflections and Summarising.
Open-ended questions draw out and explore the person’s experiences, perspectives and ideas, to help the client to reflect on how change may be meaningful and possible. It starts by first exploring what the person already knows (Elicit), then seeks permission to offer what the professional or practitioner knows (Provide) and then explores the person’s response (Elicit). The exchange of information respects that both the clinician and the client have expertise. Sharing information is considered a two-way street and needs to be responsive to what the client is saying.
Affirmation of efforts, strengths and past successes help build hope and confidence in your client’s ability to change.
Reflections are based on careful listening and trying to understand what the person is saying, by repeating, rephrasing or offering a deeper guess about what they are trying to communicate.
Summarising reinforces key points made by the client and ensures shared understanding. Attending to the language of change identifies what is being said against change (sustain talk) and in favour of change (change talk) and, where appropriate, encouraging a movement away from sustain talk toward change talk.
When using MI, goals will be less about the actual goal itself, and more about the person and how they will get there.
SMART or SMARTER goals
Setting New Year’s resolutions to “lose 30 kilos”, to “stop procrastinating”, or to “stop being stressed all the time” are not realistic goals. They could actually have an adverse effect on the person’s mental health when they don’t meet their own expectations. Instead of setting a specific weight loss goal, creating a goal that focusses on a healthy lifestyle, such as eating a full serving of vegetables every day or walking for 10 minutes at least two days per week are more obtainable and will likely lead to the same outcome (weight reduction).
Goal-setting is often likened to budgeting your money. If you have a plan about how you spend your money every week or every month, chances are that you will make ends meet. Whereas, if there is no plan, you may spend your money too quickly and could be left short when having to pay for something important later in the week. Very few people would spend money in the same way every week, even if given the same amount of money. Sitting down and making a plan can seem like a drag and will take some time, but will increase the person’s chances of success.
Setting SMART goals means that the person can clarify their ideas, focus on their efforts, use their time and resources productively, and increase their chances of achieving what they want in life.
The letters S-M-A-R-T stand for: Specific, Measurable, Achievable or Attainable, Relevant or Realistic, and Timely or Time-Bound (there are a few variations, depending on what the goal-setting is used for). Sometimes it is referred to as SMARTER goal-setting, particularly in reference to self-management. The additional letters E and R stand for Evaluate or Expect Problems and Review or Reflect.
Defining these parameters as they relate to a goal helps ensure that the objectives are attainable within a certain time frame.
Ask these questions to help your clients use goal-setting:
- Specific: What exactly do you want to do? Why is this goal important? Which limits or resources are involved?
- Measurable: How will you know that you have done it and it is working for you? How will you know when you have reached it? How much? How many?
- Achievable: Is it in your power to accomplish it? How realistic is the goal, based on other constraints, such as financial factors? How confident do you feel? Would you allow a friend to pursue this goal? If not, alter it to be more attainable.
- Realistic: Can you realistically achieve it? Does this seem worthwhile?
- Time-bound: When exactly do you want to accomplish it? What can you do six months from now? What can you do six weeks from now? What can you do today?
- Evaluate or Expect problems: Expecting problems allows you to plan for them, so ask questions such as what may get in the way? How will you overcome this? How have you overcome something like this in the past? Practice makes perfect (or at least progress) and self-management tasks are a continual learning process. The more we try a task, the more we learn from it and the better we get at it, if we revise the plan along the way until it fits the current situation.
- Review recognises that life changes, and what works at a certain time in the person’s life may not work if their circumstances change. Setting a review date is an important part of a plan, so ask your client when they want to review it and then explore what they have learned from trying out the plan? Ask questions such as what worked well? What could they do differently in future plans? Reflection is not only a tool for learning, it can also help increase self-awareness and empathy for others.
Some of the goals people may want to set for themselves are large goals that will take months or even years to achieve. To help your clients stay on track it is important to break these goals down into smaller goals and timeframes. For example, a goal such as wanting to lose 30kgs by 2026 may be Specific, Achievable, Measurable, Realistic and Time-bound, but there are a lot of factors that can get in the way in the next three years. What is realistic and achievable now may not be so in three months’ time. Setting a goal of “losing 3kgs in the next six weeks, by [insert date here]” may be a SMARTER goal as it can be reviewed and updated.
Self-management is all about choice. There is no ‘right way’, or only one way to self-manage diabetes. People experience diabetes differently depending on their situation. Most of us will do better in achieving our goals if we:
- Set SMART(ER) goals
- Get support from others
- Value our resolutions greatly
- Be prepared for obstacles in our way
- Don’t forget to take your own advice.
- Norcross, J.C., Mrykalo, M.S. and Blagys, M.D. (2002), Auld lang Syne: Success predictors, change processes, and self-reported outcomes of New Year’s resolvers and nonresolvers. J. Clin. Psychol., 58: 397-405. https://doi.org/10.1002/jclp.1151
- Understanding Motivational Interviewing https://motivationalinterviewing.org/understanding-motivational-interviewing