Diet Counseling - Is it an Under-rated skill?


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Diet Counseling - Is it an Under-rated skill?

  1. 1. Diet Counseling – Is it an under-rated skill? Padmashri Shanmugaraj Managing Partner
  2. 2. A good counselor should Excel at ‘social marketing’ Successfully ‘sell’ healthy behavior
  3. 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. 4. Stages of change Can also be listed as:  Not ready-to-change  Considering meeting goals  Ready-to-change
  5. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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!!
  16. 16. Thank You