HEAD START®

Enhancing Health in the
Head Start Workplace

Training Guides for the Head Start Learning Community

Table of Contents | Preface | Introduction | Module 1 | Module 2 | Module 3 |
Module 4 | Module 5 |
Continuing Professional Development | Resources

MODULE 3: making changes in behavior for better health

Module 3 | Activity 1 | Activity 2 | Activity 3 | Activity 4 | Activity 5 | Next Steps

Outcomes

After completing this module, participants will:

• Understand the principles of behavior change.
  
  
• Develop a plan for improving personal health.
  
  
• Practice strategies to support co-workers’ efforts to change their behavior.

Key Concepts

Habits––healthy and unhealthy—are acquired over time. We keep them because they work for us in some way; therefore, change is challenging—but possible.

A person goes through several different stages when trying to change. To provide support, a friend or co-worker must first know how the person feels about making the change. What stage is he in? Once the current stage is identified, the helper uses different strategies during the different stages of change. Stages are:

• precontemplation
  
  
• contemplation
  
  
• preparation
  
  
• action
  
  
• maintenance

Background Information

A. Habits

We all have learned to cope with life’s many demands in a variety of ways. We learn how to get the food we need, the love we need, and we learn to get around from place to place to get our business done. Some things we do to manage our lives are healthy: communicate clearly with others, feed ourselves wholesome food, ride our bicycles to the store or park. These things work for us.

Some of the ways we cope are not so healthy, but in some way these work for us too. We find that a few drinks of beer calm us down after a hectic day, smoking a cigarette keeps us away from sweets. We learn that being harsh with children keeps them quiet, at least for a time. These are unhealthy behaviors. Over the long haul, they are detrimental to us and the people around us. We would be better off if we changed these patterns. But are we ready?

B. Stages of Change

At some point, most people decide to change some problem behavior. Or, they are pushed toward change by loved ones, co-workers, or policies. Some people succeed in changing, some don’t. Some succeed after many tries. Is there any logic to the change process? Researchers believe there is. Instead of jumping into the change, going through several steps—in sequence—increases the chance of success. Different strategies at different times help move the change process along.

“Stages of Change” theory outlines five stages that a person must go through when altering behavior. The following descriptions of each stage include helpful strategies.

Precontemplation: People in this stage are not yet ready to change. They are not concerned about their problems, though others might be. During this stage, the following strategies are helpful:

• consciousness raising: The person is given as much information about the problem as she will accept.
  
  
• social liberation: Establishing social groups and situations that support the healthy behavior and discourage the unhealthy.
  
  
• helping relationships: Having people who support the person’s change, but are not aggressive and pushy, is helpful at this stage and throughout the change process.
  

Contemplation: People in this stage are aware of their problem and want to change, but believe they will change “someday.” Helpful strategies during this stage are:

• emotional arousal: Becoming disgusted with the behavior or fearful about the condition of her life helps a person who is contemplating change to move forward.
  
  
• self-re-evaluation: Becoming thoughtful about the change, what the change might mean to the person’s life, assessing the pros and cons, and making a decision.
  

Preparation: At this stage, the person begins making concrete plans to change. Helpful strategies at this stage include:

• commitment: The person makes an announcement about the change, sets a date, plans several small steps toward the change, makes a comprehensive plan of action and considers possible pitfalls.
  
  
• self-re-evaluation
  

Action: This is the most active stage of change. Most health promotion and behavior change programs fall within this area. These programs teach a variety of strategies, including:

• countering: Substituting a healthy behavior for an unhealthy one, or replacing negative, self-defeating thoughts with positive ones. Exercise, relaxation, and assertiveness are important activities in this process.
  
  
• environmental control: The person takes specific steps to avoid places, people, and situations that encourage the negative behavior––and to be in places and with people who support positive behavior.
  
  
• rewards: To reinforce the behavior change, it is most helpful to set up a system of rewards—small rewards for small steps and larger rewards for bigger achievements in change. Behavior-change contracts are very effective.

Maintenance: The change has occurred and during this stage the person is working to avoid a relapse. Helpful strategies during this stage are:

• countering
  
  
• environmental control
  
  
• rewards

At what point is it clear that a person has changed? The sixth stage is beyond change:

Termination: At this point the person no longer is interested in the negative behavior and has no desire for it, even in situations where the behavior used to be common. She has truly given it up and become thoroughly committed to a healthy behavior. She feels confident of being able to continue the healthy behaviors, having incorporated them into her lifestyle.

It is important to realize that, with most behavior changes, people do not go through the stages of change in a linear fashion and come out—presto!—changed!—on the other end. Rather, the process of change is like a spiral, with people moving up the spiral toward action and maintenance, but relapsing and returning to earlier stages once or more throughout the change process. When someone is moving successfully toward change, however, she usually does not relapse all the way back to precontemplation. There will be a setback to contemplation and preparation, then movement ahead again. Those in maintenance may have a setback, then set up another plan of action.

C. How the Head Start Workplace Can Help Staff Make Healthy Changes

The workplace is where healthy behaviors can be supported or threatened. When people decide to change, they need the support of all who are close to them––family and friends of course, and co-workers. By understanding when a person is ready for change a co-worker can offer the needed support.

It is important to realize that, at any given time, people who share the same negative health behavior most likely will be at different stages in their willingness to change. It is very easy for those of us who are enthusiastic about health promotion to try to push people into change before they are ready. We offer them action-oriented programs when they are not interested. For example, stop-smoking programs are active. The prospective quitter must take time to attend meetings, organize his life to make cigarettes less available, designate areas or times for smoking. He must try to avoid smoking at times he is usually smoking, and substitute other behaviors for smoking.

However, recent research indicates that, among current smokers, only 10%-15% are ready for action; 30%-40% are contemplating quitting smoking, and 50%-60% are in the precontemplation stage––they have no interest in changing their behavior now6.

Any health coordinator or manager must assess an individual’s or group’s readiness for change before beginning any behavior change activities. Upon assessment, strategies can be matched to the stage.

There are two strategies helpful to anyone in any stage of change. Social liberation involves techniques of altering the person’s environment and social circle to discourage undesirable behaviors and encourage positive behaviors. Helping relationships offer support for any movement toward change.

D. What Do We Do About People Who Are Not Ready to Change?

A manager or supervisor often is aware that an employee’s behavior or habit is a problem; it affects more than the individual and is detrimental to the workplace. However, the staff person doesn’t want to change and won’t join a health promotion program. Does the manager ignore the problem?

Definitely not, though this is certainly a touchy situation. For the good of the workplace, the supervisor must try to encourage change. Clear understanding of the staff person’s perspective—readiness to change—is critical. The staff member may not be good-humored about trying to change. One administrator recalled a cigarette smoker who got hostile when anyone suggested she stop smoking, considering it a form of harassment. The supervisor in such a situation should not give up. Rather apply, very carefully, the appropriate strategies for a person in the precontemplation stage of change.

Questions for Discussion/Reflection

• Think of a recent change. Which steps (stages) did you go through to make the change?
  
  
• As a supervisor, how do you feel about intervening in your staff members’ health issues? When is it justified? When is it not justified?

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6 James Prochaska, Carlo DiClemente, and John Norcross, “In Search of How People Change,” American Psychologist, (September 1992).