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Five key skills

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The concept of readiness to change comes from the Stages of Change Model, which shows how individuals are at different stages of change.

Assessing your client's readiness to change is a critical aspect of MI. Motivation is not static and can change rapidly from day to day. If you can understand where your client is in terms of their readiness to change, you will be better prepared to recognise and deal with their motivation to change.

Why is it important to know my client's attitude to changing?

In order to give effective advice, you need to gauge your client’s understanding of their issue and their interest in changing.

You may need to help your client explore the benefits of making a change and find ways around the potential barriers they may face. To help clients explore the importance of a specific behaviour change and increase their confidence to achieve their goal it helps to:

  • start where your client is
  • try to see the situation from their point of view
  • if they want to change, encourage a realistic first step
  • build of their existing strengths and positive past experiences
  • use small measurements to assess and track their progress
  • people are more likely to change when they for example, when they can see the benefit of changing
  • if a person is not ready for a change for example, you should respect their decision
  • if a person is unsure about making a change, you could ask them for example: what are the pros and cons of making the change?
  • it helps to summarise and consolidate what you have discussed, so you could ask for example: who are you going to ask to support you?  
  • relapse prevention: You need to explore the potential of relapse and how they could prevent this from happening. You could ask for example: what makes this a good time to change?

The Readiness to change ruler

While readiness to change can be evaluated using the Stages of Change Model, a simpler and quicker way is to use a Readiness to change rulerThis strategy asks clients to vocalise how ready they are to change using a scale of one to ten, where one = definitely not ready to change, and 10 = definitely ready to change. This allows you to immediately know your client’s level of motivation. Depending on where they are, the subsequent conversation will take different directions.

Why not try it on yourself with the change you would like to make?

Try asking your client how confident they feel to attempt a recommended change on a scale of 1 -10. Then ask how them how motivated they feel to make the change on a scale of 1 -10. This ruler can be used to encourage clients to talk about how they have changed, what they need to do to change further, and how they feel about changing. 

The following are some examples of clients at different scales on the change ruler.

HCA talking about dieting

HCA: On a scale of one to ten, where one is definitely not ready to change and ten is definitely ready to change, what number best reflects how ready you are right now to diet and exercise more?
Client: Seven
HCA: And where were you six months ago?
Client: Three
HCA: So it sounds like you went from not being ready to change to thinking about changing. How did you go from a 'three' six months ago to a 'seven' now?
Client: I enrolled in a group slimming programme and this has helped to motivate me.
HCA: What would it take for you to move to an eight on the scale?
Client: Maybe I could get a friend to come with me, that would really help me to go every week and I'd have someone to chat to during the week.

Health visitor talking about healthier eating

HV: On a scale of one to ten, where one is definitely not ready to change and ten is definitely ready to change, what number best reflects where you are about adding more fruit and vegetables to your family's diet?
Client: Two
HV: Why do you think you are at a 'two'?
Client: I always start with good intentions and buy fruit and veg, but it takes so long to prepare and then the kids just leave it - so it's a waste of money.
HV: Well, unless you can afford a cook, can you think of ways that means they are quick and easy to get ready?
Client: I could prepare meals at the weekend and then freeze them and I could mix the vegetables into mash potato or mice.
HV: What great suggestions! Shall I come and visit you in two weeks?

Scool nurse talking about sexual health

SN: You use condoms sometimes but not all the time. On a scale of 0 to 10, how likely would you be to change and use condoms every time you have sex, 0 being never and 10 being yes always.
Client: Three
SN: So what does three mean to you?
Client: Making sure that I have condoms and talking about using them before we have sex.
SN: Why don't you talk about using them?
Client: It can be embarrasing to talk about using them.
Client: Well, I could say that it is about looking after ourselves and staying safe.