PATIENT EDUCATION WITH REFERENCE TO THE PROCESS OF BEHAVIORAL-CHANGE

From a traditional aspect, behavioral change is conceptualized as a shift from one stable state to another, from stable unhealthy behavior to stable healthier behavior. This approach will influence the type of intervention program to be adopted as well as the type of assessment instrument applied. A concept supported by the results of studies involving a large number of subjects, which enable the natural process of behavioral change to be observed, suggests that behavioral change is a non-stable condition with distinct stages called precontemplation, contemplation, action, and maintenance. There may be relapse at any stage and this should be interpreted as a natural part of the change process. Health educators are confronted with different tasks at each level, and by addressing these tasks and tailoring the intervention programs to suit the stage of the individual subject, better support during the process of change can be given. A project involving cooperations between university institutes and the pharmaceutical industry has developed and evaluated education programs which address different stages of change in a primary care setting. Action-oriented programs for the prevention of coronary disease, sleep disturbance, and chronic pain have proven to be effective. Target behaviors are smoking, stress management, nutrition, and physical exercising. These programs have recently been complimented by others addressing precontemplation and contemplation stage subjects. Further research will have to be carried out in order to find assessment instruments designed to assign the right program to the right person.