As nutrition educators, is it our role to force people to change? I encourage you to think back to a recent time when someone asked you to change. Perhaps a friend recommended a new diet trend, or your doctor recommended that you increase your exercise levels. Did you listen? Did you resist? Why or why not? My hunch is that the way in which the recommendation was framed (e.g., judgmentally, coercively), along with your existing motivation level, played a strong role in your willingness to change. If the topic was something you were previously concerned about, perhaps you would be more likely to accept the advice than if the issue was one that you never felt was a problem for you! This is why it’s critical to consider a person or community’s level of readiness before tailoring health information.
Indeed, years of research indicate that simply providing information or guidance is not enough (what smoker doesn’t know that cigarettes cause cancer?). In order for change to occur, the motivation has to come from within the individual, rather than an outside source. Some health professionals have compared this dynamic to one of those novelty finger trap toys. The more you pull (or force change), the tighter the resistance gets, yet the more you let go, the more the resistance eases. Encouraging people to change involves the same concept—rather than prodding people and communities to change, we must allow them the space and support to come to their own conclusions (while also providing support and tools for change as appropriate). This doesn’t mean we just sit back and accept that people don’t want to change, but that we meet them where they are currently, using evidenced-based skills that encourage change.
One of the most effective methods for encouraging change at the one-on-one level is health coaching. Palmer and colleagues (2003) define health coaching as:
“the practice of health education and health promotion within a coaching context, to enhance the wellbeing of individuals and to facilitate the achievement of their health-related goals.” (p. 92)
What I believe sets health coaching apart from more traditional methods of providing guidance or education is that health coaching encourages the individual to explore and eventually resolve their own ambivalence to change. Ambivalence refers to uncertainty, or opposing beliefs, about whether to change a behavior. A health coach explores both the positives and negatives of change with the client, using the specific skills listed below. Let’s review a few key health coaching techniques that can help you work successfully with a range of clients to resolve ambivalence:
Expressing Empathy: Empathy means being able to put yourself in other people’s shoes. It doesn’t mean you necessarily have to agree with all their choices, just that you can understand their perspective.
Open-ended Questions: These are questions that don’t allow a simple “yes” or “no” answer. By asking open-ended questions (e.g., Who, What, Where, When, How) you can gather as much information as possible and allow the other person space to explore all sides of their situation.
Reflections: Reflections involve restating what you are hearing the other person say. This allows the client to hear back their statements, and also shows you are truly trying to understand their situation.
Rolling with Resistance: This one sometimes seems the most counterintuitive! Instead of countering a person’s resistant statement (e.g. “But you really should change your diet—you are prediabetic!”), rolling with resistance is essentially meeting the person where they are, so that your relationship becomes stronger and the client is less likely to continue being resistant in the future (“From what I hear you saying, you are just not sure whether changing your diet is feasible right now. Can you tell me more about that?”).
Collaboration: All goals and plans should be based on the clients’ or community’s stated goals rather than the coach’s recommendations.
These are just a few examples of a number of skills you can use to promote positive change in the communities where you work. Health coaching is an evidenced-based technique that can inform your work in a number of settings, and with a range of health issues and diverse client demographics. I hope you find these skills helpful as you continue your work in Nutrition Education.
Palmer, S., Tubbs, I., & Whybrow, A. (2003). Health coaching to facilitate the promotion of healthy behaviour and achievement of health-related goals. International Journal of Health Promotion and Education, 41(3), 91-93.
About Elizabeth Cotter
Dr. Cotter is a professorial lecturer in the Department of Health Studies at American University. She is a licensed psychologist with clinical and research interests broadly related to the prevention of eating and weight-related concerns. She is particularly interested in the evaluation of culturally-tailored health promotion interventions, especially in underserved communities. Her current work focuses on community-based obesity prevention research in affordable housing communities. She is involved with the Vive Sana program, a community gardening and nutrition education program taking place in Arlington, VA and targeting low-income, food insecure households. Dr. Cotter earned her PhD in Counseling Psychology from the University of Wisconsin.
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