I’m sure there isn’t a single patient with diabetes who hasn’t struggled with motivation in one or all areas of lifestyle change at some point. Even the most engaged patients are likely to watch their motivation or follow-through wane periodically. I have a six-prong approach to help my patients get in the groove (or back into the groove). Maybe some version of this will work with your patients as well.
I ask the following six questions.
- What is one change (in your diet, exercise, other lifestyle arena) that you would make if change were easy?”
Acknowledging that changing behavior is hard affirms your patient and offers respect. I might even say something along the lines of, “Yes, that’s definitely hard to do. If it were easy, everyone would do it.” A second benefit to this question is that you’ll learn about a specific behavior change that’s important to your patient.
- “What will your life and your health be like in a year and in five years if you follow through on your desired changes?”
It’s helpful for the patient to be both clear and visual when answering this question. I like to help them explore what their future health, behaviors, attitudes, physical comfort, etc., will be like when they become more engaged and consistent with their diabetes management. For example, a patient who responds that he’ll be able to take his grandkids to the playground and will stop feeling so exhausted at the end of the day is more likely to commit to changes than a patient who merely expects to be healthier.
- “What will it be like if you choose not to make this change?”
This helps patients to see both sides of the change equation.
- “If you did decide to make this change, what specifically will be hard about it?”
With this question, you are again affirming that the decision to change is entirely within your patient’s control and that you don’t expect it to be easy.
- “Would you like to brainstorm strategies to make this goal doable?”
By asking to brainstorm instead of simply offering suggestions, you’re allowing the patient to stay in control. And working together usually generates more potential solutions to obstacles.
- “Would you like to experiment with one of these strategies (that we just brainstormed)?”
Here’s another example of clearly keeping your patient in control. If my patients declare a readiness to change, we’ll work on writing a clear goal and discuss ways to get started. But if they respond that they do not want to change, I may simply invite them to reach out to me when they are ready. Depending on the situation, I may ask them to tell me what they are ready to change, because if they aren’t ready to change eating habits, for example, they may be willing to take a 10-minute walk after lunch now and then. Because success breeds success, any positive change in behavior may be the stepping stone to bigger, more meaningful changes.
It can be so frustrating when patients aren’t open to our advice. But I find that giving them more control helps us both. I’m free of the need to convince them to change, and they are more invested in change that comes from their own desires instead of coercion.