Open communication is key. It helps uncover hidden motivations and beliefs that can ruin mutual treatment goals.

Self-efficacy: Is the change doable?

Self-efficacy is the belief that one can succeed in adopting a new behavior. This is a predictor of whether a person is likely to maintain it. A patient, for instance, may not feel they can lose weight. For this patient, your communication would be aimed at raising their self-efficacy so they feel they can succeed. For instance, you could ask them what’s worked for losing weight in the past. With more self-efficacy, a patient is more likely to try, and be able to sustain, a new health behavior over time. Let the person know that they are the experts in their own lives. Show respect and empathy. Above all, don't argue with them.

Health beliefs: Does the change matter?

The health belief model focuses on a “perceived threat” that a patient thinks will happen if they continue an unhealthy behavior. Does your patient believe that a sedentary lifestyle can make their diabetes worse? If not, your communication with this patient would focus on explaining how exercise can lower blood sugar levels. This can help them come to believe that daily lifestyle choices really do impact health.

Stages of change: Is the patient ready?

Good communication is based on knowing where your patient is on the spectrum toward starting a new health behavior, so you can tailor your dialog accordingly:

• Precontemplation. At this stage, a patient has no intention of making a change, such as taking medicine to control hypertension or stopping smoking.

• Contemplation. A patient intends to take the action or make the behavior change in the next 6 months.

• Preparation. A patient intends to make the change in the next 30 days and has already taken some steps toward change.

• Action. A patient has just started the change or has been making it for less than 6 months.

• Maintenance. A patient has stayed with a change for 6 months or longer.