Figure 1: Four step guide to doing brief interventions
L Moloney 1999
There are many opportunities for doing brief interventions in various community settings. The four step guide described on the following pages offers examples of dialogue which you may have with a person during a consultation.
These steps outline an interaction between a person presenting for a consultation and a service provider. People can move between stages of precontemplation, contemplation, action and maintenance. A person you see often may be at different stages of decision making on different occasions. A person can stay in one stage, for example contemplation, for a long time, then move on to taking action to change. What you do after the first brief intervention will depend on the information that has already been shared.
Figure 1: Four step guide to doing brief interventions
L Moloney 1999
(click here to view PDF version)
| Goal: | to assess the person's need for intervention | |
| What to do: | assessing every individual's need for intervention is a routine part of
the day-to-day work practice of service providers. You may ask general questions which
help you to know more about the person - about what he or she has been doing lately, how
things are going at his/her place, about the family. Taking a health history includes questions about: alcohol: When was the last time you drank alcohol? How much did you drink then? Is this how much you usually drink? smoking: How long have you been smoking for? How much do you usually smoke in one day? |
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| Goal: | to find out if the health issue of concern that you have identified, is also a concern for that person to find out where the person is, in thinking about change | ||||||||||||||||||||||
| What to do: | 1 - After identifying that the person may need
intervention, discuss the issue of concern. Example questions: - Do you know that smoking can make your lung disease worse? - If you want to, we could talk about ways to help you cut down or quit. - Have you thought about not drinking alcohol while you're pregnant? - How do you think your sugar sickness is going? - Did you know that what you eat affects the sugar in your blood. Would you like some information about that? - Last time you came in you planned to wash the blankets, to see if that also helped with the skin problems. - How did you go with that? - Did other family members wash their blankets too? Because people access primary health care services many times, you may see the same person in any one of these stages, and will need to assess where he/she is, at each consultation.
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| 2 - Determine the person's stage in his or her decision
to change. The person's response will help to determine the person's stage of change. - Use the following table as a guide. |
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How to determine the person's stage in his or her
decision to change |
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| Person is not thinking about change (pre contemplation) | Person is thinking about changing (contemplation) | Person is ready to do something, and is making a change (preparing for and taking action) | Person is keeping going once the decision has been made (maintenance) |
| 1s not concerned about issue | has some concern | has expressed concern | has made change |
| may not want information | may want more information | usually happy to have more information | wants to maintain change |
| may not say anything at all may talk about something else, or look uncomfortable. | looks interested or asks questions | happy to talk about choices and support | usually happy to talk about how much better things are |
| may be thinking about need to change | wants to make a change now or very soon | may want to think about ways to maintain change through difficult times | |
| not ready to change yet | may want to plan how to make the change | ||
| Person is thinking: "No, it's ok." | Person is thinking: "Do I want to do something?" | Person is thinking: "Yes, I do want to make a change. What can I do, when and how. What else can I be doing? What else needs to happen?" | Person is thinking: "Yes, I made the change. How can I keep it going?" |
| Goal: | to match intervention to the person's stage of change at that time People can move between stages of precontemplation, contemplation, action and maintenance, or they can lapse into their previous stage. It is important to match your intervention to where the person is at the time you are with them. A person you see often may be at different stages on different occasions. Mismatched interventions may lead to frustration and disappointment for both the client and the health professional, who may feel he or she has 'failed'. Follow up and future intervention will be determined by what has gone before. |
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| What to do: | Precontemplation This person is not thinking about changing. Consider using strategies which raise awareness of the health issue by providing information if the person wants it. Strategies may include talking about it, referring to posters, playing videos, perhaps giving a pamphlet. However, do not push it. Contemplation This person is thinking about changing. Consider using strategies which may move a person towards a decision to change. Explore the issue. Ask him or her about the good, and not so good things about the issue, including how it affects family members. Explore the person's concerns with them. Ask what things he or she may find difficult about changing. Give relevant information. Suggest how change could make things better. Action This person is deciding to do something, and is making changes. Consider using strategies which reinforce the person's decision about changing. Ask how he or she will make the change. Talk about choices and support available. Encourage the person to identify someone to talk to about it. Give information and any support you can. Maintenance This person is keeping going with the change. Consider using strategies which reinforce the changes made. Ask how he or she is going. Give praise about how well he or she doing. Highlight the benefits of the change he or she has made, talk about how much better things are, or how much better the person will feel soon. Offer any support you can to help the person get through difficult times. |
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Goal: to carry out intervention which matches the person's stage of change at that time What to do: Carry out the required intervention. Record the intervention on the patient file as a reference for future interventions
