Build readiness

Building self-confidence can be as important as sharing new information in helping people to become more active.

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A lack of confidence, insufficiently strong personal reasons or a combination of the two can sometimes hold people back from change. You can support and encourage readiness to become and stay more active by first helping to strengthen their reasons for becoming more active, and then building their confidence (self-efficacy) that they could.

You have already talked about their personal top 2-3 reasons for becoming more active. The ‘imagine…’ question helps to strengthen motivation by focusing on their perception of the long term benefits that they could gain by being more active.

You may need to prompt them with questions like: ‘and what else might you notice?’ or ‘how else might your life have become better if you were more active?’ Use empathic listening and reflection, not just questions, to show that you understand their point of view.

1
Ask

“Imagine you were able to become and stay more active, and imagine that you kept this up for 1-2 years. What do you think you would notice?”

2
Explain

Use these cycles to explain how physical activity improves common symptoms.

Positive

Negative

3
Ask

“On a scale of 0-10, how confident are you that, if you did decide to become more active, you would be able to keep up an active lifestyle for, say, 6 months?”

Where 0 is not at all confident and 10 is extremely confident?’

4
Explore

“Why not 0? Why do you think you could do it if you tried?”

These questions aim to get people talking about why they could be more active, if they tried, as this can help to increase their confidence, or self-efficacy. It also helps people to think about the concrete steps that they would need to take, which can help the change seem more achievable. Listen to and explore what they say: ‘are there any other reasons why you think you might be able to keep up an active lifestyle, if you decided this was what you wanted to do?’

5
Build Confidence

“What would help move your confidence higher up the scale?”

Your focus is on encouraging them to think through what would help them to become more confident. This helps to strengthen their ideas about what else they might need to do. These questions can sometimes prompt individuals to create a personalised behaviour change plan. Continue to explore their ideas (before you share yours). Ask ‘and what else might help you become and stay more active?’

6
Share

“Can I share with you some things some people find helpful?”

If they agree, share additional tips, such as:
‘Some people find that keeping track of their activity levels with a step counter very helpful.’
‘Other people find having some kind of goal is helpful.’
‘Some people find being active with other people is helpful. ‘
Others keep to a schedule or start a diary to monitor how they do’

7
Ask

“What do you make of these ideas?”

This is shared decision making – you are supporting the individual but not telling them what to do. You are sharing new information if they want it.

Using this approach prevents the ‘yes…but…’ trap which can happen if you jump in with well-intentioned but unasked for advice such as ‘could you do this…?’ or ‘why don’t you try this…?’

Aim to keep the focus on the individual generating their own ideas about change, rather than telling and instructing. People are much more likely to make successful changes if they develop their own plans.

The next step is to summarise the discussion so far and help them to come to a decision.

Did you know?

"Exercise can prevent flare ups if I keep it up as a routine."

ARUK Listening Panel 2017

"Why haven’t I received [physical activity on prescription] before? I have been in pain for many years."

Joelsson M, Bernhardsson S, Larsson MEH. Patients with chronic pain may need extra support when prescribed physical activity in primary care: a qualitative study. Scand J Prim Health Care2017;35:64–74. doi:10.1080/02813432.2017.1288815

"When I was first diagnosed I was told I should take it easy and avoid putting pressure on it."

ARUK Listening Panel 2017

"If [my doctor] told me what to do and how to do it, I’d be at the gym right now."

Stone RC, Baker J. Painful Choices: A Qualitative Exploration of Facilitators and Barriers to Active Lifestyles among Adults with Osteoarthritis. J Appl Gerontol2017;36:1091–116. doi:10.1177/0733464815602114