How do I know if my patient is ready to change the way they take care of their diabetes?

These resources will help you start the conversation.

Health behaviors such as physical activity and exercise, healthy diet and nutrition, and adherence to prescribed medical treatments can be difficult for anyone to initiate and maintain. As such, health behavior change interventions are most successful when they are person-centered, meeting patients wherever they’re at in the change process.

The Patient Activation Measure (PAM)

The Patient Activation Measure (PAM) has been used to identify patient readiness of change in Ohio clinics. Providers can use these diabetes-specific questions to identify stages of change in their patient:

  • I do not intend to make changes to my diabetes self-care.
  • I am intending to make changes in my diabetes self-care in the next six months.
  • I am intending to make changes in my diabetes self-care in the next month.
  • I have made changes in my diabetes self-care in the last six months.
  • My diabetes has been in good control for more than six months.

 Stages of Change Model

 The Stages of Change Model is another useful tool for understanding someone’s readiness for change. Within this model, there are five primary stages of change. Keep in mind that the change process is not always linear, and return to earlier stages is not uncommon. The stages are:

  • Precontemplation: The patient is not considering behavior change. They may be unaware, or in denial, or resignation. They may believe change is not important (I won’t) or not possible (I can’t). Supports include building a trusting relationship, active listening without judgment, and identifying the patient’s core personal values (what matters).
  • Contemplation: The patient is thinking about change but not ready to commit. They may be experiencing ambivalence, indecisiveness, or “stuckness” without compelling motivation to overcome barriers (I might). Supports include exploring pros and cons, clarifying whether change aligns with values, and identifying barriers.
  • Preparation: The patient is planning for change in the near future. They may be experimenting with small steps that lead to the desired change (I will). Supports include identifying personal assets and strengths, identifying support systems, and developing a plan to reward progress.
  • Action: The patient is engaging in behavior change and actively taking steps toward goals (I am). Supports include setting SMART goals linked to values, monitoring and rewarding progress, and updating the plan as needed.
  • Maintenance: The patient is persisting in behavior and sustaining gains for more than six months (I still am). Supports include building patterns of action linked to personal values, normalizing and planning for setbacks, and encouraging lifelong practice.

The Stages of Change model is also available as a handy worksheet that you can print out on an office printer and place in staff common areas or patient rooms.

Download diabetes Stages of Change worksheet >

Tips for Success 

  • Assess patient readiness to change.
  • Match interventions and your approach to readiness level.
  • Understand that change readiness and motivation fluctuate over time for all of us.
  • If you or your patient get stuck, reassess readiness and tailor interventions accordingly.