The First Rule for Successful Lifestyle Conversations is to Start With Readiness
- Debra Klein
- 2 days ago
- 3 min read
Most lifestyle conversations fail—not because patients don’t care—but because we start too far ahead of where they are.
The fastest way to assess readiness?
Just ASK!
“On a scale from 1 to 10, how ready are you to make a change in your lifestyle to benefit your health? This is called a Readiness Scale.
Readiness Scale
If the answer is 1-2…
They are Not Ready!
A simple response is:
“That’s helpful to know. What would it take for that 1 or 2 to move to a 3 or 4 just to be thinking about change. Would you be open to talking about this more at a later visit?”
This is hard. It goes against your instincts to try to persuade or convince them because you see the need.
Resisting the urge to persuade is critical—pushing at this stage often increases resistance.
This is also when motivational interviewing can be inserted if the patient is interested in talking about the pros and cons of change. (We will write another Substack about this). This is also where asking permission to share expert advice or education fits in.
The Readiness Scale helps you know what stage of change readiness they are in. It is derived from the Transtheoretical Model for Change (TTM). Think about any change you’ve made in your life and the mental preparation you went through before you started.
The authors Nahrain Raihan and Mark Cogburn, in their article summarizing James Prochaska’s research, state that
“When using this model of change, “changers” are not coerced but rather supported and accepted at the stage at which they present. Treatment becomes personalized based on the individual and the stage at which they reside. With this method, “change behavior” is conceived as a fluid, dynamic process, with the possibility of recycling stages, rather than as a focus on the end goal of change.”.
If the answer is 3-5…
They are Thinking about change. This could go 2 ways.
Next question should be….
“Sounds like you’re thinking about it. Would you like more time, or do you feel ready to take a first step?”
If they need more “Thinking” time, this is when you can ask to share your knowledge and answer any questions.
IF they are ready, next question could be…
“What’s one small easy step that feels doable this week?”
If they give you an idea, you have opened the door to Planning.
You can move forward with co-creating a SMART goal to help spur ideas for support, timing, and right sizing the goal to be manageable.
If the answer is 6-7…
They are already in the Planning Phase. This means they have been thinking about a change and pondered how they are going to make it happen.
“What do you think you could realistically commit to starting next week?
This starts the process of co-creating a SMART goal to help spur ideas for support, timing, and right sizing the goal to be manageable.
If the answer is 8 or higher…
They are Ready! and in the Action or Starting Phase.
“What’s the first step you want to start with this week?”
Move forward with co-creating a SMART goal.
Final Thought
Instead of pushing change—match your patient’s readiness.
Even a brief conversation moves patients forward.
Why this Matters
Instead of fighting resistance, flow with readiness. It saves time and frustration.
Self-determined change improves adherence.
This very short step in the conversation is a win-win. You can feel good about deepening the therapeutic relationship.
You have empowered the patient to be an active participant in their healthcare.
Where are you on the Readiness Scale?
If you have read this far, YOU are likely somewhere between Planning and Action in starting Lifestyle conversations with your patients.
We would love to hear about your stage of change with regards to having these conversations with patients! What could you share with our readers about what has been successful with you or your patient’s experiences.
Please share this with someone who you think would benefit. (It is Free!)
See you upstream!
Dee and Deb
References:
Raihan N, Cogburn M. Stages of Change Theory. [Updated 2023 Mar 6]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK556005/
Norcross JC, Krebs PM, Prochaska JO. Stages of change. J Clin Psychol. 2011 Feb;67(2):143-54. doi: 10.1002/jclp.20758. PMID: 21157930.
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