Nutritional Counseling
Professor Salma Halai Badruddin
Honorary Life President
Pakistan Nutrition and Dietetic Society
June 2009
What is Counseling?
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Communication aimed at fostering
an individuals Desire to Change
Principle: to empower the
individuals to take responsibility for
their own decisions and actions by
increasing their self esteem and self
efficacy
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Nutritional Counseling
The theoretical basis for the nutrition
education process consists of
Cognitive-Behavioral Therapy (CBT)
This includes
 Motivational Interviewing
 The Health Belief Model
 Trans-theoretical Model or Stages of
Change Model
 Social Learning Theory
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Cognitive Behavioral Therapy

Cognitive behavioral therapy
(CBT) is an umbrella term for
therapies that share a
theoretical basis in behavioristic
learning theory and cognitive
psychology, and that use
methods of change derived from
these theories
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Motivational Interviewing
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Skillful interviewing techniques can
increase the nutritionist’s/dietitian’s
understanding of what influences a
person’s behavior
Enables the nutritionist’s to include
explicit strategies for behavioral
intervention.
That it results in better patient
compliance, or acceptance of advice.
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Motivational Interviewing*
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The process of motivational interviewing consists
of three district phases.
Eliciting phase -open questions, reflection,
summarizing, restructuring provoking
Information phase - help the patient gather and
assimilate relevant information and look at its
implications for change
Negotiating phase -what if any thing does the
patient want to change? Define goal, means for
achieving it and where to begin
Accept patients decision for ‘no change’ but leave
door open
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The Health Belief Model*
The original Health Belief Model was based on four
constructs of the core beliefs of individuals based on
their perceptions:
1.Perceived susceptibility: an individual's assessment
of their risk of getting the condition
2.Perceived severity: an individual's assessment of
the seriousness of the condition, and its potential
consequences
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The Health Belief Model*
3. Perceived barriers: an individual's
assessment of the influences that facilitate or
discourage adoption of the promoted behavior)
4. Perceived benefits: an individual's
assessment of the positive consequences of
adopting the behavior.
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The Health Belief Model*
Mediating Factors
•Demographic variables (age, gender, ethnicity,
occupation)
•Socio-psychological variables ( social economic
status, personality, coping strategies)
Perceived efficacy (self-assessment of ability to
successfully adopt the desired behavior)
•Cues to action (information, reminders by powerful
others, persuasive communications, and personal
experiences, environmental cues)
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The Health Belief Model*
Mediating Factors
•Health motivation (is individual driven to stick to
a given health goal)
Perceived control (a measure of level of selfefficacy)
•Perceived threat (whether the danger imposed by
not undertaking a certain health action
recommended is great)
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The Intervention Process Using the
Health Belief Model*
Stepped change
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The Trans theoretical Model
The objective is to empower
individuals to take responsibility
for their own decisions and
actions by increasing their selfesteem and self-efficacy. The
locus of control lies with the
individual.
 The practitioner respects the
patient’s views and concerns.
Targets are negotiated and
jointly agreed

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The Trans theoretical Model
An approach to behavioral counseling
especially aimed at fostering the
individual’s desire to change.
 The central organizing construct of the
model is the Stages of Change.
 When people deliberately make changes
in their behavior, they go through a
natural series of stages of change
 Each stage has a different frame of mind
about the behavior concerned and each
prompts a different kind of motivation.

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Stages of Change Model*
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Social Learning Theory
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Social learning theory suggests that
people learn new behavior through
reinforcement or punishment or via
observational learning.
People learn through observing others'
behavior. If people observe desired
outcomes in the observed behavior, they
are more likely to model, imitate, and
adopt the behavior themselves.
It also suggests that the environment can
have an effect on the way people behave.
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Principles of Behavior Modification
The goal is to
 Help patients move towards a positive decision
to change
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Provide them the means to make changes
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Support them to sustain that change
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Ensure that change is consolidated in their
everyday life style
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Principles of Behavior Change*
Set a positive, specific and achievable goal.
Frame goal in terms of exact behavior.
It is easier to replace a behavior with a new one than
to stop doing it.
Break major goals into smaller less daunting parts.
Try only a few changes at a time
Establish a system for monitoring the behavior to
be changed
Helps to assess success in changing behavior
Assists in determining what contributes to and
detracts from mastery
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Principles of Behavior Change*
Modify the environment so that it supports the change
Eliminate negative cues
Provide positive cues
Set up a plan for rewarding successes
Rewards should be those that will be appreciated
Appropriate to the magnitude of the achievement
Reward should be as immediate as possible
Award points towards long-range rewards to make more
immediate
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Principles of Behavior Modification*
Recruit support from family and friends.
People may want to be helpful but may not know how
Tell them of your objectives and how they can help
Allow enough time for new behavior to become a
habit
Be prepared for back sliding and plan for dealing with it.
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Self –Efficacy*
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The belief in one’s abilities or self-efficacy is influential in
determining whether individuals will change their health
behavior.
Successes increase a person’s sense of mastery of a
particular behavior which raises their feelings of self-efficacy,
and gives confidence to continue.
Setting achievable goals for change and ensuring each is
mastered before moving to the next goal increases insures
success
Personal and social change relies extensively on methods of
empowering individuals with the requisite knowledge, skills
and belief in their self-efficacy so as to enable people to alter
aspects of their lives over which they have some control
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Conclusion
Successful nutrition counseling
requires that the counselors are not
only well versed with nutrition
concepts but also that they are
skillful in applying the basic
techniques of Cognitive Behavior
Therapy and Behavior Modification
during the counseling process
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