Background on Supportive Relationships
What are supportive relationship strategies?
- Supportive relationship interventions are programs or activities designed to increase social support to increase consumption of nutritious foods through involvement with individuals, organizations and communities.
- These interventions may focus on increasing the information individuals have about nutrition [informational support], provide a venue for sharing experiences and feelings [emotional and appraisal support], or provide tangible support (e.g., altering recipes). In addition, such interventions provide opportunities to identify and address challenges collectively rather than individually (e.g., collective problem solving or advocacy).
- Supportive relationships interventions may help to change eating patterns in order to prevent a disease or health condition from occurring (primary prevention) or work with those who have already developed a health condition and acting to decrease the negative effects of that condition through changing eating patterns (tertiary prevention).
How do supportive relationships impact nutrition related behaviors?
- Supportive relationships interventions are successful for many reasons, such as: individuals can ask questions or clarify what they have been told, those providing support can also provide referrals and resources to assist the individual, and longer-term relationships can help to sustain behavior change over time, among others.
How can I use supportive relationship strategies in a nutrition intervention?
- Supportive relationship intervention strategies may be designed to discuss challenges, benefits and advice for increasing consumption of nutritious foods. Supportive Relationships may be provided in the form of face-to-face interactions, telephone calls, or through interactive web-based systems. These interventions may include specific information as part of each call or face-to-face session, or may be more open-ended and responsive to the specific needs of the individual.
Why is it important to considering tailoring in supportive relationship strategies?
- Supportive relationships interventions can be very successful when the support is tailored to the individuals’ needs.
- Supportive relationships interventions may include an assessment of the individual’s health, nutritional intake and eating patterns as well as a discussion of challenges or barriers for maintaining certain types of eating patterns over time.
- Other characteristics may be important to consider in selecting the types of supportive messages or resources to be provided, including general health status, motivation, barriers, gender, age and cultural factors.
What is “readiness to change” and how does it relate to supportive relationships?
- The concept of readiness to change (drawn from the Transtheoretical Model or Stages of Change) suggests that individuals may need different kinds of interventions to help them increase their consumption of nutritious foods depending on how ready they are to change their eating patterns. For example, individuals who are not really thinking about decreasing the fat in their diet may need information on the harmful effects of high levels of fat in the diet whereas individuals who are ready to decrease the fat in their diet may need training on how to modify recipes to decrease the fat content. Supportive relationships may be particularly important when people are ready to change their eating patterns (i.e., supportive relationships can help to reinforce these decisions).
How do supportive relationship strategies deal with relapse?
- Often, people increase their consumption of nutritious foods or change their eating patterns and then relapse, or go back to previous eating patterns. Supportive relationships, therefore, include information to help individuals to recognize that this is not unusual and to work with individuals to develop strategies to help prevent relapse in the future. (See Relapse Prevention Theory)
- It can be helpful to recognize that changes in eating patterns may happen in small steps. For example, adding fruit and vegetables may be the first step, followed by reducing the fat in commonly used recipes (e.g., skim milk instead of whole milk, canola oil rather than vegetable oil), changing snacking habits (e.g., carrot sticks instead of potato chips) or decreasing portion sizes (e.g., no super-size sodas). Every individual will have preferences for what steps make be the easiest to take first, and these preferences may depend to a large extent on the support of others for these changes (e.g., family, roommate, friends, co-workers).
How have supportive relationships been used in past nutrition interventions?
- Increase health care provider support for changing eating patterns. For example, a health care provider may provide support to an individual with heart disease to decrease their fat intake and increase the amount of fruits and vegetable they eat, a dietitian can provide support to a pregnant mom to decrease the amount of fast food they eat to improve the health of their baby or a dentist can ask a patient to reduce consumption of high sugar drinks to improve the appearance and health of their teeth. Health care provider support may be offered through face-to-face interactions, letters, or telephone calls. These support efforts may be initiated by the health care provider or the client (e.g., counseling during an office visit).
- Increase school-based support for changing eating patterns. For example, peer educators can be trained to provide support through school-based activities such as athletic programs; teachers, school nurses and coaches can be trained to provide formal structured support (e.g., class sessions covering these topics) or less formal support (e.g., advice or encouragement) and family members can be encouraged to provide support through letters, newsletters or videos sent home with the students. These cues to action (see Health Belief Model) can describe or illustrate the challenges in changing eating patterns (e.g., showing peer models making decisions not to “super-size”) and instigate discussion between school representatives, family members and students about these struggles.
- Increase worksite support for changing eating patterns. For example, worksites can be considered a mini-community with interventions that provide tangible support (e.g., co-workers can encourage the selection of low fat foods in the cafeteria), informational support (e.g., cooking classes to increase nutritious food preparation) and emotional and appraisal support (e.g., buddy systems, lay health advisors or team contests). Some worksite interventions have been offered by management, while others have been developed jointly through labor and management negotiations.
- Increase support from faith-based organizations for changing eating patterns. Faith-based organizations may, for example, help people recognize that nutrition is part of the divine message through connections between the spiritual and physical being, increase consumption of nutritious foods at social gatherings, or learn about nutritious versus non-nutritious foods. Through health ministry and membership in the faith community, these organizations can also increase knowledge and skills about the health risks or benefits of certain eating patterns (e.g.. high fat, sodium and sugar versus increased fruit, vegetables, fiber; large versus small portion sizes); offer cooking classes; include health messages as part of sermons and share testimonials from congregation members. Ministers, faith community nurses (e.g., parish nurses) and members have prayed with fellow members, found resources for them, comforted them, and helped to nurture them. Faith-based organizations are an ideal setting because people look to them for social support and interaction. Faith-based organizations can incorporate nutrition as part of their mission and serve as centers of daily life, social structure and community life.
- Increase community support for changing eating patterns. For example, informational, emotional and appraisal support can be provided through telephone hot lines (e.g., program initiated calls to individuals, a call line that is made available for people to call). Individuals staffing these lines may be medical personnel (e.g., dietitians, nurses), health educators or trained lay health advisors. Other examples of community support include the use of community role models who can speak to community members about the risks of certain eating patterns and the benefits of change (i.e., Olympic champions, sports players, and local celebrities who have experienced the negative effects of poor nutrition and related health conditions).