Trans-theoretical Moldel of Behavior Change: Presentation

Human behavior is at the center of global health challenges today.  Whether trying to decrease smoking, increase active lifestyles, or advocating more balanced diets, changing a few key behaviors holds more potential to improve overall human health and wellness than just about any treatment-based solution.  Consequently, it occupies a key place in public health - the core preoccupation fueling the growth of the entire sub-field of health education.

It's also key to what we do here at Vitality, where we examine the barriers that disable healthier behaviors and focus intensively on community and social solutions that transcend those barriers.

Behavior change campaigns - or in the case of youth, often negative behavior prevention campaigns - also happen to be at the center of my work with Peace Corps Moldova's Health Education Program.  Everything our program does, from classes to community initiatives, is essentially part of a broader strategy tackling the slow and difficult process of helping people to take control of their own health for the better.

Needless to say, I've spent a lot of time thinking about behavior change these past couple years, and hope to have some thoughts on the broader process of behavior change in a future post.  In the meantime, last month it was my pleasure to lead a 5 day In-Service Training on community-based behavior change campaigns for 33 Health Education Peace Corps Volunteers, Moldovan nurses, and community partners (social assistants and teachers).

Below is the presentation I gave on behavior change theory, primarily focused on the Trans-Theoretical/Stages of Change Model.  Contact me if you'd like to use; on the off-chance somebody is interested, slides are also available in Romanian.

Zachariah is currently serving as a Health Education Specialist with the U.S. Peace Corps in Moldova. This entry is cross posted at his personal blog, “Embarkations.”

Marathon Motivation

Motivation and inspiration have proven to be two important components in my journey to training for a marathon. Journey has become the best word to describe my marathon training because it has been full of ups and downs, twists and turns and has given me insight into myself that I did not realize before. I have needed both inspiration and motivation to get me through each step on the journey, but sometimes they are the hardest things to find.

Inspiration and motivation can come from many different places. It can come from work, movies, music but for me it has come from those closest to me. Ever since I was much younger I have watched different members of my family run marathons. For many years, I watched my cousins and uncle run The Pikes Peak Marathon and the St. George Marathon. I would hear stories about all of the other races they had run across the country and how accomplished and amazing they felt after finishing each race. I was inspired by their strength and determination to cross the finish line of such a long and demanding race. I made a promise to myself that one day I too would run a marathon. I never imagined myself winning a marathon or even coming close to winning. What I envisioned is crossing the finish line after running the entire 26.2 miles and feeling that sense of pride in myself, that pride that I had seen in the faces of my cousins and uncle when I was younger.

When I was in high school I started running. I had always been very active playing sports and dancing, so running long distances was not a difficult thing to attempt. During the season of my senior year in high school I fractured my Tibia. I started noticing a lot of pain in my lower leg. Doctors told me that I had shin splints from all of my dancing, running and playing sports, but I would be fine as long as I did not push it too hard and rested it for a week. After a week of rest, I started back to all of my activities but was still in pain. It took many doctors visits, X-Rays, and MRIs to find the problem: a fractured tibia. It had started out as a small stress fracture that continued to get worse the more active I was. I had to be on crutches for three months during the winter of my senior year and in an air cast for another month after until it was finally healed. Unable to compete in any of my sports my senior year in high school and missed out on all of my dance and Pom competitions devastated me.

Vitality Awards

Board of Directors Treasurer Bill Gugerty presenting Anjali Arnold one of two first ever Vitality Awards

Rusty Stout receiving the second of the first ever Vitality Awards from Bill Gugerty

Anjali and Rusty embrace while receiving their Vitality Awards as Vitality Ambassador Uschi Kessler and Adaptive Skating Coach Yvonne Dowlen applaud

The Vitality In Action Foundation’s first event, The Vitality Skating Fair at Apex Center on July 30 in Arvada, CO, was full of surprises and even tears of joy. The Fair, which was a demonstration of the techniques used in the adaptive ice skating program proved to be an extremely moving and emotional event for the audience and for everyone involved from Vitality In Action. The most surprising moment of the ice show for Rusty Stout and Anjali Arnold came at the end of the event. After putting together a truly inspirational and fun event and ice show, they were each presented with the first ever honorary Vitality Awards in the history of the Foundation.

Rusty Stout, the Founder and President of the Vitality In Action Foundation, received a plaque recognizing his “immense efforts and contributions without whom the ideas embodied by the organization would be mere hopes of individuals rather than the action of an organization.” Rusty was completely shocked and surprised by the award. He described his emotions saying, “We did what most people consider impossible with too few resources, people and money, but we are very pleased with the outcome.”

The Vitality In Action Foundation and the Vitality Fair embodies a lifetime of work for Rusty, without whom the organization would not touch the lives of so many in the community. With tears in his eyes and a smile on his face, Rusty recounts receiving the award as “extremely gratifying and the most precious award he has ever been given.” Rusty is a truly amazing and inspirational person for his strength and his vision for the future of the foundation and for the community. He teaches people how to take risks, so even if they fall down they are able to get back up again and continue living a vital life. Rusty is living proof that anything is possible and truly embodies the words printed on his honorary plaque.

Anjali Arnold, the Managing Director of the Adaptive Skating Programs, was also honored by the Board of Directors, which unanimously voted to name the Vitality Skating Program the Anjali Ability Academy. She was also recognized with a plaque commemorating her “immense efforts and contributions without whom the concepts of Vitality would remain mere ideas.” Anjali describes this moment as “a truly surreal experience because she was in complete shock.” The first thoughts that came to her mind upon hearing the news at the Vitality Fair were, “How ridiculous,” “how wonderful,” “but what are they thinking?”

After a having few days to regain her thoughts, Anjali was able to comment on her true feelings about the awards. “As it so happens,” she describes, “Anjali, in Sanskrit, means ‘offering’ and also means ‘receiving’. So by definition, my name represents the universal process of giving and taking, the continuous spontaneous natural flow that stems from the quintessential force of affinity that causes all effects in the universe. This is the way I teach, simultaneously, the way I learn. My name is who I am. My soul, for the first time in this incarnation, feels validated in ways that words cannot express.” Anjali helps people to recognize the everyday “miracles” that each person possesses within themselves. She has touched and changed so many lives by her amazing gifts and incredible heart. There is no one more deserving of these two awards than Anjali.

Needless to say, there was not a dry eye in the room after the Vitality Fair. Even now, looking back, Rusty and Anjali continue to re-live the powerful emotions they experienced that day from the Vitality Fair and from receiving their awards. There are no two people more deserving of the first Vitality Awards than Rusty Stout and Anjali Arnold. With them at the reigns, we look forward to many great things for our community and a very high bar for future Vitality Award honorees.

Reflections on Joining Vitality

Very few times in our lives are we truly inspired to do something greater, not only for ourselves but for others. I feel like this is the first time in my life that this has happened. I have been greatly affected and inspired by the Vitality In Action Foundation and the amazing people that work for the foundation. I know that I will forever be touched and changed by this organization.

It all began when I was working at a restaurant in Arvada. Working as a server at a restaurant, you meet all kinds of people on a daily basis. Sometimes, people come in to simply enjoy a great meal with family and friends, while others come and try to strike up a personal conversation. Anjali Arnold, the Managing Director of the Adaptive Ice Skating Program for Vitality In Action, came into the restaurant one night and changed my life.

Thank You Remarks by Rusty at the Vitality Fair

We've been stunned at the incredible reception we received last Saturday at the first ever Vitality Fair.  We drew a crowd of over 150 and international skating talent, all in support of our Adaptive Ice Program.  After the program, Founder and President James (Rusty) Stout took to the mic to thank the community that came together in mutual support.  As our first large public event, it was a moment for both celebration and reflection.  As such, we thought it fitting to post Rusty's remarks from the evening.

Good evening Vital People! Thank you for joining the Party. We do hope you've had some fun. Mom always taught the two keys to community are Please and Thank you. So first, three Pleases:

PLEASE join Apex Park and Recreation District and the Vitality Community for Cheap Skate after the show. We'll have a good time and get to know each other a bit better. As you leave this evening, PLEASE take care so that you can PLEASE keep coming back to have some fun recreating – however you choose to participate!

And now it's time for the Thank You's – there are a lot more than three of those so please bear with me – it's an emotional time and I am a passionate guy.

Everyone here is participating in the launch of the world's first adaptive skating program aimed at mainstreaming elite ice skating. That's a really high bar for human achievement and we're doing it right now, right here, the right way – EVERYONE IS WELCOME and EVERYONE here has given their time, money, and talent to build this community, the necessary FIRST STEP on this particular journey. Everyone -- audience, cast, crew, mothers, fathers, sons, daughters, all of us make up the Vitality Community. Folks, WE ARE VITALITY – THANK YOU! And Thank you Apex Park and Recreation District. You have graciously accepted Us into the Apex Community and given Vitality a home.

Mobility Gratitude

By Jessica Gingold

Tonight, after too many vinyasas to count, a wobbly, but convincing headstand, low lunges, high lunges, half splits, full splits and the happiest baby pose you could imagine, I was instructed to thank myself. I was told to have gratitude for my healthy body that allows me to do all the physical activities I want. In that moment, I was grateful. I was grateful for the practice I had just had. I felt a deep strength in the prior 90 minutes I rarely encounter in the day-to-day. Still, underneath that gratitude, I felt a sadness. The truth is, my body is limited. I can do yoga, but frog pose hurts. I can walk briskly, but it’s been ages since I went on a run.

From age eight to eighteen, I spent more time gliding on ice than walking. I never fully fit into the competitive figure skating world. My first skating outfits were bought at a dance store from the sale bucket. I had a skating dad, thus I did my own French braids and they were often a little lopsided. One of my early programs was to Stairway to Heaven by Led Zeppelin; even when I would skate a clean program, the judges never really warmed up to it. I did not cut back on school to pursue my dream of going to the Olympics. Still, I was a figure skater.

Skating was my outlet and my balance. I was a straight A student with a social justice activist family. Most minutes of life were full of intense, complex ideas. When I was on the ice, it was just me. I loved the challenge. I was never the best skater, but I was solid. I landed my double axel early, and successfully earned my gold medal in Moves in the Field and Freestyle. When I was 16, I had to write about my spirituality for my progressive Unitarian church group. God is still something I am growing to understand, so at age 16, God was not the subject. Instead, I wrote about the transcendent feeling of landing a clean double axel. So while I was perhaps a non-traditional skater, it was deep in my soul.

When I got to Colorado College, the first order of business was setting up the Colorado College Figure Skating Club. Our club went on to host two regional competitions and several shows. However, I never got to compete freestyle at our competitions.

Small Successes: the Mahala Boys

Mahala is a word deceptively simple given the complex construct it houses. In fact, it is probably this complexity that makes the word so thoroughly Moldovan. In Moldoveneşti, mahala means neighborhood. It is descended from the Turkish (and in turn Arabic) word mahalle, a term introduced throughout the Balkans during the period of Ottoman rule. In literary (i.e. Romanian) Romanian, however, mahala has come to mean more of a slum. Before even arriving at the complexities of the actual Moldovan mahala then, the word itself is a signpost showing the historical fork between Romania and Moldova. It is a very Eastern European dark irony that the word for neighborhood in Europe’s poorest country means “slum” in the same language spoken by its richer neighbor to the west. If Romanians often point out politely that Moldovan Romanian is an archaic and rural dialect, then the word mahala captures the subtler unspoken chauvinism between these richer and poorer neighbors.

Even in Moldova, however, a mahala is so much more than a geographical boundary. It’s an agricultural system, a living map of generations of familial histories, and a complex network for the exchange of gossip and information.

Peace Corps Volunteers, on the other hand, come from outside the community – we arrive mahala-less. So often, we are reminded of the frustrations that implies when trying to work with our adult colleagues – not knowing the right person to talk to in order to cut through the red tape, not knowing a particular history that prevents two potential partners from working together. But our tabula rasa also grants us some potentially powerful freedoms, particularly with students.

Just snap them off for a bit…PLEASE!!!

By Nancy Ester-Sager

That’s my lifetime plea, but of course I know I can't just snap off my legs. If I did, I'd probably misplace them. I must have been meant to do something with them, or they wouldn't be mine.

They are mine!! They hurt. They fight me, and I would never trade them.

Up until recently, I have felt like I belong (or didn't belong) in two different worlds, the disabled world, and the normal world. Now I realize I am in the right world, it’s not like anybody else's. It’s just mine, and it's the exactly where I need to be.

I have a condition called Myotonic Muscular Dystrophy. At first glance, I don't look like I have anything wrong, but very few muscles in my body have the ability to ever fully relax. I have often become dizzy from the pain that it causes me. I can get very stiff and have difficulty getting my brain and my body to work together. I prefer to think of myself and my body as two different things, because that is exactly what they are.

Vitality Skating: Welcome to a New World

My whole life on skates has been spent trying to get used to being on blades - literally - to find my feet and to feel them through the prosthetics we call skates is still my main task after 35 years. In perfect irony, Vitality In Action has asked me to devise programs on ice for people who may very likely have no feet at all, or just one foot. And I am all at once humbled in a way I can’t even express. We wear shoes – those can be considered prosthetics. We have to learn to walk in them and to use them. I get that. By logical extension, skates are no different. But after all these years on the ice, as a scientist, I’m still studying and experiencing how we learn to skate.

As Managing Director of Vitality In Action’s Adaptive Skating Program, I put together the foundational skills curriculum, both on-ice and off-ice for people who could have an artificial foot or leg, people who are aging or are recovering from injury or habilitating from surgery. A Vitality Skater could even be someone who’s been too scared to ever get on the ice…but always wanted to. Something I’ve dreamed of my whole life– my own skating school – has literally been handed to me through Vitality In Action. Vitality Skating is the US Figure Skating Association-registered house of the Adaptive Skating Program. As the director, I develop, formalize and solidify the learning bases that will be individualized for each and every skater based upon his/her own special needs. Vitality Skating programs offer the creative modifications to help those who never thought they’d be able to skate to do so.