Health Behavior Change Contract

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HEALTH BEHAVIOR CHANGE CONTRACT

Purpose: To use information, theories, and resources from class to attempt to change one health behavior

* Points: 30

Instructions: * Do not begin this project until after you’ve completed Module 1 and read Chapter 1 of your text. * Create a plan for changing one health behavior. * Use the template provided to create your contract. Below are the specific directions for each section of the contract:

1. Insert your name and your goal. 2. Insert the date you plan to begin your goal, followed by the date you plan to accomplish it. 3. Create at least three mini-goals that will help you reach your main goal. For each…show more content…
Describe clearly and specifically at least one tool you will use to monitor your progress. 5. Describe clearly and specifically at least two challenges you anticipate encountering as you work towards your goal. For each challenge, identify at least one strategy you plan to use to help minimize that challenge. Add additional rows as needed. Delete any rows not used. 6. Sign and date your contract. If you do not have an electronic signature, you may simply type your name in the space for your signature. * Review and edit your contract making sure there are no spelling or grammatical errors, and that it looks professional.

Health Behavior Change Contract

1. I, ____________________ agree to ________________________________________.

2. I will begin on _______ and plan to reach my goal by _________.

3. To reach my final goal, I have devised the following schedule of mini-goals. For each step in my program I will give myself the reward listed.

Mini-Goal | Due Date | Reward | | | | | | | | | | | |…show more content…
Mini-Goals & Rewards | At least three mini-goals necessary to achieve the goal are provided anda reasonable due date is provided for each mini-goal. | At least two mini-goals necessary to achieve the goal are provided and a reasonable due date is provided for each mini-goal. | At least one mini-goal necessary to achieve the goal are provided anda reasonable due date is provided for each mini-goal. | Mini-goals are provided, but are not necessary to achieve the goal, or due dates are unreasonable. | 4. Monitoring | Clearly and specifically describes at least one tool necessary to monitor progress towards goal achievement. | Somewhat specifically describes at least one tool necessary to monitor progress towards goal achievement. | Names one tool necessary to monitor progress towards goal achievement. | Names one tool, but the tool is insufficient to monitor progress. | 5. Challenges | Describes clearly two specific challenges and provides effective strategies for overcoming each challenge. | Describes clearly one specific challenges and provides effective strategies for overcoming it. | Describes vaguely 1-2 challenges and strategies for overcoming them are vague or unrealistic. | Describes 1-2 challenges unrelated to the goal, or provides no strategies for overcoming challenges. | 6. Commitment | Provides both a signature and date. | Provides a signature, but no date. | Provides a date, but no signature. | Provides neither a signature nor a date.