Andi Williams is 25 years old, lives just south of Dallas, TX, and is still, “trying to figure her life out” (her words, not mine). Throughout her childhood and into high school, Andi was active. She participated in competitive gymnastics, played sports, and cheered on her high school squad. With her active lifestyle, Andi never had to think much about her weight and its impact on her health.
Now, at 25 years old and still overweight, Andi is trying to reverse she lifestyle she has adapted over the past 7 years. She is losing weight and working to gain back her sense of confidence and strength. She has started CrossFit at a box near her home in Texas, and has started swimming laps as additional cardio. In addition to increasing her physical activity, Andi is also trying to change her diet. She has started the Paleo diet and has been successful with that endeavor. Several of the people at her CrossFit box also eat a paleo diet, so she has a good support system there. However, with her increase in physical activity, she has noticed that she does not drink enough water. Her lack of hydration has led to headaches and exhaustion, especially post-workouts. She says she knows she needs more water, she just doesn’t think about it until the end of the day. Andi also has general anxiety disorder and she tends to focus her anxiety on medical issues. Because of this, Andi has also mentioned to me that she is concerned about water intoxication by overhydrating.
The goal of this project is to teach Andi how to increase her water intake and alter her consumption in a safe way based on her weight and level of physical activity. A breakdown of the SMART objectives are as follows:
Specific: Andi wants to increase her daily water intake to 100 ounces of water per day in the following five weeks.
Measurable: Andi will track her water intake through a phone app. We will use this method to track her increase until she hits her goal of 100 ounces of water per day.
Achievable: This goal will be achievable because we will set smaller weekly goals of increase until she hits the 100 ounces. These smaller increases being met will help her build confidence in her ability to increase her intake in a safe way.
Realistic: I believe this goal is realistic. She currently intakes about 50 ounces of water per day, so our goal is to double it, but by setting smaller goals each week, it will create a more realistic expectation.
Time-oriented: Since this project will run for 5 weeks, we will increase her water intake by 10 ounces each week. By the end of the 5 weeks, Andi will be drinking 100 ounces of water per day.
A SWOT analysis of Andi’s situation indicates an environment that will be conducive to a healthy behavior change. Her strengths include the people she has supporting her. She lies with her parents who are actively trying do to their part to help her get healthy. She also has her CrossFit coach and group. They can help remind her to drink more during workouts. Andi has a competitive mindset and will want to reach a goal because that will prove her ability to succeed in her mind. Some weaknesses include her anxiety. Her fear of water intoxication by increasing her water intake may inhibit her from scaling up her intake to where it should be for her size and activity level. Also, when Andi begins to worry that she will fail to reach a goal, she tends to shut down and will no longer work towards it. Her fear of failure takes over and she avoids the actions she may need to take to be successful. A couple opportunities that can help Andi achieve her goal are the app, Aqualert from iTunes, which can easily track her water intake and remind her when to drink. Her mom is also buying her an Orca chaser, which will keep her water cold for extended periods of time, and it holds 25 ounces of water in it. Also, her CrossFit box has a water filter that turns the water into alkaline water, which she enjoys more than regular tap. Some threats to her success will be days when she does not work out, she may not feel the need to pay much attention to her water intake. Also, going out with her parents and friends for meals may be an issue. Her parents may remind her to order water, but if they are not also drinking water, Andi may not as well. With her friends, they like to grab margaritas/daiquiris sometimes when they meet up, and when she is drinking alcohol, Andi is less likely to supplement her water intake.
Week One. Let’s get this party started!
Goals and activities
This week I plan to discuss these goals with Andi, and have her track her current daily average water intake and her weekly physical activities. The information gathered during this talk will be used for me to asses her readiness to change using constructs from DiClemente and Procheska’s Transtheoretical Model. Once I have determined what stage she is in, I can then determine what processes of change would best benefit her and help her to become more likely to achieve her goal. My goal is to determine this early in the week and then use the rest of the week to begin increasing her water intake. The specific and measured goal for this week is to increase her daily intake from 50 ounces to 60 ounces.
Measurements of performances
*No data collected on days without bars.
As the chart indicates, Andi tends to fall short of her goal of 100 ounces per day, with her highest intake being just over 68 ounces on Thursday. She is also inconsistent in tracking her water intake. We discussed barriers that arose during her initial week, which will be discussed in the sections.
Application of course material
Using the Transtheoretical model this week to assess Andi’s readiness, I feel that Andi is now in the preparation stage. When she first agreed to help me with this project, I believe she was in the contemplation phase. She knew she needed to increase her water intake, and she wanted to, however, she was unsure of the best way to proceed. We worked on her self-evaluation process of change, and discussed her desire for change; why did she feel it was important to change and how will doing so affect her lifestyle?
After a couple talks, she moved into preparation stage. She began reviewing information that I sent her from the CDC regarding safe water intake levels, finding a water bottle that will hold a substantial amount of water and keep it cold for extended lengths of time, and downloading and familiarizing herself with the Aqualert app for tracking her intake. We also spent some time focusing on the self-liberation process, in order to help her move into the action stage. Andi has been doing a lot of work over the past few months to change her behavior to adapt a healthier lifestyle (CrossFit, paleo). She is committed to increasing her health, and has committed to this project.
Reflexive journaling
Andi seems very excited to work towards achieving this goal. We are very close and since her move to Texas, we obviously do not get to see each other as much, and with our busy schedules, we do not talk on the phone or video chat as often as we would like. I think she is also excited that we can help each other with this project. She is very willing to read anything I send her and is trying hard to remember to track her water intake and workouts. I am confident in her ability to increase her water intake. Her competitive nature, hatred of failure, and desire to help me are factors that I think will help her to stay focused on her goals. The shorter weekly goals will be encouraging and will help her self-efficacy as well. I think the biggest barrier will be cues to action, which I will focus on next week, using the Hochbaum, Rosenstock, and Kegel’s Health Belief Model and its constructs.
Goals for the following week
Next week, I plan to have Andi in full swing of the Transtheoretical model action stage. As she starts using her Aqualert app regularly and works to establish a routine, I will use constructs of the Health Belief Model to help identify perceived barriers, perceived benefits, cues to action, and Andi’s self-efficacy. The Aqualert app has an alarm that will go off and alert Andi with a reminder to drink water. In addition to the reminder, it tells her why she should drink more water and gives her tips on how to increase her water intake.
The specific goals and activities for week 2 are:
· Increase her daily water intake to 70 ounces of water per day.
· Use Aqualert app every day
· I will send her daily texts with information and encouragement
Andi's Water Intake
Water Tuesday Wednesday Thursday Friday Saturday Sunday Monday 68 64.2 48.6 70