Small Steps

Last week I wrote about Ingrid, who went from a complete couch potato (with an A1C[1] above 12%) to an active, positive woman who makes other people feel good (and has an A1C of less than 8%). This week I want to go into some nuts and bolts of making such big changes.

If you haven’t read Ingrid’s story, go back and read it now[2]. I’ll wait.

OK, how did she do it? Ingrid’s big problem was getting started. She didn’t think she could do anything for herself, certainly not move her body. In psychological terms, her self-efficacy was low. Self-efficacy (SE) is the belief that you can do the things you set out to do. It’s self-confidence applied to a particular activity or area of life.

People who have low SE about something are unlikely to try it or stick with it. That’s why good self-management programs focus on building people’s SE. The best way to raise SE is by actually accomplishing something. When you’ve done something, it’s easier to believe that you can do it again.

The second-best way is by seeing other people like you accomplish something. It wouldn’t have helped Ingrid to have a 25-year-old aerobics instructor teach her step aerobics. But if she had someone closer to her own age and size take her for a walk in the mall, that might have worked.

We didn’t have anyone like that for Ingrid, but we had a strategy for building her SE by accomplishing small steps. She had heard somewhere that she needed to walk three miles a day, and that was overwhelming. Her SE for that was zero. When I asked her how far she could walk, she said “down to the mailbox.”

Now the important thing in SE terms was that she succeed. If she failed, her SE would drop even lower, and it might be years before she was willing to try again. I needed to know if she could succeed at this plan or not. So I asked her what her confidence level was.

A confidence level means “On a scale of 1–10, how confident are you that you can carry out this plan?” It’s not the percentage of the plan you think you can do. It’s your confidence of completing the entire plan.

When I asked Ingrid for her confidence level, she said, “about six.” Well, six is not high enough. We know from experience and research that a confidence level needs to be at least seven, preferably eight or more, or the plan won’t get done.

I asked her, “Why is it a six and not an eight?”

“I’m not sure I can make it back to the house,” she said. “It’s a little bit uphill.”

“Could you think of a way to raise your confidence to seven or more?”

Ingrid thought. “I guess I could have my husband put a chair by the mailbox. Then I could rest for minute before I go back to the house.”

“OK. What’s your confidence level of that?”

“I can do that. I’d give it a nine.”

This is called problem-solving. If your confidence level is less than seven, ask yourself what would make it higher. Realize what your obstacles are. Then you can either brainstorm solutions to the barriers, or make the plan easier. Remember, the important thing is to succeed. Then you can build up.

When Ingrid said, “I think I can make it to the corner,” I asked her again for a confidence level. This time she said “eight,” so I knew she would probably make it. I didn’t know she would make it to three miles a day, but I’m not shocked that she did. That’s what happens when you take small steps and raise your SE.

To do this for yourself, try writing a weekly action plan. It doesn’t have to be about exercise; it doesn’t even have to be about health. It can be anything you want to do for yourself, anything that would make life better for you or the people around you.

Here’s a basic form for an action plan from the Seattle-based organization Improving Chronic Illness Care[3]:

You can use action plans to build toward larger goals, or to keep focused on something important to you, as I wrote about in this blog entry[4].

  1. A1C:
  2. read it now:
  3. Improving Chronic Illness Care:
  4. this blog entry:

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David Spero: David Spero has been a nurse for 40 years and has lived with multiple sclerosis for 30 years. He is the author of four books: The Art of Getting Well: Maximizing Health When You Have a Chronic Illness (Hunter House 2002), Diabetes: Sugar-coated Crisis — Who Gets It, Who Profits, and How to Stop It (New Society 2006, Diabetes Heroes (Jim Healthy 2014), and The Inn by the Healing Path: Stories on the road to wellness (Smashwords 2015.) He writes for Diabetes Self-Management and Pain-Free Living (formerly Arthritis Self-Management) magazines. His website is His blog is

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