RVT, CVT, VTS (SAIM)
With 20 years of veterinary experience, Yvonne was the 2021 president of the Academy of Internal Medicine for Veterinary Technicians and founder and cohost of the Internal Medicine For Vet Techs membership and podcast. She works as a clinical trainer for National Veterinary Associates and loves to teach about a variety of medicine topics. Yvonne is passionate about elevating the profession around the world. To find out more about her, visit internalmedicineforvettechs.com.Read Articles Written by Yvonne Brandenburg
This article is aimed at helping veterinary team members understand how to get clients to buy into veterinary recommendations for parasite control medications and provides ideas on how to support clients as they change their behaviors.
The “6 Stages of Behavior Change” (precontemplation, contemplation, preparation, action, maintenance, and relapse) are the different phases clients go through whenever creating a new habit—in this case, remembering medications to help prevent parasite infestations, infections, and serious diseases that can be transmitted by parasites. Knowing these stages of behavior change is important to create plans to support clients and obtain greater client compliance.
- Following the “6 Stages of Behavior Change” can help the veterinary team gain better client compliance in preventive medicine and, in this case, parasite control specifically.
- In stage 1, precontemplation, provide basic information on why parasite preventive medications are important to help prevent infestations, infections, and serious, potentially fatal diseases.
- In stage 2, contemplation, look at the different options for parasite control and what will work best for your clients and patients.
- In stage 3, preparation, provide tools to help clients be successful.
- In stage 4, action, support clients as they start giving preventive medications to their pet.
- In stage 5, maintenance, support clients as they continue to routinely give the medications and watch out for any potential distractions from giving the products on time.
- In stage 6, relapse, recognize that even with the best-laid plans, slip-ups happen. Being prepared with a plan to get back into the habit can help get clients back into the maintenance stage.
“Oops, I did it again!” How many times have we heard this from a client, and the famous song starts playing through our head? While lapses in compliance can be frustrating, they represent an opportunity to educate the client and strengthen the relationship with the veterinary healthcare team. Being an advocate for our clients and patients may take a little extra time, but in the long run our patients will stay healthier for longer and our clients will feel like they are part of a team.
The Pests and Parasites series is brought to you by Merck Animal Health, the makers of Bravecto® (fluralaner) and Sentinel® (milbemycin oxime/lufenuron).
So, how do we get clients to comply better with veterinary recommendations for parasite control and infectious disease prevention? A good set of tools in our toolbox are the “6 Stages of Behavior Change,” as described in an article by Kendra Cherry and based on research by Carlo DiClemente and James Prochaska.1
Stage 1: Precontemplation
In this stage, clients have not thought about changing their behavior around parasite control. They could be in denial (“I live in a gated community. My Fluffy couldn’t possibly have fleas!”), or they have not been educated about parasites or parasite control in the past. A client may not understand how serious of a health risk parasites are to their pets and to themselves. Maybe they just do not know how to solve the issue (for instance, the parasite control product they have been using for years isn’t cutting it anymore).
Provide Visual Cues
The first point of contact can be in the lobby of your clinic. Does your clinic have educational posters and pamphlets for clients to read while waiting? Is there a TV or monitor in your lobby that plays informational programs? Can the clinic start a conversation before the client gets into the exam room?2
The best thing to do in this stage is to ask clients questions like:
- Do you see your pet scratching or licking at the paws or rear end excessively?
- Are they scooting on the floor?
- Have you seen parasites in the environment?
- Can you see any issues caused by parasites? Have you noticed itching, redness, loss of hair, or any sores?
- Tell me what the typical day looks like for your dog/cat. (Look for high-risk lifestyles or travel that could expose the pet to different parasites.)
These questions are designed to start the process of helping clients realize there may be some issues that need to be addressed.3
We can begin with some basic education about parasites and the potential for harm they pose (see Additional Resources). This can provide clients with an understanding of risks associated with not using parasite control products.
Stage 2: Contemplation
During this stage, clients may start to have conflicting thoughts about using preventive medications. They have started looking at their options, they may ask about the benefits between brands, they may be comparing prices, and they may ask the veterinary team for help. During the contemplation stage, clients become aware of potential benefits or may have heard from friends—or worse, the internet—that some products are harmful. But the cost of the medication may stand out to them.
Offer Pamphlets or Online Resources
Doing the legwork for our clients can help in their decision-making process when choosing the parasite control product that will work best for their pet and their lifestyle. For instance, you can show them comparisons of:
- All-in-ones versus products that work against a single parasite
- Route of administration (oral, topical, injectable, or collar)
- Cost per dose
- Frequency of dose
- Tolerance by the pet
These are all important factors going into the client’s decision. Providing infographics can help narrow down the best choice for them. Create one with products your clinic recommends, similar to the table created by the Ontario Animal Health Network, “Anti-Parasitics for Dogs and Cats (Canada, 2022).”4
Be Available for Questions
We can also help clients by asking them what they can do to help make the change to routinely giving a parasite control product. If they haven’t committed to a specific prevention plan during the office visit, schedule a follow-up call to see if they have any questions. Providing extra touchpoints can increase client satisfaction and compliance and can help them get out of contemplation mode.5
Stage 3: Preparation
Helping clients during the preparation stage can include sharing tools to keep track of dates for giving medication, such as online calendars, wall calendars, and reminder emails. This is a good time to write down the goals and to offer additional information to make the decision easier. Maybe they can create a group of friends who all give their parasite control products on the same date, and they can support each other with helpful messages.
Whenever creating a new habit, it helps to associate the new habit with something that is already being done. This is why giving preventives on a specific day of the month can help. If the parasite medication is a monthly product, maybe the client can give it the same day they pay their rent or mortgage. Or if they schedule a once-a-month delivery of the preventive, the client gives the product as soon as they receive it. Ask what habits clients already have to help them remember to give the medications.
Set Up Reminders
In this stage, we can help support clients by providing a year’s worth of preventive medications and set up reminder calls, emails, or texts. Use the clinic’s medical record system to its fullest potential and schedule reminder mailers. How about booking that yearly exam and heartworm/parasite testing ahead of time as well?6
Stage 4: Action
The fourth stage of behavior change sees clients taking action to provide preventive medications for their pets. This could be ordering the medications, setting up a schedule, and giving the first dose.
Remind and Reinforce
Using stickers on calendars works for some people as a fun reminder of their success. Remind clients to celebrate their successes. Remember: Reinforcement and support are extremely important in helping to maintain positive steps toward change.1 Placing the medication in an easy-to-spot, convenient place helps keep it top of mind too.
Create a social media post on the clinic’s page for Preventive Day. This can be called the “Action Win Celebration,” and we can encourage clients to post photos of their pets receiving the preventive medication. Who doesn’t want to share photos of their adorable dogs and cats? Providing social support can help reinforce client compliance. What other creative ways can your clinic celebrate wins with clients?7
Stage 5: Maintenance
The maintenance stage sees clients needing to maintain their new behavior of providing prevention medications to their pet. This is a time when relapses into their old behavior are common. This is a time we can remind clients of the risks of serious disease if doses are missed.
Remind and Reinforce Again
Reminders can help clients stay on the path to maintaining those new habits. Remind clients to reward themselves for maintaining a streak and to not give up if they forget on their designated day of the month. It’s OK. Reinforce this with them—we all slip up! Then remind them to get back into the habit when they remember.
Stack Those Habits
What if we build on our previous “Action Win Celebration” post and raffle off a prize to a client who posts a photo each month? Maybe they get a free exam and yearly heartworm test? What are other ways we can help remind clients to maintain their pet’s health?
Stage 6: Relapse
The dreaded relapse of forgetting parasite control products can spiral into months of not giving the medications. Maybe the automatic refill expired. Maybe their pet is due for its yearly heartworm test and the client forgot to schedule an appointment ahead of time. Whatever the reason, it happens.
This might be a moment when a veterinary team member provides more client education or helps problem solve why the client fell off the wagon. What prompted the client to not give the medication? What can they do in the future to avoid the same response? This is a good time to help clients reaffirm their motivation and action plan and recommit to the goal of keeping their pet happy and healthy.
Provide Client Support
In this stage, clients may need more preparation and action support from the veterinary team, and we can work with them to come up with solutions. Do they want monthly email reminders? Phone calls? What would help them be successful? Ask the client for an idea; you might be surprised at a simple solution that could work for them.
Hopefully by using the “6 Stages of Behavior Change” (BOX 1), the veterinary team can work collaboratively for the health of our patients and decrease the dreaded “Oops, I did it again!” And instead of blaming our clients, we now have some tools we can use to help our patients stay as healthy as possible.
❏ Precontemplation: Provide basic information on why parasite preventive medications are important to help prevent infestations, infections, and serious, potentially fatal diseases.
❏ Contemplation: Look at the different options and what will work best for clients and patients.
❏ Preparation: Provide tools to help clients be successful.
❏ Action: Reinforce and remind clients as they start giving the preventive medications to their pet.
❏ Maintenance: Support clients as they continue to routinely give the medications, and watch out for any potential distractions.
❏ Relapse: Be prepared with a plan to help clients get back into the maintenance phase when slipups happen.
Understanding these “6 Stages of Behavior Change” allows us to create a path to be our patients’ advocate by providing excellent care and helping to keep them protected against parasites. Use your superpowers to continue to do good in our profession. And instead of forgetting to give parasite control medications, our clients will remember to give them on time and completely change the meaning of “Oops, I did it again!”
- American Animal Hospital Association’s client education guidelines aaha.org/aaha-guidelines/infection-control-configuration/client-education
- Companion Animal Parasite Council’s general guidelines for dogs and cats capcvet.org/guidelines/general-guidelines
1. Cherry K. The 6 stages of change: the transtheoretical, or stages of change, model. Verywell Mind. Updated December 19, 2022. Accessed April 8, 2023. https://www.verywellmind.com/the-stages-of-change-2794868
2. Garrison G. Keep the parasite prevention compliance conversation alive. Veterinary Advantage. April 2020. Accessed April 8, 2023. https://vet-advantage.com/vet_advantage/keep-the-parasite-prevention-compliance-conversation-alive
3. Paul M, Thomas M. Parasite protection: compelling clients to comply. Companion Animal Parasite Council. Accessed April 8, 2023. https://capcvet.org/articles/parasite-protection-compelling-clients-to-comply
4. Ontario Animal Health Network. Anti-parasitics table for cats and dogs 2022. Accessed April 8, 2023. https://www.oahn.ca/resources/anti-parasitics-table-for-cats-and-dogs
5. Soldavin K. Promoting parasite prevention in practice. Todays Vet Pract. 2013;3(2):28-32.
6. Liger M. To be continued …. Todays Vet Bus. 2021;5(3):20-22.
7. MacKay C. Client compliance—the key to successful veterinary practice. Presented at: World Small Animal Veterinary Association World Congress Proceedings; May 11-14, 2005; Mexico City, Mexico. Accessed April 8, 2023. https://www.vin.com/doc/?id=3854148