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Facilitating Health Behaviour Change Helping individuals to help themselves Dympna Pearson RD Behaviour Change Trainer & Registered Dietitian.

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Presentation on theme: "Facilitating Health Behaviour Change Helping individuals to help themselves Dympna Pearson RD Behaviour Change Trainer & Registered Dietitian."— Presentation transcript:

1 Facilitating Health Behaviour Change Helping individuals to help themselves Dympna Pearson RD Behaviour Change Trainer & Registered Dietitian

2 Key Points Environment Individuals Influencing health behaviour

3 The Environment The environment in which somebody lives clearly has a major influence on health. Public health interventions are designed to make healthy choices easier and are likely to have maximum impact if fully implemented NICE 2007

4 Individuals What influences change? If you are told what to do, there is a good chance that you will do the opposite! (Miller & Rollnick 2002)

5 For example: Well intentioned, advice-giving Why dont you……. Use a smaller plate Take one bite at a time Chew slowly Use stairs instead of the lift

6 Advice Giving Research has demonstrated that this approach can render the client a passive recipient to expert knowledge and combined with persuasion can reduce client autonomy and generate resistance.

7 Providing Information Has a place but….evidence clearly shows that giving knowledge alone does not necessarily lead to a change in behaviour Glanz 1985, Contento 1995, Roe 1997, Thorogood 2001

8 Healthcare Professionals Many HCPs express frustration with: Non-compliant patients Patients who are less than truthful Patients who are not motivated Patients who expect a magic wand Those who wont take responsibility Lack of time, the system…

9 People change if they come to believe it is both of value and achievable Enhancing motivation and encouraging change is a complex task that demands skilful consulting Practitioners need to consider their style in consultations about behaviour change What works? Rollnick et al. BMJ 2005

10 Why a Behavioural Approach? There is overwhelming evidence that changing peoples health-related behaviour can have a major impact on some of the largest causes of mortality and morbidity. NICE (2007)

11 What is a behavioural approach? The main principles of this approach include the modification of current behaviour patterns, new adaptive learning, problem solving and a collaborative relationship between client and therapist (HDA 2003 )

12 Changing Habits Bad habits are like a comfortable bed, easy to get into, but hard to get out of Anon

13 A Behavioural Approach A behavioural approach is based on the patient- centred method

14 A patient-centred approach 1.Explores the disease and the experience 2.Understands the whole person 3.Finds common ground 4.Incorporates prevention and health promotion 5.Enhances the patient-practitioner relationship 6.Is realistic (Stewart el 1995)

15 A Behavioural Model Strategies Skills Theory & Principles


17 Client Expectations To be heard and understood The opportunity to tell their story To gain information To feel able to cope (Gable 2007) Failure to meet expectations leads to frustration

18 Empathy The ability to empathise is key. Those with empathy have the ability to put themselves in others shoes, to see things from others perspectives and to gauge the likely impact of their behaviour.

19 Empathy is not just nice to have – its a crucial and sophisticated skill. Without it we diminish our ability to influence; we create needless conflict and resistance Empathy

20 Key Skills Active Listening Skills Active Listening Skills Greeting/opening the interview Greeting/opening the interview Non-verbal communication Non-verbal communication Reflection (min. encouragers, paraphrasing, reflecting feelings, summarising) Reflection (min. encouragers, paraphrasing, reflecting feelings, summarising) Ending the interview Ending the interview

21 The Evidence The single most important factor for an effective helping relationship is the practitioners possession of strong interpersonal skills (Najavitis and Weiss 1994 )

22 Evidence There is good evidence that a client centred approach: Improves clinical outcomes Increases client satisfaction Improves compliance Reduces patients concerns (Moira Stewart 1995)

23 The Evidence Good Communication is Good Evidence-Based Medicine Stewart (1995) The therapists style can and does influence motivation and change Miller & Rollnick (2002)

24 But I have no time…. The use of good listening skills can be very effective – even in a short space of time.

25 Motivation Motivation is not something you can do to people It has to come from within It is not an all or nothing state It is influenced by the helping style of the health practitioner (Miller & Rollnick (2002)

26 Motivational Interviewing A patient-centred, directive method for enhancing intrinsic motivation to change. Miller & Rollnick (2002 )

27 Motivating Change The goal of motivational interviewing is that the patient, not the practitioner, expresses concerns about the current behaviour and presents arguments for change. (Miller & Rollnick 2002)

28 Enhancing Motivation Increasing Talk About Change Listen/reflect, listen/reflect, listen/reflect….. (Miller & Rollnick 2002)

29 Enhancing Motivation Reducing Resistance to Change Listen/reflect, listen/reflect, listen/reflect….. (Miller & Rollnick 2002)

30 Specific Motivational Strategies Exchanging information Explore current behaviours Explore Ambivalence Explore motivation/readiness (Miller & Rollnick 2002)

31 Assessing Readiness to Change Ready or Not? Scaling Questions?

32 Exploring Motivation/Readiness Importance –Reasons Confidence –Obstacles

33 Behavioural strategies Problem solving Self-monitoring Goal setting (Plan: what, how, when) Social support Self-rewards (reinforcement) Cognitive restructuring (CBT) (Foreyt J & Paschali 2001)

34 Summary Working in a behavioural way is not just about using a set of techniques It is relies heavily on the use of good interpersonal skills and a strong collaborative relationship between the patient & the practitioner

35 At the very least, we should be sure that we are doing no harm with our well intentioned interventions

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