1. Dympna Pearson RD Behaviour Change Trainer & Registered Dietitian
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 don’t 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 won’t take responsibility
Lack of time, the system…

9. What works?
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
Rollnick et al. BMJ 2005

10. Why a Behavioural Approach?
There is overwhelming evidence that changing people’s 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
Explores the disease and the experience
Understands the whole person
Finds common ground
Incorporates prevention and health promotion
Enhances the patient-practitioner relationship
Is realistic
(Stewart el 1995)

15. A Behavioural Model

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

20. Key Skills Active Listening Skills Greeting/opening the interview
Non-verbal communication
Reflection (min. encouragers, paraphrasing, reflecting feelings, summarising)
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. Increasing Talk About Change
Enhancing Motivation
Increasing Talk About Change
Listen/reflect, listen/reflect, listen/reflect…..
(Miller & Rollnick 2002)

29. Reducing Resistance to Change
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