Behaviour Change

Question 1

What are the patients and clinicians role in behavior change

Answer 1

• It is the patients task to say how and when they should change
• It is the clinicians role to elicit these arguments for change
Use of specific skills such as agreeing on priorities can facilitate this process

Question 2

What is the first step in behavior change

Answer 2

• First step is to build a good rapport

Question 3

How do you build a good rapport

Answer 3

○ Smile and welcoming patients into appointments
○ Think about non-verbals
○ Think about when you ask questions
○ Take time to listen to patients
○ Make them comfortable enough to come back in the future
select the right communication

Question 4

What are the 3 communication styles

Answer 4

directing
following
guiding

Question 5

Describe the directing communication style

Answer 5

§ Delivery of expert advice
§ Traditionally dominant within healthcare
§ Best employed when there is good rapport between patient and dentist
§ Should be well timed, personally relevant and delivered in such a way as to engage the patient

Question 6

Describe the following communication style

Answer 6

§ Utilising listening skills and occurs in situations where sensitivity is required such as when patient is upset
§ Goal of the clinician is not to solve patient’s problems immediately
Aim to provide support and encouragement in difficult situations such as breaking bad news

Question 7

Describe the guiding style

Answer 7

§ More complex than other two
§ Patient and clinician work together to help the patient identify his or her goals, and how they might be achieved
§ Useful for those unsure about change (ambivalent)

Question 8

What are the key skills for communicating about health behavior change

Answer 8

OARS
open questions
affirmation 
reflective listening
summary

Question 9

What is open questions

Answer 9

Gives clinician a deeper understanding of the patient’s views

Question 10

What is affirmation

Answer 10

○ Demonstrate an appreciation for patients efforts

○ I can see that ..

Question 11

What is reflecting listening

Answer 11

○ I understand that ..

○ Enables listener to check what has been said by the speaker

Question 12

What is summary

Answer 12

○ So in summary, I ..
○ Important because people forget what happens in the middle of the consultation
○ Require recency
○ People will remember specifically what happened at the end so a summary is important

Question 13

How do you seek permission for discussing health behavior

Answer 13

○ How do you feel having a quick chat about your smoking
○ There are a number of things we could talk about today. I’m just wondering if there is anything related to your oral health that you would like to talk about

Question 14

What does asking questions provides

Answer 14

○ Valuable clinical info
○ Gives the opportunity for patient perspective
○ Gives an insight into factors affecting change
Helps the clinician understand why the patient may behave in a certain way

Question 15

How do you provide support

Answer 15

• You took the time to think this through..
  
  • You’ve thought about how you might handle things
  • You’ve managed to cut your smoking
  • You’ve managed to keep the flossing up though you did find it a bit of a struggle
  • Demonstrates appreciation for patient’s effort and reinforces positive acts
  • Can build patient’s confidence that they can change

Question 16

How do you convey understanding

Answer 16

reflective listening ○ It sounds like you are doing well with the floss and interdental brushes
○ It sounds like you are really trying and determined to give quitting a go

Question 17

What is the cycle of reflective listening

Answer 17

1. What the speaker says
   2. The words the speaker SAYS
   3. The words the listener HEARS
   What the listener THINKS the speaker means

Question 18

How do you get the information across

Answer 18

assess what px already know
provide further information
find out what information means for the patient

Question 19

How do you assess what the patient already knows

Answer 19

○ What do you know about …

○ How much do you know about …

Question 20

How do you provide further information

Answer 20

○ Some patients find that …
○ Research has shown that …
○ One thing that improves this condition is..

Question 21

How do you find out what information means for the patient

Answer 21

○ What does this mean for you?

○ What do you understand from?

Question 22

What is behavior change cancelling

Answer 22

• Slightly different technique/approach to patients
  
  • Brief form of motivational interviewing (MI)
  • Should help with compliance
  • Do not blame them for their ill health
  • Patient centred method
  • Have to be directive - practitioners are encouraged to provide clear structure to consultation
  • Has to be a negotiation - patient encouraged to make positive changes in collaboration with practitioner

Question 23

What is the cycle behavior change

Answer 23

precontemplators
contemplators
preparation

precontemplation –> contemplation —> preparation –> action —> maintenance

Question 24

What do changes in behavior practitioners focus on

Answer 24

○ Eating less, different foods
			§ Frequency of sugar, amount, type
		○ Drink less, abstain
			§ Alcohol, coffee, drugs
		○ Smoke fewer cigarettes
			§ Quit, give up chew tobacco 
		○ Take up/modify OHI
			§ Frequency, techniques in interdental cleaning

Question 25

How do you establish rapport

Answer 25

○ Ask questions that might help you understand the patient better
○ Asking them to take you through a typical day with regards to .. (smoking, alcohol, diet)
○ Use of smoking, diet diaries
○ Using various apps, wearable technology

Question 26

How do you set an agenda

Answer 26

○ Single or multiple behaviours?
§ Smoking and alcohol puts px at risk of oral cancer
§ Obesity requires diet and increased exercise
○ Diet and toothbrushing
§ High caries rate child with suboptimal oral hygiene and lots of sucrose
○ Or singly
§ Diet, take up exercise, oral hygiene, smoking cessation

Question 27

What is readiness to change

Answer 27

○ Individual has to see value in change
§ How do you feel at the moment about change?
§ How important is it to you personally?
○ Individual has to be confident that they can change (self efficacy)

Question 28

What are the ingredients of readiness to change

Answer 28

§ Importance - why should I change

§ Confidence - how will I change

Question 29

What do smokers often exhibit

Answer 29

○ Smokers often exhibit high importance/low confidence

Patients who have high importance and confidence are most likely to be successful

Question 30

How do you exchange information

Answer 30

○ Would you like to know more about?
		○ How much do you already know about?
		○ Do you know about?
		○ Can I say to you?
		○ On patients terms, pitched at right level

Question 31

What is resistance

Answer 31

○ Have you misjudged the patient’s feelings about readiness, importance and confidence
○ Are you meeting with too much force
○ Are you being too confrontational

Question 32

How do your educe resistance

Answer 32

§ Emphasise personal choice and control

Back off and come alongside patient