Behaviour Change and MI Flashcards
Non Communicable diseases rankings
- Cardiovascular diseases
- Cancer
- Respiratory diseases
- Diabetes
What groups of diseases account for over 80% of all premature non-communicable disease (NCD) deaths?
The four groups of diseases that account for over 80% of all premature NCD deaths are cardiovascular diseases, cancers, respiratory diseases, and diabetes.
How do tobacco use, physical inactivity, harmful use of alcohol, and unhealthy diets impact the risk of dying from a non-communicable disease (NCD)?
Tobacco use, physical inactivity, the harmful use of alcohol, and unhealthy diets all increase the risk of dying from a non-communicable disease (NCD).
What does NCD mean
Chronic diseases of lifestyle
What are the four main risk factors
- Physical activity
- Unhealthy diet
- Tobacco use
4/ Harmful use of alcohol
Other risk factors for chronic disease and injury
- genetic markers
- poor knowledge of disease
- psychosocial distress
- environmental exposure
- previous injury
- other “biochemical” risk factors
- chronic inflammation
*raised plasma homocysteine
*vitamin D deficiency - raised HbA1c
- other
Name other risky behaviors
*Unsafe sex
*Disclosure of HIV status
*Non-adherence to medication
Definition of Motivational Interviewing
MI is a skillful, patient-centered counselling style that is goal-directed and seeks to elicit from patients their own good motivations for making behaviour changes, in the interest of their health.
Composition of Motivational Interviewing
- Spirit of MI
-Associated patient centered interviewing techniques
What is the core principle of Motivational Interviewing-Spirit in terms of patient involvement?
Patient-centered–enable patients to be active participants in decision-making (not passive recipients of instructions)
What are the three styles of interaction in Motivational Interviewing?
The three styles of interaction are Guiding, Directing, and Following.
What are the 5 approaches of MI
- Collaboration vs Confrontation
- Autonomy vs Authority
- Eliciting vs Educating (Installing)
- Patient-centred vs Doctor-centred
- “Dancing” vs“Wrestling”
Principles of Motivational Interviewing
–Resist righting reflex
–Understand your patient’s motivation
–Listen to your patient
–Empower your patient
Skills for motivational interviewing
–Open-ended questions
–Affirmation
–Reflection (active listening)
–Summarising
3 Categories of behaviour change
- Goals
- Strategies
- Targets
Name the interviewing techniques
- Elicit Medical Problem
- Elicit Risk Behaviours
- Set an agenda
- Assess the Stage of Change
- Assess readiness to change
What is the task of healthcare practitioners when eliciting medical problems?
The task is to list the medical problems in which healthcare practitioners can facilitate behavior change.
What is the task of healthcare practitioners when eliciting risk behaviors?
The task is to list the behaviors that need to change. (risk factors)
Setting an agenda
a. Collaborate with patient
b. Categorise issues/items
c. Prioritise –ask patient
d.Forge “contract of management” with patient
Name stages of change model
- Precontemplation
- Contemplation
- Preparation Action
- Action
- Maintenance
Precontemplation
The person is quite happy to continue with his usual behaviour.
Contemplation
The person considers the pros and cons of both the current behaviour and the changed behaviour.
i.eS/he is AMBIVALENT
Preparation action
The person plans the behaviour change.
Action
The person implements the change.
Because the changed behaviour is still new, this stage is not an entirely comfortable one.
Maintenance
The person has comfortably made the change, and, has managed to sustain this change over time.
What is relapse in the context of behavior change?
Relapse occurs when a person reverts to their original behavior after attempting to change.
What must a person do after experiencing a relapse?
After a relapse, the person has to pass through all the stages of change again to reach the stage of maintaining the changed behavior.
How many times can relapse occur before behavior change becomes permanent?
Relapse can happen a few times before the behavior change becomes permanent.
Is relapse considered a stage of change?
No, relapse is NOT considered a stage of change.
What is the positive approach to dealing with relapse?
Adopt a positive approach to relapse by viewing each relapse cycle as an opportunity for learning.
2 components of readiness to change
- Importance
- Confidence
Importance
How important it is for the person to make the change.
e.g. “Why should I …….”
Confidence
How confident the person is about making the change.
e.g. “Will I be able to …..”
“How can I ………”
What need to be present for one to be ready to change a behavior
both the importance and the confidence have to be present.
When importance is lacking
- provide relevant information
Where confidence is lacking
identify the barriers to behaviour change and explore ways in which these barriers can be removed.
What is the first step in the Elicit–Provide–Elicit (EPE) Technique?
The first step is to Elicit information from the patient about the topic
How do you start the Elicit step in the Elicit–Provide–Elicit (EPE) Technique?
Get the patient to indicate if and what they would like to know about the topic
Who should do most of the talking during the Elicit step?
The patient should do most of the talking. This step is also called assessment
What should you do if the patient does not want information during the Elicit step?
If the patient does not want information, back off.
What are some example questions you can ask to elicit information from the patient?
“Would you like to know more about ……?”
“How much do you know about …….?”
“Would you like to know how ……?”
What is the second step in the Elicit–Provide–Elicit (EPE) Technique?
The second step is to Provide information.
How should information be conveyed during the Provide step?
How should information be conveyed during the Provide step?
What word should be avoided when providing information, and what should be used instead?
Avoid using “you”; use “other people” instead.
How should the information be delivered during the Provide step?
Deliver the information at the patient’s pace, starting from general information and moving to specifics.
What are some example phrases to use when providing information?
“What happens to some people is that ……”
“Other people find that ……”
What is the third step in the Elicit–Provide–Elicit (EPE) Technique?
The third step is to Elicit the patient’s interpretation and opinion of the information provided.
What is the main goal during the final Elicit step?
The main goal is to encourage the patient to make sense of the meaning of the information.
How should you phrase questions during the final Elicit step?
Use the word “you” to personalize the questions and engage the patient.
What are some example questions to use during the final Elicit step?
“What do you make of this?”
“How have you been affected by …..?”
When does resistance occur in an interview?
- Resistance occurs during a confrontational interviewing style.
- It happens when the patient is not ready to change.
- It can occur when only one side of ambivalence is addressed.
How should resistance be dealt with in an interview?
- Acknowledge the resistance, don’t argue against it (i.e., ‘Roll with resistance’).
- Emphasize the patient’s autonomy and their ability to choose.
- Reflect the resistance back to the patient.
- Explore the reasons for the resistance.
What is the Righting Reflex?
The Righting Reflex is the practitioner’s strong urge to set things right by advising, teaching, persuading, and arguing for what they believe is the correct solution. This often involves a directing style where the practitioner may assert, “I know what’s best for you, so you should do as I say.”
How might an ambivalent person respond to the Righting Reflex?
An ambivalent person may argue for the opposite of what the practitioner suggests.
This response can be perceived as resistance, denial, or non-compliance.
Strategies for reducing resistance: Rolling with resistance
*Emphasize personal choice & control. Make advice ambiguous & in neutral terms:
I think you should stop smoking, but it’s really up to you…
*Back off & come alongside the client use reflections
So you feel that …
*Ask about the pros and cons of current behaviour
What are the “good things” and “less good things” about drinking?
*Reassess importance, confidence & readiness
How do you feel about exercising?
Types of listening
a. non- verbal/ passive listening
b. active/ reflective listening
Active/ Reflective listening
*Reflective question
*Simple reflection
-Repeat words
-Rephrase
*Complex reflection
-Paraphrase
-Reflection of feeling
5A’s
- ask
- alert (advice)
- assess
- assist
5 .arrange
ask
-About Medical Problem and Risk Behaviour
-What patient knows about risk behaviour
-Permission to provide further information
alert (Advice)
About relevant information in a neutral manner
assess
-Information provided
-Readiness to Change(Move to 4a if not ready, 4b if ready)
assist
a) Not ready: Acknowledge autonomy, Provide information
b) Ready: Practical assistance, set realistic goals
arrange
follow up, referral, support group
4 risk behaviours
- unhealthy eating (poor nutrition)
-smoking
-alcohol
-not exercising
