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Family Medicine > Behaviour Change and MI > Flashcards

Behaviour Change and MI Flashcards

1
Q

Non Communicable diseases rankings

A
  1. Cardiovascular diseases
  2. Cancer
  3. Respiratory diseases
  4. Diabetes
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2
Q

What groups of diseases account for over 80% of all premature non-communicable disease (NCD) deaths?

A

The four groups of diseases that account for over 80% of all premature NCD deaths are cardiovascular diseases, cancers, respiratory diseases, and diabetes.

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3
Q

How do tobacco use, physical inactivity, harmful use of alcohol, and unhealthy diets impact the risk of dying from a non-communicable disease (NCD)?

A

Tobacco use, physical inactivity, the harmful use of alcohol, and unhealthy diets all increase the risk of dying from a non-communicable disease (NCD).

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4
Q

What does NCD mean

A

Chronic diseases of lifestyle

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5
Q

What are the four main risk factors

A
  1. Physical activity
  2. Unhealthy diet
  3. Tobacco use
    4/ Harmful use of alcohol
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6
Q

Other risk factors for chronic disease and injury

A
  • 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
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7
Q

Name other risky behaviors

A

*Unsafe sex
*Disclosure of HIV status
*Non-adherence to medication

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8
Q

Definition of Motivational Interviewing

A

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.

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9
Q

Composition of Motivational Interviewing

A
  • Spirit of MI
    -Associated patient centered interviewing techniques
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10
Q

What is the core principle of Motivational Interviewing-Spirit in terms of patient involvement?

A

Patient-centered–enable patients to be active participants in decision-making (not passive recipients of instructions)

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11
Q

What are the three styles of interaction in Motivational Interviewing?

A

The three styles of interaction are Guiding, Directing, and Following.

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12
Q

What are the 5 approaches of MI

A
  1. Collaboration vs Confrontation
  2. Autonomy vs Authority
  3. Eliciting vs Educating (Installing)
  4. Patient-centred vs Doctor-centred
  5. “Dancing” vs“Wrestling”
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13
Q

Principles of Motivational Interviewing

A

–Resist righting reflex
–Understand your patient’s motivation
–Listen to your patient
–Empower your patient

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14
Q

Skills for motivational interviewing

A

–Open-ended questions
–Affirmation
–Reflection (active listening)
–Summarising

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15
Q

3 Categories of behaviour change

A
  1. Goals
  2. Strategies
  3. Targets
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16
Q

Name the interviewing techniques

A
  1. Elicit Medical Problem
  2. Elicit Risk Behaviours
  3. Set an agenda
  4. Assess the Stage of Change
  5. Assess readiness to change
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17
Q

What is the task of healthcare practitioners when eliciting medical problems?

A

The task is to list the medical problems in which healthcare practitioners can facilitate behavior change.

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18
Q

What is the task of healthcare practitioners when eliciting risk behaviors?

A

The task is to list the behaviors that need to change. (risk factors)

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19
Q

Setting an agenda

A

a. Collaborate with patient
b. Categorise issues/items
c. Prioritise –ask patient
d.Forge “contract of management” with patient

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20
Q

Name stages of change model

A
  1. Precontemplation
  2. Contemplation
  3. Preparation Action
  4. Action
  5. Maintenance
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21
Q

Precontemplation

A

The person is quite happy to continue with his usual behaviour.

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22
Q

Contemplation

A

The person considers the pros and cons of both the current behaviour and the changed behaviour.
i.eS/he is AMBIVALENT

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23
Q

Preparation action

A

The person plans the behaviour change.

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24
Q

Action

A

The person implements the change.
Because the changed behaviour is still new, this stage is not an entirely comfortable one.

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25
Q

Maintenance

A

The person has comfortably made the change, and, has managed to sustain this change over time.

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26
Q

What is relapse in the context of behavior change?

A

Relapse occurs when a person reverts to their original behavior after attempting to change.

27
Q

What must a person do after experiencing a relapse?

A

After a relapse, the person has to pass through all the stages of change again to reach the stage of maintaining the changed behavior.

28
Q

How many times can relapse occur before behavior change becomes permanent?

A

Relapse can happen a few times before the behavior change becomes permanent.

29
Q

Is relapse considered a stage of change?

A

No, relapse is NOT considered a stage of change.

30
Q

What is the positive approach to dealing with relapse?

A

Adopt a positive approach to relapse by viewing each relapse cycle as an opportunity for learning.

31
Q

2 components of readiness to change

A
  1. Importance
  2. Confidence
32
Q

Importance

A

How important it is for the person to make the change.
e.g. “Why should I …….”

33
Q

Confidence

A

How confident the person is about making the change.
e.g. “Will I be able to …..”
“How can I ………”

34
Q

What need to be present for one to be ready to change a behavior

A

both the importance and the confidence have to be present.

35
Q

When importance is lacking

A
  • provide relevant information
36
Q

Where confidence is lacking

A

identify the barriers to behaviour change and explore ways in which these barriers can be removed.

37
Q

What is the first step in the Elicit–Provide–Elicit (EPE) Technique?

A

The first step is to Elicit information from the patient about the topic

38
Q

How do you start the Elicit step in the Elicit–Provide–Elicit (EPE) Technique?

A

Get the patient to indicate if and what they would like to know about the topic

39
Q

Who should do most of the talking during the Elicit step?

A

The patient should do most of the talking. This step is also called assessment

40
Q

What should you do if the patient does not want information during the Elicit step?

A

If the patient does not want information, back off.

41
Q

What are some example questions you can ask to elicit information from the patient?

A

“Would you like to know more about ……?”
“How much do you know about …….?”
“Would you like to know how ……?”

42
Q

What is the second step in the Elicit–Provide–Elicit (EPE) Technique?

A

The second step is to Provide information.

43
Q

How should information be conveyed during the Provide step?

A

How should information be conveyed during the Provide step?

44
Q

What word should be avoided when providing information, and what should be used instead?

A

Avoid using “you”; use “other people” instead.

45
Q

How should the information be delivered during the Provide step?

A

Deliver the information at the patient’s pace, starting from general information and moving to specifics.

46
Q

What are some example phrases to use when providing information?

A

“What happens to some people is that ……”
“Other people find that ……”

47
Q

What is the third step in the Elicit–Provide–Elicit (EPE) Technique?

A

The third step is to Elicit the patient’s interpretation and opinion of the information provided.

48
Q

What is the main goal during the final Elicit step?

A

The main goal is to encourage the patient to make sense of the meaning of the information.

49
Q

How should you phrase questions during the final Elicit step?

A

Use the word “you” to personalize the questions and engage the patient.

50
Q

What are some example questions to use during the final Elicit step?

A

“What do you make of this?”
“How have you been affected by …..?”

51
Q

When does resistance occur in an interview?

A
  • 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.
52
Q

How should resistance be dealt with in an interview?

A
  • 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.
53
Q

What is the Righting Reflex?

A

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.”

54
Q

How might an ambivalent person respond to the Righting Reflex?

A

An ambivalent person may argue for the opposite of what the practitioner suggests.

This response can be perceived as resistance, denial, or non-compliance.

55
Q

Strategies for reducing resistance: Rolling with resistance

A

*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?

56
Q

Types of listening

A

a. non- verbal/ passive listening
b. active/ reflective listening

57
Q

Active/ Reflective listening

A

*Reflective question
*Simple reflection
-Repeat words
-Rephrase
*Complex reflection
-Paraphrase
-Reflection of feeling

58
Q

5A’s

A
  1. ask
  2. alert (advice)
  3. assess
  4. assist
    5 .arrange
59
Q

ask

A

-About Medical Problem and Risk Behaviour
-What patient knows about risk behaviour
-Permission to provide further information

60
Q

alert (Advice)

A

About relevant information in a neutral manner

61
Q

assess

A

-Information provided
-Readiness to Change(Move to 4a if not ready, 4b if ready)

62
Q

assist

A

a) Not ready: Acknowledge autonomy, Provide information
b) Ready: Practical assistance, set realistic goals

63
Q

arrange

A

follow up, referral, support group

64
Q

4 risk behaviours

A
  • unhealthy eating (poor nutrition)
    -smoking
    -alcohol
    -not exercising

Family Medicine (3 decks)

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