Fundamentals of Health Behaviour Change

Question 1

how to establish effective provider patient relationship

Answer 1

1.assess the readiness level for change from Trans model
2.offer stage matched brief intervention
3.empower patients
4.create an inclusive environment in which patient feels comfortable and valued.

Question 2

Give examples of people first language

Answer 2

1. say patient with diabetes as opposed to a diabetic a patient with obesity as opposed to an obese patient
   2.use people first language with patients and when discussing patient with other professionals

Question 3

additional care when discussing weight and lifestlye intervention in the clinic

Answer 3

ask permission to check weight and do it in private.
Motivational interviewing skills to be used to enhance patient’s self efficacy

Question 4

The National Board for Health and wellness Coaching.

Answer 4

Coaches can help patient in the Behaviour change Journey.

Question 5

The National Board for Health and wellness Coaching
NBHWC

Answer 5

Coaches can help patient in the Behaviour change Journey.

Question 6

Motivational Interviewing

Answer 6

1. Helpful in Precontemplation and contemplation stages
2. Four General principles of MI
   Express Empathy
   Support self efficacy
   Roll with Resistance
   Display discrepancy

Question 7

Motivational Interviewing

Answer 7

1. Helpful in Precontemplation and contemplation stages
2. Four General principles of MI
   Express Empathy
   Support self efficacy
   Roll with Resistance
   Display discrepancy
3. Four core skills of MI
   open ended questions: tell me more explore patients needs, ideas, concerns expectations, experiences, feelings, priorities
   Affirmations: use the word You rather than I. enhance patients self efficacy by recognising their strengths, intentions or efforts
   Reflections
   Summaries

Question 8

Motivational Interviewing

Answer 8

1. Helpful in Precontemplation and contemplation stages
2. Four General principles of MI
   Express Empathy
   Support self efficacy
   Roll with Resistance
   Display discrepancy
3. Four core skills of MI
   Open ended questions: tell me more explore patients needs, ideas, concerns expectations, experiences, feelings, priorities
   Affirmations: use the word You rather than I. enhance patients self efficacy by recognising their strengths, intentions or efforts
   Reflections: active listening by being empathic while seeking to understand what patient is saying.
   Summaries: provide a recap what the patient has shared.

Question 9

CBT

Answer 9

1. Most useful during Preparation, action and maintenance stages.
   2.provider can apply basic principles using a coach approach.
2. Go through the following four steps before CBT with the patient
   Hear your internal dialogue
   analyse your internal dialogue: any cognitive distortions?
   reconstruct your thinking: write factual statements to replace distorted thinking.
   Practice: to eliminate distorted thinking.

Question 10

10 Examples Non productive Thinking or cognitive distortions

Answer 10

1. All or Nothing Thinking: i have not accomplished anything since i have been in graduate school
2. Overgeneralisation: he never washes his dishes
3. Mental Filter: my boss’ review of full of criticism
   4.Mind Reading: i know my partner think i did a terrible job on that presentation
   5.Fortune Telling: i will probably just mess up and make a fool of myself.
4. Magnification/Minimisation: i haven’t accomplished anything since i’ve been in medical school.
   7.Personlisation and blame: that jerk just cut me off and made me spill my coffee they just ruined my day.
   8.Emotional Reasoning: i feel like an idiot so i really must be one.
5. Labelling/Mislabelling: i am such a disorganised person.
6. Disqualifying the positive: giving up caffeine may have benefits but those benefits will be worthless since i might have a headache for a few days.

Question 11

ABCDE Model of Dr Albert Ellis to identify and reframe non productive thinking

Answer 11

A: what Action or Event occurred
B: what Beliefs do you have about what happened
C: What are the consequences of those beliefs? how does it make you feel?
D: how can you disrupt those beliefs that seem to be distorted and unhealthy?
E: what effect does this new way of thinking have on how you feel and how you will move forward?

Question 12

positive psychology

Answer 12

benefits:
1.builds patient’s confidence
2.emphasizes patient’s current skills and abilities.
3.reinforces autonomy and self efficacy which are keys to sustainable self management.
4.emphasizes the patient’s strengths and positive actions. what did the patient achieve and what successes were achieved with each step.
5.enhanaces resiliency and helps undo negative feelings.
6.increases the positivity of the patient-provider interaction.

Question 13

positive emotions part of the positive psychology

Answer 13

affection, love, enjoyment, happiness, playfulness, contentment and satisfaction.

Question 14

social support

Answer 14

A support from patient’s social circles
1. engage family and friends with whom the patient has a positive relationship to support the patient’s autonomy, accountability and self efficacy.
2. support groups: sports team, club, class, workplace and faith based or social networks including social media.
3. behaviour change working groups: 1. peer modeling strategies: pain the patient with some one who has succeeded in making the desired change : e:g Alcohol anonymous uses peer modelling
peer to peer programs: peers encourage and help each other troubleshoot scenarios which are difficult to overcome. group classes are an example of peer to peer programs.
B encourage patient to use their current social support maximally.
C. refer the patient to relevant community resources.
D. ask patient to complete an analysis of their social support.

Question 15

life style prescription vs action plan

Answer 15

lifestyle prescriptions are brief, clear instructions for care or treatment pertaining to an individual patient
prescriptions describe the action or behaviour change in the full extent necessary to treat or prevent.
e:g a prescription for 150 minutes of moderate PA for a week.
action plan: the life style prescription is adjusted and personalized for the patient’s ability, readiness and confidence.
e:g of action plan: start with walking 5 minutes a day for 5 days a week increased as tolerated up to the recommended amount of 150 minutes per week.

Question 16

demonstrate use of readiness, importance, and confidence scales.

Answer 16

0-10 above 7 more likely to accomplish their goal
7 or less than 7 : find ways to improve confidence and importance.
confidence and importance 0-3/10 in precontemplation
4-6/10 contemplation
7/10 preparation
8-9/10 action
10/10 maintenance.

Question 17

goals SMART

Answer 17

specific: identify the exact behaviour to be addressed
measurable: how one will know when the goal is reached.
Attainable: the goal is achievable and can be accomplished
Realistic/ relevant: the goal is in alignment with the specific behaviour change
time-bound: the time frame for achieving that goal.

Question 18

step by step maintenance of action plan

Answer 18

what benefits have you gained from the changes you have made
what have you learnt from the challenging areas
how do you feel about your situation.

Question 19

3 Health Behaviour change theories
1. Health behaviour model: 6 key constructs of behaviour change
perceived susceptibility, perceived severity, perceived benefit, perceived barriers, cues to action, self efficacy
2. Theory of planned behaviour: attitude, behaviour intention, subjective norms, social norms, perceived power, perceived behavioural control.
3. Social cognitive theory:: reciprocal determinism, behavioural capability, observational learning (modeling), reinforcements, expectations, self efficacy
4. Trans-theoretical model: PCPAM Termination
5.self determination theory: 3 primary psychological needs which influence motivation: autonomy, competence and relatedness.
6.precaution adoption model
7.diffusion of innovation theory

Answer 19

common components of these theories:
1. beliefs about risks and benefits
2.motivation
4.self efficacy
5.environemental influence e:g social norms.

Question 20

health behaviour is influenced by various factors

Answer 20

1. intrapersonal: knowledge attitude, beliefs and personality
2. interpersonal: influence of friends, family, peers and health providers.
3. institutional: rules, regulations and policies
   4.community factors: social network, social norms in one’s circle and built environment
4. public policy: local, state, federal and laws that regulate action for disease prevention, detection, control and management ( calories listed on menus or laws regarding where you can smoke)

Question 21

effective sustainable self management

Answer 21

1. cognitive behavioural techniques
2. social support strategies
   3.community and employee programs
3. support with digital technology: apps wearable devices.
   5.focus of skill power not will power

Question 22

relapse prevention planning
lapse is short term period when an action plan is not followed
relapse is a sustained period when an action plan is not adhered to

Answer 22

relapse prevention plan addressed the following
1.when might a lapse occur
2.under what circumstances
3.with whom
4.how to notice a lapse before it becomes relapse
5.who to turn to during a lapse? relapse?
identify relapse prevention tools: identify relapse prevention support: family friends, social and faith groups. establish a relapse reminder and back up plan: e: g patient will contact physician’s office in 3 weeks to check in, a family member will go with the patient to the party to make sure he doesn’t drink.

Question 23

follow up for ongoing lifestyle change progress including building patient’s self efficacy

Answer 23

follow up in person, by phone or digital medium

if the patient’s plan is not achieved discuss and congratulate them on any progress they have made. discuss barriers and co create solutions.
develop a revised action plan that the patient has more than 7/10 confidence they can achieve.

Question 24

5 A’s of personal behaviour change.

Answer 24

assess: practice in context of health risks
advice: changing practice with clear, specific and personalised advice for behaviour change
agree: on the focus of counselling and treatment based on patient’s interest and willingness to change and collaboratively set specific goals.
assist: the patient in achieving goals to change practices, address motivational barriers via counselling, if needs additional info or help, refer to dietitian
arrange: regular follow up and support.

Question 25

In relation to the evidence base for effective coaching that promotes health behaviour change and improves health outcomes, which of the following is/are not correct
A. a 2017/2019 systematic review published in AJLM showed the most consistent effects of health and well being coaching were observed in both exercise and nutrition behaviour. Health coaching also improved HbA1c, weight reduction and BMI
B. systematic review of 35 studies results: 73% trials showed that intervention did alter provider/patient interaction. Health outcomes were positively affected in 44% trials and negatively affected in 20% trial
C. Physician’s with high empathy scores from their patient were less likely to achieve good HbA1c control than those with low empathy scores.
D. Ten hours of provider training on empathy skills can achieve similar empathy results as those providers who have had longer training on empathy.
E. Health outcomes for HT, glucose levels and functional status are NOT related to the patient-provider relationship.

Answer 25

Answer C and E
C Physician’s with high empathy scores from their patient were more likely to achieve good HbA1c control than those with low empathy scores ( 56% vs 40%)
E Health outcomes for HT, glucose levels and functional status are related to the patient-provider relationship.

Question 26

The following are Strategies to foster self motivation and self confidence except.
A. Hold the possibility that the patient can commit to change and master change.
B. clear one mind of ‘noise’ in order to listen to the patient with full attention.
C. Be smpathetic.
D. focus on and affirm the positives as much as possible.
E. Dont share personal or other anonymous examples
F Encourage patient to take charge, decide on and commit to a wellness plan.
G. View obstacles and setbacks as necessary parts of behaviour change and the path to success.
H. Look for teachable moments. Physicians often underestimate the importance and power of these moments and impact they can have on health behaviour change.

Answer 26

Answer C and E
C be empathic
E share where disclosure will be beneficial to the patient.
Self motivation is also known as autonomous or internal motivation.
Self confidence is the trust a person has in their reasoning, capabilities and qualities.

Question 27

The following are reflective strategies in health coaching which help to make connections with the patient. True or False.
A. Simple reflections
B Amplified reflections
C. Double sided reflections
D. Shifting focus
E. Reframing.

Answer 27

True