Health Behaviour Change

Question 1

Basis of evidence based medicine?

Answer 1

Evidence based medicine (EBM) is based on the principle of ‘integrating individual clinical experience with the best available clinical evidence from systematic research’

Question 2

What are BCTs?
How would you describe BCTs?

Answer 2

Behaviour change techniques are the building blocks of behaviour change interventions
* 93 different BCTs
* analysing the content of behaviour change interventions and expert consensus (N= 42).

BCTs are:
* Observable
* Replicable
* Irreducible components
Used alone or in combination

Examples:
* Information provision
* Goal setting
* Feedback
* Action plans

Question 2

How are BCTs most effective?

Answer 2

• Self-monitoring of behaviour
• Those studies that used self-monitoring of behaviour in combination with 1+ BCTs demonstrated even greater efficacy.

Question 3

What is the impact of motivation?
How can motivation be influenced?

Answer 3

Motivation explains initiation (intention), direction, persistence, and termination of behaviour (Jensen et al., 2003)

State that can be influenced by:
* Conscious deliberative processes
* Unconscious automatic processes

Question 4

What is Role of health care professional?

Answer 4

• Proactively engage the patient in health behaviour change
• Evoke arguments for changing their behaviour
• Bolster the patient’s confidence by supporting patient autonomy, reinforcing their commitment to behaviour change
• Provide information tailored to individual need

Question 5

What is MI?
What does it include?

Answer 5

Motavational Interviewing provides a communication skills framework for implementing BCTs
It includes:
* 4 Stages
* 4 principales
* 4 Skills

Question 6

What is 4 skills of motivation?

Answer 6

Open questions – allows you to elicit patient perspective fully and identify their capability and motivation
“You mentioned you don’t know where to start with dieting. To help me get a better understanding, what is a typical day like for you?”

Affirm – Recognise the positive attributes of the patient – helps to avoid defensive behaviours.

“It’s really good that you’re finding out information about diabetes.”

Reflect – Use short statements to confirm you’re listening.

“It must be hard for you not seeing your friends anymore now you’re making these changes”

Summarise – Allows you to check-in with the patient that you have a correct understanding of their situation.

Question 7

4 Stages of Motivational Interviewing?

Answer 7

Engagement
Collaborative relationship
Generating an accepting and trusting environment

Focussing
Raising with the patient the target behaviour and maintaining direction towards it

Evoking
Eliciting arguments for change from the patient
Use health psychology models to identify capacity, motivation, and opportunity

Planning
Developing a commitment for change
A detailed plan for action

Question 8

What are Motivational interviewing- 4 guiding principles?

Answer 8

Expressing empathy

Develop discrepancy

Rolling with resistance

Supporting self-efficacy

Question 9

How do doctors affirm and why is it important?

Answer 9

Affirmation sustains collaboration
Praising the strengths of the patient
Prompts for providing affirmation include:
i) Patient recognition of need to change
ii) Patient reflections on previous attempts that went well
iii) Elements of behaviour change that the patient has achieved (even if not all)

Question 10

How do you tell the difference between sustain talk and change talk?

Answer 10

The more a person defends their behaviour (e.g. smoking) the more committed they become to sustaining it – sustain talk

The more a person reinstates a commitment for change (e.g. stopping smoking) the more likely the change will occur – change talk

Question 11

What do you use to tell the changes?

Answer 11

Desire
Ability
Reason
Need
DARN

Question 12

Motivational Interviewing- toolkit

Answer 12

IMPORTANCE RULER
For example, if a score of 6 is given:
“Why did you not put down 5?” - identification of necessity beliefs
“What would help you move to a 7 or 8?” - identification of how to increase necessity beliefs

CONFIDENCE RULER
For example, if a score of 4 is given:
“Why did you not put down 3?” - supporting self-efficacy
“What would help you move to a 7 or 8?” -> identification of problem-solving strategies

Question 13

BCTs recommended by NICE include:
What are they effective for?

Answer 13

• Goal setting and planning
• Feedback and monitoring
• Social Support

Techniques effective for following behaviours:
* Alcohol
* Diet
* Physical Activity
* Sexual Behaviour
* Smoking

Question 14

How do goal setting & action planning?

Answer 14

• Specific
  Define precisely what/where/when/how the goal will be achieved.
• Measurable
  Define parameters to allow recognition of when the goal is complete (e.g. able to prepare 4 new healthy meals).
• Achievable
  Make sure goals are realistic for the patients level of confidence/skill.
• Relevant
  Ensure the goal meets the patient’s needs otherwise motivation is low.
• Timely
  Set a time limit for completion of the goal.