Healthcare and Lifestyle Coaching

Question 1

What referrals are recommended for mild-to-moderate depression?

Answer 1

Low-intensity psycosocial intervention by IAPT.
Group-based CBT.

Question 2

Which patients should you consider referral GP for anti-depressants for?

Answer 2

A history of moderate or severe depression.
Subthreshold depressive symptoms which have persisted for at least 2 years.
Subthreshold symptoms or mild depression that persists after other interventions.
Mild depression is complicating the care of a chronic physical health problem.

Question 3

What is the 5-stage scale of depression?

Answer 3

1. Sub-threshold - fewer than 5 but at least 1 key symptoms.
2. Mild - >5 symptoms required to make diagnosis but just. Symptoms result in minor functional impairment.
3. Moderate - symptoms or functional impairment between mild and severe.
4. Severe - most symptoms present and are interfering with functioning.
5. Complex - inadequate response to multiple treatment and is complicated by psychotic symptoms.

Question 4

What are the key symptoms of depression?

9

Answer 4

Depressed mood most of the day, nearly every day.
Diminished interest/pleasure in almost all activities for most of the day, nearly every day,
Significant (>5%) weight loss when not dieting, weight gain, or decrease in appetite.
Insomnia or hypersomnia.
Fatigue or loss of energy.
Feelings of worthlessness or guilt.
Diminished concentration.
Indecisiveness.
Recurrent thoughts of death, suicidal ideation.

Question 5

What is an easy way to remember a balanced diet?

Answer 5

Each meal should have:
Proteins - 1 palm
Vegetables - 1 fist
Carbs - 1 cupped hand
Fats - 1 thumb

Question 6

What is the GROW model for feedback?

Answer 6

1. Goal setting - define a clear goal and evoke an emotional response.
2. Reality - what are the current challenges at the moment?
3. Options - use OARS. Keep things simple and in line with their lifestyle/culture/values.
4. What - what is the plan? What changes will be made, and how will we deal with obstacles? Use success boards, diaries etc.

Question 7

What is OARS model?

Answer 7

Open questions - what do you think you can change? What would you prefer to do?
Affirmation - that’s a great idea, that would be even better if…
Reflective listening
Summary reflection - summarise options to help choose.

Question 8

What technique can be used to help patients avoid triggers?

Answer 8

Shield -remove triggers from their life.
Survive - if a trigger can’t be removed, alter it so its less likely to be triggering.
Step away - if a trigger cannot be removed or altered, remove yourself from the situation.

Question 9

Normal HbA1c range

Answer 9

<6% or 42mmol/L

Question 10

Normal cholesterol

Answer 10

Total: <5mmol/L
HDL: >1mmol/L
Non-HDL: <4mmol/L

Question 11

Normal BP

Answer 11

<120/80mmHg

Question 12

Normal BMI

Answer 12

18.5-24.89
>25 = overweight
>30 = obese

Question 13

What are some good initial open-ended questions?

Answer 13

What would you like to get out of this session?
What would you like to be different when we finish this session?
What are you ultimately seeking to achieve?
What is your first step to achieving this?

Question 14

What are presuppositions and mind-reads?

Answer 14

Pre-suppositions - general statements we accept from someones language.
Mind-reads - addition of our own assumptions, emotions.

For example: “I stopped eating meat”.
Presupposition: They used to eat meat.
Mind-read: They dislike cruelty to animals.

Question 15

What are the different types of questions?

Answer 15

Closed - no opportunity for development, there is a selected number of answers.
Open - patient has freedom of answer.
Leading - insinuates a certain answer should be given.
Probing - usually used when requiring more information about a previous answer.

Question 16

When are closed questions best used?

Answer 16

To assist people with linguistic difficulties.
To give pharmacists control of the interaction.
To gather specific information.
To help embarrassed patients who may not open up otherwise.

Question 17

What is an example of a negative closed question and why should they never be used?

Answer 17

Positive: “Are you using your inhaler as prescribed?”
Negative: “Am I right in thinking you’re not using your inhaler as prescribed?”

Decreases trust, rapport, and empathy.

Question 18

What is the concept of clean language?

Answer 18

Designed to reduce any influence from the coach’s belief and assumptions by directing the patient’s attention to some aspecys of their experiences.

Question 19

What are some questions which can be used for clean language?

Answer 19

And is there anything else about…?
And what kind of …….. is that?
And where is……..?
And what happens next?
And then what happens?
And what happens just before …..?
And where could …………come from? -And that ………….. is like what?

Question 20

What questions could be used in the Goal setting section of GROW?

Answer 20

What would you like to work on?

What would you like to have after answering this set of questions (eg, a first step/strategy/solution)?

What is your goal related to this issue?

When are you going to achieve it?

What are the benefits for you in achieving this goal?

Who else will benefit and in what way?

What will it be like if you achieve your goal?

What will you see/hear/feel?

Question 21

What questions could be used in the Realty checking section of GROW?

Answer 21

What action have you taken so far?

What is moving you toward your goal?

What is getting in the way?

Question 22

What questions could be used in the options section of GROW?

Answer 22

What different kind of options do you have to achieve your goal?

What else could you do?

What are the principal advantages and disadvantages of each option?

Question 23

What questions could be used in the What section of GROW?

Answer 23

Which options will you choose to act on?

When are you going to start each action?

How committed are you, on a scale of 1–10, to taking each of these actions?

If it is not a 10, what would make it a 10? What will you commit to doing?

Question 24

What is a safe weight loss rate?

Answer 24

0.5-1kg per week.
5% in 6-12 months.

Question 25

What are the 6 constructs of social cognitive theory?

Answer 25

1. Reciprocal Determinism - interaction of person, environment, and behaviour.
2. Behavioural capability - persons ability to perform a behavior through essential knowledge and skills.
3. Observational learning - observing and reproducing a behaviour/action.
   4.Reinforcements - internal and external responses to a persons behaviour and its influence on continuation e.g., self-rewarding.
4. Expectations - anticipated outcomes of a person’s behaviour and how can they be used to influence behaviour.
5. Self-efficacy - confidence in their ability to successfully complete the behaviour.

Question 26

What is the difference between SLT and SCT?

Answer 26

Social Learning theory:
Reciprocal determinism
Behavioural capability
Observational learning
Reinforcement
Expectations

Social Cognitive theory:
+ Self-efficacy

Question 27

What is the basis of the transtheoretical model?

Answer 27

People do not change behaviours quickly and decisively. Change in behaviour, especially habitual behaviour, occurs continuously through a cyclic process.

Question 28

What is the transtheoretical model?

Answer 28

6 stages of change in behaviour:
1. Pre-contemplation - no intention to take action within 6 months. Unaware of problematic behaviours.

2. Contemplation - intend to take action within 6 months. Recognise problematic behaviours and consider pros and cons of changing.
3. Preparation/determination - intend to take action within 30 days. Start taking small steps towards changing behaviour. Can receive support and advice from HCP, as wekk as a goal-orientated programme.
4. Action - people have changed their behaviour within the last 6 months and intend to keep moving forward.
5. Maintenance - sustained behaviour change for >6 months and intend to keep moving forward. Work may need to be done to prevent relapse.
6. Termination - people have no desire to return to their unhealthy behaviours and aren’t at risk of relapse. Very rare that people reach this stage.

Question 29

What is behaviour procrastination/chronic contemplation?

Answer 29

Where patients who are contemplating changing problematic behaviours weight up pros and cons and decide the pros do not outweigh the cons at this moment. They will continue contemplating until an event changes their mind.

Question 30

How to convey empathy?

Answer 30

Simple reflection - acknowledge emotion presenting.
+
Complex reflection - convey a deeper picture understanding

Question 31

What is the rational man theory? What are some assumptions it makes?

Answer 31

People decide how to behave by weighing up the costs and benefits of each choice and choose the action that maximises their expected benefits.

It assumes people behave in a solely self-interested way, cognitively deliberate each decision they make, and don’t at all care about the fall-out consequences of their actions.

Question 32

What is the Fogg Behaviour Model?

Answer 32

The Fogg Behavior Model shows that three elements must converge at the same moment for a behavior to occur: Motivation, Ability, and a Prompt. When a behavior does not occur, at least one of those three elements is missing.

Question 33

What are the 3 types of motivators on the Fogg model?

Answer 33

Pleasure-pain
Hope-fear
Social rejection-social acceptance

Question 34

What are the 3 types of triggers/prompts in the Fogg model?

Answer 34

Facilitator - make it easier so increase ability.
Spark - increase motivation.
Signal - trigger which doesn’t affect motivation or ability.

Question 35

What is SBAR?

Answer 35

Situation - identify yourself, the patient, and describe the concern.

Background - any relevant medical history.

Assessment - key diagnostic information and clinical impressions. Provide assessment of the issue.

Recommendation - explain what you need to happen.

Question 36

What is the discharge medicines service?

Answer 36

Checking similarities and differences between medicines regimen before and after hospital stay.
Assess patients understanding of new medicines, any changes, and offer to dispose of old unneeded medicines to prevent confusion.