introduction to behaviour change Flashcards
what is the problem with behaviour change
- is a complex process and can be struggle
- ambivalence is a normal part of process
- limits to what can be achieved with advice alone
why is good communication important
- to build rapport
- ## good rapport directly correlates with patient behaviour change
what are the 3 consulting styles
- directing
- following
- guiding
- need to be able to use all 3 in a consultation
what is directing
- delivery of expert advice
- traditionally dominant within healthcare
- best employed when there is good rapport between patient and dentist
- should be well-timed, personally relevant and delivered in such a way as to engage the patient
what is following
- utilising listening skulls, and occurs in situations where sensitivity is not required such as when patient is upset
- goal of the clinician is not to solve patients problems immediately
- aims to provide support and encouragement in difficult situations such as breaking bad news
what is guiding
- more complex then other two
- patient and clinician work together to help patient identify their goals
- useful for those unsure about change
what are the 4 main communication skills for guiding style
- OARS
- o =open questions (gives deeper understanding for patient view)
- a= affirmation (demonstrate appreciation for efforts)
- r=reflective listening (take elements picked up from patient and reflect back)
- s= summary
why is how you ask questions important
- provides valuable information
- gives opportunity for patient perspective
- never give advice without gathering all information first
- helps clinician understand patient
how do we provide support
- demonstrates an appreciation for patients efforts and reinforces positive acts
- can build patients confidence that they can change
- people respond to positive encouragement rather than shaming
how do you convert understanding
- reflective listening
- acknowledge that you hear what they said and understand
how do you get information across
- assess what patient already knows and understands
- provide further information
- find out what the information means for the patient
how do you bring it all together
- summary
- summarise what they have told you and reflect it back to them
what are important features for behaviour change counselling
- not blaming them for their ill health
- patient-centred method
- directive- practitioners are encouraged to provide clear structure to consultation
- negotiation - patient encouraged to make positive changes in collaboration with practitioner
what is the cycle of behaviour change
precontemplation contemplation preparation action maintenance relapse
what are the 3 different categories for behaviour change
precontemplators
contemplators
preparation
what are precontemplators
- not interested in changing
- don’t want to change
what are contemplators
- want to change sometime in the future
what are preparation
- want to change now
what are some changes on behaviour that practitioners focus on
- eat less, different foods
- drink less, abstain
- smoker fewer cigarettes
- take up/modify OH
how do you establish rapport
- any question that might help you understand the patient better
- use of smoking, diet diaries
- various apps, wearable technology
how do you set an agenda
- single or multiple
- multiple behaviours = smoking and alcohol, patient at risk of oral cancer, obesity, diet
- diet and toothbrushing
- or singly
- smoking and alcohol is usually addresses individually
what two things are important for readiness to change
- importance
- confidence
why is importance needed
- individual has to see value in change
- has to be important to patient
- personal values and expectations of the importance of change
why is confidence needed
- individual has to be confident they can change
- self-efficacy
- need to believe in themselves
what is a patient with high confidence/low importance like
- know they can change, but don’t want to
what is a patient with low confidence/high importance
- they know they want better , but they doubt themselves and think they won’t manage
- often smokers exhibit this
what are 2 ongoing tasks with behaviour management
- exchange information
- resistance
how do you exchange information with patients
- on patients terms, pitched at the right level
- may pass on same type of information but the way you present it to different patients can vary
how do you deal with patient resistance
- can sometimes feel the barrier between the two of you
- emphasis personal choice and control
- back off and come alongside patient
