Introduction to Health Behaviour Change Flashcards
What are the 3 aspects involved in EBM
Clinician’s judgement
Best available evidence
Patient values
What are the 4 properties of BCTs
Observable
Replicable
Irreducible components
Can be used alone/in combination
Describe the evidence for using BCTs
- effect of education
- efficacy of other BCTs in isolation/in combination
- total no of BCTs found
- the most effective method
Education only => 10% of people benefitted
90% used other BCTs in isolation/in combination
93 different BCTs can be used
Most effective => self monitoring + 1 BCT
What are the 3 considerations that should be made when choosing a BCT
- 3 patient dependent factors
- 1 target behaviour dependent factors
Patient dependent
Capability
-psychological and physical capability to change
Opportunity
-cues that prompt behaviour
Motivation
-voluntary (weigh pros and cons) and involuntary processes
Target behaviour dependent
-Behaviour being targetted
Why is motivation so important
Intention, direction, persistence and termination of behaviour occurs as a result of motivation
Describe the importance of a patient centered consultation
BCT selected to target 1 or more components of COM-B framework
Target capability and opportunity at the patient level and explore the patient’s motivations
What are the 4 stages of motivational interviewing
What do they involve
Engagement
- establish rapport and build a trusting environment
- collaboration
Focusing
-raising the target behaviour and maintaining direction towards it with the patient
Evoking
- elicit arguments for change from patient
- identify capacity, capabilities, motivations and work around this
Planning
- develop a committment for change
- Make a detailed action plan together
What are the 4 guiding principles
What do they involve
Express empathy
- show that you understand the barriers they face
- no judgement
Support self efficacy
-boost their feelings of self worth and capabilities
Develop discrepancies
- evoke arguments for change
- highlight patient barriers
Roll with resistance
-work collaboratively with the patient around their barriers
What are the 4 skills (OARS)
What do they involve
Open questions
- non judgmental
- allows patient to go into detail
Affirm
- sustain collaboration, prevents defensive behaviour
- praise their strengths
Reflective listening
- paraphrase what they say
- reflect feelings underlying words and body language
Summarising
- confirm understanding by summarising patient thoughts and concerns
- collaboratively decide on a behaviour to focus on
What is the difference between sustain and change talk
Sustain talk
-the more a person defends their behaviour, the more committed they are to sustaining it
Change talk
-the more a person reinstates a committment for change, the more likely they are to change
How would you use DARN to encourage more Change talk
Desire
-encourage preference for change
Ability
- encourage reflection on skills and resources available
- discourage absence of efficacy to change
Reason
- explore their rationale for change
- try to discourage their rationale for sustaining
Need
-their use of imperatives
USE YOUR MOTIVATIONAL INTERVIEWING SKILLS TO SHIFT TO CHANGE TALK
What are the 2 types of motivational rulers
What are the 2 types of questions that you could ask for each ruler?
Importance ruler
- why not lower => identify necessity beliefs
- why not higher => identify how to increase necessity beliefs
Confidence ruler
- why not lower => support self efficacy
- why not higher => identify problem solving strategies
What are the 3 BCTs reccommended by NICE
Goal setting and planning
Feedback and monitoring
Social support
Behaviour specific guidance can be used too
Describe how you would use SMART goal setting
Specific
-precise goals
Measurable
-define parameters to allow recognition of when goal is complete
Achievable
-must be realistic for patients confidence/skill
Relevant
-goals must meet patient needs to maintain motivation
Timely
-time limit for goal completion
What else would you do when action planning
Develop action plans
Develop coping plans to prevent and manage relapse
