Introduction to Health Behaviour Change

Question 1

What are the 3 aspects involved in EBM

Answer 1

Clinician’s judgement
Best available evidence
Patient values

Question 2

What are the 4 properties of BCTs

Answer 2

Observable
Replicable
Irreducible components
Can be used alone/in combination

Question 3

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

Answer 3

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

Question 4

What are the 3 considerations that should be made when choosing a BCT

• 3 patient dependent factors
• 1 target behaviour dependent factors

Answer 4

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

Question 5

Why is motivation so important

Answer 5

Intention, direction, persistence and termination of behaviour occurs as a result of motivation

Question 6

Describe the importance of a patient centered consultation

Answer 6

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

Question 7

What are the 4 stages of motivational interviewing

What do they involve

Answer 7

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

Question 8

What are the 4 guiding principles

What do they involve

Answer 8

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

Question 9

What are the 4 skills (OARS)

What do they involve

Answer 9

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

Question 10

What is the difference between sustain and change talk

Answer 10

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

Question 11

How would you use DARN to encourage more Change talk

Answer 11

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

Question 12

What are the 2 types of motivational rulers

What are the 2 types of questions that you could ask for each ruler?

Answer 12

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

Question 13

What are the 3 BCTs reccommended by NICE

Answer 13

Goal setting and planning
Feedback and monitoring
Social support

Behaviour specific guidance can be used too

Question 14

Describe how you would use SMART goal setting

Answer 14

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

Question 15

What else would you do when action planning

Answer 15

Develop action plans

Develop coping plans to prevent and manage relapse

Question 16

What are implementation intentions (if then planning)
How would you do this
Who should be dominant in this process

Answer 16

Aims to manage habits and prevent relapse
Identify cues that could hinder progress and generate plans to overcome barriers

Plans must be generated by the patient

Question 17

Describe the purpose and function of feedback and monitoring

Answer 17

Provides feedback on behaviour and outcomes
Allows patient and practitioner to identify links between cues and behaviours
-implement new If Then plans

Helps identify when target behaviour achieved
Supports self efficacy

Question 18

Describe the importance of social support
What can they do?

What should you try to avoid

Answer 18

Arrange for friends, relatives, colleagues to

• provide practical
• emotional
• motivational support

BUT identify potential -ve social contacts too