Motivation, Adherance, and Collaborative Care Flashcards
What is Motivation?
Motivation-the psychological feature that arouses an organism to action toward a desired goal
What is Adherence?
Adherence-choosing to engage in behaviors of one’s own volition
What is Compliance?
Compliance-engaging in behavior as instructed or prescribed by a healthcare professional
(Doing what others want or ask rather than being driven by an inner desire)
What are four concepts related to Motivation and adherence?
- Locus of control
- Self-efficacy
- Self-esteem
- Social determinants of health
What is the difference between an internal and external locus of control?
Preconceived notions about what will happen
- Internal Locus of Control
- Self-motivated
- Follow treatment protocols because they think they make a difference
- External Locus of Control
- Believe what happens is result of outside influences/events
- Believe efforts will not make a difference
Is locus of control a fluid concept that can shift or a static concept that stays the same?
It is a Fluid Concept→ Can shift
What is self efficacy?
Sense of competence and ability to complete a task
How might someone with low self efficacy respond to a task?
may avoid a task
How might someone with high self efficacy respond to a task?
why?
High self-efficacy-may continue a task even if having difficulty
Thy have Better coping ability
Is self efficacy a dynamic or static concept?
Dynamic
What are three ways to improve self efficacy?
- Observing others’ accomplishments
- Learning to complete tasks successfully
- Introduction to role models
What is something that self-efficacy is related to?
Related to outcome expectation
What are outcome expectations?
What a pt thinks their actions will result in
(their expectations about the outcome of their actions)
What is self esteem and how might in affect motivation?
Self esteem: How individuals feel about themselves
- High self-esteem-more motivated to be an active participant
- Low self-esteem-may decrease motivation
What are three things that can affect someone’s self-esteem?
(Corrected Card!)
- Ability to control one’s appearance
- Compliments
- Alterations in body image
(Corrected card)
What might low self-esteem be a symptom of?
Low self-esteem may be a symptom of depression.
What is the difference between self-esteem and self-efficacy?
Self-Efficacy - client’s perception of their ability to be successful at a task
Self-Esteem - how a patient feels about themselves (more about self-worth than direct ability to be successful)
What are three categorires of social determinants of health?
- Cultural Factors
- Community Resources
- Social support
What are two cultural factors that can affect health/motivation?
Beliefs and values
Role of family and community
What are two Community Resources factors that can affect health/motivation?
Lack of knowledge
Lack of money/transportation
What are three Social Support factors that can affect health/motivation?
Caregivers, spouse, family
What are 5 positive effects of having more social support?
- More optimistic
- Less depression and anxiety
- Higher self-esteem
- Better quality of life
- Adherence to more treatment interventions
What are 2 negative effects of having a lack of social support?
Lower levels of motivation
Non-adherence
What are two examples of how social factors can influence health behaviors?
- College and drinking habits: hanging out with other college students who like to drink can result in heavier drinking yourself
- The way family stress can influence your ability to adhere to an exercise program
What is our goal in regards to social support?
Our goal is to empower our patients and give them resources.
What are 6 potential barriers [categories] to motivation and herence? TO HELP
- Time, Family, and occupation
- Other
- Health
- Environment
- Lack of Supervision and Direction
- Psychosocial factors
What are 5 health barriers to motivatoin and adherence? UPP-FM
- Unhealthy behaviors,
- Perception of poor health,
- Physical illness
- Fear of adverse events,
- Medication side effects,
What was the most important determinant of exercise adherence in older adults?
What about this makes them more/less likely to adhere?
In older adults: biomedical status the most important determinant of exercise adherence
More likely to adhere if they have a serious or acute condition
List 11 ways to improve motivation and adherence GEM2 FITS3
- Goals- negotiated, specific, challenging, yet attainable
- Education
- Modify health behaviors (theories)
- Motivational interviewing
- Functional programs
- Interaction strategies- Patient/Client-Practitioner
- Technology
- Strategies- Control enhancing
- Social support- Increase
- Self-efficacy- Increase
What are 5 interventions that can help improve a patient’s adherance using a self-efficacy approach?
- Verbal encouragement
- Goal setting
- Role modeling (Successful experiences of other patients)
- Mastery experiences
- Decreasing unpleasant experiences
What is role modeling?
Exposing the patient to successful experiences of other patients
What are three (3) important things to educate pts on to increase motivation and adherance?
- Condition,
- Benefits of exercise, and
- How to exercise
Education: What are three things to consider about what students remember?
Students remember:
- 10% of what they read
- 80% of what they personally experience
- 90% of what they teach to others
Education: what are keys to remember? (what should PTs do or consider) (5-6)
C2ARLI
Keys to Remember:
- Be Culturally sensitive
- Consider pt’s level of pain, worry, or concern
- Let pt Ask questions
- Repeat or demonstrate a behavior
- Consider pt Learning style
- Avoid Information overload
Why is it important to individualize patient motivation?
Some pts may be motivated by a certain thing that does not motivate others
(like dogs are motivated by dog treats, but people are not)
What are 8 things that may affect motivation that may or may not be personally motivating to your patient?
PatientsBAILS2
(almost the same as things that affect motivation and adherance from previously in the presentation)
These are things that may or may not matter to your individual patient
You should determine and pay attention to if they are personally motivating to your pt or not
- Patient-practitioner interaction (amount of trust the pt feels between pt and practitioner is important)
- Personal Attributes: Patient personality, self-determination, and resilience
- Beliefs about outcomes (example: pt may be hesitant to do something they believe will cause pain)
-
Ability to develop personal goals and evaluate performance
- how much the pt is involved in goals
- how well the PT and pt can and does monitor progress towards goals
- Individualized care (how careful a PT is to make the exercise plan, etc. specific to the pt and how much the pt feels like they are being treated for thei specific problem and circumstance)
- Locus of control: Internal or external
- Self-efficacy
- Social support (especially pts Role as caregiver or receiver of care)
Older adults vs younger adults: Do older adults have greater or less self-regulatory capacity? Why?
Greater self-regulatory capacity mostly due to a lifetime of experience
Do Older adults respond better to empahsizing positive outcomes or negative outcomes?
They respond better to emphasizing positive outcomes
What are three examples of positive outcomes that older adults respond to emphasizing?
- Positive outcomes of Engaging in a behavior
- Avoiding regret
- Maximizing satisfaction
Do older adults respond better to immediate benefits or long-term benefits of behaviors?
Specifically interested in immediate benefits
Do not respond well to long-term benefits
Do older adults focus more on positive or negative emotions?
How might this affect the role of their emotions in behavior change?
Older adults are Focused more on positive than negative emotions.
Disappointment is less likely to undermine behavior change in older adults than younger adults
T/F: Older adults are very interested in information seeking when making a decision compared to younger adults
False
- Older adults are Less interested in information seeking when making a decision
- They rely more on intuition, gut feelings, and simple heuristics
What are three theories of behavior change that were focused on in the presentation?
Health Belief Model
Transtheoretical (stages of change) Model
Five A’s Behavioral Intervention Protocol
What are three theories of behavior change that were mentioned but not talked about in detail in the presentation?
Social Cognitive Theory
Self-Determination Theory
Humanistic Theory (Maslow’s Hierarchy)
Foundation of Health Belief Model: What is readiness to change based on and what does this include?
- Readiness to change is based on health beliefs
- Includes understanding of what causes the problem
Foundation of Health Belief Model: What are two things that choices are influenced by?
Choices are influenced by
- The value people place on a potential outcome
- Belief that course of action would result in desired outcome
What are the 6 componenets of the Health Belief Model?
6 Components
- Perceived Benefits [of change]
- example: didn’t understand that the goal of flossing is to disrupt the bacteria every 24 hours to keep it from gaining a foothold. didn’t understand why mouthwash wouldn’t work just as well until dentist educated me on this.
- Perceived Barriers [to change]
- I was rushed in the morning and sleepy in the evening, which made it harder for me to floss
- the floss was hurting my fingers, so the dentist showed me how to do it without hurting my fingers. Dentist also said that, although they were not as ideal as floss, I could use the little individual flossers because I said they are easier for me to use.
- Perceived Severity
- Perception of how bad consequences of not changing would be
- I didn’t think my not flossing would lead to anything very bad as long as I saw the dentist every year. Then I got a cavity that was bad enough for the dentist to recommend a root canal (which is lots and lots of $). The cavity was between my teeth where my tooth brush could not reach (but floss could). I then understood how bad it could be.
- Perceived Susceptibility
- Perception of likelihood that consequences could apply to them
- I knew that others get cavities and root canals, but I didn’t think I would get a cavity that bad. I learned that I was suceptible when I got the bad cavity between my teeth that a root canal was reccomended for.
- Cues to Action
- Significant event that causes person to want to take action
- The fact that I got a bad cavity was a big wake-up call that made me want to start flossing and protect my other teeth.
- Putting a sign next to my bathroom mirror that asked if I wanted to pay for a root canal or floss even when I was tired in the evening.
- Keeping the flossers by my tooth brush to remind me to floss when I saw them each night.
- Self-Efficacy
- Belief that one can successfully make change
- I believed I could perform flossing correctly
What does the Transtheoretical Model emphasize?
Emphasizes behavior change over time
How many stages does the transtheoretical model have?
How long does a person typically stay in each stage?
6 Stages that person may stay in for varying lengths of time
What are the 6 stages of the Transtheoretical Model?
- Precontemplation
- Contemplation
- Preparation
- Action
- Maintenance
- Termination
What mainly defines the precontemplation stage?
What are three things that may be affecting the pt in this stage?
What can we do to help?
Precontemplation: No intention of changing in next 6 months
- May be under-informed
- May have given up trying
- May feel pressured by others
We can help patient identify personal goals & build rapport
Transtheoretical Model: Each stage presents us with an ________________ to
influence the pt and . .. .
Transtheoretical Model: Each stage presents us with an opportunity to influence the pt and help them reach the next stage.
How can the transtheoretical model assist us with helping our patients change?
If we identify which stage a pt is in, we can better meet them where they are at in the continuum of change and assist them in more personalized and appropriate ways.
What mainly defines the contemplation stage?
What can we do to help?
Contemplation: Considering change within next 6 months
We can ncourage them, provide additional resources, & reduce barriers
What mainly defines the Preparation stage?
What can we do to help?
Preparation: Plan to action within next month
We can Engage patient in planning alternative ways to reach goals
**One source said they “Know what they need to do” but other sources have said we can help them with figuring out and planning how to take action to make a change.
What mainly defines the Action stage?
What can we do to help?
Action: Pt is actively engaged in making change
We can engage patient in POC and relapse prevention strategies
What mainly defines the Maintenance stage?
What can we do to help?
Maintenance: pt Has maintained change for > 6 months
we can Assist patient with thinking of ways to avoid boredom and prevent relapse
What mainly defines the Termination stage?
What can we do to help?
Termination: Pt Has incorporated positive lifestyle changes (behavior has become almost automatic)
- Pt is Confident they will not return to “old ways”
- example: brushing my teeth is automatic, but flossing is not yet
We will probably not be seeing this patient anymore to work on this behavioral change.
**There is Some debate over whether this stage exists (some sources leave it off’ I have also heard it called termination/relapse because sometimes people relapse to any of the other stages from the Maintanance stage instead of habituating the behavior)
What is the Five A’s Behavioral Intervention Protocol good for?
It Provides format for interacting with clients
It is based off several behavior change theories (Transtheoretical influences it the most) and has been show to be easy to use, quick, and useful for improving behavior change.
What are the Five A’s from the Five A’s Behavioral Intervention Protocol?
Explain them briefly
Provides format for interacting with clients
- Address the now
- Get patient’s attention, name problem, & present need for intervention
- Assess the clients
- Determine the stage of change and identify barriers to change
- Advise the clients
- Patient education
- Assist the clients
- Help patient make change; negotiate an agreeable plan of care
- Arrange for follow up
- Behavior change usually requires more than one visit
*
What does the “University of Rhode Island Change Assessment (URICA): Short Form for Physical Health Behavior State” do?
It is a questionnaire that can be used to determine which stage of change in the Transtheoretical Model a pt is in for exercise/diet behaviors
(it was an outside resource for the presentation)
List 6 things that can increase adherence of HEP: (what the PT could do)
- Giving patient positive incentives
- Giving feedback about their progress and treatment
- Providing clinical knowledge
- Giving reminders
- Monitoring results and adherence to exercise program
- More time spent educating patient on expectations of rehabilitation and prognosis
List 6 things that can decrease adherence of HEP:
- Lack of time to exercise
- Inability to fit exercise into everyday routine
- Complexity of the exercise
- Poor care provider’s style
- Cultural barrier
- Instructions aren’t clear
List 9 considerations for a good HEP
- Length
- Stage of healing
- Tissue irritability/ symptom stability
- Daily activities
- Time between visits
- Patient’s time and willingness to participate
- Patient’s goals
- Cognitive level
- Cultural background
What is learning style?
Why is it important for HEP prescription?
Learning style refers to how information is processed by a pt and is Unique to every individual
Need to use individual pt’s learning style to adjust treatment and HEP
What are 3 primary dimentions of Learning Style?
- Content (Detailed learner or Main idea learner)
- Initiative (Active or Passive)
- Tactics (Analytic or Creative)
Describe the two parts of the Content dimension of learning style
Detailed learner
- do better with Step-by-step instructions, and pay less attention to overall goal
Main idea learner
- are Eager about overall goals and give less attention to specifics
Describe the two parts of the Initiative dimension of learning style
Active
- pt gives High degree of attention and has lots of questions
Passive
- Needs a lot of encouragement to participate
Describe the two parts of the Tactics dimension of learning style
Analytic
- pt is Better with step-by-step instructions and structure
Creative
- pt enjoys More open ended instruction
How would you treat a patient who has a detail learning style?
Make sure to address details and focus more on the details than the big picture
(i think)
How would you treat a patient who has a main-idea learning style?
focus more on the overal reasons for the HEP and the ultimate goals of the exercises.
(I think)
Would an active or passive learning style be bigger challenge?
passive learning style
Would an analytical or creative learning style be more helpful for problem solving and shared decision making?
I think LB said more creative would be more helpful because they will be open to more options and are more open to creativity involved in shared decision making?
II think)
Why is collaboration between pt and clinician important?
Clients conceptualize their needs in terms of functional abilities and resources in order to return to pre-morbidity status. Therefore, it is important as health care providers that we take these conceptualizations into account and not view a patient as simply a diagnosis and .
Importance of Collaborate care (pt with clinician): What is something we should keep in mind about adult learners?
Adult learners seek involvement in their care, and are better motivated when allowed to do so.
Why is colaborative goal setting (between pt and clinician) important?
Collaborative goal setting: important for establishing empowered patients which take accountability for their own therapy.
What are three ways you can encourage collaborate goal setting between pt and clinician?
- Try to understand the patient’s perspective.
- Gather pts explicit expectations for recovery.
- Provide opportunities for patients to make choices regarding their treatment.
What are two benefits of collaborative goal setting between pt and clinician?
- Client satisfaction has been shown to be higher in patients involved in collaborative goal setting.
- Clinical outcomes are improved with increased patient input on goal setting and treatment planning.
Collaboration between health care professionals: what are two things that health care providers generally agree upon about plans of care?
Studies show health care providers generally agree that plans of care should be:
- Client centered
- Involve collaboration of all healthcare providers
Collaboration between health care professionals: what is a big benefit?
Expertise can be shared between the team of health care providers in order to best evaluate and meet the needs of the patient.
US Healthcare vs Canada: How do citizens usually pay for healthcare?
US:
- Majority of individuals insurance through employment, followed by government and direct purchase. Still some 30 million individuals not covered.
Canada:
- Universal Healthcare
US Healthcare vs Canada: What are 4 points about healthcare in the US
US:
- Majority of individuals insurance through employment, followed by government and direct purchase. Still some 30 million individuals not covered.
- Shorter wait times for specialty care.
- Greater share of total nation’s expenditures (per capita).
- Competition for services between providers seeking reimbursement often makes it more difficult for interprofessional collaboration.
US Healthcare vs Canada: What are 6 points about healthcare in Canada
Canada:
- Universal Healthcare
- Longer wait times for specialty care
- Lesser share of total nation’s expenditures.
- Higher life expectancy
- Lower infant mortality rate
- Often used as a model when discussing interdisciplinary care for patients (greater collaboration, less competition between healthcare providers).
True or False: most clinicinas involve pts in treatment planning on a regular basis
False
Most clinicians involve patients in their treatment planning far less than optimal levels,
What are 6 common barriers to collaboration between pt and clinician?
- Client mental disability
- Patient lack of interest in collaboration.
- Provider lack of time
- Practitioner desire to maintain power or control over situation
- Therapist failure to identify exactly what the patient desires to achieve and in what manner they wish to achieve it
- Inadequate knowledge on how to collaborate on treatment planning. This may require some patient education
what are 4 strategies to improve collaboration between pt and clinician?
- Asking clients to identify the biggest problems they feel they are facing in overcoming or managing their illness.
- Gather information on patient beliefs regarding their own role in recovery, the role of the health care provider and how they define terms such as goals, and outcomes.
- Use of the Ozer-Payton-Nelson (OPN) model which is designed to elicit appropriate functional goals from patients. The model emphasizes using open ended questions to allow the patient a chance to verbalize exactly what needs they require.
- Client education on collaborative treatment planning.
What is the Ozer-Payton-Nelson model
OPN is a model designed to elicit appropriate functional goals from patients. The model emphasizes using open ended questions to allow the patient a chance to verbalize exactly what needs they require.
It can help improve collaboration between pt and provider
Many ________ __________ may affect a pt’s motivation and adherence to exercise.
Many psychosocial concepts may affect a patient’s motivation and adherence to exercise.
T/F: It is not important to identify differences in pt motivation
False
•It is important to identify differences in patient motivation
what could theories of change help us with?
•Theories of change can help us determine where a patient lies on the continuum of change and assist us in helping them change
Tell me about treatment and HEP in relationship to pt’s preferred learning style? (1 sentance summary)
•Treatment and HEP should be adjusted to match a patient’s preferred learning style
Both _________ ________ and __________ __________ are improved with collaborative care
•Both client satisfaction and clinical outcomes are improved with collaborative care
What is our overall job that summarizes the purpose of this presentation?
Our job is to identify barriers to motivation, adherence, and collaboration and find strategies to overcome them
What are three things that can affect someone’s self-esteem?
(Corrected Card!)
- Ability to control one’s appearance
- Compliments
- Alterations in body image
(Corrected card)
