Patient Education & Behaviour Change Flashcards
How do you implement lifestyle modification?
Patient education focusing on
- Increasing intrinsic motivation
- Decreasing reliance on extrinsic motivation
What are the 6 principles to guide adult education?
- Need to know (benefits, info that applies to them)
- Self-directed approach
- Prior experiences influence learning (knowledge of benefits, existing skills, attitudes/beliefs)
- Readiness to learn
- Problem-centred approach to learning
- Motivation to learn
What are the cultural considerations for patients?
- Assess & incorporate patient’s perceptions & beliefs
- Conduct patient education in a culturally appropriate manner
- Use interpreter services
- Translate written materials
- Use multimedia resources
What is health literacy?
Cognitive & social skills that determine the motivation & ability of individuals to gain access to, understand & use info in ways which promote & maintain good health
What is the relationship between chronic conditions and health literacy?
In patients with chronic conditions, inadequate health literacy is associated with poor knowledge of their disease & medications
What is low individual health literacy associated with?
- Higher rates of hospitalisations & emergency care
- Lower uptake of preventative approaches e.g. mammography & flu vaccine
What are the risk factors for inadequate health literacy?
- Elderly
- Low income
- Didn’t finish high school
- Minority ethnic group
- English as a second language
- Recent immigrant
What are the health literacy communication principles?
- Use plain language
- Include visual images
- Limit the amount of info provided at one time & repeat it
- Encourage questions
What are the considerations when designing printed education materials for patients?
- Make sure purpose is clear to the patient
- Use at least 12-point font
- Write in the active voice (you, I)
- Aim for year 5-6 reading level
What are the considerations when organising printed education materials for patients?
- Keep content clear, simple & concise
- Use one & two syllable words
- Use short sentences & paragraphs
- Provide examples
- Focus on what info the patient needs
What are the considerations for presentation of printed education materials for patients?
- Use adequate spacing with lots of white space
- Use dark print on light background
- Use illustrations that are clearly labelled
How should education be implemented?
- Reinforce learning through repetition (written, video, audio etc)
- Use professionally developed written materials where possible
- Provide opportunities for individual & group education
- Seize the teachable moment where possible
How should education be delivered in a group environment?
- Cut down on non-critical health education
- Tailor education & info to patients’ needs
- Deliver in an interactive way
- Include fun, humour & activity
- Welcome carers
- Use local experts
How should education sessions be evaluated?
- Outcome measures (knowledge, behaviour change, self-efficacy, QOL, satisfaction etc)
- Use ‘teach back’ method to ensure patient has understood
What are the stages of the health change approach (HCA)?
- Knowledge & understanding
- Motivation
- Decision/commitment to action
- *Decision line**
- Planning
- Action
- Self-regulation
What are the BEST barriers to behaviour change?
- Behaviours (ingrained habits, lifestyle behaviours)
- Emotions (moods, emotional reactions)
- Situations (finances, medical conditions, social supports)
- Thinking (beliefs, attitudes, expectations, motivation)
What is the RICK evaluation?
Used to assess patients’ readiness to change
- Readiness
- Importance
- Confidence
- Knowledge
What are the characteristics of behavioural goal setting?
- Builds individual’s ability to manage their chronic condition in the long term
- Collaborative process of exploration & confidence-building
- Supports self-management
- Patient has equal role in goal setting
What should be considered before starting goal setting?
Assess/identify areas that may impact self-efficacy or confidence
- Enablers of behaviour change
- Beliefs about the need for change
- Barriers to behaviour change
- Stage of change
- Past experience with attempts to change
What happens in the pre-contemplation stage of change?
Help move towards the possibility of changing behaviour e.g. discuss risks & benefits
What happens in the contemplation stage of change?
Support patient in making the decision to change e.g. discuss pros & cons, suggest ways
What happens in the preparation stage of change?
Support patient to change behaviour e.g. discuss ways, develop action plan
What happens in the action stage of change?
Support patient to continue, e.g. reinforce health benefits
What happens in the maintenance stage of change?
Support patient to continue
What are the considerations for one-on-one consultations?
- Consider RICK at all times, but be flexible
- Ensure the patient is ready to work on a health issue before setting goals
- Before the patient leaves, ensure they are confident they can do all the things discussed
What are the considerations for group education session?
- Advise participants not to attempt too many changes at once
- Create menu of options
- Incorporate education about health behaviour change
- Consider asking participants to set goals & create action plans
- Discuss strategies to maintain skills & behaviours
What are the characteristics of the ‘spirit’ of motivational interviewing?
- Collaborative
- Evocative
- Honouring patient autonomy
What are the 4 guiding principles of motivational interviewing?
RULE
- Resist the righting reflex
- Understand the patient’s motivations
- Listen to the patient
- Empower the patient
What are the key aspects of motivational interviewing?
- Open questions
- Ambivalence
- Change talk
- Motivation (importance + confidence)
- Reflective listening
- Inform (ask permission first)
- Listening for commitment
What is an example of a type of change talk?
DARN
- Desire (I want to change)
- Ability (I can change)
- Reason (It’s important to change)
- Need (I should change)
What is an acronym for the key aspects of motivational interviewing?
OARS
- Open-ended questions
- Provide affirmations
- Reflect, use active listening
- Summarise
What did Vong et al 2011 find regarding motivational interviewing?
- Compared PT +/- MI
- Patients receiving both had significantly better motivation outcomes, physical capacities, self-perceived general health & home exercise compliance
