Encouraging and Improving Concordance

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Encouraging and Improving Concordance
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Martin Nunn

• Podiatry Service Manager
• Hotter Comfort Concept
• Lancashire

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Traditional Health Education

• Focuses on individuals responsibility to
  maintain personal health
• Considers that poor health results from failure
  to follow advice and maintain healthy lifestyle
• Absolves clinician from blame if problem fails to
  resolve

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Problems With This Approach

• Views patients as ignorant if they havent
  received information or non-compliant if they
  have
• Over-simplifies the reasons why a pathology may
  have developed
• Fails to recognise that many health problems are
  due to social constraints
• Leads to low self-esteem may worsen situation

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Changing Health BehaviourAssumptions

• Behavioural issues are common
• Change often takes a long time
• The pace of change is variable
• Knowledge is usually not sufficient to motivate
  change

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Improving Individual Compliance

• Many models developed attempting to explain
  individuals health behaviour
• Stages of Change
• Health Belief Model
• Motivational Interviewing

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Stages of Change

• Prochaska DeClement (1982) smoking cessation
• Six stages of change
• Continuous circular process
• Patient may improve or relapse
• No fixed time scale

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Termination
Maintenance
Relapse
Contemplation
Action
Preparation
Precontemplation
Source Prochaska DeClement, 1982
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Pre- contemplation

• Are not considering change
• Believe their behaviour to be acceptable
• We should
• Raise awareness
• Explore understanding of an issue

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Contemplation

• Ambivalent about change
• sitting on the fence
• We Should
• Encourage self-evaluation of pros cons of
  change
• Give Client reasons to change

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Determination

• Ready to change
• Unsure how to proceed
• We Should
• Help overcome obstacles
• Give support to achieve goal

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Action

• Engaged in new behaviour
• We Should
• Anticipate problems and address concerns
• Reinforce long-term benefits

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Maintenance

• Commitment to sustaining new behaviour
• We should
• Provide Follow-up support
• Council to cope with relapse

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Relapse

• Return to old behaviour
• We should
• Identify what triggered relapse
• Re-assess motivation barriers
• Plan stronger coping strategies

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Health Belief Model

• 1950s peoples failure to take up health
  screening in USA
• People will undertake health related actions if
  they
• Feel a negative health condition can be avoided
• Expect that by taking a positive health action,
  they will avoid a negative health condition
• Believe that they can successfully undertake a
  positive health action

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Motivational Interviewing

• Motivational Interviewing is a directive,
  client-centred counselling style for eliciting
  behaviour change by helping clients to explore
  and resolve ambivalence (Rollnick Miller,
  1995)
• Aims to enable clients to resolve their
  ambivalence or resistance to change
• Fits well into Stages of Change helps clients
  to move from Contemplation to Action

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Health Behaviour Models

• Provide a framework for understanding the process
  of how people change
• People are more likely to change if they feel
  that
• Their actions will have a positive impact
• They are personally able to carry through and
  sustain the changes they choose to carry out

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Hints and Tips

• Give clear and compassionate advice
• Identify and remove obstacles to change
• Give options
• Practice empathy
• Help the person clarify their goals
• Give clear positive feedback