SELF CARE Understanding Behaviour Change

1
SELF CAREUnderstanding Behaviour Change

• Lisa Newson

2
Overview

• Introduction/ background
• Context of self-care management
• Training proposal

3
Health Psychology

• Integration of psychological understanding into
  the promotion, prevention and treatment of
  health.
• Collaboration of approaches- bio-psycho- social
  model, as apposed to primary medical model
• Personal Background
• Training focus Behaviour change techniques
• Specialist interest Lifestyle change (eating
  behaviour)

4

• Health Promotion Disease Prevention Illness
  management
• REQUIRE
• BEHAVIOUR CHANGE
• Including psychological emotional adjustment

5
This person needs to deal with

• Information and education
• Acceptance
• Identification with illness
• Beliefs
• Attitudes
• Emotions
• Management of condition etc.
• AND ACT UPON THEM

6
Stages of Change
7
PROCESS of CHANGE
Preparation
Action
Contemplation
Maintenance
Pre-contemplation
Relapse
8
Stages of ChangeThe model

• Process of Change
• The techniques used to proceed through a stage

9
PROCESS of CHANGE
COGNITIONS- Beliefs Attitudes Understanding Commit
ment Confidence BEHAVIOURS- What, when, how,
why Problem solving EMOTIONS COPING
EDUCATION INFORMATION MOTIVATION CONFIDENCE RE
LEVANT Review barriers to change
Preparation
Action
Contemplation
Maintenance
Pre-contemplation
Relapse
10
Sothe process of the stages of change is in the
hands of the client, along with the specialist
support of the lifestyle services (if accessed)
Preparation
Action
Contemplation
Maintenance
Pre-contemplation
Relapse
11
However..

• A person diagnoses with Heart disease, diabetes
  etc, does not have the luxury of time to process
  through these stages.
• Therefore

12
Illness
ACTION REQUIRED
Preparation
Action
Contemplation
Maintenance
Pre-contemplation
Relapse
13
Patients Perception Vs. Health Professionals
Perception
14
..

• The role of many health professionals is
  wider than helping with tailored lifestyle
  change, and requires knowledge and bio-medical
  information/ procedures (i.e. practice nurse).
  Helping a range of clients, through allsorts of
  procedures.
• Therefore, although the nurse may have behaviour
  change skills available, does the practice nurse
  have enough skills in the toolbox to understand
  the patient and help them make these changes?

15
Already skilled

• To a point yes.
• But why aren't people changing their lifestyle
  behaviours, or adhering to medication?
• Possibilities
• Are we all using the same approach?
• Do staff have time to use techniques training in?
  Do staff use techniques?
• What do staff do when they have used 1 approach
  and client still struggling?

16
How do we enhance staff skills

• Staff require a variety of skills
• Skills are communication based, and success
  depends on the individual client and health
  professional working together.
• This does not have a standard medical protocol
  and so No one consultation is the same as another

17

• Therefore any training for staff around
  communication issues to enhance behaviour change
  should be
• Able to offer a variety of techniques and
  approaches.
• Be used alongside the client to empower them to
  take responsibility
• Be able to use in case management with colleagues
  as a support aid

18
Training

• Should enhanced staff skills which enable them to
  provide quick effective techniques to
• Help understand clients perspective better
• Work with client in behaviour change way
• Be focussed on the application of techniques and
  not the theoretical or background development of
  the technique
• Should be suitable for the health professionals
  daily role (2 mins- 20mins of time)

19
Skills required to help a person proceed through
the stages
Cognitive behavioural techniques
Brief Skills (i.e. 5As)
Preparation
Action
Leventhals model of self-regulation
Contemplation
Maintenance
Motivational Interviewing
Pre-contemplation
Solution focused brief therapy
Relapse
Others available
20

• Proposal
• (as per info received Brief
• How to begin to incorporate training into current
  working practices. Proposal subject to change to
  meet agreed requirements)

21
3 Tiered Training Model

• Level 1 Basic overview (all staff)
• Supported by Wirral e-learning behaviour change
  CD
• Level 2 An introduction to Tools and Techniques
  to encourage self-care management
• Level 3 Advance behaviour change module

22
Level 2

• Series of educational and practical training
  sessions on various tools and techniques which
  can been applied during consultation with the
  client, and/or can help the HP gain insight into
  the perspectives of their clients.
• Suggestion to pull together variety of techniques
  into one training level. (for example separate
  evidence based courses exist on individual
  techniques e.g. motivational interviewing,
  Solution Focused, Cognitive behavioural etc.
  This new way of working would bring together the
  main element of these applied techniques to use
  in practical settings.

23
Content

• Models to understand clients perspective-
  beliefs, attitudes, knowledge, coping etc
• Tools to empower the client to take
  responsibility for self-care management
• Alternative techniques to prevent the health
  professional feeling frustrated/ unskilled.

24
Sessions

• Recommend 3/4 days training
• Each day split into
• Part 1- educational training session (Group)
• Part 2- practical application of techniques into
  working practice
• Equates to
• 4 ½ day release into training sessions
• 4 ½ days to implement and reflect on techniques
  within practice.
• Practical element demonstrates application of
  techniques
• Evaluation from clients.is this a more
  successful approach?

25
Practicalities of providing proposed training
model

• Delivery
• practical NOT theoretically driven
• Medical thinking vs patient thinking
• Trainers
• Background/ approach

26
Recommendation

• Train the Trainers course
• Provide trainers with knowledge of variety of new
  techniques and model and how to promote these
  methods to staff
• Demonstrate how to adapt current teaching and
  learning techniques to demonstrate these skills
• Provide Resources for training use?