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SELF CARE Understanding behaviour change and its context

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But why aren't people changing their lifestyle behaviours, or adhering to medication? ... his behaviour, he continues to smoke, even though he agrees he should ... – PowerPoint PPT presentation

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Title: SELF CARE Understanding behaviour change and its context


1
SELF CAREUnderstanding behaviour change and its
context
  • Jane Briers, Lisa Newson
  • Knowsley PCT

2
The purpose of this presentation is to..
  • Look at the policy drivers around self care.
  • Gain insight into the different techniques that
    could be used to support self care.
  • Look at what is currently available
  • Generate discussion as to the best way forward

3
GLOBAL World Health Report 2002, Reducing
risks, promoting a healthier lifestyle.
  • These are dangerous times for the well being of
    the world..
  • Too many of us are living dangerously whether
    we are aware of it or not
  • Emphasises that it is now not just the wealthier
    nations that has these problems, but these are
    becoming more prevalent in the developing world,
    where they create a double burden on top of the
    infectious diseases that still afflict poorer
    countries.

4
WANLESS 2002
  • more success in public health a substantially
    larger positive impact on health needs from the
    focus on health promotion and disease prevention.
  • development of improved health information to
    help people engage with their care in an informed
    way
  • in parallel with improved information, the use of
    pro-active policies to encourage reductions in
    key health risk factors

5
Choosing Health?
  • The public believe that the NHS should
    take a lead role in providing information, advice
    and support to enable everyone to lead healthier
    lifestyles and prevent illness.
  • Now is the time for the NHS to move
    onto become a true health service and
    not just a sickness service.

6
Our Health, Our Care, Our Say
  • Better prevention services with earlier
    intervention
  • Give people more choice with a louder voice
  • Do more on tackling health inequalities
  • More support for people with long term conditions

7
Source DH/MORI survey (2005) Public views on
self care
  • More than half of people who had seen a care
    professional in previous 6 months said they had
    not often been encouraged to do self care
  • A third said they had never been encouraged by
    the professionals to do self care

8
Wanless 2007
  • However, recent departmental publications
    indicate that health inequalities, as measured by
    infant mortality and life expectancy at birth,
    demonstrate that health inequalities, have
    actually widened

9
  • Health Promotion Disease Prevention Illness
    management
  • REQUIRE
  • BEHAVIOUR CHANGE
  • Including psychological emotional adjustment

10
Stages of change
11
Stages of changeThe model
  • Process of change
  • The techniques used to proceed through a stage

12
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
13
CONTEXT
14
SMOKERS
  • Have time to consider the stages and processes of
    change
  • The person who is a contemplator and thinks about
    stopping but doesnt do anything about
    it..6months, 2, 3, 10 years later seeks help to
    quit

15
Weight Loss
  • always on a diet, and trying to lose weight

Issue Raised
Educated
Personalised information/ beliefs and attitude
Motivated and become committed
Confident able to make change
Start preparation/action
16
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
17
However..
  • A person diagnosed with Heart disease, diabetes
    etc, does not have the luxury of time to process
    through these stages.
  • Therefore

18
Diabetes
ACTION REQUIRED
Preparation
Action
Contemplation
Maintenance
Pre-contemplation
Relapse
19
This person needs to deal with
  • Information and education
  • Acceptance
  • Identification with illness
  • Beliefs
  • Attitudes
  • Emotions
  • Coping
  • Management of condition etc.
  • AND ACT UPON THEM

20
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
Motivational Interviewing
Contemplation
Maintenance
Pre-contemplation
Solution focused brief therapy
Relapse
And others
21
Already skilled
  • To a point yes.
  • But why aren't people changing their lifestyle
    behaviours, or adhering to medication?

22
Do Health Professionals already have these skills?
  • i.e. Specialist services smoking or weight
    management
  • Role is focused on helping clients change their
    identified
  • lifestyle behaviours
  • Staff in these services, concentrate on behaviour
    change
  • techniques.
  • If you evaluate staff skills you will find they
    have developed
  • skills in
  • motivational interviewing
  • CBT
  • Solution focused etc.

23
However.. With the exception these specialist
services directed towards individual lifestyle
behaviour change.
  • 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 health professional may
    have behaviour change skills available, does the
    he/she have enough skills in the toolbox to
    understand the patient and help them make these
    changes?

24
CASE EXAMPLE (REAL)cardiac rehabilitation
  • the Awkward patient
  • Mr X had MI 6 months ago. Attended
    rehabilitation, and always attends 1-1
    appointments, he has never missed an appointment,
    always asks questions and listens to my
    information. He takes on board the information
    and seems motivated.
  • However, although he takes his medication, he
    just wont change his behaviour, he continues to
    smoke, even though he agrees he should stop and
    will try. He hasnt lost any weight, and doesnt
    conduct any exercise. I dont know what more I
    can do with him

25
Health Professional 20 years experience,
specialised role
  • Provided information and education about MI,
    medications need for lifestyle change
  • Discussed exercise, diet and smoking habits and
    needs
  • Used motivational skills to encourage change

26
Seems obvious buta bit of psychology From
the patients perspective
  • Concerned about his health. Attends every
    appointment on time or early
  • Wants the support and advice form health
    professionals. Has intention and motivation to
    change
  • However, worries about having another MI, Lives
    alone
  • Doesnt exercise, unable to recognise angina
  • Drives to shop, but socially anxious in case of
    another attack. Picks up same food to be quick.
  • Drives home, has cigarette to reduce
    stress/anxiety
  • This person has Health anxiety- requires support
    changing thoughts, feelings and behaviours

27
Outcome
  • Health professional able to angle sessions
    towards reducing anxiety, because understanding
    patient perceptions
  • Client able to communicate more effectively with
    HP
  • Behaviour change increased as result.

28
Need to strengthen HPs skills
  • By adding more techniques to their toolbox.

29
Training
  • Should consider quick effective techniques to
  • Help understand clients perceptions better
  • Work with client in a behaviour change way
  • Be focussed on the application of techniques and
    not the theoretical or background development of
    the technique
  • Realistic. Should be suitable for the health
    professionals daily role (2 mins- 20mins of time)

30
Discussion point
  • When education leads are approached for education
    around motivational interviewing, is it that
    practitioners feel fully competent and confident
    to use all the other techniques to support
    behaviour change appropriately, and there is
    purely a gap in their knowledge base for one
    particular technique?
  • OR
  • Is it that they have a recognition of the policy
    drivers discussed earlier, and wish to improve
    their knowledge skills in this area, and ask
    for motivational interviewing as it has been
    traditionally the method of delivering same.

31
Discussion point- the way forward? Our personal
view
  • 2-3 day workshop that will give practitioners a
    practical toolkit with a variety of different
    approaches to support self care.
  • ? To link this in with the passport initiative.
  • In the longer term work closely with our HEI
    colleagues to develop modules that incorporate
    these approaches.

32
  • Any Questions ?
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