SELF CARE Understanding behaviour change and its context

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SELF CAREUnderstanding behaviour change and its
context

• Jane Briers, Lisa Newson
• Knowsley PCT

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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

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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.

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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

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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.

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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

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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

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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

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

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Stages of change
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Stages of changeThe model

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

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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
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CONTEXT
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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

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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
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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
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However..

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

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Diabetes
ACTION REQUIRED
Preparation
Action
Contemplation
Maintenance
Pre-contemplation
Relapse
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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

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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
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Already skilled

• To a point yes.
• But why aren't people changing their lifestyle
  behaviours, or adhering to medication?

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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.

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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?

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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

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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

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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

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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.

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Need to strengthen HPs skills

• By adding more techniques to their toolbox.

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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)

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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.

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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.

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• Any Questions ?