In this section we have compiled a list of FAQs and common misconceptions about behaviour change skills. If you don't find your query answered here, use the contact us section to get in touch and we'll be glad to help you.

How does this approach differ from other approaches?

There are many different approaches, many of which overlap, to influencing health behaviour. What is clear is that there are some common denominators which thread through the different approaches and influence change. The helping relationship is paramount and this is underpinned by the core qualities and the interpersonal skills of the practitioner. This approach focuses on the importance of embedding these underpinning skills and then building in motivational and behavioural strategies as appropriate.


Is there any evidence for using this approach?

There is an abundance of evidence to support the use of good communication skills and patient centred care (1, 2, 3, 4 & 5). Nice Guidance on Behaviour Change supports the use of a behavioural approach and the importance of generic skills and competencies which underpin this approach (6).Practitioners value these and although practitioners perceive themselves to be effective in using good communication skills, this has not yet been demonstrated in performance (8,9). Clearly, there is a need for further research in this vital area as well as support for opportunities to truly integrate the approach into everyday practice.  In order that we can replicate the approaches, studies need more precision about the methods used, how practitioners are taught and how quality control is maintained throughout the study. What we do know is that when we communicate effectively, patients have a better experience (10).


How does this fit in with measuring outcomes?

Increasing emphasis has been placed on measuring outcomes, not just clinical outcomes, but also patient-reported outcomes (PROMS) and patient reported experience measures (PREMS). Working in a patient centred way helps address the requirements of PREMS:

  • Being seen on time
  • Being able to ask questions
  • Having everything explained
  • Patients, their families and carers being treated with respect

A recent study by Hancock and colleagues showed that patients like practitioners to adopt a patient-centre approach, which might be either patient or practitioner led, to take into account what they want from consultations, adapting these to meet their individual requirements (10).


Do I HAVE to do Part 1 before Parts 2 & 3?

The courses have been developed as a modular programme to be completed in the order of Part 1, 2 and 3. All practitioners benefit from the opportunity to reflect on current practice and receive individual feedback. If you have any queries, concerns or would just like to discuss in more detail, do not hesitate to contact us


Integrating skills into everyday practice

Once I have completed the courses, can I confidently say that I am ‘doing behaviour change’?

On-going supervision with the opportunity to receive feedback from a more experienced practitioner is an essential part of developing your skills. We can offer guidance and support on how you might achieve this. The courses are a starting point for integrating the skills into everyday practice. Developing as a practitioner is lifelong and using a patient-centred behavioural approach is not something that can be switched on/off, but rather a way of working and being with people.


Myth Number 1

‘Behaviour Change Skills can only be used for lifestyle change’

Behaviour change skills can be used in a wide variety of settings: with individuals, groups, organisations and population levels. They can be used to influence health when working with carers and families, with colleagues, in multi-disciplinary teams and even in meetings and everyday communication with healthcare staff.


Myth Number 2

‘A behavioural approach is ‘touchy, feely’ and non-directive’

An effective behavioural approach is directive as well as patient-centred. The health professional has an agenda to influence health. That needs to be combined with the patient’s agenda, which means working in collaboration towards a common goal. A guiding style can help the practitioner to combine both approaches (2). A behavioural approach is structured, where a clear understanding of the problem is established, options considered, leading to an agreed way forward, using a problem solving approach. The main principles of this approach include the modification of current behaviour patterns, new adaptive learning, problem solving and a collaborative relationship between client and therapist (11)

Problem-solving
Problem-solving is often described as being at the heart of a behavioural approach. Although practitioners are familiar with the steps involved, it is challenging to achieve in daily practice.

Steps of problem-solving

  1. Identify the problem
  2. Explore Options
  3. Choose preferred option/s
  4. Develop a Plan
  5. Implement the Plan
  6. Review the Plan

Patient empowerment is defined as helping patients discover and develop the inherent capacity to be responsible for one’s own life (12). Going through the steps of problem-solving in a collaborative manner is one way of building patient capacity with the skills to manage their health behaviour in the long-term. Using this approach the health practitioner takes on the role of coach and mentor.


Myth Number 3

‘Behaviour change skills are not so important in acute settings - critically ill patients have no choice’

A lack of understanding of the different elements that contribute to health behaviour often underpin this commonly held belief. The importance of good interpersonal skills and a person-centered approach in any helping relationship is undisputed. Use of a wide range of behavioural tools or strategies may not always be relevant with critically ill patients, but at the very least providing information in a helpful way (a key behavioural tool) is highly likely to be relevant. Influencing motivation is also likely to be extremely relevant to a patient’s determination to get better and as a result build desire to undertake tasks which will help them to do so e.g. take prescribed supplements. Also, respecting patient autonomy is a key principle of patient-centred care – they have a choice whether to adhere to treatment or not and need to involved in decisions relating to their health where possible.


Myth Number 4 

‘This approach takes longer’

Marvel et al found that consultations undertaken by medical practitioners highly skilled in communication skills did not take longer and were more effective (13). If practitioners try to change their practice to incorporate all skills at once, it is likely to take longer as with any skills development. For this reason, it is recommended that new skills are incorporated over time. Incorporating health behaviour change skills needs to be viewed as part of continuing professional development, where skills are constantly reviewed, with peer feedback and supervision in place. 


Myth Number 5

My patients wouldn’t like this approach’

One size does not fit all. A patient centred approach needs to be adapted to the needs of the patient – at times patient-led and at times practitioner-led. Some patients prefer to talk more than others; some prefer not to discuss their feelings. It is important that the approach is not imposed on the patient. The practitioner needs to be very aware of patient feedback both verbal and non-verbal which will help direct the approach used. Practitioners need to be flexible and responsive in their approach to ensure that they meet each patient’s needs.


References

  1. Stewart, Moira. (1995). Effective physician-patient communication and health outcomes: A review. Canadian Medical Association Journal, 152, 1423-1433.
  2. Rollnick S, Butler C, McCambridge J, Kinnersley P, Elwyn G, Resnicow K.(2005) Consultaions About Changing Behaviour.BMJ2005;331:961
  3. Funnell, MM, Anderson, RM, Arnold MS, Barr PA, Donnelly MB, Johnson PD, Taylor-Moon D, White NH: Empowerment: an idea whose time has come in diabetes education. Diabetes Educ 17:37–41, 1991
  4. Najavits LM, Weiss RD. Variations in therapist effectiveness in the treatment of patients with substance use disorders: an empirical review.  Addiction 1994; 89: 679-688.
  5. Marvel MK, Epstein RM, Flowers K, Beckman HB. Soliciting the patient’s agenda: have we improved? JAMA 1999; 282 (10): 942-3.
  6. NICE (2007). National Institute of Health and Clinical Excellence. Behaviour change at population, community and individual levels (Public Health Guidance 6). 
  7. Whitehead K, Langley-Evans, Tischler V, Swift JA. (2009). Communication Skills for behaviour change in dietetic consultations. J. Hum. Nutr. Diet. 22, 93-500.
  8. Miller, W. R. and Mount, K. A. (2001). A small study of training in motivational interviewing: does one workshop change clinician and client behavior? Behavioural and Cognitive Psychotherapy, 29, 457–471
  9. Lu AH & Dollahite J. (2010) Assessment of dietitians’ nutrition counselling self-efficacy and its positive relationship to reported skill usage.J. Hum. Nutr. Diet. 23, 144-153.
  10. Hancock REE, Bonner G, Hollingdale R, Madden AM. (2010). ‘If you listen to me properly, I feel good’: a qualitative examination of patient experiences of dietetic consultations. J. Hum. Nutr. Diet. 25, 275-284.
  11. Health Development Agency (2003). The management of obesity and overweight: An analysis of reviews of diet, physical activity and behavioural approaches. London HAD 2003.
  12. Funnell, MM, Anderson, RM, Arnold MS, Barr PA, Donnelly MB, Johnson PD, Taylor-Moon D, White NH: Empowerment: an idea whose time has come in diabetes education. Diabetes Educ 17:37–41, 1991
  13. Marvel MK, Epstein RM, Flowers K, Beckman HB. Soliciting the patient’s agenda: have we improved? JAMA 1999; 282 (10): 942-3.

Key Guidance Documents on Behaviour Change:

  1. National Institute for Clinical Excellence. Behaviour Change at population, community and individual levels. (2007). NICE Public Health Guidance No. 6. www.nice.org.uk
  2. Department of Health (2012) Compassion in Practice. Nursing, Midwifery and Care Staff. http://www.england.nhs.uk/nursingvision/
  3. GSR Behaviour Change Knowledge Review (2008). Reference Report: An overview of behaviour change models and their uses. http://www.gsr.gov.uk/
  4. National Institute for Clinical Excellence.(2012). Patient experience in adult NHS services (CG138). http://guidance.nice.org.uk/CG138
  5. National Institute for Clinical Excellence. Behaviour change: individual approaches (PH49). (2014). http://guidance.nice.org.uk/PH49

Suggested Reading List:

Patient-Centered Medicine Transforming the Clinical Method (1995)
Stewart, Brown, Weston, McWhinney, McWilliams, Freeman.
Pub: Sage
ISBN: 0-8039-5689-4

Counselling Skills for Dietitians (2007)
Judy Gable
Pub: Blackwell Publishing
ISBN: 978-1-4051-4727-9

Motivational Interviewing, 3rd Edition: Helping People Change (Applications of Motivational interviewing) (2012)
William Miller & Stephen Rollnick
Pub: The Guildford Press
ISBN: 1-57230-563-0

Health Behaviour Change A Guide for Practitioners (1999)
Stephen Rollnick, Pip Mason & Chris Butler
Pub: Churchill Livingstone
ISBN: 0-443-05850-4

Motivational Interviewing in Health Care (2008)
Stephen Rollnick, William Miller, Christopher Butler
Pub: Guildford
ISBN -13: 978-1-59385-612-0

Weight Management: A Practitioner’s Guide (2012)

Dympna Pearson & Clare Grace

Pub: Wiley-Blackwell

ISBN: 978-1-4051-8559-2

In Manual of Dietetic Practice (2007): Changing Health Behaviour. Chapter 1.7, Pages 46 – 58 by Dympna Pearson & Lorna Rappoport. Blackwell Publishing

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