Introductory Certificate in Obesity, Malnutrition and Health

Slide set for Workshop 1Supporting behaviour change in practice

Acknowledgments S Thompson and C Hughes

WORKBOOK PAGES 6- 11

Workshop 1Supporting behaviour change

in practice

To get good conversations started

Unlock the patient’s motivation

Ensure goals are realistic – avoid setting up to fail. 

Explore the barriers to making changes

Acknowledge the patients efforts

Use a reflective listening style-avoid the righting reflex

Summarise the discussion

Aims

Acknowledge both HP and patient may find the topic awkward

Deal with patients main concern first

Ask if they would like to discuss their weight

Start with asking “How do you feel about your weight?”, or “ Do you keep an eye on your weight?”

Be aware of local weight management resources

Starting the conversation

MI is a refined form of the familiar process of guiding

MI works by activating patient’s own motivation for change and adherence to treatment.

The way in which you talk with patients about their health can substantially influence their personal motivation for behaviour change.

MI is not a magic bullet and consulting styles may need to change as appropriate. There are times when a patient may need to be challenged

Ref Motivational interviewing and healthcare.2008 Rollnick, Miller, and Butler.

Motivational interviewing (MI)

Resist the ‘righting reflex’

Understand and explore the patient’s own motivations

Listen with empathy

Empower the patient, encouraging hope and optimism.

RULE: Resist, Understand, Listen, and Empower.

4 Guiding Principles

Asking; to develop an understanding of the patients problems

Active Listening – body language

Informing

3 core communication skills

Ask open questions

Listen by reflecting

Help to weigh up pros and cons

Goal setting; SMART

Use a ruler ‘scale of one to ten’

Use hypotheticals ‘what might it take for you to make a choice to ..’

What next?

The consultation

Active Listening

Task is to elicit ‘change talk’ from patient rather than resistance

Desire: statement about preference for change

I want to… I wish…

Ability: statement about capacity I could… I might be able to...

Reasons: specific arguments for change I would probably feel better if I …

Need: statements about feeling obliged to change

I ought to… I really should…

Commitment: statements about likelihood of change

I am going to... I will…

Taking steps: statements about action this week I started… I actually went out and…

Each reflection is a short summary of what is happening at that moment

Reflecting back what the patient means (hypothesis), the patient then confirms or refutes the hypothesis

Practitioners voice inflection turns down at the end of a good reflection, not up as if asking a question

Acknowledge the value of what you have heard

Listening by reflection

Resist the righting reflex – that tendency to say “You just need to…” or “it would be better if you could…”

Reflect ‘change talk’

Work through ambivalence

Periodically draw together what the person has said into a summary which contains the persons own motivations for change

Reflecting resistance

Roadblocks to listening

Interrupting the patient means s/he has to deal with this ‘roadblock’ before continuing with their agenda. Silence is an important part of listening.

Limit the following interruptions:-

Agreeing/disagreeing

Instructing

Questioning

Warning

Reasoning

Sympathising

Suggesting

Analysing/interpreting

Persuading

Ask permission

Offer choices

Talk about what others do

Elicit-provide-elicitElicit – “what would you like to know?”

Provide – give information requested

Elicit – “what does this mean to you?”

Beware the righting reflex

What does this information mean for me?

Informing

Open

questions

questions that encourage patients to think before

answering and allow a choice in how to respond

Affirmation acknowledge patient’s efforts, strengths and volitional

choice

Reflective

listening

capture patient’s meaning

Summarise pull together what’s been said

‘OARS’ summarises the overall approach

Motivational Interviewing in Healthcare. Rollnick S, Miller WR, Butler CCISBN 978-1-59385-612-0

International motivational interviewing network of trainers www.motivationalinterview.orgWorld Obesity SCOPE e-learning SCOPE (Specialist certificate of obesity professional education). Over 25 modules, internationally recognised certificate in obesity management. CPD and CME points.

RCGP e-learning; SCOPE accredited http://elearning.rcgp.org.uk/

RCGP Ten top tips; Raising the topic of weight Obesity learning centre www.obesitylearningcentre.org.uk College of Contemporary Health Postgraduate Certificate in Obesity Care http://contemporaryhealth.co.uk National Obesity Forum www.nationalobesityforum.org.uk

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