2: Fundamentals of Health Behaviour Change Flashcards
Review of Section 2 in ACLM manual, 4th Ed.
prompt
List 4 steps to establishing effective provider-patient relationships
1.assess the readiness level for change from TTM
2.offer stage-matched brief intervention
3.empower patients
4.create an inclusive environment in which patient feels comfortable and valued.
What are the 4 principles of Motivational Interviewing?
What stages is it most helpful?
Four General principles of MI [ESRD]
Express Empathy
Support self efficacy
Roll with Resistance (stay non-judgmental, supportive, curious)
Discuss discrepancy (between current and desired future state)
Helpful in Precontemplation and contemplation stages
What are the 4 core skills of Motivational Interviewing?
Four core skills of MI - OARS
Open ended questions: tell me more
explore patients needs, ideas, concerns expectations, experiences, feelings, priorities
Affirmations: use the word You rather than I. enhance patients self efficacy by recognising their strengths, intentions or efforts
Reflections
Summaries
What are 4 steps to prepare a patient for CBT?
HARP
What do you Hear in your internal dialogue?
Analyse your internal dialogue: any cognitive distortions?
Reconstruct your thinking: write factual statements to replace distorted thinking.
Practice: to eliminate distorted thinking.
takes a lot of practice…
10 Examples Non productive Thinking or cognitive distortions
- All or Nothing Thinking: i have not accomplished anything since i have been in graduate school
- Overgeneralisation: he never washes his dishes
- Mental Filter: my boss’ review of full of criticism
-
Mind Reading: i know my partner think i did a terrible job on that presentation
5.Fortune Telling: i will probably just mess up and make a fool of myself. -
Magnification/Minimisation: i haven’t accomplished anything since i’ve been in medical school.
7.Personlisation and blame: that jerk just cut me off and made me spill my coffee they just ruined my day.
8.Emotional Reasoning: i feel like an idiot so i really must be one. - Labelling/Mislabelling: i am such a disorganised person.
- Disqualifying the positive: giving up caffeine may have benefits but those benefits will be worthless since i might have a headache for a few days.
ABCDE Model of Dr Albert Ellis to identify and reframe non productive thinking
A: what Action or Event occurred
B: what Beliefs do you have about what happened
C: What are the Consequences of those beliefs? how does it make you feel?
D: how can you Disrupt those beliefs that seem to be distorted and unhealthy?
E: what Effect does this new way of thinking have on how you feel and how you will move forward?
- What are the 3 approaches within positive psychology?
- What are 4 benefits of this approach?
- APPROACH
emphasizes patient’s current skills and abilities, strengths and positive actions (and associated successes)
Values positive emotions, engagement relationships and meaning
- healthy ratio of positive to negative
- BENEFITS
Builds patient’s confidence
Reinforces autonomy and self efficacy which are keys to sustainable self management.
Enhances resiliency and helps undo negative feelings.
Increases the positivity of the patient-provider interaction.
life style prescription vs action plan
lifestyle prescriptions are brief, clear instructions for care or treatment pertaining to an individual patient
prescriptions describe the action or behaviour change in the full extent necessary to treat or prevent.
e:g a prescription for 150 minutes of moderate PA for a week.
action plan: the life style prescription is adjusted and personalized for the patient’s ability, readiness and confidence.
e:g of action plan: start with walking 5 minutes a day for 5 days a week increased as tolerated up to the recommended amount of 150 minutes per week.
What are the three components of motivation?
Importance, relevance, readiness
Define the 5 components of a SMART goal:
specific: identify the exact behaviour to be addressed
measurable: how one will know when the goal is reached.
Attainable: the goal is achievable and can be accomplished with current resources
Relevant: the goal is in alignment with the specific behaviour change
time-bound: the time frame for achieving that goal.
3 questions for maintenance of action plan
what benefits have you gained from the changes you have made
what have you learnt from the challenging areas
how do you feel about your situation.
What are 4 common components to the following behavior change models?
Health belief model (HBM)
Theory of planned behaviour
Social cognitive theory
Trans-theoretical model
Self determination theory
common components of these theories:
1. beliefs about risks and benefits
2.motivation
4.self efficacy
5.environmental influence e:g social norms.
5 A’s of personal behaviour change.
assess: practice in context of health risks
advice: changing practice with clear, specific and personalised advice for behaviour change
agree: on the focus of counselling and treatment based on patient’s interest and willingness to change and collaboratively set specific goals.
assist: the patient in achieving goals to change practices, address motivational barriers via counselling, if needs additional info or help, refer to dietitian
arrange: regular follow up and support.
In relation to the evidence base for effective coaching that promotes health behaviour change and improves health outcomes, which of the following is/are not correct
A. a 2017/2019 systematic review published in AJLM showed the most consistent effects of health and well being coaching were observed in both exercise and nutrition behaviour. Health coaching also improved HbA1c, weight reduction and BMI
B. systematic review of 35 studies results: 73% trials showed that intervention did alter provider/patient interaction. Health outcomes were positively affected in 44% trials and negatively affected in 20% trial
C. Physician’s with high empathy scores from their patient were less likely to achieve good HbA1c control than those with low empathy scores.
D. Ten hours of provider training on empathy skills can achieve similar empathy results as those providers who have had longer training on empathy.
E. Health outcomes for HT, glucose levels and functional status are NOT related to the patient-provider relationship.
Answer C and E
C Physician’s with high empathy scores from their patient were more likely to achieve good HbA1c control than those with low empathy scores ( 56% vs 40%)
E Health outcomes for HT, glucose levels and functional status are related to the patient-provider relationship.
All of the following are strategies to foster self motivation and self confidence except:
A. Hold the possibility that the patient can commit to change and master change.
B. clear one mind of ‘noise’ in order to listen to the patient with full attention.
C. Be sympathetic.
D. focus on and affirm the positives as much as possible.
E. Avoid sharing personal or other anonymous examples
F Encourage patient to take charge, decide on and commit to a wellness plan.
G. View obstacles and setbacks as necessary parts of behaviour change and the path to success.
H. Look for teachable moments. Physicians often underestimate the importance and power of these moments and impact they can have on health behaviour change.
Answer C and E
C be empathic
E share where disclosure will be beneficial to the patient.
Self motivation is also known as autonomous or internal motivation.
Self confidence is the trust a person has in their reasoning, capabilities and qualities.
