What are the patients and clinicians role in behavior change
• It is the patients task to say how and when they should change
• It is the clinicians role to elicit these arguments for change
Use of specific skills such as agreeing on priorities can facilitate this process
What is the first step in behavior change
• First step is to build a good rapport
How do you build a good rapport
○ Smile and welcoming patients into appointments
○ Think about non-verbals
○ Think about when you ask questions
○ Take time to listen to patients
○ Make them comfortable enough to come back in the future
select the right communication
What are the 3 communication styles
directing
following
guiding
Describe the directing communication style
§ Delivery of expert advice
§ Traditionally dominant within healthcare
§ Best employed when there is good rapport between patient and dentist
§ Should be well timed, personally relevant and delivered in such a way as to engage the patient
Describe the following communication style
§ Utilising listening skills and occurs in situations where sensitivity is required such as when patient is upset
§ Goal of the clinician is not to solve patient’s problems immediately
Aim to provide support and encouragement in difficult situations such as breaking bad news
Describe the guiding style
§ More complex than other two
§ Patient and clinician work together to help the patient identify his or her goals, and how they might be achieved
§ Useful for those unsure about change (ambivalent)
What are the key skills for communicating about health behavior change
OARS open questions affirmation reflective listening summary
What is open questions
Gives clinician a deeper understanding of the patient’s views
What is affirmation
○ Demonstrate an appreciation for patients efforts
○ I can see that ..
What is reflecting listening
○ I understand that ..
○ Enables listener to check what has been said by the speaker
What is summary
○ So in summary, I ..
○ Important because people forget what happens in the middle of the consultation
○ Require recency
○ People will remember specifically what happened at the end so a summary is important
How do you seek permission for discussing health behavior
○ How do you feel having a quick chat about your smoking
○ There are a number of things we could talk about today. I’m just wondering if there is anything related to your oral health that you would like to talk about
What does asking questions provides
○ Valuable clinical info
○ Gives the opportunity for patient perspective
○ Gives an insight into factors affecting change
Helps the clinician understand why the patient may behave in a certain way
How do you provide support
- You took the time to think this through..
- You’ve thought about how you might handle things
- You’ve managed to cut your smoking
- You’ve managed to keep the flossing up though you did find it a bit of a struggle
- Demonstrates appreciation for patient’s effort and reinforces positive acts
- Can build patient’s confidence that they can change
How do you convey understanding
reflective listening ○ It sounds like you are doing well with the floss and interdental brushes
○ It sounds like you are really trying and determined to give quitting a go
What is the cycle of reflective listening
- What the speaker says
2. The words the speaker SAYS
3. The words the listener HEARS
What the listener THINKS the speaker means
How do you get the information across
assess what px already know
provide further information
find out what information means for the patient
How do you assess what the patient already knows
○ What do you know about …
○ How much do you know about …
How do you provide further information
○ Some patients find that …
○ Research has shown that …
○ One thing that improves this condition is..
How do you find out what information means for the patient
○ What does this mean for you?
○ What do you understand from?
What is behavior change cancelling
- Slightly different technique/approach to patients
- Brief form of motivational interviewing (MI)
- Should help with compliance
- Do not blame them for their ill health
- Patient centred method
- Have to be directive - practitioners are encouraged to provide clear structure to consultation
- Has to be a negotiation - patient encouraged to make positive changes in collaboration with practitioner
What is the cycle behavior change
precontemplators
contemplators
preparation
precontemplation –> contemplation —> preparation –> action —> maintenance
What do changes in behavior practitioners focus on
○ Eating less, different foods § Frequency of sugar, amount, type ○ Drink less, abstain § Alcohol, coffee, drugs ○ Smoke fewer cigarettes § Quit, give up chew tobacco ○ Take up/modify OHI § Frequency, techniques in interdental cleaning
How do you establish rapport
○ Ask questions that might help you understand the patient better
○ Asking them to take you through a typical day with regards to .. (smoking, alcohol, diet)
○ Use of smoking, diet diaries
○ Using various apps, wearable technology
How do you set an agenda
○ Single or multiple behaviours?
§ Smoking and alcohol puts px at risk of oral cancer
§ Obesity requires diet and increased exercise
○ Diet and toothbrushing
§ High caries rate child with suboptimal oral hygiene and lots of sucrose
○ Or singly
§ Diet, take up exercise, oral hygiene, smoking cessation
What is readiness to change
○ Individual has to see value in change
§ How do you feel at the moment about change?
§ How important is it to you personally?
○ Individual has to be confident that they can change (self efficacy)
What are the ingredients of readiness to change
§ Importance - why should I change
§ Confidence - how will I change
What do smokers often exhibit
○ Smokers often exhibit high importance/low confidence
Patients who have high importance and confidence are most likely to be successful
How do you exchange information
○ Would you like to know more about? ○ How much do you already know about? ○ Do you know about? ○ Can I say to you? ○ On patients terms, pitched at right level
What is resistance
○ Have you misjudged the patient’s feelings about readiness, importance and confidence
○ Are you meeting with too much force
○ Are you being too confrontational
How do your educe resistance
§ Emphasise personal choice and control
Back off and come alongside patient
