1. Module 4.3
Promoting Behaviour Change
For individuals and populations
Produced by The Alfred Workforce Development Team
on behalf of DHS Public Health Diabetes Prevention and Management Initiative
June 2005
2. Presentation purpose
Target audience
Service providers and project workers on DPMI projects
Aim
To explore the concepts of behaviour change and self management
Objectives
Provide an overview of behaviour change and self management
Explore best practice models of behaviour change
Discuss the key concepts of self management and empowerment
Explore self management models and evidence
Discuss and workshop problem solving and goal setting
DPMI Workforce Development – The Alfred Workforce Development Team June 2005
3. Communicating risk
Factors
influencing thinking on risk
People underestimate risk related to chronic
disease overestimate communicable disease
Trust
Who
is telling me are they trustworthy?
Risk less acceptable if:
Imposed
Distributed
unevenly
Resulting from man made
Hidden/irreversible
DPMI Workforce Development – The Alfred Workforce Development Team June 2005
4. Behavior change cycle
Trigger
Action &
maintenance
Awareness raising
Assessment
Goal
setting/action
plans
Promote self
efficacy
Precontemplation
contemplation
Preparation
Promote benefits
Identify obstacles
DPMI Workforce Development – The Alfred Workforce Development Team June 2005
5. Self efficacy
• Self efficacy strong predictor of behavior change
• Self efficacy is your belief in your ability to
perform a task
Promoting self efficacy
Promote performance accomplishment
Use verbal persuasion
Role modelling
Identifying feelings and helping work through
strategies to deal with feelings
Meaningful to the individual
DPMI Workforce Development – The Alfred Workforce Development Team June 2005
6. Developing resources to support
behavior change
Thinking of quitting smoking?
Identifying feelings
Here are all the facts that show quitting is the right choice.
Verbal persuasion
Make this site work for you. Bookmark the pages that really mean
something to you.
Meaningful to the individual
For more help, call the Quitline 131 848.
Like all good things, it's going to take some time and effort for you
to quit smoking, but thousands of smokers in Australia have already
stopped. You can too.
Identifying feelings & verbal persuasion
DPMI Workforce Development – The Alfred Workforce Development Team June 2005
7. Tailoring information to
stages of change
Deciding
to Quit
Getting Ready to Quit
Quitting
Staying
Pre-contemplation
Contemplation
Preparation
a Non-smoker
Coping with Setbacks
Helping Others Quit
Action &
maintenance
DPMI Workforce Development – The Alfred Workforce Development Team June 2005
8. Contemplation: Deciding to Quit
Here is how to get started with your quitting.
You
need to know
Smoking
Kills
Cigarettes
Smoking
Some
Quit
are full of poisons
causes disease
benefits of quitting
and save a packet
More
good reasons to quit
Deciding
to quit checklist
The
internet & stopping smoking - research project
Quit
Pack Order Form
How
DPMI
much do you spend on smoking? Workforce Development – The Alfred Workforce Development Team June 2005
9. Deciding to quit checklist
I’ll reduce my risk of heart attack.
I’ll reduce my risk of getting cancer.
I’ll feel fitter and my skin will look younger.
Within twelve hours, my body will be free of nicotine.
I’ll set a great example for the children around me.
My lungs will start to recover and be able to clean
themselves properly.
I’ll have more money to spend any way I choose.
I’ll give myself a confidence boost by quitting
cigarettes
Verbal persuasion, raise awareness
DPMI Workforce Development – The Alfred Workforce Development Team June 2005
10. Contemplation: Deciding to Quit
Try this
List all your reasons for quitting, and then number the three reasons
you think are important.
Meaningful to the individual & promote benefits
Try this
From the following list, tick the things that you want to do when you
are a non-smoker. Add your own ideas in the space provided.
Having more energy to play sport or keep up with the kids.
Knowing I'm back in control and no longer addicted.
I'll be free from the hassle of always checking that I have enough
cigarettes.
Reducing the risk of getting sick from cancer or heart disease.
Identifying feelings, promoting performance &
promote benefits
DPMI Workforce Development – The Alfred Workforce Development Team June 2005
11. Preparation: Getting ready to Quit
Smokers who plan before they quit are more successful
than those who don't, and planning can be done quickly
Understand your nicotine addiction
The Quit Book
Know why you smoke
Smoking Record
Plan ways to deal with quitting
Quit course
Set a date to quit
Some words about weight gain
DPMI
Getting ready to quit checklist Workforce Development – The Alfred Workforce Development Team June 2005
12. Set a date to quit
Unless there is a very good reason, make the date within
two weeks from now.
Choose an easy date to stop, one when you will not be
under much pressure, but will have plenty to occupy
yourself.
Practice Quitting
Once you have picked a date to quit, stick to it.
Before you quit, you might try a practice smokefree day
to see how you would go.
Or you could experiment by not smoking at times when
you normally would;
This will help you to work out how much you need to
prepare for these situations when you quit completely.
Goal setting/action planning
DPMI Workforce Development – The Alfred Workforce Development Team June 2005
13. Action: Quitting
Now's the time to put all your
work into practice and quit.
You are ready
Understand withdrawal symptoms
Coping with cravings
Excuses for not quitting –
myths and reality
Quitting checklist
DPMI Workforce Development – The Alfred Workforce Development Team June 2005
14. Action: Quitting
You are ready
You've made your decision to quit.
You have any extra information or support you feel you need.
You've done your planning.
You've set your quit date.
Stick to your decision. You're doing the right thing.
Choose an approach that will work for you
You could go cold turkey. For many people, this is a successful
method.
You could cut down by reducing gradually
If you choose to cut down make sure your quit date is set for two
weeks after you start reducing your smoking.
On your quit date, cut out cigarettes altogether.
DPMI Workforce Development – The Alfred Workforce Development Team June 2005
15. Quitting checklist
I will choose whether to stop suddenly or gradually.
Withdrawal symptoms are a good sign
I can confront cravings by remembering the 4Ds:
Delay
Deep breathe
Drink water
Do something else.
I will congratulate myself every time I resist the urge for a
cigarette.
Reminding myself of my reasons to quit will make it easier to
refuse cigarettes.
I have the right to refuse a cigarette and can do so without
upsetting others
I can keep my hands busy
Even if I decide to have alcohol, I’ll stick to my decision to quit.
DPMI Workforce Development – The Alfred Workforce Development Team June 2005
16. Maintenance:Staying a Non-smoker
The worst is over. You'll feel the urge to smoke less and
less, and soon you'll hardly think about cigarettes.
But the urge to smoke can return when you least expect
it.
You can stay stopped, but you need to be prepared.
There is always something better than a cigarette.
The new you
Find new ways to relax & other things to do
Staying a non-smoker checklist
DPMI Workforce Development – The Alfred Workforce Development Team June 2005
17. Maintenance:Coping with setbacks
Quitting can be hard.
You might be going along OK, and suddenly you feel like
smoking again.
Sometimes, as you gain confidence, you actually start to
think quitting is easy, so why not smoke again? Your
resolve starts to weaken.
Try this
If you have a cigarette
If you go back to regular smoking
DPMI Workforce Development – The Alfred Workforce Development Team June 2005
18. Method
R
esearch &
Development
F
ocus Group
Individual Interviews
Content /Script Dev’t
Concept
Development
Concept T
esting
P
roduct M
odification
Product T
esting
Product
Development
P
roduct M
odification
F
inal P
roduct
Promotional Strategy – The Alfred Workforce Development Team June 2005
DPMI Workforce Development
19. Consumers have had a say !
DPMI Workforce Development – The Alfred Workforce Development Team June 2005
20. Empowerment and self management
principles
HPs
provide
Expertise
Information
Psychological support
Individual
The daily decision making in the treatment of their
condition
Adults
more likely to make and maintain change if
they are personally meaningful and freely chosen
Robert Anderson
DPMI Workforce Development – The Alfred Workforce Development Team June 2005
21. Key concepts of self management
Recognition
of problems as seen by the
person and encouraging them to identify
solution
“Identifying problems often means HP needs to
be silent!!” (Skinner)
Discovery
and enhancement of internal
reinforcement for behavior change
Encompasses social learning and behavioral
theories
DPMI Workforce Development – The Alfred Workforce Development Team June 2005
22. How self management differs from
patient education
Self-Management
Purpose
Purpose:
Self-Management
Patient
Education
With Disease
Behaviors
To Increase Skills/SelfConfidence
To Increase
Knowledge
To manage life
To Manage Life disease
with
To Change
To increase skills
To Use Specific
Tools
/self confidence
To Problem Solve
And Make Decisions
Patient
Education
To change
behaviors
To increase
knowledge
Kat e Lor ig
To problem solve
and make decisions
To use specific
tools
Kate Lorig
DPMI Workforce Development – The Alfred Workforce Development Team June 2005
23. How self management differs
from patient education
Self
Management
Patient
Education
Needs
Assessment
Patient
problems
What patients
need to know
Content
Disease, role,
& emotional
management
Disease knowledge
and behaviors
Leader
Leader is guide
Leader is expert
Kate Lorig
DPMI Workforce Development – The Alfred Workforce Development Team June 2005
24. Evidence
Good
evidence to support
self management
Improves quality of life
Supports behavior change
Decreases health care
utilisation
www.cfah.org.au
Barlow. J et al
WHO
DPMI Workforce Development – The Alfred Workforce Development Team June 2005
25. References
Robert Anderson et al “Using the empowerment
approach to help clients” Chapter 17 in “Practical
psychology for diabetes Clinicians” Anderson, B and
Rubin, R. Published ADA Alexandria Virginia 1996.
Barlow J. et a “Self – management approaches for
people with chronic conditions: a review” Patient
Education and Counseling 48 (2002) 177-187
“Patients as effective collaborators in managing chronic
conditions”
www.cfah.org.au
Adherence to long term therapies www.who.org go to
publications link
DPMI Workforce Development – The Alfred Workforce Development Team June 2005
26. Diabetes self management education
in Australia
Norsworthy document reviewed
8 articles / 153 studies of the effectiveness of diabetes
interventions.
Concluding the evidence presented provides
powerful arguments that diabetes self management
education is:
Able to influence behaviour change and improve knowledge
and skill for diabetes self management
Can result in a reduction in secondary complication rates
Can reduce the person’s reliance on health services.
DPMI Workforce Development – The Alfred Workforce Development Team June 2005
27. Diabetes self management education in
Australia
Access and equity issues
Rural areas
Indigenous people
CALD communities
People of low socio-economic
status.
People in socially
disadvantaged areas receive
fewer long consultations than
people in higher socioeconomic areas.
DPMI Workforce Development – The Alfred Workforce Development Team June 2005
29. Self management models
Disease – related, education- focus
provision of information, skill
development
Behaviour change focused
Motivational interviewing
Readiness to change
Goal orientated programs
Psychosocial – focused support
Support groups
Social isolation
Self efficacy
DPMI Workforce Development – The Alfred Workforce Development Team June 2005
30. Delivery of self management
programs
Provided
through a variety
of modalities
Face to face
Telephone
Email
Web based
Principles
can be
incorporated into group or
individual counselling
sessions
DPMI Workforce Development – The Alfred Workforce Development Team June 2005
32. Automated telephone disease
management
RCT : People with diabetes
Intervention:
Received weekly calls from automated telephone system
To discuss self-care activities and hear self-care tips
Control: Normal office visits and information
FINDINGS:
Intervention Group
Reported fewer depressive symptoms
Higher self efficacy for self care
Greater satisfaction with services received
Improvement in health related quality of life
Petitte et al
Medical Care 38, 2000
DPMI Workforce Development – The Alfred Workforce Development Team June 2005
33. Automated telephone disease
management
FINDINGS:
Intervention Group
Reported fewer depressive symptoms
Higher self efficacy for self care
Greater satisfaction with services received
Improvement in health related quality of life
DPMI Workforce Development – The Alfred Workforce Development Team June 2005
34. Back pain email discussion group
RCT 580 subjects
Intervention:
Closed moderated email discussion group & back pain book
and video tape
Controls:
Non health magazine subscription of their choice
Findings at 1- year:
Significant improvements in pain, disability, role function
and health distress
Less physician visits and hospitalisation days
DPMI Workforce Development – The Alfred Workforce Development Team June 2005
Kate Lorig
Stanford Patient Education Centre
35. Behavioural weight loss program
Objective: Determine effectiveness of Internet
behavioural weight loss program compared to weight loss
education website
RCT 6 months, 91 subjects, 18-60yrs, 81 female, BMI 25-36
Control
loss
Group: web based information relating to weight
Intervention: as above plus weekly email messages,
online submission of diaries, therapist feedback
FINDINGS
Mean weight loss in intervention group at 6 months 4.1kg (4.5)
Mean weight loss in control group at 6 months 1.6kg (3.3)
DPMI Workforce Development – The Alfred Workforce Development Team June 2005
Tate
36. Essential elements of self
management interventions
Disease,
medication and health management
Role management
Emotional management
Support enhancement of self efficacy
Problem solving training
Follow up
Tracking and ensuring implementation
The Robert Wood Johnson Foundation
The Centre for the Advancement of Health
www.cfah.org
DPMI Workforce Development – The Alfred Workforce Development Team June 2005
38. Motivational interviewing
Seeks to understand the persons
frame of reference – reflective
listening
Expresses acceptance and affirmation
Elicits and selectively reinforces the
patients own self motivational
statement, expression of problem,
concern, desire and intention and
ability to change.
Helen Linder
Latrobe university
DPMI Workforce Development – The Alfred Workforce Development Team June 2005
39. Assessment/Problem definition
Aim
To help clients realise they are
responsible for, and in charge of, their
condition
Prioritise problems and identify situations
they want to improve
Experience emotional and psychological
commitment
Develop a plan of action
DPMI Workforce Development – The Alfred Workforce Development Team June 2005
40. Assessment/Problem definition
Interview questions
What part of living with your condition
is the most difficult or unsatisfying for
you?
2. How does the situation make you feel?
3. How does this situation have to change
for you to feel better about it?
1.
Robert Anderson
DPMI Workforce Development – The Alfred Workforce Development Team June 2005
41. Assessment/Problem definition
4.
Are you willing to take action to improve the
situation for yourself?
5.
What are the steps that you can take to bring
you closer to where you want to be?
6.
Is there one thing that you will do when you
leave here to improve things for yourself?
Robert Anderson
DPMI Workforce Development – The Alfred Workforce Development Team June 2005
42. Problem solving and decision making
Identifying
problems
Set
goals
Helping find alternative ways of to
accomplish goals
Setting contracts with themselves
Checking the results
Making changes as needed
DPMI Workforce Development – The Alfred Workforce Development Team June 2005
43. Goal setting- Getting started
Choose long term goal
Goals should be something you want to do
Identify
steps needed to reach long term
goal
Choose
one of those steps to start
working towards goal
DPMI Workforce Development – The Alfred Workforce Development Team June 2005
44. SMART
Specific
Measurable
Achievable
Realistic
Timely
Flinders University
DPMI Workforce Development – The Alfred Workforce Development Team June 2005
45. Guidelines for helping with - Problem
solving
Identify
the problem
List ideas
Select one
Assess the results
Substitute another idea (if first didn’t
work)
Accept that the problem may not be
solvable
Kate Lorig
DPMI Workforce Development – The Alfred Workforce Development Team June 2005
47. Implementing change
Individual
practice
Program changes
Organisational approach
Small incremental changes can still have an
effect
Can require philosophical shift
Education process/skill development
Reorganisation of services
Systematic approach to assessment and care planning
using tools that support identification of problem &
patient generated goals
DPMI Workforce Development – The Alfred Workforce Development Team June 2005
48. Our changing roles
Patient:
Manager
Health Professional: Assistant
Responsible to clients rather than for them
Sharing knowledge and expertise to help
make informed decisions to about their care
Collaborative approach with client generated
solutions to problems as perceived by client
DPMI Workforce Development – The Alfred Workforce Development Team June 2005
49. EDWARD DE BONO
It
is better to have enough ideas for
some of them to be wrong, than to be
always right by having no ideas at all.
DPMI Workforce Development – The Alfred Workforce Development Team June 2005
Notas do Editor
<number>
26/01/14
Teeth Flossing example
Our views have been essential in deciding on engagement strategies and appropriate segmentation for the focus groups
The CRG has been actively involved in the development all the project consumer resources and have played a key role in promotion of the courses.