Choices and Changes: Motivating Healthy Behaviours
Historically, many clinicians had a rather limited view of their role in helping to change patients’ health behaviours. Clinicians have generally been taught to simply provide information, give advice and prescribe treatments. We now know that many patients are not ready to commit to change and that merely prescribing medication or telling patients what they should do has limited impact on patient change in or adoption of health behaviours. We also know that, even when clinicians believe in the importance of counseling their patients to change health behaviours, they lack the confidence and skills to do this in a time-efficient manner. The challenge, then, is to provide the clinician with efficient and effective tools to help them to enhance patient health behaviour change and adherence to a treatment plan.
Clinicians frequently express frustration about their capacity to influence patient behavior, especially when they see the negative impact of that behavior on their patients’ health outcomes. A patient’s difficulty giving up smoking, following a diet, or sticking to a treatment plan often creates frustrations for both the clinician and the patient. Clinicians recognize that patients’ behaviors and adherence to treatment plans are essential to producing positive health outcomes, especially among patients with chronic illness. Clinicians are well-versed in how specific behavioral changes can improve patients’ health, but are typically ill-equipped to help patients make changes.
Choices and Changes: Motivating Healthy Behaviors is designed to help clinicians influence patients’ health behaviors. Drawing upon the research evidence in behavior change, Choices and Changes is directed to the needs of clinicians working within the constraints of contemporary clinical practice.
Historically, many clinicians have believed their role in helping to change patients’ health behaviors was limited. Clinicians were taught to simply provide information, give advice and prescribe treatments. We now understand that patients vary in their readiness to commit to change, and that readiness can shift over time, as a result of internal and/or external influences. Merely prescribing medication or telling patients what they should do has limited impact on patient behaviors. We also know that, even when clinicians believe in the importance of counseling their patients to change health behaviors, they may lack the confidence and skills to do this in a time-efficient manner.
Choices and Changes provides clinicians with efficient and effective tools to help them to motivate patients’ health behavior changes and adherence to treatment plans. In recognition of the curriculum’s efficacy, strong evidence base and enthusiastic embrace by clinicians, The California HealthCare Foundation engaged IHC to provide training to clinicians at nine primary care sites as part of the Team Up for Health initiative. Team Up for Health was designed to make measurable and sustainable improvements in patient behaviors contributing to improved health outcomes. IHC’s Choices and Changes curriculum was presented at the nine sites, and all demonstrated positive trends in patient-provider communication. The Team Up for Health evaluation report is available for review.
The Choices and Changes curriculum is usually presented as a half-day workshop; it is also available as a full-day workshop or a one-hour Grand Rounds presentation. The workshop format provides clinicians with an opportunity to explore their own beliefs about the change process and learn about the research evidence that has been gathered during the past twenty-five years. The program also provides clinicians with specific, brief and efficient communication strategies that can be utilized within the constraints of a typical office visit.
Choices and Changes: Motivating Healthy Behaviors is appropriate for a wide range of clinicians, at every stage of their careers. Physicians, nurses, nurse practitioners, physician assistants, case managers, diabetes educators, social workers, psychologists, pharmacists, physiotherapists, addiction counselors, health coaches, health educators and dieticians have benefitted from the program.
The workshop can accommodate 6 to 24 participants to ensure optimal experiential learning in small and large group exercises.
The Choices and Changes workshop is based on theories and models of change, communication and education. Guiding models and theories include the conviction and confidence model, motivational interviewing, social cognitive theory, self-determination theory, and the transtheoretical model of health behavior change, of which the stages of change model is a key component. Participants learn specific strategies and skills to apply these models in the setting of brief office visits. Choices and Changes teaches skills that are consistent with motivational interviewing; it is not affiliated with the Motivational Interviewing Network of Trainers (MINT).
The workshop is divided into three parts:
1. Summary of research about health behavior change. There is now a large body of evidence that indicates that clinicians can have a positive impact on the health behaviors of our patients.
We can influence a wide variety of behaviors that include:
- Self-management strategies that enhance chronic illness outcomes (e.g., self-monitoring, diet and exercise)
- Adherence to specific treatment recommendations (e.g., medication use)
- Avoidance, reduction or cessation of unhealthy behaviors (e.g., smoking or excessive drinking)
- Adoption of healthy behaviors (e.g., stress management techniques)
2. Clinicians’ roles and ideas and beliefs about change.
3. Focus on patients. Change models, skills and specific strategies are applied to our work with our patients to help patients change their health behaviors and improve their ability to self-manage their conditions.
The optional expanded full-day workshop includes more in-depth subject matter content and additional
practice opportunities via small group exercises using video cases.
The one-hour Grand Rounds presentation provides a brief overview of key concepts and an abbreviated video case study and discussion opportunity.
Learners are expected to participate in all activities in the workshop. To minimize distraction, IHC recommends that learners be freed from additional work-related tasks for the duration of the training.
The Choices and Changes workshop provides clinicians with opportunities to reflect on their role as facilitators of change and practice specific skills. By the end of the workshop participants will be able to:
- Describe two theoretical models of behavior change that can guide conversations with patients;
- Demonstrate three motivational interviewing core skills;
- Describe the four key elements of the visit with a patient/client; and
- Put into practice two techniques to use in clinical settings to influence change.
Choices and Changes workshop consists of brief lectures, interactive exercises, videotaped case studies and skills practice with peers to build participant awareness, knowledge, skills and confidence regarding health behavior counseling. Case examples frame realistic issues involving patients with diabetes, hypertension, asthma and cardiovascular disease; patients who smoke or use alcohol problematically; and patients reluctant to follow through with plans for screening or treatment. Workshop materials include an extensive annotated bibliography.
At the end of the workshop, participants are asked to commit to trying out one or two new motivational/behavior change counseling strategies for several weeks and then to evaluate the outcomes associated with these approaches.
The faculty for Choices and Changes is drawn from the faculty of the Institute for Healthcare Communication (IHC). Most faculty members are clinicians with extensive experience as teachers and clinicians. All Choices and Changes faculty members have completed an extensive faculty development program sponsored by IHC.