Module 4.3

Promoting Behaviour Change
For individuals and populations

Produced by The Alfred Workforce Development Team
...
Presentation purpose
Target audience


Service providers and project workers on DPMI projects

Aim


To explore the conc...
Communicating risk
 Factors

influencing thinking on risk

People underestimate risk related to chronic
disease overestim...
Behavior change cycle
Trigger
Action &
maintenance

Awareness raising

Assessment
Goal
setting/action
plans
Promote self
e...
Self efficacy
• Self efficacy strong predictor of behavior change
• Self efficacy is your belief in your ability to
perfor...
Developing resources to support
behavior change


Thinking of quitting smoking?

Identifying feelings


Here are all the...
Tailoring information to
stages of change
  Deciding


to Quit 

Getting Ready to Quit 

  Quitting 
  Staying

Pre-co...
Contemplation: Deciding to Quit
Here is how to get started with your quitting.
You

need to know

Smoking

Kills

Cigar...
Deciding to quit checklist









I’ll reduce my risk of heart attack.
I’ll reduce my risk of getting cancer.
I’...
Contemplation: Deciding to Quit
Try this
List all your reasons for quitting, and then number the three reasons
you think a...
Preparation: Getting ready to Quit
Smokers who plan before they quit are more successful
than those who don't, and plannin...
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 sto...
Action: Quitting
Now's the time to put all your
work into practice and quit.
 You are ready


Understand withdrawal symp...
Action: Quitting
You are ready
 You've made your decision to quit.
 You have any extra information or support you feel y...
Quitting checklist




I will choose whether to stop suddenly or gradually.
Withdrawal symptoms are a good sign
I can c...
Maintenance:Staying a Non-smoker
The worst is over. You'll feel the urge to smoke less and
less, and soon you'll hardly th...
Maintenance:Coping with setbacks
Quitting can be hard.
You might be going along OK, and suddenly you feel like
smoking aga...
Method
R
esearch &
Development

F
ocus Group

Individual Interviews

Content /Script Dev’t
Concept
Development

Concept T
...
Consumers have had a say !

DPMI Workforce Development – The Alfred Workforce Development Team June 2005
Empowerment and self management
principles
 HPs




provide

Expertise
Information
Psychological support

 Individual...
Key concepts of self management
 Recognition

of problems as seen by the
person and encouraging them to identify
solution...
How self management differs from
patient education
Self-Management
Purpose
Purpose:

Self-Management

Patient
Education

W...
How self management differs
from patient education
Self
Management

Patient
Education

Needs
Assessment

Patient
problems
...
Evidence
 Good

evidence to support
self management
Improves quality of life
 Supports behavior change
 Decreases healt...
References







Robert Anderson et al “Using the empowerment
approach to help clients” Chapter 17 in “Practical
psyc...
Diabetes self management education
in Australia


Norsworthy document reviewed




8 articles / 153 studies of the effe...
Diabetes self management education in
Australia


Access and equity issues
 Rural areas
 Indigenous people
 CALD commu...
Lois’s Story

DPMI Workforce Development – The Alfred Workforce Development Team June 2005
Self management models


Disease – related, education- focus
provision of information, skill
development



Behaviour ch...
Delivery of self management
programs
 Provided

through a variety
of modalities





Face to face
Telephone
Email
Web...
DPMI Workforce Development – The Alfred Workforce Development Team June 2005
Automated telephone disease
management



RCT : People with diabetes
Intervention:





Received weekly calls from au...
Automated telephone disease
management
FINDINGS:
 Intervention Group
Reported fewer depressive symptoms
 Higher self eff...
Back pain email discussion group


RCT 580 subjects



Intervention:




Closed moderated email discussion group & bac...
Behavioural weight loss program
 Objective: Determine effectiveness of Internet

behavioural weight loss program compared...
Essential elements of self
management interventions
 Disease,

medication and health management
 Role management
 Emoti...
Ray’s story

DPMI Workforce Development – The Alfred Workforce Development Team June 2005
Motivational interviewing


Seeks to understand the persons
frame of reference – reflective
listening



Expresses accep...
Assessment/Problem definition
Aim
 To help clients realise they are
responsible for, and in charge of, their
condition
 ...
Assessment/Problem definition
Interview questions

What part of living with your condition
is the most difficult or unsati...
Assessment/Problem definition
4.

Are you willing to take action to improve the
situation for yourself?

5.

What are the ...
Problem solving and decision making
 Identifying

problems

 Set

goals
 Helping find alternative ways of to
accomplish...
Goal setting- Getting started


Choose long term goal


Goals should be something you want to do

 Identify

steps need...
SMART
 Specific
 Measurable
 Achievable
 Realistic
 Timely

Flinders University
DPMI Workforce Development – The Alfr...
Guidelines for helping with - Problem
solving
 Identify

the problem
 List ideas
 Select one
 Assess the results
 Sub...
Behavior Change
Information

Prevention

Chronic disease care
 Target




Case Management

Audience

Population
Indivi...
Implementing change
 Individual

practice
 Program changes
 Organisational approach
 Small incremental changes can sti...
Our changing roles
 Patient:

Manager
 Health Professional: Assistant


Responsible to clients rather than for them


...
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 ide...
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Self empowerment

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  • <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.
  • Do self Efficacy Role play here
  • Role Play of problem definition here
  • Break into pairs to do following steps
  • Ask group to write down goal share with group
  • Role Play if Possible in pairs
  • Self empowerment

    1. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 19. Consumers have had a say ! DPMI Workforce Development – The Alfred Workforce Development Team June 2005
    20. 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. 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. 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. 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. 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. 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. 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. 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
    28. 28. Lois’s Story DPMI Workforce Development – The Alfred Workforce Development Team June 2005
    29. 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. 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
    31. 31. DPMI Workforce Development – The Alfred Workforce Development Team June 2005
    32. 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. 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. 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. 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. 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
    37. 37. Ray’s story DPMI Workforce Development – The Alfred Workforce Development Team June 2005
    38. 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. 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. 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. 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. 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. 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. 44. SMART  Specific  Measurable  Achievable  Realistic  Timely Flinders University DPMI Workforce Development – The Alfred Workforce Development Team June 2005
    45. 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
    46. 46. Behavior Change Information Prevention Chronic disease care  Target    Case Management Audience Population Individual Group programs DPMI Workforce Development – The Alfred Workforce Development Team June 2005
    47. 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. 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. 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

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