Managing patient behaviour towards lifestyle modification

a

Lifestyle Component

DietPhysical ActivitySmokingAlcoholTobacco Uses

Self-Care Behaviour

Assessment of diabetes management problem

Disease related knowledge

Assessment of diabetes management problem

Inappropriate

health beliefs

and attitudes

Environmental

barriers

Conflicted family relations

hips

Socially isolated

Psychological or

psychiatric

disorders, such as

depression, anxiety, or eating disorders,

Improving Patient self-care behavior

Patients compliance &

Adherence

Diabetes self Management

Collaborative relationship with

patient

Techniques for Behavior Change

• Do not establish rapport• Tell patients what to do• Take control away from patients• Misjudge patient’s • Overestimate their readiness to change• Argue with patient Blame them for not taking better care of themselves• Use scare tactics

Behavior-Change Protocol

Stages of Lifestyle change

Stage BehaviorPhysician's goal for visit

(to move patient forward)

Tips

Precontemplation Not considering change Move toward thinking about change

Get patient talking: “Have you ever considered this before?” “What would have to happen to get you to consider this?”

Emphasize patient's autonomy: “I'm concerned about your health … of course, this is entirely your decision … I can help when you are ready to change…”

Contemplation Considering change Move toward preparing for change

“How have your friends or family members made this change?” “Would you like a list of local programs?” “I have some new information comparing various approaches to weight loss.”

Stages of Lifestyle change

Preparation Preparing for change (e.g., reading about diets, asking friends about gyms)

Move toward taking action

Praise preparation, discuss options, assist in setting initial goals and behavior targets, and set a start date.

Action Establishing the change

Maintain change Praise all efforts, limit suggestions of additional changes to one or two, and begin to anticipate obstacles.

Stage BehaviorPhysician's goal for

visit (to move patient forward)

Tips

Stages of Lifestyle Change

Maintenance Struggling to maintain the gains

Maintain change Praise all efforts, limit suggestions of additional changes to one or two, and help patient deal with obstacles.

Identification Incorporating the change into routine and view of self (the new pattern is now automatic, there is little temptation to lapse)

Maintain change Praise all efforts.

Stage BehaviorPhysician's goal for visit (to

move patient forward)Tips

Making Lifestyle Changes

Component of Motivation

Conviction

Confidence

How confident are you in your ability to succeed in eating a healthier

diet?”

How important is it for you to eat healthier food?”

Enhance ConvictionIf conviction is very low,

Expand on limited conviction.

Identify ambivalence.

Identify barriers to considering change. Brainstorm replacements:

Brainstorm around obstacles.

Address stated worries directly.

Discuss pros and cons..

Take a hypothetical look over the fence.

Enhance Confidence

Review previous change successes, praising positive steps and exploring obstacles..

Expand on limited confidence. Brainstorm solutions, Facilitate the shift from success or

failure to a stage model. Address relapse prevention.

Advance Skills in Maintaining Lifestyle Changes

Skills Behavior Target ActionControlling cues Learn to recognize and change

environmental and social cues for eating and physical activity.

Shop from a list, eat in one place in the house, add exercise cues to several rooms in the house, and add physical activity to social life.

Problem solving Use problem-solving approach to obstacles.

Describe, brainstorm, choose, plan, try, and see.

Eating out Learn skills for eating at restaurants and the homes of others.

Plan ahead, choose carefully, and assertively ask for what you want.

Cognitive change Talk back to common negative thoughts. Recognize “all or nothing” thinking, excuses, “shoulds,” competing with others, and self-defeating thoughts. Use thought stopping and reality testing to break patterns.

Advance Skills in Maintaining Changes

Relapse prevention Anticipate slips and get back on track.

Identify previous triggers of slips, plan ahead for likely triggers, challenge thoughts that a slip means failure (i.e., “get back on the horse”) and problem solve about how to deal with triggers.

Avoiding boredom Vary physical activity to keep motivated.

Change some aspect of physical workout each month; take exotic cooking classes.

Coping Learn stress management techniques.

Prevent stress by saying no, asking for help, setting realistic goals, problem solving, organizing, planning, and prioritizing.

Cope with unavoidable stress by identifying stress, taking breaks, and using self-soothing techniques, relaxation, physical activity, and social support.

Social support Enhance support for lifestyle change.

Involve significant others in activities, and develop new social supports compatible with lifestyle changes.

Skills Behavior target Action

Helping patients to take charge of their illness

KEY POINTS: The old models of care, where physicians

tell patients what to do and try to motivate them to change, do not work.

Because patients' day-to-day decisions have a tremendous impact on their health, they must be active, informed participants in the health care process.

Physicians can help patients take charge of their conditions by encouraging them to set self-management goals.

Patient says: Doctor responds:

(Old model) (New model)“I hate this exercise plan.” “Then try walking after dinner

every night with your husband for 10 minutes.”

“What do you hate about it? What would help you do better at it?

“I don't think I can quitsmoking.”

“Smoking is the leading cause of preventable death...”

“Why do you think that? What has happened in the past when you tried to quit? What concerns you most when you think about trying to quit?

“I haven't been able to test my blood sugar four times a day.”

“It's hard at first, but just keep trying. You really need to keep track of it.”

“What is preventing you from doing that? Do you know what the numbers mean?”

Old Model Vs New Model

Empowerment through Education Their illness is serious. There are still

patients out there who believe they have the “not-so-serious kind of diabetes.” If they don't believe it is a problem, they will never make changes to improve their health

Their condition is essentially self-managed. Every decision patients make throughout the day, from what they eat to whether they walk or ride the bus, has an influence on their health. Communicate to patients that they are the most important individuals in managing their illnesses.

Empowerment through Education

Empowerment through Education They have options : patients can be treated

through diet and exercise, oral medication, insulin and so on. Patients need to understand the different treatment options available and should be encouraged to look at the personal costs and benefits of each. Only the patient can decide if the benefits are greater than the costs.

Empower through Education They can change their behavior. Rarely do

patients leave the doctor's office and immediately enact

whatever change was recommended. The reality is that

it often has to be spread out into a series of steps.

Teach patients that significant behavioral changes can

be made by setting goals, taking that first step and

figuring out what you learn about yourself along the

way

Health behavior change is a key component in the prevention of disease.