1. Behaviour change: Principles and Practice
Prof Alf Collins
Clinical Director for Personalised Care
NHS England
University of Keele Good Practice day
September 13th 2018

2. What is it like to be you? Identity

3. Identity Values, beliefs, memories, habits
Thoughts, feelings, behaviours

4. Illness as a threat to identity: the ’common sense model’ of self regulation. Leventhal H 1997

5. Health information can reinforce adaptive (coping) responses or maladaptive (anxiety/avoidance) responses

6. Example: cough Socio-cultural context: Cough=TB=death Patient may have
heightened vigilance to cues
from you that reinforce that
‘common sense’ belief
Assess health literacy, understanding and beliefs:
’What do you know about the kind of cough you have?’ Does it concern you in any way?”
Offer a helpful explanation if needed: ‘you have a throat infection caused by a virus. Your cough will improve over the next week’

7. Example: back pain Socio-cultural belief: Pain=damage=seek help
Sociocultural belief will drive
fear and avoidance behaviours
that will promote chronicity
Socio-cultural belief:
Pain=damage=seek help
Severe pain=severe damage
Assess health literacy, understanding and beliefs:
’What do you know about back pain?’ Does it concern you in any way?”
Offer a helpful explanation: ‘you have a muscular back pain. It can be very painful indeed. The best treatment is gentle exercise to keep the muscles moving- or they can seize up and make the pain worse’

8. Health literacy

9. 3 simple steps to improving health literacy
Remember Leventhal: use ‘common sense’ and helpful/positive/optimistic information that runs a low chance of being misinterpreted:
Health professionals tend to speak the language of illness/pathology (arthritis/risk/infection) and much of that language has ‘folk meanings’ that reinforce the health threat axis of the common sense model

10. 3 simple steps to improving health literacy
2. Use chunk and check and pick up on behavioural cues. Consider rephrasing if necessary

11. 3 simple steps to improving health literacy
3. Use teach back.
‘I want to check I’ve explained this well enough:
Could you tell me/show me what you have learned/what you plan to do?’

12. Sharing decisions…..

13. Shared decision making
Angela Coulter
Shared decision making
Patients:
My circumstances, my preferences
Clinicians:
Options, benefits, harms, consequences
Informed decision
Informed demand on system
SDM Webinar

14. The Silent Misdiagnosis
Angela Coulter
The Silent Misdiagnosis
Patients:
unaware of all reasonable options and outcomes
Clinicians:
unaware of patients’ circumstances and
preferences
Uninformed decision
Uninformed demand on system
nb Montgomery
SDM Webinar

15. The 3 talk model

16. Motivational interviewing/health coaching/relational approaches
All rely on:
A belief that patients are innately resourceful
A belief that untapping innate resourcefulness and resolving ambivalence are key to taking responsibilty and changing behaviour
Development of rapport is key

17. Rapport/trust/challenge

18. Building rapport

19. Motivational scaling: importance and confidence

20. Resolving ambivalence

21. Decisional balance

22. Commitment, problem solving, goal setting and follow up
It’s difficult to argue with your own plans
All trials demonstrate that supporting people to set their own goals and action plans is one of the most powerful tools we have

23. Your attitude………and how not to burn out!
It’s my job to get patients
to change their behaviour
It’s my job to support people to consider their options
and to engage with and develop their
own sense of resourcefulness

24. Behaviour change evidence- look it up. : COM-B
Behaviour change evidence- look it up!: COM-B. The behaviour change wheel. Michie et al

25. Thank you
Alf Collins FRCA FRCP FRCGP
NHS England
September 2018