1. Understanding behaviour change Michelle Constable Health Psychologist inTraining

2. Content What is health psychology? Lets start a conversation! Models of behaviour change Communication Motivational Interviewing How to communicate your message Things to consider when planning a project

3. Health Psychology? Promotion and Maintenance of Health Prevention and Treatment of Illness Cause and diagnostic relationship of Health and Illness Health care system and health policy

4. What areas do Health Psychologists research? Stress Dr/patient communication Risk behaviours – smoking/alcohol Health protective behaviours Health cognitions/beliefs Long term conditions – coping/resilience

5. Lets start a conversation! What does current practice look like? What tools/apps do you recommend? What methods/theories do you use? How do you communicate your message? What challenges do you face?

6. Models of Behaviour change

7. Determinants of health

8. Stages of change Procheska and DiClemente (1982)

9. The COM-B Model Michie S, M van Stralen, West R (2011) The Behaviour Change Wheel: A new method for characterising and designing behaviour change interventions. Implementation Science, 6, 42.

10. The Behaviour Change Wheel

11. Self efficacy/Health beliefs Self efficacy important factor in behaviour change (Ashford et al. 2010) Shown to predict physical activity in adults Positive experience – increases self efficacy – can increase physical activity (Parschau et al. 2013) Participation greater for those with a belief that physical activity is beneficial for their disease. (Ehrlich-Jones et al. 2011 )

12. Things to consider in the planning phase 1.Base interventions on a proper assessment of the target group, where they are located and the behaviour that is to be changed: 2.Work with other organisations and the community itself to decide on and develop initiatives 3.Build on the skills and knowledge that already exists in the community, for example, by encouraging networks of people who can support each other 4.Take account of – and resolve – problems that prevent people changing their behaviour (for example, the costs involved in taking part in exercise programmes or buying fresh fruit and vegetables, or lack of knowledge about how to make changes) 5.Base all interventions on evidence of what works 6.Train staff to help people change their behaviour 7.Evaluate all interventions.

13. Communication

14. Brief intervention A 3 step 30 second systems based approach

15. Make Every Contact Count (MECC) Offering brief advice on healthy lifestyles opportunistically, smoking, weight, physical activity Giving information about importance of behaviour change Simple advice and signposting Aims to reduce health inequalities Encourages patient to take responsibility for own health http://learning.nhslocal.nhs.uk/feature-list/making-every- contact-counthttp://learning.nhslocal.nhs.uk/feature-list/making-every- contact-count http://www.alcohollearningcentre.org.uk/eLearning/IBA/

16. MOTIVATIONAL INTERVIEWING What is MI? MI is a collaborative, goal-orientated style of communication which pays particular attention to the language of change. It’s aim is to strengthen personal motivation and commitment to a specific goal (like increasing physical activity) by exploring the person’s own reasons for change.

17. FEATURES OF MI MI’s style is conversational and accepting It’s a shared decision making conversation It’s collaborative and solution focussed EQUALITY- They are the expert in their own behaviour but you have the skills and knowledge to help them!

18. THE TASK OF MI CONVERSATIONS Identify when behaviour is inconsistent with the client’s goals or ambitions. Focus where there is a discrepancy between their values i.e. I don’t want to smoke and their current behaviour i.e. smoking. It’s very hard to be resistant to someone who is trying hard to understand you. With MI we don’t necessarily wait for the client to be ready for change, MI is good for people who are in two minds.

19. THE PRINCIPLES OF MI R ESIST THE RIGHTING REFLEX U NDERSTAND/ EXPLORE CLIENTS’ MOTIVATIONS L ISTEN WITH EMPATHY E MPOWER THE CLIENT, ENCOURAGE OPTIMISM S UPPORT SELF EFFICACY

20. MOTIVATIONAL INTERVIEWING - How Do We Do This? Eliciting Change is like climbing a mountain where our client is the climber and we are the guide. A guide can’t take you up the mountain, he/she can’t make those steps for the client. The guide can only suggest when to rest, what to eat, what to wear, what has helped others climb. Most importantly, the practitioner holds the confidence they will ultimately succeed

21. Instead of… Could you? Have you thought of…? TRY How might you best go about that? What would that be like for you? What are your thoughts? What strengths do you have? Looking forward 1-2 years, how would you like your life to be? Where should the focus of our conversation be today, to make it as helpful as possible for you?

22. Clear messages? Importance of clear information Stoke-on-Trent study Readability assessment Identify jargon Patient/public involvement group Lower then anticipated reading age Estacio EV & Protheroe J; Assessing the readability of sexual health information leaflets in GP practices in Stoke-on-Trent: A multi stage study.

23. Next steps? Consider psychological factors when setting up a project/intervention Review the evidence to see what works Think about the skill mix within your team Work with partners Communication is key to success Contact the Public Health Service Health Psychology in Public Health Network

24. Thank you! michelle.constable@hertfordshire.gov.uk