1. Slide set for Workshop 1 Supporting behaviour change in practice Acknowledgments S Thompson and C Hughes

2. WORKBOOK PAGES 6- 11 Workshop 1 Supporting behaviour change in practice

3. To get good conversations started Unlock the patient’s motivation Ensure goals are realistic – avoid setting up to fail. Explore the barriers to making changes Acknowledge the patients efforts Use a reflective listening style-avoid the righting reflex Summarise the discussion Aims

4. Acknowledge both HP and patient may find the topic awkward Deal with patients main concern first Ask if they would like to discuss their weight Start with asking “How do you feel about your weight?”, or “ Do you keep an eye on your weight?” Be aware of local weight management resources Starting the conversation

5. MI is a refined form of the familiar process of guiding MI works by activating patient’s own motivation for change and adherence to treatment. The way in which you talk with patients about their health can substantially influence their personal motivation for behaviour change. MI is not a magic bullet and consulting styles may need to change as appropriate. There are times when a patient may need to be challenged Ref Motivational interviewing and healthcare.2008 Rollnick, Miller, and Butler. Motivational interviewing (MI)

6. Resist the ‘righting reflex’ Understand and explore the patient’s own motivations Listen with empathy Empower the patient, encouraging hope and optimism. RULE: Resist, Understand, Listen, and Empower. 4 Guiding Principles

7. Asking; to develop an understanding of the patients problems Active Listening – body language Informing 3 core communication skills

8. Ask open questions Listen by reflecting Help to weigh up pros and cons Goal setting; SMART Use a ruler ‘scale of one to ten’ Use hypotheticals ‘what might it take for you to make a choice to..’ What next? The consultation

9. Active Listening Task is to elicit ‘change talk’ from patient rather than resistance Desire: statement about preference for change I want to… I wish… Ability: statement about capacityI could… I might be able to... Reasons: specific arguments for changeI would probably feel better if I … Need: statements about feeling obliged to change I ought to… I really should… Commitment: statements about likelihood of change I am going to... I will… Taking steps: statements about actionthis week I started… I actually went out and…

10. Each reflection is a short summary of what is happening at that moment Reflecting back what the patient means (hypothesis), the patient then confirms or refutes the hypothesis Practitioners voice inflection turns down at the end of a good reflection, not up as if asking a question Acknowledge the value of what you have heard Listening by reflection

11. Resist the righting reflex – that tendency to say “You just need to…” or “it would be better if you could…” Reflect ‘change talk’ Work through ambivalence Periodically draw together what the person has said into a summary which contains the persons own motivations for change Reflecting resistance

12. Roadblocks to listening Interrupting the patient means s/he has to deal with this ‘roadblock’ before continuing with their agenda. Silence is an important part of listening. Limit the following interruptions:- Agreeing/disagreeing Instructing Questioning Warning Reasoning Sympathising Suggesting Analysing/interpreting Persuading

13. Ask permission Offer choices Talk about what others do Elicit-provide-elicit Elicit – “what would you like to know?” Provide – give information requested Elicit – “what does this mean to you?” Beware the righting reflex What does this information mean for me? Informing

14. O Open questions questions that encourage patients to think before answering and allow a choice in how to respond A Affirmation acknowledge patient’s efforts, strengths and volitional choice R Reflective listening capture patient’s meaning S Summarisepull together what’s been said ‘OARS’ summarises the overall approach

15. Motivational Interviewing in Healthcare. Rollnick S, Miller WR, Butler CC ISBN 978-1-59385-612-0 International motivational interviewing network of trainers www.motivationalinterview.org World Obesity SCOPE e-learning SCOPE (Specialist certificate of obesity professional education). Over 25 modules, internationally recognised certificate in obesity management. CPD and CME points. RCGP e-learning; SCOPE accredited http://elearning.rcgp.org.uk/ RCGP Ten top tips; Raising the topic of weight Obesity learning centre www.obesitylearningcentre.org.uk College of Contemporary Health Postgraduate Certificate in Obesity Care http://contemporaryhealth.co.uk National Obesity Forum www.nationalobesityforum.org.uk Education Resources