1. “Healthy Conversation Skills” training Dr Wendy Lawrence PhD CPsychol Senior Research Fellow MRC Lifecourse Epidemiology Unit The intervention Delivery of pilot Evaluation Embedding in practice

2. Changing health behaviour

3. A training course in skills to support behaviour change Key skills:  Asking Open Discovery Questions – ‘how’ and ‘what’ questions that help people to explore their own world and find their own solutions.  Listening more than talking – allowing people to explain what makes behaviour change difficult.  Reflection – identifying good practice and areas for improvement  Supporting goal-setting – using SMARTER action planning, practitioners and patients have a sense of change and progress. Training timetable:  2 x 3 hour group sessions (in training setting)  1 x one-to-one session (in clinical setting) Training activities:  Exploring current beliefs / challenges  Practising “Healthy Conversation Skills” in a range of activities  Role play, recordings, team challenges  Reflecting on making a change  Trainers modelling the skills throughout

4.  Between September & November 2012  2 training courses delivered by 2 facilitators:  1 in Hampshire (n = 8)  1 in Buckinghamshire (n = 8)  7 trainees in each location (14 in total) participated in the one-to-one session in their own Practice  Practice Nurses  Healthcare Assistants  Occupational Health Nurses  Sexual Health Promotion Specialist  Workplace Health Promotion Specialist Training Delivery

5. Start & end of training: responses to 4 statements coded into categories Evaluating Impact on Staff Practice: short-term All practitioners used many more ODQs post- training, and no-one responded with telling/suggesting/ information-giving post-training. “I need to lose weight, but I don’t like vegetables.” “What change could you make to your diet?” “Eat less cake!” “You should eat 5- a-day.” “How else could you lose weight?”

6. Evaluating Impact on Staff Practice: medium-term Use of Open Discovery QuestionsProportion of time spent listening Observations made in one-to-one session in the trainee’s workplace How? What?

7. Evaluating Impact on Staff Practice: medium-term

8. Overall competency in the 4 key skills All trainees demonstrated good-high competency in using “Healthy Conversation Skills”. Each skill scored from 0-4, giving a total possible score of 16.

9. In pairs: “How” and “What” conversation 1 = Talker (person wishing to change a behaviour) 2 = Listener (can only listen and ask Open Discovery Questions, beginning with “how” or “what”) Consider what behaviour you’d like to change 2 mins for discussion, then swap Afterwards, reflect on: (Talker) How did it feel to be listened to? (Listener) How did it feel to use only ODQs? (Both) How far did the conversation move you towards change? How? What? Your turn!

10. Reflective practice – what our trainees said “Because it’s more interesting for me which is better because they were getting quite dull to be honest, ‘cos I was on a road driven by a computer programme!” “Well this has highlighted some extra skills that we’ve got there that we haven’t been utilising, which will actually get the client to give us more information and evaluate more which I haven’t thought about previously. So I’m certainly going to get them working a little bit more.” “I found it really beneficial actually - as I said I thought I was quite a good inter-personal skills and when we did the first day and you did the recording on it, I was like ‘Why?’ and then I thought ‘Oh my goodness, I’m giving closed questions’ which I hadn’t thought of before. So it did make me think and I have certainly changed my behaviour.” “We know paper doesn’t work and we give away a rainforest here, and you know why we give a rainforest away? So the patient can’t say we haven’t told them; that’s why we get them to sign pieces of paper to say that I have worked through and told them everything!”