1. Methodology of Counselling in Health Promotion MUDr. Věra Kernová National Institute of Public Health MUDr. Dagmar Schneidrová, CSc. 3rd Faculty of Medicine, Charles University in Prague

2. Methods 1. Diagnostic part : find out a risk profile related to lifestyle: - nutritional habits, food consumption - physical activity - smoking, alcohol (level of dependence) - type of behaviour (stress)

3. QUESTIONNAIRE ON RISK FACTORS IN A PATIENT (WHO/HPH) RISK FACTORS YESNo DATA not available COMMENTS A. MALNUTRITION A 1 Patient has BMI <20,5 A 2 Patient lost weight in last 3 months A 3 Pacient had decreased food consumption in the last week A 4 Patient is seriously ill (sepsis, burns…) B. OVERWEIGHT B 1 Patient has BMI >25 B 2 Patient´s waist circumference > 80 cm (females) >94 cm (males) C. PHYSICAL INACTIVITY C 1 Patient´s physical activity <30 min/day (moderate PA with increased pulse rate – e.g. walking, riding a bicycle) D. DAILY SMOKING D 1 Patient smokes daily E. ALKOHOL ABUSE E 1 Patient´s drinking exceeds max. recommended limits (females - 14 drinks, males - 21 drinks a week) Number of risk factors / 9

4. Health promotion in a patient (HPH) Entrance examination Hospitalization Discharge Questionnaire on RF RF - A RF - B RF - C RF - D RF - E Skills Recommendations Contacts

5. Methods 2. Analytical part : data processed by a comprehensive PC programme findings compared to optimal indicators related to age, gender, health status individual changes suggested respecting needs of a client

6. Counselling 3. Individual counselling on risk behaviour retaled to lifestyle: - nutrition - physical activity - smoking, alcohol - stress - complex counselling Group intervention

7. Counselling Based on recent research (medicine, psychology, psychotherapy) Systematic, complex and sustained activity Specific to age, gender, education and particular problem of a client or group Respects social environment of a client Requires personal involvement of a client

8. Counselling Based on collaboration of a counsellor and a client Counsellor is active, encouraging, supporting, motivates and guides a client to behaviour change Directive and didactic (health education) Counsellor and client formulate goals of behaviour change Counsellor provides guidance and respects needs of a client

9. Client Man, 44 years, married, sedentary occupation (PC) GP found at the preventive examination: * family history (CVD) – father died (IM) at 50 years * increased level of triglycerides, cholesterol, LDL cholesterol Assessment of lifestyle factors showed a low level of physical activity

10. Counselling 1. Inform the client about the risk: - family history (father – premature death on IM) - relationship betweeen a low level of PA and increased level of blood lipids 2. Motivate the client to increase PA: - explain advantages of change (lowering of a health risk, improving physical and mental condition, etc.)

11. Counselling 3. Agree with the client on a step by step change: GP might prescribe PA (Manual of NIPH): - low intensity – 60 min/day (walk) - middle intensity – 30-40 min/5 days (fast walk, biking, swimming, dance) - high intensity – 20-30 min/5 days (running, aerobic, hockey, fast swimming, dancing) GP will formulate together with a client specific goals of change of PA

12. Goals Are they specific? May I control, measure them (records)? When, where, with whom may I reach goals? What will change in my life when I reach my goals (advantages)?

13. Counselling 4. Negotiate the framework of collaboration (contract) What can the client invest (time, effort, money, etc.)? What does the client need from the GP? Time framework (frequency of controls, number and length of sessions) Evaluation of the behaviour change (after 3 months at least)

14. Training – making a contract Work in pairs – GP, client/patient (20 min) Feedback to the group (outcome, process) Discussion