Facilitating Behavior Change
Supporting patients in navigating change is at the heart of clinical care. A behavior change conversation may be as straightforward as asking a patient to come in for a follow-up visit or to pick up and take a course of antibiotics. Or it may be as complicated as guiding a patient to adhere to a complex medication regimen, accept a vaccine, increase activity, reduce substance use, or monitor and track their blood sugar regularly.
These changes can have a huge positive impact on patients’ health, but as we all know, change is hard. It is much more likely to be successful when patients’ autonomy, individual and social context and personal goals and values are honored. This module introduces key principles and communication techniques useful for helping patients navigate change. You’ll practice in the workshop and then we hope that you’ll take every opportunity to apply these crucial skills in your primary care clinic.
General principles to apply:
- Partner with patients, avoiding the ‘expert’ role
- Express empathy, conveying your understanding of your patient’s situation.
- Resist the “righting reflex”, our natural tendency to tell people what they should do differently.
- Develop discrepancy – discrepancy between goals and current behavior leads to motivation.
- Roll with resistance, reflecting rather than arguing with resistance to change
- Support self-efficacy, creating hope that change is possible
Specific skills and strategies to demonstrate:
- Use OARS
- Open-ended questions: to explore concerns, goals and ideas for change
- Affirmations: to highlight strengths & build self-efficacy
- Reflections: to respond to sustain talk, evoke change talk, and highlight ambivalence
- Summary: to demonstrate active listening, highlight ambivalence, and make connections
- Elicit and recognize change talk
- Assess readiness to change
- Highlight ambivalence and discrepancy with double sided reflections and summary
- Apply importance and confidence rulers
- Establish a SMART goal