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  What works and what doesn't work?

Why changing health behaviours can be hard

Many people find lifestyle change difficult, so lets think about aspects of lifestyle change that patients might find harder or easier to achieve.

How about you?

Think about a time when you have tried to change your lifestyle. This could be reducing alcohol, giving up smoking, changing your diet, increasing the amount of exercise you do. Spend a couple of minutes thinking about what you tried to do, what happened, what got in the way and what was helpful.

How about other people?

Watch the clip at the bottom of the page of Miles talking about the challenges he faced when quitting smoking, and what motivated him to not give in.

The second clip shows Chelsea talking about her diet habits. Think about the barriers she faced, and the aspects of her diet that may be problematic to her oral and general health.

Common pit-falls to avoid in consultations

Pitfall 1. Scaring patients into changing

A common misconception is that people need to be sufficiently scared of the damaging effects of their behaviour on their health in order to motivate themselves to change. This might seem reasonable – if only people understood what damage they were doing then they would stop it. Over the years this type of reasoning has led to many healthcare professionals (and public health campaigns) putting out fear inducing message such as ‘smoking kills’. These have largely been ineffective because, unfortunately, people don’t always behave this rationally. In fact sometimes, increasing people’s fear can actually increase the unhealthy behaviour.

Why?

Feeling scared is very unpleasant and people try to reduce the sensation of fear wherever possible. This doesn’t mean focusing on reducing the true risk (e.g. smoking) but avoiding the source of the fear (e.g. the scary message, or messenger). This might mean covering up anti-smoking messages on cigarette packages, avoiding healthcare professionals or disengaging from smoking cessation clinics. Some behaviours, like eating or smoking, may be comforting, so trying to scare someone might inadvertently drive them to eat or smoke more.

Instead

Try to identify the patient’s fears and reduce these. Focusing on bolstering their ability to achieve the healthier behaviour will help them feel more confident in being able to make changes and encourage them to see you as a source of support.


Pitfall 2. I need to persuade the patient

Another common pitfall that healthcare professionals make is to offer lots of arguments for why the patient needs to change their behaviour. You may believe that if the patient just understood the arguments, then they would be convinced and would behave more healthily.

But

Patients probably already know the arguments for why they should stop smoking, or change their diet or alcohol consumption. They will also have built up arguments to counter these. If you take the side of change then you are likely to end up, inadvertently, encouraging patients to develop the counter arguments, and dig their heels in further.

Instead

Listen for cues from patients (however subtle) that they want to make changes, and explore this. Encourage them to come up with reasons for wanting to change.


Pitfall 3. Patients need more information

As healthcare professionals we spend a lot of time giving patients information about disorders and treatments. It’s tempting to think that if we give patients enough information about changing their behaviour, then this will result in behaviour change. Unfortunately, research shows that information alone is rarely sufficient. Often patients will know quite a lot about how to eat healthily, the risks of smoking and consuming alcohol.

In the next part of the session we will look at specific techniques to help you support patients behaviour changes.