Novel approaches: helping individuals to help themselves?

The environment in which somebody lives clearly has a major influence on health. Public health interventions are designed to make healthy choices easier and are likely to have maximum impact if fully implemented1. If people are motivated to change health behaviour, easy availability of healthy and economic choices will support the process.

On an individual basis, an advice-giving style has been traditionally used to encourage people to live healthier lifestyles. The expectation being that once people are told what to do, they will follow this advice. However, research shows that giving advice alone does not automatically change behaviour2, 3. The challenge is to understand human behaviour, and work with it to influence health behaviour.

Setting the stage psychologically is of prime importance when helping others changes their behaviour 4, 5. It is necessary to understand how a person thinks and feels about their situation, as this will ultimately influence their health behaviour. Their attitudes, beliefs, individual learning styles, social, cultural, religious and economic situation will also affect behaviour.

There is evidence that the use of a behavioural approach is effective in influencing lifestyle changes. The main principles of this treatment approach include the modification of current behaviour patterns, new adaptive learning, problem solving and a collaborative relationship between client and therapist6.

A behavioural approach is based on a client-centered approach. Research shows that the single most important aspect of care which influences health behaviour change is the relationship between the client and the therapist 7, 8.

Knowledge alone does not lead to behaviour change 9,10. Practitioners and others working with individuals need to develop the knowledge and skills to equip them to influence health behaviour.

Although Behaviour Change Skills are increasingly seen as important in influencing health behaviour, there is often a lack of agreement and understanding about what is meant by ‘Behaviour Change Skills’ (BCS). BCS are a medley of approaches taken from the world of psychology, which can be applied in traditional clinical settings. ‘Motivational Approaches’ (adapted from Motivational Interviewing) and ‘Cognitive Behavioural Approaches’ (adapted from Cognitive Behavioural Therapy) are currently viewed as the psychological approaches that are best suited to everyday practice.

However, in order to use these approaches effectively, practitioners need to have a good understanding of the theory underlying health behaviour change and have a strong possession of good interpersonal skills. This can only be achieved through appropriate training.

This presentation focuses on achieving health behaviour change in the individual and how interventions can be maximised through extending traditional practice to form an integrated approach to health behaviour change.

References

1. National Institute for Health and Clinical Excellence. Public Health Guidance 6 – Behaviour Change (2007). www.nice.org.uk

2. Contento J, Balch GI, Bronner YL, Lytle LA, Maloney SK, Olson CM, Swadener SS. The effectiveness of nutrition education and implications for nutrition education policy, programs, and research: a review of research. Journal of Nutrition Education 1995; 27 (6) Nov/Dec Special Issue.

3. Thorogood M, Hillsdon M, Summerbell C. Changing Behaviour. Clinical Evidence 2002; 8: 37-59.

4. Brownell KD, Cohen LR. Adherence to dietary regimens 1: An overview of research. Behavioral Medicine 1995a; 20: 149-154.

5. Brownell KD, Cohen LR. Adherence to dietary regimens 2: Components of effective interventions. Behavioral Medicine 1995b; 20: 155-164.

6. HDA (Health Development Agency) (2003). The management of obesity and overweight: an analysis of reviews of diet, physical activity and behavioural approaches. www.hda.nhs.uk

7. Najavits, L. M. & Weiss, R. D. (1994). Variations in therapist effectiveness in the treatment of patients with substance use disorders: an empirical review. Addiction 89, 679-688

8. Miller W& Rollnick S. (2002) Motivational Interviewing Preparing People for Change. The Guildford Press ISBN: 1-57230-563-0

9. 7 Glanz, K. (1985). Nutrition education for risk factor reduction and patient education: A review. Preventive Medicine 14, 721-752.

10. Thomas, J. (1994). New approaches to achieving dietary change. Current Opinion in Lipidology, 5, 36-41