In addition to motivational interviewing, AHP’s may have their own favourite method of motivation to elicit behaviour change that they wish to use. In promoting exercise, alternative socio-behavioural approaches have also been developed to help people change physical activity patterns. The following case study is an example of such a technique.
In recent years, 50 year old Edith has experienced more and more bouts of prolonged unhappiness. She has not been diagnosed with clinical depression, but her GP has recommended she becomes physically active. She has done little if no purposeful exercise since her teenage years when she used to hate sport and physical education at school, finding it threatening and embarrassing. Edith is on the borderline between overweight and obesity with a BMI of 29 and has been recently been diagnosed with mild hypertension. She has a family history of type 2 diabetes.
The start point for Edith is to construct an activity programme with the help of an exercise professional using a person-centred approach.
The first step is to discuss with Edith her past history in sport and exercise and help her to work out which activities she might be interested in starting. During this discussion, we discover she has not been involved in any sport or exercise since leaving school (her 7-day recall of activity revealed less than 10min of activity- only walking- each day) and that she never enjoyed team games such as hockey at school. She says she might enjoy some group activity, but feels she is not confident to join a group at the moment. She would like to think she could join a group of women with similar kinds of issues at some point.
The second step is to weigh up the pros and cons Edith perceives in becoming more active. Edith agrees that being more active is important for her and might help her feel more positive about herself and life in general, as well as help her lose some weight and get her blood pressure down. However, Edith does not feel very sporty or athletic and finds it difficult to see ways in which she can be more active, so the conversation turns to walking as a starting strategy.
The next important task is short-term goal setting that can provide a sense of steady but safe improvement. Short term goals have to have a flavour of where, when, and what. They need to be specific and agreed (following the SMART principle of being Specific, Measurable, Agreed, Realistic and Time phased).
The discussion moves to time difficulties, as Edith is still holding a demanding full-time job and finding it difficult to cope. The key motivational issue, then, is to ensure small goals for the early weeks that are achievable but that will move her forwards. Goals that are too demanding at this point may undermine confidence and disappoint if they are not reached. It is important to emphasize that mental health or mood benefits may be experienced fairly quickly and there will be changes in exercise capacity in a matter of a few weeks.
Case study reference.7
NICE guidelines recommend using techniques that create attitude and behaviour change within health care interventions.8 Whilst no single method can be universally applied, a combination of motivational interviewing and written physical activity on prescription has been used effectively in Sweden for the past 15 years. A follow up study there has shown a majority (65%) still adhering to the advice after 6 months, with partial adherence at 19% and non adherence 16%. This, as they point out: “is as good as adherence to other treatments for chronic diseases. This is significant because even a small increase in physical activity is important both on an individual level and for public health”.9
Key message: Behaviour change techniques are an important part of any consultation on lifestyle advice.
Read more on Motivational Interviewing here
1. Attending a course on behaviour change.
Benefits for GPs and teams: Greater success in supporting behaviour change in all lifestyle issues, leading to reduced appointments drug costs and healthier patients.
Patient resources: A work sheet is available on behaviour change from the patient Benefit from Activity website on ‘How do I change’