“Healthy Conversation Skills” training

Dr Wendy Lawrence PhD CPsycholSenior Research FellowMRC Lifecourse Epidemiology Unit

The intervention

Delivery of pilot

Evaluation

Embedding in practice

Changing health behaviour

A training course in skills to support behaviour change

Key skills:

Asking Open Discovery Questions – ‘how’ and ‘what’ questions that help people to explore their own world and find their own solutions.

Listening more than talking – allowing people to explain what makes behaviour change difficult.

Reflection – identifying good practice and areas for improvement

Supporting goal-setting – using SMARTER action planning, practitioners and patients have a sense of change and progress.

Training timetable:

2 x 3 hour group sessions(in training setting)

1 x one-to-one session(in clinical setting)

Training activities:

Exploring current beliefs / challenges Practising “Healthy Conversation Skills” in

a range of activities Role play, recordings, team challenges Reflecting on making a change Trainers modelling the skills throughout

Between September & November 2012

2 training courses delivered by 2 facilitators:

1 in Hampshire (n = 8) 1 in Buckinghamshire (n = 8)

7 trainees in each location (14 in total) participated in the one-to-one session in their own Practice

Practice Nurses Healthcare Assistants Occupational Health Nurses Sexual Health Promotion Specialist Workplace Health Promotion

Specialist

Training Delivery

Start & end of training: responses to 4 statements coded into categories

Evaluating Impact on Staff Practice: short-term

All practitioners used many more ODQs post-training, and no-one responded with telling/suggesting/ information-giving post-training.

“I need to lose weight, but I

don’t like vegetables.”

“What change

could you make to

your diet?”

“Eat less

cake!”

“You should eat 5-

a-day.”

“How else could you

lose weight?”

Evaluating Impact on Staff Practice: medium-term

Use of Open Discovery Questions Proportion of time spent listening

Observations made in one-to-one session in the trainee’s workplaceHow?How?

What?

Evaluating Impact on Staff Practice: medium-term

specific

measurable

action-orientated

realistic

timed

evaluated

reviewed

Overall competency in the 4 key skills

All trainees demonstrated good-high competency in using “Healthy Conversation Skills”.

Each skill scored from 0-4, giving a total possible score of 16.

In pairs: “How” and “What” conversation

1 = Talker (person wishing to change a behaviour)

2 = Listener (can only listen and ask Open Discovery Questions, beginning with “how” or “what”)

Consider what behaviour you’d like to change

2 mins for discussion, then swap

Afterwards, reflect on:

(Talker) How did it feel to be listened to?

(Listener) How did it feel to use only ODQs?

(Both) How far did the conversation move you towards change?

How?How?

What?

Your turn!

Reflective practice – what our trainees said

“Because it’s more interesting for me which is better because they were getting quite dull to be honest, ‘cos I was on a road driven by a computer programme!”

“Well this has highlighted some extra skills that we’ve got there that we haven’t been utilising, which will actually get the client to give us more information and evaluate more which I haven’t thought about previously. So I’m certainly going to get them working a little bit more.”

“I found it really beneficial actually - as I said I thought I was quite a good inter-personal skills and when we did the first day and you did the recording on it, I was like ‘Why?’ and then I thought ‘Oh my goodness, I’m giving closed questions’ which I hadn’t thought of before. So it did make me think and I have certainly changed my behaviour.”

“We know paper doesn’t work and we give away a rainforest here, and you know why we give a rainforest away? So the patient can’t say we haven’t told them; that’s why we get them to sign pieces of paper to say that I have worked through and told them everything!”