Improving Health: Changing Behaviour. NHS Health Trainer Handbook

Abstract

Contents 3-4 Introduction and the role of a Health Trainer 5 How to use this handbook 6-8 Sample meeting structure 9-10 Suggested introductory and closing scripts for each meeting 11 How to assess clients 12-13 Finding out about your client 14 Encouraging people to change 15 Confidentiality and competence checklist Thinking about changing behaviour 16 Choosing a behaviour to change 17-20 Health benefit cards 21-24 Health Behaviour Check 25 Deciding to change 26-27 Balance sheets (client worksheets) 28-29 Increasing confidence to change Planning the behaviour change 30 Goal Setting 31 SMART goals 32 SMART goals (client worksheet) 33 ABC Forms 34-35 ABC example and blank form 36 Rewards 37 Rewards (client worksheet) 38-39 Action planning 40 Personal Health Guide (client worksheet) 41 Barriers and facilitators (client worksheet) Recording and Reviewing behaviour change 42-43 Using the Behaviour Change Diary and other diaries 44 The Behaviour Change Diary (client worksheet) 45 Food Diary (client worksheet) 46 Physical Activity Diary (client worksheet) 47 Smoking Diary (client worksheet) 48 Alcohol Diary (client worksheet) 49 Reviewing behaviour change Maintaining behaviour change 50-51 Preparing for Setbacks 52 Difficult situations and if-then plans (client worksheet) 53-54 Dealing with setbacks (client reminder sheet) 55 Building habits 56 Building habits (client worksheet) 57 Becoming your own Health Trainer 58-60 Becoming your own Health Trainer (client worksheet) 61-68 References and theoretical explanations Appendix 69-73 Evaluation forms 74 Feedback form Specific-some goals can be vague and difficult to measure. It is important to set goals that are clear and precise. E.g. A vague goal would be "Being fit and athletic", whereas a clear, specific goal would be "I will work out at the local gym for at least 30 minutes three times a week at 7pm on Monday and Thursday and 10am on Saturday." 1 would correspond to 1 Carver, C.S. & Scheier, M.F. (1998). On the self-regulation of behaviour. New York. Cambridge University Press The theoretical basis of these ideas comes from Carver & Scheier's Control Theory. They defined these levels within the goal hierarchy as; system concepts (abstract goal), principles (action goal) and programmes (courses of action). in the references and theoretical information section. Pages which have mostly red text are client worksheets, for example, pages 52-54. The worksheets are intended for you to copy and adapt as appropriate for use with your clients. Also included are 'Client reminder sheets' (see page 32 for an example). These sheets are designed to be copied and given to clients to use at home. NB The illustrations used in this version are intended to break up solid blocks of text and make the handbook more readable and user friendly. It is anticipated that the final version will use professional illustrations. 6 Sample Meeting Structure The following section is an example of how you could structure your meetings with clients and tells you which sections of the handbook are relevant ...

UPBEAT-UK: a programme of research into the relationship between coronary heart disease and depression in primary care patients

“…Having goals and social support are known to be important to well-being. 64 Although no participant specifically mentioned goals, several noted that the causes of depression are specific to individuals and that to be effective, management plans should be patient driven. Evidence-based interventions that involve patients deciding which areas of their lives to address, such as problem-solving therapy, motivational interviewing or the technique of 'SMART goals', where individuals identify an area to change that is Specific, Measurable, Appropriate, Realistic and Timely, may therefore be useful in CHD depression and would most likely be accepted by GPs and PNs.…”

“…Identification by the patient of an individual who can support them in their self-management is a commonly used and effective strategy in several health-care interventions, for example weight loss and health training. 64 This type of intervention may be appropriate for many CHD patients and would be supported by GPs and PNs.…”

“…2 Case managers are often nurses, but studies lack details concerning implementation and process 104 Evidence-based behaviour change interventions, such as goal-setting and action-planning, have been identified for use in primary care 64 Pilot work should be undertaken to understand which aspects of case management are effective in CHD patients with depression and which outcomes should be targeted…”

A longitudinal, qualitative study exploring sustained adherence to a hand exercise programme for rheumatoid arthritis evaluated in the SARAH trial

“…The behavioural components of the intervention utilised strategies published in the the Improving Health: Changing Behaviour NHS Health Trainer Handbook. This is based on the Health Belief Model and are evidenced based strategies to plan and implement behavioural change (12,16,17). The therapist also assessed any facilitators and barriers to exercise promoting discussion with each participant.…”

“…Seventeen National Health Service (NHS) Trusts took part in the SARAH Trial. Ensuring that participants carried out daily exercises was a key element of the intervention and we utilised evidence based strategies to maximise adherence (12). The aim of this parallel, interview study explored the trial participants' experiences of the exercise programme and, in particular, how successfully they adhered to the programme over time.…”