Michael Vallis, PhD, R Psych

Psychologist and Lead, CH Behaviour Change Institute

Associate Professor, Dalhousie University

Halifax, CANADA

Supporting Self-Management in Chronic Disease

2

What, Me Judgmental?

What is the Standard of Care?

•Dominant models of behaviour in health care

•After giving rounds to dialysis/transplant team I was cornered by several staff

• “You work in the diabetes centre, right? We need you to take a message to the staff”

• You don’t talk enough about complications

• Our patients say: “if I knew my life would be this bad I never would have let my diabetes stay out of control”

•After giving a talk on behaviour change a family physician said

• “The problem is we just don’t scare our patients enough. If we put the fear of god into them they would do what we say”

25

DAWN2% of people with diabetes and health care professionals reporting their health care team/they engage in each behavior most of the time or always

N = 4,785

N = 8,596

Establishing

Change-Based

Relationships

Readiness:

How to Assess

How to Enhance

Supporting

Behaviour

Change

Reduce

Risk of

Relapse

Effective Self

ManagementInterventions

Outcomes aredependent on how goodyou are

• Fundamental change in the relationship between the individual and the HCP

• From

• Expert clinician with uninformed helpseeker

• “Let me tell you what you need to do”

• “Let me tell you what you need to know”

• To

• We both have a role to play

• “I understand that you will make your own decisions and I respect that. Can we have a conversation about your health”

Interpersonal Dynamics

•What do patients want?•To minimize the impact of diabetes in their life •This often means avoiding the tasks

•What do providers want?•To get the recommended glucose (A1c) and bp control•This means using lifestyle, medication and insulin

Interpersonal Dynamics

More Recipe for Disasterthan Match Made in Heaven

Therapeutic Alliance

Interpersonal Dynamics

Interpersonal Dynamics

Series1

Change-Based

Relationship

Motivational Enhancement:

Getting to Behaviour

• Is the behaviour (or lack of it) a problem for you?

• Does the behaviour (or lack of it) cause you any distress?

• Are you interested in changing your behaviour?

• Are you ready to do something to change your behaviour now?

Getting to the BehaviourReadiness Assessment

Not ReadyReady

Go Right to BehaviourModification

Ambivalent

Understanding the behaviour•Personal meaning

•Seriousness, personal responsibility, controllability, optimism

Expanding on readiness•Personal/meaningful

reasons to change

•Willingness to work hard - connect to principles

•Delay of gratification

Barriers/TemptationsEspecially social, cultural and environmental

Decisional Balance

Self-Efficacy

Series1

Change-Based

Relationship

Motivational Enhancement:

Getting to Behaviour Behaviour Modification

Series1

Change-Based

Relationship

Motivational Enhancement:

Getting to Behaviour

Behaviour Modification

Emotion Management

Assess and address the 4 SsSelf-image

Explore if the behaviour is internally of externally motivatedSelf-efficacy

A person’s confidence to perform a specific behaviour in a specific context for a specific time period and in the face of specific barriers

Social SupportAre there external factors that help sustain the behaviour?

StressIdentify emotional issues and search for opportunitiesto replace the function of unhealthy behaviourIdentify and encourage stress managementLink stress management to adherence, participation

• It is not Psychotherapy

• Your role is best delivered in the following manner:

• Identify and label

• Educate

• Recommend

• Support

THAT’S ALL: THANK YOU!

tvallis@dal.ca

www.behaviourchangeinstitute.ca

www.improvingdiabetescare.com