UConn AH 4242 Exam 2

Educating Caregivers

1. Ensure patient consent

2. Involve them early

3. Assess their willingness to help

4. Assess their ability to help

Educating Children

1. Build trust

2. Limit sessions to 10 minutes

3. Use age-appropriate toys/equipment

4. Give lots of praise

Teaching Tools

1. Adapt them to meet the patient's needs

2. Buy prepackaged tools

3. May need approval of the medical director or supervisor

4. Access web resources for reliability

What are health behaviors?

An action taken by a person to maintain, attain, or regain good health and to prevent illness

Interpersonal vs Intrapersonal considerations

Inter: Skills involving self-awareness, self-regulation, and managing one's own thoughts and emotions

Intra: Skills focused on how individuals interact and communicate with others

Knowledge-Attitude-Behavior Model

Change in knowledge --> change in attitude --> change in behavior

Knowledge vs skills

Weak scientific support

Health Belief Model (6 constructs)

1. Perceived susceptibility

-Is this really going to happen to me?

2. Perceived severity

-What are the physical and/or social consequences?

3. Perceived benefits

-Is it worth it to change

4. Perceived barriers

-What are the obstacles to changing my behavior

5. Cues to action

-Stimulus that triggers the decision-making process

6. Self-efficacy

-Level of confidence in ability to change

What are health behaviors based on?

1. The desire to avoid illness/get well from illness

2. The belief that a specific action will prevent/cure an illness

The Theory of Planned Behavior

1. Attitude towards behavior

- Positive/negative feelings toward the behavior, past success/failure, possible outcomes of performing the behavior

2. Subjective/social norms

-Beliefs about how family, friends, and society will view the individual if they perform the behavior

3. Perceived behavioral control

-Individuals' perception of how easy/difficult it will be to perform the behavior

-Increases when the individual has more resources and confidence

Stages of Change (Transtheoretical) Model

1. Pre-contemplation

-Unaware/interested in change

2. Contemplation

-Thinking about change (6 months)

3. Preparation

- Actively decides and plans to change (within 1 month). May have tried change before

4. Action

- Making the change for less than 6 months

5. Maintenance

-Sustaining change for 6 months or more

Intervention strategies for each SOC

1. Pre-contemplation

- Encouraging the patient to self-analyse and rethink their behavior

-Explain the risks of current behavior

2. Contemplation

-Weigh the pros and cons of changing behavior

-Address barriers and encourage confidence

3. Preparation

-Prepare an action plan or goal

-Motivate the patient to change

4. Action

-Encourage the patient to seek social support and motivate them to sustain the behavior

5. Maintenance

-Strategies to cope with temptation

Motivational Interviewing: Client-centered

1. Help them help themselves build commitment and change behaviors

2. Requires assessing the stages of change

3. Might include assisting with client-generated realistic goals and strategies

4. Uses open-ended questions

R.U.L.E.

Resist: Resist the urge to tell your patients how to fix (unsolicited)

Understand: Understand what their motivations are

Listen: Listen with empathy. Acceptance facilitates change

Empower: Belief in the ability to change is an important motivator

What is scaling?

A counseling skill in which the patient is asked to rate the following two items on a scale of 1- 10:

1. How important it is to them to make a particular behavior change

2. Their confidence in their ability to make a particular change

What follow-up questions should you ask?

1. What made you pick a __ and not a __?

2. What would need to happen to bring your confidence from a __ to a __?

Benefits of motivational interviewing

1. Allows patients the opportunity to reflect on their values and self-efficacy

2. Allows the patient/provider to focus efforts on making changes that are important to the patient

3. Initiates a conversation about potential barriers to success

Risk factors for low HL

- Age 65+

- lower socioeconomic status

- racial & ethnic minority

- chronic mental or physical health conditions

- Immigrant population

Two assessments of low HL

SAHL: Short Assessment of Health Literacy

REALM: Rapid Estimate of Adult Literacy in Medicine

Signs of low HL

- frequently missed appointments

- failure to complete registration forms

- difficulty naming meds or explaining their purpose/dosing

- identification of pills by looking at the pill itself

- difficulty providing coherent, sequential med history

- lack of follow-through on tests or referrals

- bringing help along

- avoiding medical care

- quick to agree

Health outcomes of low HL

1. Less frequent preventative screenings

2. Disproportionately high rates of disease and mortality

3. Increased hospitalization rates

4. Increased use of emergency rooms for primary care

5. Increased healthcare costs

Ways to improve patient comprehension

1. Slow down

2. Use living room language

3. Convey only the most important concepts

4. Involve family members

5. Use visual aids

6. Employ the teach-back method

Ways to create a shame-free environment

1. Adopt an attitude of helpfulness

2. Convey a safe, non-judgmental environment

3. Engage the entire staff

4. Be alert to cues

-Incompete forms

-Info from social history

-Insights from medication review

5. "How happy are you with how you read?"

8 NACE Competencies

1. Communication

2. Critical Thinking

3. Equity and Inclusion

4. Leadership

5. Professionalism

6. Teamwork

7. Technology

8. Career and Self-Development

Identify and describe the 4 characteristics of the "Spirit of MI"

1. Partnership: Work collaboratively

2. Acceptance: Respect the client's autonomy

3. Compassion: Keep the patients best interests in mind

4. Evocation: Best ideas come from the client