Support your Patients with Behavior Change Strategies

Lifestyle changes are hard to make and can be even harder to sustain, but evidence-based lifestyle intervention programs and strategies are available and have been shown to enable people with prediabetes to lose weight and cut their risk of developing type 2 diabetes in half. Patients who are ready to attend such a program will benefit from a health care provider’s referral. Patients not ready for a lifestyle change program will likely need assistance from their health care team and others to learn how to make these changes and stay on track. For resources, see Support Patients with Resources and Referrals.

The health care team may select different strategies to provide education and support according to comfort level, experience and training, and feasibility for use of the strategy in their practice setting. Health care teams may need to use different communication skills in order to support patients getting started with their behavior change efforts and help them persist when they face barriers and challenges. For more information about how to implement multidisciplinary care, see NDEP’s Team-Based Care.

NDEP’s Diabetes HealthSense for Health Care Professionals offers information and resources to improve expertise and skills surrounding behavior change. During patient encounters, health care teams can consider using the Diabetes HealthSense Make a Plan resource to help patients set goals and develop action plans. This resource can be used online or printed as a PDF. It helps patients identify:

  • What is important to their health and what has been getting in the way
  • What their specific health goals are
  • What will help them reach their goals, including addressing preparation, barriers, measures of success, and rewards
  • Finding resources to support their behavior change efforts

NDEP provides free resources to help patients make lifestyle changes. (See NDEP Resources.)

To further expand skills in the area of behavior change, health care teams may consider integrating one or more of the following behavioral techniques and strategies into patient encounters:

Shared decision-making

Shared decision-making enables patients to be active participants in their care and make informed choices.

Shared decision-making helps patients understand what is known and not known about the health outcomes that matter to them. Patients’ values and preferences play an important role in the decision-making. Performing shared decision-making during clinic visits relies on the three steps of choice talk, option talk, and decision talk:1

  1. Choice talk: The clinician presents an unbiased view of the pros and cons for all options, including “do nothing.” This may require the patient to do homework (read about a treatment, watch a video, etc.) and then return for further discussion.
  2. Option talk: The patient tells the clinician about personal factors that might make one option more appealing or feasible than another. These include personal values, goals, preferences, and circumstances. Decision aids may be used to guide the conversation.
  3. Decision talk: Together, the patient and clinician decide which option best reflects the patient’s needs and values.

To learn more about shared decision-making, go to:

Motivational interviewing

Motivational interviewing is a collaborative conversation for strengthening a person’s own motivation and commitment to change.

Motivational interviewing is a conversation about change using a patient-centered counseling style to address the common problem of ambivalence about change. It helps patients to understand and weigh the benefits of action and disadvantages of the status quo, while expressing optimism toward the potential for success and support for intentions to act. The result is to promote goal setting and action by building self-efficacy (i.e., confidence) for successful behavior change. Motivational interviewing uses several effective communication strategies that can be learned and adopted by all members of the health care team who have received motivational interviewing training. The O.A.R.S. mnemonic is a brief way to remember the basic communication skills used in motivational interviewing:

  • Open-ended questions to focus on the patient and understand his or her knowledge, attitudes, and beliefs
  • Affirmations that acknowledge his or her strengths and actions in ways that build confidence for ongoing success
  • Reflective listening to express concern and validate that his or her ideas and feelings are being heard and understood
  • Summarization of what has been heard to help the patient move forward from ambivalence toward action

For more information and videos demonstrating motivational interviewing, go to:

5 A’s behavior change model

The 5 A’s Behavior Change Model2 has been adapted for self-management support improvement.

The 5 A’s Behavior Change Model includes the following steps:

  1. Assess: Ask about or assess behavioral health risk(s) and factors affecting choice of behavior change goals or methods
  2. Advise: Give clear, specific, and personalized behavior change advice, including information about personal health harms and benefits
  3. Agree: Collaboratively select appropriate treatment goals and methods based on the beneficiary’s interest in and willingness to change the behavior
  4. Assist: Using behavior change strategies (self-help and/or counseling), aid the beneficiary in achieving agreed-upon goals by acquiring the skills, confidence, and social or environmental supports for behavior change, supplemented with adjunctive medical treatments when appropriate
  5. Arrange: Schedule follow-up contacts (in person or by telephone) to provide ongoing assistance or support and to adjust the treatment plan as needed, including referral to more intensive or specialized treatment

To learn more about the 5 A’s behavior change model, go to:

References