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Hollis JL, Kocanda L, Seward K, Collins C, Tully B, Hunter M, Foureur M, Lawrence W, MacDonald-Wicks L, Schumacher T. The impact of Healthy Conversation Skills training on health professionals' barriers to having behaviour change conversations: a pre-post survey using the Theoretical Domains Framework. BMC Health Serv Res 2021; 21:880. [PMID: 34452634 PMCID: PMC8394191 DOI: 10.1186/s12913-021-06893-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 08/12/2021] [Indexed: 12/05/2022] Open
Abstract
Background Changing people’s behaviour by giving advice and instruction, as traditionally provided in healthcare consultations, is usually ineffective. Healthy Conversation Skills (HCS) training enhances health professionals’ communication skills and ability to empower and motivate people in health behaviour change. Guided by the Theoretical Domains Framework (TDF), this study examined the impact of HCS training on health professional barriers to conducting behaviour change conversations in both clinical and non-clinical settings. Secondary aims were to i) identify health professionals’ barriers to having behaviour change conversations, and explore the ii) effect of HCS training on health professionals’ competence and attitudes to adopting HCS, iii) feasibility, acceptability and appropriateness of using HCS in their clinical and non-clinical roles, and iv) acceptability and quality of HCS training. Methods HCS training was conducted in October-November 2019 and February 2020. Pre-training (T1), post-training (T2) and follow-up (T3; 6-10 weeks post-training) surveys collected data on demographics and changes in competence, confidence, importance and usefulness (10-point Likert scale, where 10 = highest score) of conducting behaviour change conversations. Validated items assessing barriers to having these conversations were based on eight TDF domains. Post-training acceptability and quality of training was assessed. Data were summarised using descriptive statistics, and differences between TDF domain scores at the specific time points were analysed using Wilcoxon matched-pairs signed-rank tests. Results Sixty-four participants consented to complete surveys (97% women; 16% identified as Aboriginal), with 37 employed in clinical settings and 27 in non-clinical settings. The training improved scores for the TDF domains of skills (T1: median (interquartile range) = 4.7(3.3-5.3); T3 = 5.7(5.3-6.0), p < 0.01), belief about capabilities (T1 = 4.7(3.3-6.0); T3 = 5.7(5.0-6.0), p < 0.01), and goals (T1 = 4.3(3.7-5.0); T3 = 4.7(4.3-5.3), p < 0.01) at follow-up. Competence in using ‘open discovery questions’ increased post-training (T1 = 25% of responses; T2 = 96% of responses; T3 = 87% of responses, p < 0.001), as did participants’ confidence for having behaviour change conversations (T1 = 6.0(4.7-7.6); T2 = 8.1(7.1-8.8), p < 0.001), including an increased confidence in having behaviour change conversations with Aboriginal clients (T1 = 5.0(2.7-6.3); T2 = 7.6(6.4-8.3), p < 0.001). Conclusions Provision of additional support strategies to address intentions; memory, attention and decision processes; and behavioural regulation may enhance adoption and maintenance of HCS in routine practice. Wider implementation of HCS training could be an effective strategy to building capacity and support health professionals to use a person-centred, opportunistic approach to health behaviour change. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06893-4.
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Affiliation(s)
- Jenna L Hollis
- Hunter New England Population Health, Hunter New England Local Health District, Newcastle, New South Wales, Australia. .,School of Medicine and Public Health, The University of Newcastle, Newcastle, New South Wales, Australia. .,Hunter Medical Research Institute, Newcastle, New South Wales, Australia. .,Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, New South Wales, Australia. .,Priority Research Centre for Physical Activity and Nutrition, The University of Newcastle, Newcastle, New South Wales, Australia.
| | - Lucy Kocanda
- School of Medicine and Public Health, The University of Newcastle, Newcastle, New South Wales, Australia.,Hunter Medical Research Institute, Newcastle, New South Wales, Australia.,Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, New South Wales, Australia.,Priority Research Centre for Physical Activity and Nutrition, The University of Newcastle, Newcastle, New South Wales, Australia.,Department of Rural Health, University of Newcastle, Tamworth, New South Wales, Australia
| | - Kirsty Seward
- Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, New South Wales, Australia.,School of Health Sciences, The University of Newcastle, Newcastle, New South Wales, Australia
| | - Clare Collins
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia.,Priority Research Centre for Physical Activity and Nutrition, The University of Newcastle, Newcastle, New South Wales, Australia.,School of Health Sciences, The University of Newcastle, Newcastle, New South Wales, Australia
| | - Belinda Tully
- Hunter New England Population Health, Hunter New England Local Health District, Newcastle, New South Wales, Australia.,Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Mandy Hunter
- Hunter New England Local Health District Nursing and Midwifery Services, Newcastle, New South Wales, Australia
| | - Maralyn Foureur
- School of Nursing and Midwifery, The University of Newcastle, Newcastle, New South Wales, Australia.,Nursing and Midwifery Research Centre, Hunter New England Health, Newcastle, New South Wales, Australia
| | - Wendy Lawrence
- Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK.,NIHR, Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Lesley MacDonald-Wicks
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia.,Priority Research Centre for Physical Activity and Nutrition, The University of Newcastle, Newcastle, New South Wales, Australia.,School of Health Sciences, The University of Newcastle, Newcastle, New South Wales, Australia
| | - Tracy Schumacher
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia.,Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, New South Wales, Australia.,Priority Research Centre for Physical Activity and Nutrition, The University of Newcastle, Newcastle, New South Wales, Australia.,Department of Rural Health, University of Newcastle, Tamworth, New South Wales, Australia
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Lawrence W, Vogel C, Strömmer S, Morris T, Treadgold B, Watson D, Hart K, McGill K, Hammond J, Harvey NC, Cooper C, Inskip H, Baird J, Barker M. How can we best use opportunities provided by routine maternity care to engage women in improving their diets and health? Matern Child Nutr 2020; 16:e12900. [PMID: 31736283 PMCID: PMC7038869 DOI: 10.1111/mcn.12900] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 09/12/2019] [Accepted: 09/30/2019] [Indexed: 01/30/2023]
Abstract
Pregnancy provides motivation for women to improve their diets and increase their physical activity. Opportunistic brief interventions delivered as part of routine primary care have produced improvements in patients' health behaviour. Consequently, there have been calls for midwives to use contacts during pregnancy in this way. This study explored the experiences of pregnant women and research midwives/nurses of a brief intervention called Healthy Conversation Skills (HCS) being delivered as part of a randomised control trial, assessing the acceptability and feasibility of including this intervention in routine maternity care. Three research questions were addressed using mixed methods to produce four datasets: face-to-face interviews with participants, a focus group with the HCS-trained midwives/nurses, case reports of participants receiving HCS and audio-recordings of mid-pregnancy telephone calls to the women which produced midwife/nurse HCS competency scores. Midwives/nurses used their HCS to support women to make plans for change and set goals. Women welcomed the opportunity to address their own health and well-being as distinct from that of their baby. Midwives/nurses were competent in using the skills and saw healthy conversations as an effective means of raising issues of diet and physical activity. Recent extension of maternity appointment times provides ideal opportunities to incorporate a brief intervention to support behaviour change. Incorporating HCS training into midwifery education and continuing professional development would facilitate this. HCS is a scalable, brief intervention with the potential to improve the diets and physical activity levels of women during pregnancy, and hence the health of themselves and their babies.
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Affiliation(s)
- Wendy Lawrence
- MRC Lifecourse Epidemiology UnitUniversity of SouthamptonSouthamptonUK
- NIHR Southampton Biomedical Research CentreUniversity of Southampton and University Hospital Southampton NHS Foundation TrustSouthamptonUK
| | - Christina Vogel
- MRC Lifecourse Epidemiology UnitUniversity of SouthamptonSouthamptonUK
- NIHR Southampton Biomedical Research CentreUniversity of Southampton and University Hospital Southampton NHS Foundation TrustSouthamptonUK
| | - Sofia Strömmer
- MRC Lifecourse Epidemiology UnitUniversity of SouthamptonSouthamptonUK
- NIHR Southampton Biomedical Research CentreUniversity of Southampton and University Hospital Southampton NHS Foundation TrustSouthamptonUK
| | - Taylor Morris
- MRC Lifecourse Epidemiology UnitUniversity of SouthamptonSouthamptonUK
| | - Bethan Treadgold
- School of Primary Care and Population SciencesUniversity of SouthamptonSouthamptonUK
| | - Daniella Watson
- MRC Lifecourse Epidemiology UnitUniversity of SouthamptonSouthamptonUK
| | - Kate Hart
- MRC Lifecourse Epidemiology UnitUniversity of SouthamptonSouthamptonUK
| | - Karen McGill
- MRC Lifecourse Epidemiology UnitUniversity of SouthamptonSouthamptonUK
| | - Julia Hammond
- MRC Lifecourse Epidemiology UnitUniversity of SouthamptonSouthamptonUK
| | - Nicholas C. Harvey
- MRC Lifecourse Epidemiology UnitUniversity of SouthamptonSouthamptonUK
- NIHR Southampton Biomedical Research CentreUniversity of Southampton and University Hospital Southampton NHS Foundation TrustSouthamptonUK
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology UnitUniversity of SouthamptonSouthamptonUK
- NIHR Southampton Biomedical Research CentreUniversity of Southampton and University Hospital Southampton NHS Foundation TrustSouthamptonUK
- NIHR Oxford Biomedical Research CentreUniversity of OxfordOxfordUK
| | - Hazel Inskip
- MRC Lifecourse Epidemiology UnitUniversity of SouthamptonSouthamptonUK
- NIHR Southampton Biomedical Research CentreUniversity of Southampton and University Hospital Southampton NHS Foundation TrustSouthamptonUK
| | - Janis Baird
- MRC Lifecourse Epidemiology UnitUniversity of SouthamptonSouthamptonUK
- NIHR Southampton Biomedical Research CentreUniversity of Southampton and University Hospital Southampton NHS Foundation TrustSouthamptonUK
| | - Mary Barker
- MRC Lifecourse Epidemiology UnitUniversity of SouthamptonSouthamptonUK
- NIHR Southampton Biomedical Research CentreUniversity of Southampton and University Hospital Southampton NHS Foundation TrustSouthamptonUK
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Lawrence W, Black C, Tinati T, Cradock S, Begum R, Jarman M, Pease A, Margetts B, Davies J, Inskip H, Cooper C, Baird J, Barker M. 'Making every contact count': Evaluation of the impact of an intervention to train health and social care practitioners in skills to support health behaviour change. J Health Psychol 2016; 21:138-51. [PMID: 24713156 PMCID: PMC4678584 DOI: 10.1177/1359105314523304] [Citation(s) in RCA: 92] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
A total of 148 health and social care practitioners were trained in skills to support behaviour change: creating opportunities to discuss health behaviours, using open discovery questions, listening, reflecting and goal-setting. At three time points post-training, use of the skills was evaluated and compared with use of skills by untrained practitioners. Trained practitioners demonstrated significantly greater use of these client-centred skills to support behaviour change compared to their untrained peers up to 1 year post-training. Because it uses existing services to deliver support for behaviour change, this training intervention has the potential to improve public health at relatively low cost.
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Affiliation(s)
| | | | | | - Sue Cradock
- NIHR Nutrition Biomedical Research Centre, Southampton Centre for Biomedical Research, UK
| | - Rufia Begum
- MRC LEU, University of Southampton, UK NIHR Nutrition Biomedical Research Centre, Southampton Centre for Biomedical Research, UK
| | - Megan Jarman
- MRC LEU, University of Southampton, UK NIHR Nutrition Biomedical Research Centre, Southampton Centre for Biomedical Research, UK
| | - Anna Pease
- School of Social and Community Medicine, University of Bristol, UK
| | - Barrie Margetts
- Primary Care and Population Sciences, University of Southampton, UK
| | | | | | - Cyrus Cooper
- MRC LEU, University of Southampton, UK NIHR Nutrition Biomedical Research Centre, Southampton Centre for Biomedical Research, UK
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