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The Health Change Approach to
Behaviour Change:
Overview for Practice Nurses and
Allied Health
Presented by Health Change Australia
Caroline Bills
www.healthchangeaustralia.com
Please switch mobiles to silent
© 2013 Health Change Australia
Slide 1
Workshop content
Health Change Approach practice
principles and essential techniques
Client videos & group
demonstration
Overview of decision framework
and patient documentation
© 2013 Health Change Australia
Pathway
Page 2
The Health Change Approach supports
behaviour change and self-management for…
Severe chronic complex
condition management
Chronic complex
condition management
Early intervention
Prevention
© 2013 Health Change Australia
Page 3
What do you want take away from
this workshop?
© 2013 Health Change Australia
Page 4
Only 1 in 2 patients can be expected to take action
to achieve better health outcomes!
66%
Patients with hypertension who have poor BP control due to
non-adherence
50%
Patients who act on GP referrals to other practitioners and
services*
50%
Overall adherence to chronic conditions treatment including
lifestyle changes
25%
Maintenance of new exercise behaviours after rehabilitation
in the general population, and
following cardiac rehabilitation
50%
(WHO 2003; GP clinic audit*; Dishman 1988; Oldridge 1991)
© 2013 Health Change Australia
Slide 5
Common patient predictors of
non-adherence & poor self-management
“Don’t tell me
what to do!”
© 2013 Health Change Australia
“Yes, Yes, tell me
what to do”
Slide 6
How to turn patients into elks or polar bears
• Tell patients what to do and argue the point with
logic
• Overeducate with non-personalised information
• Overwhelm patients by expecting them to do too
much at once
• Don’t let them know about expected course of
disease and expected course of treatment
• Use scare tactics without offering hope and help
© 2013 Health Change Australia
Slide 7
Common coping strategy for patients
Cognitive, behavioural & emotional
Avoidance response
© 2013 Health Change Australia
Slide 8
Patient demonstration
© 2013 Health Change Australia
Insulin Pump Video
Slide 9
Patient and clinician behaviour change pathway
Knowledge & understanding
Motivation & expectations
Decision & commitment
Decision Line
Ready to take
action
Macro View
Micro View
Planning
Action
Self-regulation
Build Motivation
© 2013 Health Change Australia
Build Confidence
Page 10
Complementary clinical pathways:
Clinical condition pathway / Health Change Approach
Clinical Assessment
HBC Assessment
Clinical Decision-making
Algorithm
HBC Decision-making
Algorithm
Diagnosis
RICk Clarity
E-b Treatment Plan or
Recommendations
E-b Behaviour Change
Support
HBC = health behaviour change
RICk = readiness, importance, confidence, knowledge
E-b = evidence-based
© 2013 Health Change Australia
Page 11
The Health Change Australia Model of Behaviour Change
(Health Change Approach)
Integrates patient-centred communication and behaviour
change support into a clinical practice decision framework
Client behaviour change pathway
Knowledge & understanding
Client-centred
Practice Principles
Essential Behaviour
Change Techniques
Motivation & expectations
Decision
Line
Decision & commitment
Decision Framework
Planning
Action
Self-regulation
Build Motivation
Build Confidence
But, it is not a magic pill!
© 2013 Health Change Australia
Page 12
Key questions above and below the decision line
Does the patient know and understand the clinical issues and broad
referral, lifestyle and treatment categories applicable to their
conditions and risk factors?
Have they been assisted to collaboratively prioritise these?
Are they ready, willing, able and committed to taking action?
Decision Line
Macro View
Ready to
Take Action
Micro View
What options do they have for taking action in a particular category?
What is their personalised goal and plan?
Are they confident they can do this and what might get in the way?
Will I review the client and what other support do they need?
Build Importance
© 2013 Health Change Australia
Build Confidence
Page 13
The Health Change Approach uses a
conversational style to:
1. Provide clinical information and treatment advice
is in a way that enhances patient knowledge,
understanding and engagement
2. Quickly identify and address adherence issues
(barriers to patient engagement)
3. Increase patient motivation and self-efficacy for
following treatment advice and build patient selfmanagement skills
© 2013 Health Change Australia
Page 14
What stops people from taking action to
achieve better health and quality of life?
Behaviours
• Actions, everyday habits, planning or lack of
planning
Emotions
• Emotional reactions to things that happen to
us, mood states
Situations
• Medical, cognitive abilities, social, physical,
access, $, changes in circumstance, clinicians
Thinking
• Beliefs, attitudes, expectations & habitual
thinking patterns, motivation (RIC),
knowledge (k)
© 2013 Health Change Australia
Adapted from Grant & Greene 2001
Page 15
What’s the evidence?
• Evidence-based health behaviour change principles
and techniques (see Gale & Skouteris, 2012)
•
•
•
•
•
•
Health behaviour change theory
Chronic disease prevention and management programs
Brief motivational interviewing
Solution-focused counselling
Cognitive behavioural counselling techniques
Health coaching literature
• The Health Change Australia model bridges the gap
from theory to practice to make the evidence-base
usable in health consultations and other services
© 2013 Health Change Australia
Page 16
Potential benefits to nurses & practices
• Better work satisfaction
• Greater confidence in working with ‘difficult’ patients and
those low in readiness
• Greater time efficiency in consultations
• Fewer ‘fail to show’ patients
• Fewer “yes buts” and less resistance from patients
• Less frustration with review patients that take no action
• Transferable skills to be used in any context
• Better recruitment and retention in programs
• Measurable processes
© 2013 Health Change Australia
Page 17
How can I assist this patient,
to achieve these specific health outcomes,
at this point in time, given their…..?
• Current clinical issues
• Current psychosocial issues
• Current level of readiness
• Current barriers to taking action
• Current knowledge levels
• Current life circumstances
• Levels of ability, and
• Consultation time constraints
© 2013 Health Change Australia
Page 18
Health Change practice principles
RICk = Readiness, Importance, Confidence, knowledge
© 2013 Health Change Australia
Slide 19
Adapt your conversation style
to suit your patients
Cognitive
Impairment ?
Cultural
Issues ?
Acute/Chronic
Health
Issues ?
Resistance ?
Psychosocial
Issues ?
Language/
Lit. Issues ?
Personality?
Passive
Compliance ?
Depression
Anxiety ?
Age-Related
Issues ?
© 2013 Health Change Australia
Slide 20
Call it as you see it (or hear it)
Avoid playing the
practitioner-client game!
© 2013 Health Change Australia
Slide 21
Patient care
plan or
treatment
plan
1
Clinical
targets
(physiological)
4
Motivational
drivers
Personal selfmanagement
plan
2
Broad
lifestyle &
treatment
categories
© 2013 Health Change Australia
3
Specific
personalised
health goals
Wound Care Video
Personal
action plan
Page 22
How do treatment goals relate to the behaviour change
pathway?
1
Clinical
Targets
Patient behaviour change pathway
Knowledge & understanding
2
Lifestyle &
Treatment
Categories
Motivation & expectations
Decision
Line
Decision & commitment
Planning
Action
Macro View
Micro View
4
Motivational
Drivers
3
Specific
Personalized
Health Goals
Self-regulation
Build Motivation
© 2013 Health Change Australia
Page 23
Different patients will have different
motivators
What might motivate the following groups of patients?
• Children?
• Teens?
• Working age adults?
• Seniors?
• People with disabilities?
• People with mental health issues?
• Different cultures?
• Others?
© 2013 Health Change Australia
Slide 24
© 2013 Health Change Australia
Derek Case
Slide 25
The RICk principle
Readiness
Importance
Confidence
knowledge
© 2013 Health Change Australia
}
Action
Slide 26
The HCA RICk principle
Listen and look for cues that
indicate RICk levels
Use your RICk radar
when in doubt, ask the client
RICk tips:
1) If importance is low: build motivation, raise priority
2) If confidence is low: identify and address barriers
© 2013 Health Change Australia
Page 27
First ask the client,
Then offer:
• Clinical assessment
• Clinical education
• Health recommendations
• Treatment and referral options
• Strategies to achieve goals
• Suggestions regarding possible barriers
© 2013 Health Change Australia
Slide 28
WAIT til 8
Why
Am
I
Talking?
Why
Am
I
Taking Notes
or Typing?
People often need time to think and answer
A response at the 8 second mark is common
© 2013 Health Change Australia
WAIT til 8 video
Slide 29
Invite the client to write
Why might this increase a client’s
success rate?
© 2013 Health Change Australia
Invite to write video
Slide 30
Trial & error
When you don’t succeed…
...try a different strategy!
© 2013 Health Change Australia
Trial and error video Slide 31
Health Change essential techniques
© 2013 Health Change Australia
Slide 32
Are you ready to do something
about your own health?
1. Knowledge & Understanding
2. Motivation & Expectations
3. Decision & Commitment
Decision
Line
4. Planning
© 2013 Health Change Australia
Page 33
Knowledge & understanding: What would benefit your health?
Consider your own clinical indicators & risk factors:
Other?
Health
Checks?
ZZZZZ…
© 2013 Health Change Australia
Slide 34
Motivation & expectations: importance
How important is it to you personally to work
on this issue (given all the other priorities
currently in your life)?
© 2013 Health Change Australia
Slide 35
Motivation & expectations: confidence
How confident are you that you will make
some manageable and sustainable behaviour
changes in relation to this issue?
© 2013 Health Change Australia
Slide 36
Decision & commitment
In relation to your chosen health issue consider...
1. If you continue to do what you are currently doing (or
not doing), what will the long-term consequences be for
you? What about the people or things that are important
to you?
2. If you do make some manageable and gradual changes,
what immediate or long-term benefits would you expect
to gain? What would the impact of this be?
3. Do these expected negative or positive outcomes make it
important enough for you to work on this issue now?
© 2013 Health Change Australia
Slide 37
Decision & commitment
• Are you ready to do something about this?
• Is it relatively important to you?
• Are you confident that you will take some action?
• Do you have all the information you need to make a
decision and take action?
Did your RICk levels change?
© 2013 Health Change Australia
Slide 38
Planning: create a wish list of possible options
for pursuing your health aims
• Write down at least 6 or more different ways that
you could take action in the lifestyle or treatment
category that you selected
• Think of this as a wish list: for the time being ignore
any barriers that might come to mind for any of the
options you consider
• Try to include some options that you have not tried
before
© 2013 Health Change Australia
Slide 39
The client first technique
Elicit information from the client prior to
offering your own education and suggestions:
• What do they already know?
• What are they already doing?
• What would work for them?
• What could they do to address a particular
barrier?
© 2013 Health Change Australia
Slide 40
The client first technique
High readiness application
Person 1 – The clinician
•
Use reflection, summarising and questioning
•
Provide NO suggestions or advice just for this exercise
•
Guide partner toward creating a goal and an action plan
•
Use prompt questions (from slide or manual)
•
Respect confidentiality
Person 2 – The client
•
Choose a REAL change that you are very ready to work on from the options list
you created
•
Avoid story telling! (10 mins each – we will tell you when to swap)
•
Write down your personal goal and action plan
•
Give your partner a big cheery “yes but” if they give suggestions!
© 2013 Health Change Australia
Slide 41
Optional prompt questions for client first technique
• Which health aspect would it benefit you to work on?
• How ready are you to work on this health area with me today?
• What are you currently doing regarding this issue?
• What benefits do you expect to achieve?
• From the list of options that you wrote down, which of these
options might work for you now?
• What personal goal could you set for yourself?
• What actions would you need to take to achieve this goal, step by
step? What else?... What else?
• Would it help to write these steps down to remember them?
• What might get in the way and what could you do about it?
• How confident are you that you will achieve this personal goal?
© 2013 Health Change Australia
Slide 42
How did you go?
Was it difficult to refrain from
jumping in with your own solution?
•
•
What was it like being the client?
What was it like being the clinician?
© 2013 Health Change Australia
Slide 43
How do you offer suggestions & avoid
“yes, but…” ?
Offer a menu of options!
Behind every “yes, but” is a barrier
© 2013 Health Change Australia
Slide 44
Ensure that patients understand the ‘big picture’ of what they
need to do over time
Manage
Metabolic
Syndrome
Manage
Medications
Reduce Body
Weight by
5-10%
Cardiovascular
Exercise &
Resistance
Exercises
Reduce/Quit
Smoking
Manage
Alcohol Intake
Reduce
Saturated Fat
& Increase
Fibre
Manage
Osteoarthritis
Manage
Medications
Effectively
Specific
strengthening
exercises
© 2013 Health Change Australia
General
physical
activity
Manage
Weight
Manage
Pain
Slide 45
Use Menus of Options for consistency of education and advice
Reduce diabetes
risk
Increase CV
exercise
Increase muscle
mass
Replace
saturated fats
Increase fibre
Reduce body
weight by 5-10%
Gym exercises
Change to
polyunsaturated
fats
5 serves
vegetables
Reduce portion
sizes
Walk, jog or
ride
Home exercises
Speak with a
Dietitian
2 serves fruit
Reduce serves
at dinner
Group-based
exercise
Incidental
activities
Read
information
about fats
Hi-fibre breads,
pasta and rice
Manage night
time eating
Other...
Other...
Other...
Other...
Other...
Water-based
exercise
© 2013 Health Change Australia
Slide 46
Beware the Motivation Trap!
Motivation to
reduce pain
lose weight
retain independence
etc.
© 2013 Health Change Australia
≠
Motivation to engage in
actions or tasks
required to reduce pain,
lose weight, retain
independence etc.
Page 47
Signs of shaky commitment (ambivalence)
• Body language or tone of voice contradict RICk
responses
• Statements like ‘I know I should…, but, ….’
• Laughing nervously when talking about a topic
• Strong emotion when discussing conditions ,
lifestyle/treatment categories or goals and actions
• Weak reasons to take action & strong reasons not to
• Changing the subject during discussion
• Others?
© 2013 Health Change Australia
Page 48
Decision making when a patient is ambivalent
Current Behaviours
1.
Positive aspects
of unhealthy
behaviours
(short term)
2.
Negative aspects
of unhealthy
behaviours
(long term)
© 2013 Health Change Australia
Slide 49
Decision making when a patient is ambivalent
Alternative Behaviours
3.
Positive aspects
of healthy
behaviours
(long term)
4.
Negative aspects
of healthy
behaviours
(short term)
© 2013 Health Change Australia
Slide 50
RICk-focused decisional balance
Pros
Cons
Alternative A
Alternative B
(Current behaviour)
(Health-enhancing behaviour)
1.
Positive aspects
of selecting this
alternative
(short term)
3.
Positive aspects
of selecting this
alternative
(long term)
2.
Negative aspects
of doing this
(long term)
4.
Negative aspects
of doing this
(short term)
© 2013 Health Change Australia
Slide 51
RICk-focused DB: Clinician objectives
Current behaviour
Alternative behaviour
Pros
1.
Acknowledge
reasons for current
behaviours
(barriers)
3.
Identify possible
benefits to be gained
from taking action
Cons
2.
Identify possible
negative
consequences of
inaction
4.
Acknowledge
undesirable
aspects of taking
action (barriers)
Is anything the client has mentioned important enough for them to want to work on this?
© 2013 Health Change Australia
Slide 52
Stay Sedentary
Be More Active
• No hassle or effort
• Doesn’t compete with other
priorities (family and work) *
• More time to unwind
• Health benefits (cardio,
blood sugar levels, strength,
flexibility…)
• Lose weight (maybe)
•?
• Long-term health
consequences (maybe)
• Carry more weight
•?
• Costs $ (gym membership)
• Takes time & adds time
pressure
• I don’t have the energy so
couldn’t be bothered
• Discomfort (pain)
© 2013 Health Change Australia
* Intrinsic (de)motivators
Slide 53
Stay Sedentary
Be More Active
• No hassle, effort or pain
• Doesn’t compete with other priorities
• More time to unwind (but maybe I can
enjoy being active)
• Health benefits (cardio, blood sugar
levels, strength, flexibility…)
• Keep my weight down
• Be a role model for kids & may
improve family’s health
• Increase energy, strength and mobility
• Keep working and earning income*
• Better quality of life – can keep doing
what I like*
• Long-term health consequences
• Carry more weight over time
• My arthritis will be worse and I may
get diabetes or heart disease
• Big impact on my quality of life and
mobility*
• I might have to retire early and I won’t
be able to look after my family as
well*
• $ (but it doesn’t have to cost much)
• Time (but I can use it as time out or
time with the family)
• Discomfort or pain (but I’ll be much
better off in the long run, especially if
I pace myself and I get a lot of pain
anyway)
• I don’t have the energy (but maybe
this will give me some)
© 2013 Health Change Australia
* Intrinsic motivators
Slide 54
Digging down in the consequences:
Should I go to bed earlier or not?
I will be tired in the morning
I’ll have a worse start to the day (less organised/feel worse)
I’ll have a worse day at work (less productive, more grumpy)
I’ll get home in a bad mood
I’ll be grumpy at home and
likely to fight with my wife *
© 2013 Health Change Australia
* Intrinsic motivator
Slide 55
RICk-focused decisional balance
Decision: __________________________________________?
What is the decision that the patient is
trying to make?
Is it very clear what the two sides of the
decision are?
Is the decision black and white?
© 2013 Health Change Australia
Slide 56
Possible outcomes from RICk-focused DB
1. Patient decides not to work on chosen
category
2. Patient decides to take action within the
category
3. Patient needs more information to make
the decision
4. Patient remains ambivalent
© 2013 Health Change Australia
DB Examples
Slide 57
Key questions above the decision line
Does the patient know and understand the clinical issues and broad
referral, treatment & lifestyle categories applicable to their conditions
and risk factors?
Have they been assisted to collaboratively prioritise these?
Are they ready, willing, able and committed to taking action?
Decision
Line
Ready to
Take Action
Build Motivation
© 2013 Health Change Australia
Slide 58
Health Change 10 step decision framework
Above the line processes
Set the Scene & Explain Your Role
 Identify Clinical Issues & Broad Lifestyle & Treatment Categories
 Prioritise & Choose a Category to Work on (in this interaction)
 Ask RICk   Make a Decision
Decision
Line
Ready to
Take Action
Readiness
Build Motivation
RICk = readiness, importance, confidence, knowledge
© 2013 Health Change Australia
Slide 59
Explain your role:
Set up accurate expectations
How do you currently explain your role?
Elements:
1. Who I am
2. How I work
3. What I won’t do
4. What’s in it for you (the patient)
© 2013 Health Change Australia
Slide 60
Step 1: identify clinical issues &
broad lifestyle & treatment categories
1. Identify clinical issues
• Assessment, referral letters, care plans, patient information
2. Check patient knowledge and understanding of health issues:
1) Health conditions, clinical indicators, risk factors
2) Implications of these and reasons for clinical targets
• Check what they already know before offering information
3. Provide treatment advice, education & guidance:
1) Broad lifestyle and treatment categories for action
2) Reasons for taking action (macro level education)
• Check what they are already doing before offering advice
© 2013 Health Change Australia
Slide 61
Step 2: prioritise and choose a category
to work on
1.
2.
3.
Prioritise broad lifestyle and treatment categories
Balance duty of care with patient choice
Prevent the patient from becoming overwhelmed
Messy Head Syndrome
© 2013 Health Change Australia
Tidy Head
Slide 62
Step 3: ask RICk 
Readiness, Importance, Confidence, knowledge
Use your RICk radar,
but when in doubt, ask the patient
© 2013 Health Change Australia
Slide 63
Step 4: make a decision
Patient choices:
1. “yes”
2. “no”
3. “maybe”
Clinician choices:
1. Patient “yes” - proceed below the
decision line
2. Patient “no” – revisit Step 2 or invite
them to opt out
3. Patient ambivalence – ask RICk-
focused decisional balance questions
© 2013 Health Change Australia
Slide 64
Patient demonstration
Video - Terry
•
•
•
•
•
CAD, heart attack
Hypertension
Diabetes T2
Obesity, Lap banding
Gall bladder removed
© 2013 Health Change Australia
Terry above the line video
Slide 65
Health Change 10 step decision framework
Below the line processes
Decision
Line
Ready to
Take Action
 Generate Personal Goal Options
 Choose & Refine an Option  Create an Action Plan
 Identify & Address Barriers  Ask RICk
 Consider Review & Referral
Readiness
Build Confidence
RICk = readiness, importance, confidence, knowledge
© 2013 Health Change Australia
Slide 66
Patient demonstration
Video - Terry
•
•
•
•
•
CAD, heart attack
Hypertension
Diabetes T2
Obesity, Lap banding
Gall bladder removed
© 2013 Health Change Australia
Terry below the line video
Slide 67
Thinking strategies to support adherence:
• Do you ever procrastinate or talk yourself out of
doing things you had planned to do?
• What excuses do you usually give yourself for not
taking action?
• What do you need to say to motivate yourself
instead, to make sure you do what you are planning
to do?
• How will you practise these thoughts so that you can
say them to yourself when you need them?
© 2013 Health Change Australia
Slide 68
Using care plans to inform behaviour change
Patient problems, needs
& relevant conditions
Clinical goals
Required
treatment &
services
Provider for
treatment & services
Type 2 Diabetes
HbA1c < 7%
3 monthly checks
Diabetes Education
Exercise Program
Foot care
GP/Practice Nurse
D. Educator/Dietitian
Ex. Physiologist
Podiatrist
Hypercholesterolaemia
TC: < 4mmol/L
LDL < 2.5mmol/L
HDL> 1.0mmol/L
TG < 2.0 mmol/L
Lipitor 10mg
Low saturated fat
diet
GP/Practice Nurse
Dietitian
Obesity
BMI < 25
Maintain a healthy
diet
GP/Practice Nurse
Dietitian
Back pain
Reduce pain &
improve mobility
Physiotherapy
Bone density scan
Physiotherapist
Nuclear imaging
© 2013 Health Change Australia
Page 69
Documenting action priorities using a
personal self-management plan
Referral, Treatment,
Lifestyle Categories
Priority
Client
Decision
Action Time
Frame
1. Medications
(see GP)
2

Next week
2. Rehabilitation
exercises
-

Daily exercises
Already provided.
Going well
3. Wound care
1

Elevate leg daily
for 30 mins
Visit by community
nurse?
4. Dietary changes
(see dietitian)
4
Unsure
5. Tests (bone density
scan & bloods)
2

2 weeks
Needs to organise
transport
6. Home assessment
(see OT)
3

TBA
Wait until daughter
is available
© 2013 Health Change Australia
Personalised Goal
Comments
Unsure re diabetes
meds
Page 70
© 2013 Health Change Australia
Slide 71
How to increase adherence without adding time
1. Provide patients with macro level information that
creates accurate expectations (referral, treatment
and lifestyle categories)
2. Normalise the challenge of changing habits
3. Be conservative regarding the number of things you
give people to do all at once (informally assess
confidence)
4. Provide pen and paper and invite the patient to
write down relevant information in their own words
5. Keep the generic behaviour change pathway and
the RICk principle in mind
© 2013 Health Change Australia
Slide 72
Health Change integrated suite of tools to increase adherence
Knowledge & understanding
Client-centred
Practice Principles
Essential Behaviour
Change Techniques
Motivation & expectations
Decision & commitment
Planning
Change Barriers
& Facilitators
Decision
Framework
Action
Behaviours
Emotions
Situations
Thinking
Self-regulation
Build Motivation
© 2013 Health Change Australia
Build Confidence
Page 73
What can you do now to enhance
your current practice?
Menu of Options:
1. Choose one or two practice
principles to work on per week
2. Practise the essential techniques
3. Use the Health Change selfassessment sheets to track your
progress
4. Attend the HCA Core Training
Workshops to embed behaviour
change into your practice, or
5. Read the HCA Practitioner’s
Manual
© 2013 Health Change Australia
Slide 74
Thank you for your participation!
Download case studies, session records,
practice guides & worksheets at
www.healthchangeaustralia.com
HCA tools can be used freely in clinical practice
and programs as long as HCA intellectual property
is visibly acknowledged
© 2013 Health Change Australia
Slide 75
Patient case – ‘toxic wasteland’
• Male, mid-30’s, BMI = 34 (96 kg), elevated BP, BGLs & Chol.,
married, 2 children, manager in hospitality industry
• Told to change diet, lose weight, start exercising, reduce alcohol
and caffeine dramatically, quit smoking:
• 18-24 shots per day espresso per day
• 1 bottle of wine per night, plus multiple martinis
• 15 cigarettes/day
• Low energy, poor sleep, frequent waking, needed naps on
days off
• Very little water – doesn’t like it
• No exercise, poor diet, hardly any fruit and vegetables
© 2013 Health Change Australia
Page 76
Patient case – 1 x 20 minute intervention
Reaction to Dr’s advice: “What can I do? I would have to quit my job!”
•
1 x 20 minute impromptu conversation in Nov 2009:
• High importance, but low readiness due to very low confidence in
making any changes
• One thing at a time, one step at a time, adding up over time
• Client chose alcohol reduction as a priority
• Planned to eat dinner early with family (doesn’t drink when
children are up and drinks less if he eats first), and not keep any
chilled wine in the house
• No review consultation
© 2013 Health Change Australia
Page 77
Patient case – behavioural changes
1.5 years:
• 5 alcohol free days/week, 1 bottle of wine over 2 nights, no martinis
• No more than 2 x skinny latte’s per day
• 2-3 cigarettes per day, work days only
• 1.9 ℓ jug of water/day (hot water + ice + touch of cordial)
• 1 x vegetarian meal per week, aims for daily vegetables + 2 x fruit per
day
• 3 x per week on exercise bike, plus conscious use of (many) stairs at
work
• No longer takes naps on days off
2.5 years:
• 5 serves vegetables plus 2 serves of fruit per day
• 5 x exercise sessions per week
© 2013 Health Change Australia
Page 78
Patient case – physiological outcomes
Results at 1 & 1.5 years:
• BMI 29 (82 kg) - previously 34 (96 kg)
• BP, BGLs and Chol. in normal range – previously all
elevated
• No longer gets daily headaches
• Sleeps through the night and reports increased
energy
Results at 2.5 years:
• 76 kg
• Waist circumference 88 cm (previously 110 cm)
• BP, BGLs and Chol. All in normal range
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Patient case – intrinsic motivators
• Dreamt he had to watch his daughter’s wedding on video due
to ill health – used this mental imagery to motivate himself
• “I couldn’t be there for her on her happiest day”
• Can feel and see the difference that his healthy choices have
made and wants to maintain these benefits
• Work colleagues have commented on the visible changes
• He reports that he doesn’t miss his old habits
• The first 3 months was the hardest
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Patient reflection
“What the Dr told me to do was impossible”
“I am thankful that she told me (about the critical nature of
my health issues) but I expected more help with how to do it”
“The Dr doesn’t know why I do what I do and why it is hard
to change. Health professionals need to know why!”
“I was in a nasty evil cycle”
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© 2013 Health Change Australia
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© 2013 Health Change Australia
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