A book for professionals and lay health guides. Reduce your frustrations in working with so-called resistant patients. To help your patients develop healthier habits and enhance their self-care of chronic diseases, discover how to change from a health adviser (giving information) to a motivational guide before enhancing your motivational skills. Embark on a journey of lifelong learning.
Section I explores how cultural, personal and professional issues affect the change process in patients. Scientific rationality lacks sophistication in addressing human irrationality and in dealing with otherwise knowledgeable patients who lack the critical factor: motivation. Chapter 1 highlights the limitations of the rational, scientific approach in providing health information and advice to patients about changing their unhealthy behaviors, and explores key concepts, models and ideas for addressing common, everyday situations. Chapter 2 offers a case study that contrasts the advice-giving or fix-it approach with a motivational one. The aim here is to highlight the merits of adopting a motivational role. Chapter 3 explores the implications for patient change based on which role you adopt-the fix-it, preventive or motivational one. Each of these roles is defined according to its characteristics, functions and boundaries to examine how they differ in helping patients change their behavior. Chapter 4 examines how assumptions can help or hinder the change process for the patient.
Section II is an overview for understanding and facilitating individual change. Using a Forces of Change model, you learn how both individual and systems factors can generate positive and negative forces for change (Chapter 5). More specific attention is then given to understanding the individual dynamics of resistance (Chapter 6) and motivation (Chapter 7) from different perspectives. These three chapters help you become familiar with the key theories, models and concepts that have shaped the development and practical applications of the six-step approach. To prepare for using the materials in Section III, Chapter 8 is an overview of the six-step approach with an example of a practitioner-patient partnership working toward behavior change and using this approach as a mental map for thinking about how to motivate behavior change.
Section III (Chapters 9-14) describes in detail the six-step, interdisciplinary approach for negotiating behavior change with patients. A chapter is devoted to each of the six steps, describing micro skills that you can use for addressing a broad range of health behaviors in health promotion (e.g., physical activity), disease prevention (e.g., smoking cessation, regular mammograms), chronic disease management (e.g., diabetes) and injury prevention (e.g., the use of car safety belts). Though you will become familiar with a wide range of micro skills used in this method, you still need to learn how to use these skills in an effective, patient-centered way.
Section IV (Chapters 15-17) specifically addresses tobacco use, excessive alcohol intake and self-care of diabetes. Consider doing an in-depth study of a specific behavior so that you can learn how to generalize this approach to other behaviors. You can also use these chapters when you get stuck with patients to identify new ideas for interventions.