Supporting self management in chronic disease
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Supporting Self-Management in Chronic Disease. Michael Vallis, PhD, R Psych Psychologist and Lead, CH Behaviour Change Institute Associate Professor, Dalhousie University Halifax, CANADA. What, Me Judgmental?. What is the Standard of Care?. Dominant models of behaviour in health care

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Supporting Self-Management in Chronic Disease

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Supporting self management in chronic disease

Supporting Self-Management in Chronic Disease

Michael Vallis, PhD, R Psych

Psychologist and Lead, CH Behaviour Change Institute

Associate Professor, Dalhousie University

Halifax, CANADA


What me judgmental

What, Me Judgmental?


What is the standard of care

What is the Standard of Care?

  • Dominant models of behaviour in health care

    • After giving rounds to dialysis/transplant team I was cornered by several staff

      • “You work in the diabetes centre, right? We need you to take a message to the staff”

        • You don’t talk enough about complications

        • Our patients say: “if I knew my life would be this bad I never would have let my diabetes stay out of control”

  • After giving a talk on behaviour change a family physician said

    • “The problem is we just don’t scare our patients enough. If we put the fear of god into them they would do what we say”


  • Supporting self management in chronic disease

    DAWN2

    % of people with diabetes and health care professionals reporting their health care team/they engage in each behavior most of the time or always

    N = 4,785

    N = 8,596

    25


    Supporting self management in chronic disease

    Effective

    Self

    Management

    Interventions

    Reduce

    Risk of

    Relapse

    Readiness:

    How to Assess

    How to Enhance

    Supporting

    Behaviour

    Change

    Establishing

    Change-Based

    Relationships


    Supporting self management in chronic disease

    Outcomes are

    dependent on

    how good

    you are


    Supporting self management in chronic disease

    • Fundamental change in the relationship between the individual and the HCP

      • From

        • Expert clinician with uninformed helpseeker

          • “Let me tell you what you need to do”

          • “Let me tell you what you need to know”

      • To

        • We both have a role to play

          • “I understand that you will make your own decisions and I respect that. Can we have a conversation about your health”

    Interpersonal Dynamics


    Supporting self management in chronic disease

    • What do patients want?

    • To minimize the impact of diabetes in their life

    • This often means avoiding the tasks

    • What do providers want?

    • To get the recommended glucose (A1c) and bp control

    • This means using lifestyle, medication and insulin

    Interpersonal Dynamics


    Supporting self management in chronic disease

    Therapeutic Alliance

    More Recipe for Disaster

    than Match Made in Heaven

    Interpersonal Dynamics


    Supporting self management in chronic disease

    Interpersonal Dynamics


    Supporting self management in chronic disease

    • Is the behaviour (or lack of it) a problem for you?

    • Does the behaviour (or lack of it) cause you any distress?

    • Are you interested in changing your behaviour?

    • Are you ready to do something to change your behaviour now?

    Motivational Enhancement:

    Getting to Behaviour

    Change-Based Relationship


    Getting to the behaviour

    Ready

    • Understanding the behaviour

    • Personal meaning

    • Seriousness, personal responsibility, controllability, optimism

    Ambivalent

    Not Ready

    Readiness Assessment

    Go Right

    to Behaviour

    Modification

    • Expanding on readiness

    • Personal/meaningful reasons to change

    • Willingness to work hard - connect to principles

    • Delay of gratification

    Getting to the Behaviour

    • Decisional Balance

    • Self-Efficacy

    • Barriers/Temptations

      • Especially social, cultural and environmental


    Supporting self management in chronic disease

    Behaviour Modification

    Motivational Enhancement:

    Getting to Behaviour

    Change-Based Relationship


    Supporting self management in chronic disease

    Emotion Management

    Assess and address the 4 Ss

    Self-image

    Explore if the behaviour is internally of externally motivated

    Self-efficacy

    A person’s confidence to perform a specific behaviour in a specific context for a specific time period and in the face of specific barriers

    Social Support

    Are there external factors that help sustain the behaviour?

    Stress

    Identify emotional issues and search for opportunities

    to replace the function of unhealthy behaviour

    Identify and encourage stress management

    Link stress management to adherence, participation

    • It is not Psychotherapy

    • Your role is best delivered in the following manner:

      • Identify and label

      • Educate

      • Recommend

      • Support

    Behaviour Modification

    Change-Based Relationship

    Motivational Enhancement:

    Getting to Behaviour


    Supporting self management in chronic disease

    THAT’S ALL: THANK YOU!


    Supporting self management in chronic disease

    • [email protected]

    • www.behaviourchangeinstitute.ca

    • www.improvingdiabetescare.com


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