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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
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 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”
slide4
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

slide5
Effective

Self

Management

Interventions

Reduce

Risk of

Relapse

Readiness:

How to Assess

How to Enhance

Supporting

Behaviour

Change

Establishing

Change-Based

Relationships

slide9
Outcomes are

dependent on

how good

you are

slide10
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

slide11
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

slide12
Therapeutic Alliance

More Recipe for Disaster

than Match Made in Heaven

Interpersonal Dynamics

slide14
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
slide17
Behaviour Modification

Motivational Enhancement:

Getting to Behaviour

Change-Based Relationship

slide19
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

slide21
tvallis@dal.ca
  • www.behaviourchangeinstitute.ca
  • www.improvingdiabetescare.com
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