Healthy conversation skills:increasing competence and confidence in front-line staff

OBJECTIVE: (i) To assess change in confidence in having conversations that support parents with healthy eating and physical activity post-training. (ii) To assess change in staff competence in using 'open discovery' questions (those generally beginning with 'how' and 'what' that help individuals reflect and identify barriers and solutions) post-training. (iii) To examine the relationship between confidence and competence post-training. DESIGN: A pre-post evaluation of 'Healthy Conversation Skills', a staff training intervention. SETTING: Sure Start Children's Centres in Southampton, England. SUBJECTS: A total of 145 staff working in Sure Start Children's Centres completed the training, including play workers (43%) and community development or family support workers (35%). RESULTS: We observed an increase in median confidence rating for having conversations about healthy eating and physical activity (both P < 0·001), and in using 'open discovery' questions (P < 0·001), after staff attended the 'Healthy Conversation Skills' training. We also found a positive relationship between the use of 'open discovery' questions and confidence in having conversations about healthy eating post-training (r = 0·21, P = 0·01), but a non-significant trend was observed for having conversations about physical activity (r = 0·15, P = 0·06). CONCLUSIONS: The 'Healthy Conversation Skills' training proved effective at increasing the confidence of staff working at Sure Start Children's Centres to have more productive conversations with parents about healthy eating. Wider implementation of these skills may be a useful public health nutrition capacity building strategy to help community workers support families with young children to eat more healthy foods

The Southampton Initiative for Health:A Complex Intervention to Improve the Diets and Increase the Physical Activity Levels of Women from Disadvantaged Communities

The Southampton Initiative for Health is a training intervention with Sure Start Children’s Centre staff designed to improve the diets and physical activity levels of women of childbearing age. Training aims to help staff to support women in making changes to their lifestyles by improving three skills: reflection on current practice; asking ‘open discovery’ questions; and goal-setting. The impact of the training on staff practice is being assessed. A before and after non-randomized controlled trial is being used to evaluate the effectiveness and cost-effectiveness of the intervention in improving women’s diets and increasing their physical activity levels

'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

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

Diabetes self-management arrangements in Europe: a realist review to facilitate a project implemented in six countries

Background: Self-management of long term conditions can promote quality of life whilst delivering benefits to the financing of health care systems. However, rarely are the meso-level influences, likely to be of direct relevance to these desired outcomes, systematically explored. No specific international guidelines exist suggesting the features of the most appropriate structure and organisation of health care systems within which to situate self-management approaches and practices. This review aimed to identify the quantitative literature with regard to diabetes self-management arrangements currently in place within the health care systems of six countries (The United Kingdom, The Netherlands, Norway, Spain, Bulgaria, and Greece) and explore how these are integrated into the broader health care and welfare systems in each country. Methods: The methodology for a realist review was followed. Publications of interest dating from 2000 to 2013 were identified through appropriate MeSH terms by a systematic search in six bibliographic databases. A search diary was maintained and the studies were assessed for their quality and risk of bias. Results: Following the multi-step search strategy, 56 studies were included in the final review (the majority from the UK) reporting design methods and findings on 21 interventions and programmes for diabetes and chronic disease self-management. Most (11/21, 52%) of the interventions were designed to fit within the context of primary care. The majority (11/21, 52%) highlighted behavioural change as an important goal. Finally, some (5/21, 24%) referred explicitly to Internet-based tools. Conclusions: This review is based on results which are derived from a total of at least 5,500 individuals residing in the six participating countries. It indicates a policy shift towards patient-centred self-management of diabetes in a primary care context. The professional role of diabetes specialist nurses, the need for multidisciplinary approaches and a focus on patient education emerge as fundamental principles in the design of relevant programmes. Socio-economic circumstances are relevant to the capacity to self-manage and suggest that any gains and progress will be hard to maintain during economic austerity. This realist review should be interpreted within the wider context of a whole systems approach regarding self-care support and chronic illness management

Managing type 2 diabetes: a dynamic approach

Traditional educational programmes for people with type 2 diabetes have many weaknesses. In the third article in this series, Sue Cradock and Chas Skinner propose a new approach that focuses on a more flexible system of self-care for this growing client group

Four theories and a philosophy: self-management education for individuals newly diagnosed with type 2 diabetes

Many reviews of educational interventions for people with diabetes have criticized the lack of reported theory in the development or descriptions of these programs.1,2 Yet these reviews seem to ignore a fundamentally more important omission in the self-management education and behavior change literature—a lack of reporting of the projects’ philosophies of care. A program that is designed to persuade or motivate individuals with diabetes to do what health care professionals think they should do, for example, is substantially different from a program built on the philosophy of supporting individuals to achieve their own goals for diabetes management. This issue of philosophy is of fundamental importance because it influences the theories that may be used, the educators’ attitudes (cognitive, affective, and behavioral), and the content and style of any educational material and interaction.This article reports on the development of a series of self-management education workshops for individuals newly diagnosed with type 2 diabetes. It focuses on how different theories from health psychology have been used to guide the development of the workshops and how these theories have been implemented in delivering the workshops

The impact of an intervention for nurse prescribers on consultations to promote patient medicine-taking in diabetes: a mixed methods study

Background: nurse prescribers are in a key position to promote medicine-taking in diabetes. Although patients' beliefs about medicines are important predictors of medicine-taking, evidence suggests nurses do not routinely explore these.Objectives: to evaluate a theory-based intervention designed to increase nurse prescribers' exploration of medicines' beliefs with people with diabetes. Design: mixed methods concurrent triangulation design. Settings: nurse prescribers were recruited from 7 Trusts in England.Participants purposive sample of 14 nurse prescribers attended 4 one day workshopsMethods: audio-recordings of each nurse prescribers' consultations with diabetes patients were collected at baseline, 1 week, 3 months and 6 months after the intervention. Nurse prescribers were interviewed at 1 month and 6 months post-intervention. Changes in medicines' discussion and participation in consultations were analysed using MEDICODE. Interview data were analysed using Framework Analysis.Results: MEDICODE themes of 'attitudes towards medication' showed a significant rise at 1 week (p&lt;0.01) and 3 months (p&lt;0.05). 'Asks patient opinion about medication' significantly increased at 1 week (p&lt;0.01). Discussion on 'concerns about medication' rose significantly at 1 week (p&lt;0.001) and 6 months (p&lt;0.01). Discussion on 'expected effects of medication', 'action of medication' and 'reasons for medication' showed no change. There were no significant changes in Dialogue Ratio. However, the Preponderance of Initiative moved towards more patient initiative at 1 week (p&lt;0.0001), 3 months (p&lt;0.0001), and 6 months (p&lt;0.0001). In interviews, nurses reported increased attention to patients' medication beliefs and adoption of patient-centred skills. Contextual factors that positively influenced ability to explore medicines beliefs in practice settings were: support of colleagues and practising new skills. Inhibiting factors included: patients' perceived lack of receptivity, time constraints, and concerns about opening a 'can of worms'. Six month interviews revealed using skills in practice enhanced nurses' confidence and sustainability of skills requires a nurse-patient relationship. Method triangulation illuminated how the intervention was implemented in practice contexts.Conclusions: the intervention was effective at changing some key dimensions of prescribing consultations. The use of a self-efficacy framework in the intervention, to promote nurses' confidence in working in a different way, may have been instrumental in effecting the changes found. Contextual factors influencing beliefs exploration in medicine-taking consultations were identified.What is already known about this topic:• Medicines management plays an important part in the successful self-management of diabetes, but patient medicine-taking may not always be optimal for control of diabetes• Evidence suggests that patients’ concerns and beliefs about the necessity of medicines are significant in influencing medicine-taking across a range of conditions• Although nurse prescribers have an important opportunity to understand and influence patients’ beliefs about medicines, evidence from studies with patients with a range of conditions suggests they do not routinely explore these in their consultationsWhat this paper adds:• The study highlights that an intervention designed to influence nurse prescribers’ exploration of medicines’ beliefs in diabetes was successful at increasing patient initiative in discussion of medicines, as well as discussion of concerns about medicines, consequences of non-adherence, attitudes to medication and patient opinions about medicines. Other ‘compliance-oriented’ discussion decreased following the intervention.• The findings show that not all changes in nurses’ consultations were sustained at 6 month follow up and some key characteristics of their medication discussion showed no change from baseline• Using a mixed methods design, the study identified factors that nurses perceived influenced the implementation of change in practice, including patient receptiveness to engage in discussion, time constraints, the support of colleagues and the importance of a nurse patient relationship<br/