Sustainable Change Sequence: a framework for developing behavior change interventions for patients with long-term conditions

Objective Interactive interventions are increasingly advocated to support behavior change for patients who have long-term conditions. Such interventions are most likely to achieve behavior change when they are based on appropriate theoretical frameworks. Developers of interventions are faced with a diverse set of behavioral theories that do not specifically address intervention development. The aim of our work was to develop a framework to guide the developers of interactive healthcare interventions that was derived from relevant theory, and which guided developers towards appropriate behavior change techniques. Methods We reviewed theories that inform behavior change interventions, where relevant to the management of long-term conditions. Theoretical constructs and behavior change techniques were grouped according to similarity in aims. Results We developed a logic model that operationalizes behavior change theories and techniques into five steps likely to lead to sustained behavior change. The steps are: 1) create awareness of need; 2) facilitate learning; 3) enhance motivation; 4) prompt behaviour change; and 5) ensure sustainability of behaviour change. Conclusion and Practice implications A framework that sequences behavioural change techniques along a sustainability model provides a practical template for the developers of interactive healthcare applications and interventions

On a learning curve for shared decision making: interviews with clinicians using the knee osteoarthritis Option Grid

Rational: Tools used in clinical encounters to illustrate to patients the risks and benefits of treatment options have been shown to increase shared decision making. However, we do not have good information about how these tools are viewed by clinicians, and how clinicians think patients would react to their use. Objective: Our aim was to examine clinicians’ views about the possible and actual use of tools designed to support patients and clinicians to collaborate and deliberate about treatment options, namely Option Grid TM decision aids. Method: We conducted a thematic analysis of qualitative interviews embedded in the intervention phase of a trial of an Option Grid decision aid for Osteoarthritis of the knee. Interviews were conducted with six participating clinicians before they used the tool, and again after clinicians had used the tool with six patients. Results: In the first interview, clinicians voiced concern that the tool would lead to an increase in encounter duration, to patient resistance regarding involvement in decision making, and potential information overload. At the second interview, after minimal training, the clinicians reported that the tool had changed their usual way of communicating, and it was generally acceptable and helpful integrate it into practice. Discussion and Conclusions: After experiencing the use of Option Grids, clinicians became more willing to use the tools in their clinical encounters with patients. How best to introduce Option Grids to clinicians and adopt their use into practice will need careful consideration of context, workflow and clinical pathways

Shared Decision Making and Motivational Interviewing: Achieving Patient-Centered Care Across the Spectrum of Health Care Problems

Patient-centered care requires different approaches depending on the clinical situation. Motivational interviewing and shared decision making provide practical and well-described methods to accomplish patient-centered care in the context of situations where medical evidence supports specific behavior changes and the most appropriate action is dependent on the patient's preferences. Many clinical consultations may require elements of both approaches, however. This article describes these 2 approaches-one to address ambivalence to medically indicated behavior change and the other to support patients in making health care decisions in cases where there is more than one reasonable option-and discusses how clinicians can draw on these approaches alone and in combination to achieve patient-centered care across the range of health care problems