Behaviour change support can be integrated into the following areas of group education sessions.
For tips on delivering the health education component of group education see Tips for delivery of education topics in a group.
Practical ways to increase participation
- Advise participants not to attempt too many changes at once – as this can decrease confidence and lead to inaction and non-adherence
- Create ‘menus of options’, i.e., a smorgasbord of ideas for action in each treatment and lifestyle area
- Whiteboard the things that the participants think would be beneficial to work on and what they are already doing. A different set of tasks or actions may be relevant to each participant
- Incorporate education about health behaviour change into education content. Highlight the principles of successful health behaviour change that participants can apply to their own lifestyle
- Before leaving the end of the meeting, ask participants to write down the things they intend to do before the next session. Consider formally setting goals and creating action plans or perhaps simply have a group discussion about the types of things participants intend to do as a consequence of attending
- At the next education session, discuss as a group or in pairs how participants went got on with their task lists and action plans
- When providing patients with exercise plans, check that each person is willing to do the required exercises (importance) and believes they will be able to do them regularly (confidence)
- Before the end of the program, discuss strategies to maintain the skills and behaviours learned throughout the program
Recruitment to groups (see columns 1 and 2 in the table below)
Sometimes, situational barriers prevent people from attending programs, such as prior commitments or lack of transport. However, often there are avoidable factors that result in a patient choosing not to attend because of low motivation. Common patterns of thinking, which become barriers, include:
- Denial of a seriousness or cardiac disease – ‘My heart isn’t that bad; I don’t need to come’
- Do not see how the program will benefit them –‘I wouldn’t enjoy talking to/exercising with a bunch of other patients’, ‘Turning up to that program won’t help me’
- A negative expectation of the program – ‘They will make me do some really hard exercise’
Retention of participants (see column 3 in the table below)
If participants are not staying in the program, it could mean they do not perceive any benefits of attending, or that the program itself is not enjoyable. Clinicians can gain feedback about the participants’ experience to identify any factors affecting the drop off rate. It may be useful to contact participants who drop out of programs to find out why they have done so.
Evaluation and sustainability of outcomes (see column 4 in the table below)
Clinicians commonly find that participants do not continue to engage in the relevant behaviours or skills once the program has finished. This could reflect a lack of emphasis on supporting self-regulation and maintenance after completion of the program. Clinicians should ensure that participants have the skills to continue with what they have learned after the program. Some clinicians invite participants in the final session to create a ‘survival kit’ containing individualised tips for them to get back on track if their new lifestyle and treatment habits taper off at any stage.
Table 1: Questions to consider asking to help improve participant involvement
|Engaging Referring Clinicians
||Recruitment of Participants
||Retention of Participants
||Evaluation & Sustainability of Outcomes
|Who are your referral sources?
||What do you want to enrol in your program and are they registering?
||Are participants staying until the end of the program?
||Does the program have a component on maintaining skills?
|What knowledge do they need to have about the program? Are they ‘selling’ it to patients?
||What’s in it for them? Do they understand the benefits?
||What is the percentage that completes the program?
||Are patients continuing with behaviour changes after the program?
|How can you communicate the benefits of your program to referring clinicians and services so that they refer effectively?
||What is affecting the enrolment rate? What can be done about this?
||What is affecting the drop off rate? What can be done about this?
||Are you collecting follow-up data on participant outcomes? If so, what type (motivational, psychosocial, behavioural, physiological) and over what timeframe?
|Have you asked referral sources why they have/haven’t referred patients to your program? Are you providing feedback on patients that have enrolled/attended?
||Have you asked patients why they did/didn’t enrol in the program?
||Have you collected participant feedback on the program?
||What other resources can participants access to aid self-regulation after your program?
©2012 HCA. Reproduced with permission from Health Change Australia (from training materials)