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?
2
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”
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
Effective
Self
Management
Interventions
Establishing
Readiness:
Supporting
Reduce
Change-Based
How to Assess
Behaviour
Risk of
Relationships
How to
Enhance
Change
Relapse
Outcomes are
dependent on
how good
you are
Interpersonal Dynamics
•
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
•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
Therapeutic Alliance
More Recipe for Disaster
than Match Made in Heaven
Interpersonal Dynamics
•
•
•
•
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?
Getting to the Behaviour
Readiness Assessment
Not Ready
Understanding the
behaviour
•Personal meaning
•Seriousness, personal
responsibility, controllability,
optimism
Ready
Go Right
to Behaviour
Modification
Ambivalent
Expanding on readiness
•Personal/meaningful reasons
to change
•Willingness to work hard connect to principles
•Delay of gratification
Decisional Balance
Self-Efficacy
Barriers/Temptations
Especially social, cultural and environmental
•
•
It is not Psychotherapy
Your role is best delivered in the
following manner:
•
•
•
•
Identify and label
Educate
Recommend
Support
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
THAT’S ALL: THANK YOU!
tvallis@dal.ca
www.behaviourchangeinstitute.ca
www.improvingdiabetescare.com