Effective Strategies to Support Behavior Change

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Diabetes is a disease that requires the efforts of both the physician and patient. The physician makes the recommendations, but it is up to the patient to successfully manage their disease on their own. An important aspect of self-managing diabetes is changing the behaviors that may have led to the diagnosis; Martha Funnell, MS, RN, CDE, from the Department of Medical Education, Diabetes Research and Training Center at the University of Michigan, presented several effective strategies that healthcare professionals can utilize to support the behavior changes of their patients today in the session “Using Behavior Change Tools in Clinical Practice” at the American Diabetes Association’s 70 Scientific Sessions.

According to Funnell, physicians should start their patient visits by asking their patients to identify the most important agenda item. By doing this they can recognize where the patients thinking is at and see if they are on the same page; if not, they can then educate their patients and give the appropriate recommendations to ensure they understand what they must do to successfully manage their disease. Physicians should also provide information about the appropriate behaviors in a way that’s relevant to them; relating to their lifestyles, personal goals, and culture will go a long way towards realizing the patient’s clinical goals.

A very important thing that physician’s must also keep in mind is that the decision to make behavior changes is the patient’s choice. The physician cannot force the patient to change; they can only make recommendations and hope that their advice is followed. But by providing the information in an educational and understandable way, they will facilitate the patient’s decision towards proactively following that advice. A way that this can be done is by helping their patients to identify personally important goals. The physician’s goal may differ from that of their patient, so for instance, if the physician’s goal is to lower certain levels to clinically recommended numbers but the patient is more concerned with losing weight, focusing on the weight loss first may help the patient realize that the physician cares about what they want and not just their own clinical agenda.

A way to help patient’s realize these personal goals is by breaking them into action steps, Funnell said, referring to I-SMART as a useful way to do this. After breaking their goals down into action steps, monitoring their behavior and the progress they are making in changing their behaviors will not only help physician’s keep track of where the patient is at, but it will also show the patient the progress they are making, which can reinforce the implemented changes. If the patient runs into barriers in making the specified changes, the physician should do everything they can to assist them in overcoming these barriers; providing ongoing self-management support and other educational methods and encouragement techniques can do this.

With the increasing adoption of electronic medical records in physician’s offices, it is important that physicians realize that not only do they help streamline their practice processes, but that they can be used as an educational tool, as well. Instead of just having the EMR in front of them during the visit, the physician should turn it around and review past appointments and test results with their patients. This could help them get a better understanding of where they’re at in the process and reinforce the advice and recommendations that have been made. The teach-back method is another effective way of reinforcing the message to patients. By asking them to repeat what was reviewed and suggested during the visit the physician can see what their patient was focused on during the visit and how much they comprehended. Instead of just sending them home without knowing whether or not the message was received, by asking them what they would tell their family about the visit will enable physician’s to know their patient’s level of understanding before they leave the office.

All patient visits should also end by asking the patient about the one thing they’ll do this week, month, year, etc…This gives the physician a good place to begin the next visit by following-up on that agenda item and assessing the patient’s progress.

Physicians should also let their patients know about the tools that are available to them in the management of their diabetes; the Diabetes Self-Management Education (DSME), Medical Nutrition Therapy (MNT), and weight management programs are great places to start. Funnell also said the physician should refer to programs and community resources for weight loss and physical activity. But one of the most important things that a physician can do is letting their patient know that they understand the management of diabetes is not easy; by empathizing with their patients, the physician will foster a comfort level in their patients who will realize their plight is understood.

Funnell’s talk was concluded with a review of the National Diabetes Education Program’s Support for Behavior Change Resource (SBCR), which is a very useful tool for physicians to help them make program recommendations for their patients. The resource was developed to be an online resource that is interactive, cross-referenced, and query-based; it is current and periodically updated. The tools on the site, like research articles programs, are available by specialty, practice, and audience. For instance, if a patient comes in for a visit who is recently retired, bored, and is not interested in group meetings, the physician could consult the SBCR and see that the MOVE program, a weight management program for veterans, would be a perfect fit for him and make the recommendation to their patient.

The next step for the SBCR is formative research with health care professionals to enhance, develop, and extend the reach of the tool. They will also incorporate their findings into already existing components of the NDEP.

The SBCR can be found at http://ndep.nih.gov/sbcr/SBCRSearchTool.aspx.