Evaluation of training in behaviour change counselling skills: the application of clinical-audit methodology

1997 ◽  
Vol 56 (4) ◽  
pp. 393-403 ◽  
Author(s):  
Debra Hall ◽  
Peter James ◽  
Sue Roberts
Keyword(s):  
Behaviour Change ◽  
Clinical Audit ◽  
Behaviour Change Counselling ◽  
Evaluation Of Training

scholarly journals Adapted motivational interviewing for brief healthcare consultations: protocol for a systematic review and meta-analysis of treatment fidelity in real-world evaluations of behaviour change counselling

BMJ Open ◽  
2019 ◽  
Vol 9 (7) ◽  
pp. e028417 ◽  
Author(s):  
Alison K Beck ◽  
Erin Forbes ◽  
Amanda L Baker ◽  
Ben Britton ◽  
Christopher Oldmeadow ◽  
...  
Keyword(s):  
Behaviour Change ◽  
Health Behaviour ◽  
Real World ◽  
Treatment Effects ◽  
Random Effect ◽  
Treatment Fidelity ◽  
Systematic Evaluation ◽  
Complex Behaviour ◽  
Behaviour Change Counselling ◽  
The Impact

IntroductionTreatment fidelity is an important and often neglected component of complex behaviour change research. It is central to understanding treatment effects, especially for evaluations conducted outside of highly controlled research settings. Ensuring that promising interventions can be delivered adequately (ie, with fidelity) by real-world clinicians within real-world settings is an essential step in developing interventions that are both effective and ‘implementable’. Whether this is the case for behaviour change counselling, a complex intervention developed specifically for maximising the effectiveness of real-world consultations about health behaviour change, remains unclear. To improve our understanding of treatment effects, best practice guidelines recommend the use of strategies to enhance, monitor and evaluate what clinicians deliver during patient consultations. There has yet to be a systematic evaluation of whether and how these recommendations have been employed within evaluations of behaviour change counselling, nor the impact on patient health behaviour and/or outcome. We seek to address this gap.Methods and analysisMethods are informed by published guidelines. Ten electronic databases (Medline, PubMed, EMBASE, PsycINFO, CINAHL Complete, ScienceDirect, Taylor and Francis; Wiley, ProQuest and Open Grey) will be searched for published and unpublished articles that evaluate behaviour change counselling within real-world clinical settings (randomised and non-randomised). Eligible papers will be rated against the National Institute of Health fidelity framework. A synthesis, evaluation and critical overview of fidelity practices will be reported and linear regression used to explore change across time. Random-effect meta-regression is planned to explore whether fidelity (outcomes reported and methods used) is associated with the impact of behaviour change counselling. Standardised effect sizes will be calculated using Hedges’ g (continuous outcomes) and ORs (binary/dichotomous outcomes).Ethics and disseminationNo ethical issues are foreseen. Findings will be disseminated via journal publication and conference presentation(s).PROSPERO registration numberCRD42019131169

scholarly journals Assessing Adherence, Competence and Differentiation in a Stepped-Wedge Randomised Clinical Trial of a Complex Behaviour Change Intervention

Nutrients ◽  
2020 ◽  
Vol 12 (8) ◽  
pp. 2332
Author(s):  
Alison Kate Beck ◽  
Amanda L. Baker ◽  
Gregory Carter ◽  
Chris Wratten ◽  
Judith Bauer ◽  
...  
Keyword(s):  
Behaviour Change ◽  
Real World ◽  
Best Practice ◽  
Research Question ◽  
Randomised Clinical Trial ◽  
Routine Care ◽  
Stepped Wedge ◽  
Behaviour Change Intervention ◽  
Complex Behaviour ◽  
Behaviour Change Counselling

Background: A key challenge in behavioural medicine is developing interventions that can be delivered adequately (i.e., with fidelity) within real-world consultations. Accordingly, clinical trials should (but tend not to) report what is actually delivered (adherence), how well (competence) and the distinction between intervention and comparator conditions (differentiation). Purpose: To address this important clinical and research priority, we apply best practice guidelines to evaluate fidelity within a real-world, stepped-wedge evaluation of “EAT: Eating As Treatment”, a new dietitian delivered health behaviour change intervention designed to reduce malnutrition in head and neck cancer (HNC) patients undergoing radiotherapy. Methods: Dietitians (n = 18) from five Australian hospitals delivered a period of routine care and following a randomly determined order each site received training and began delivering the EAT Intervention. A 20% random stratified sample of audio-recorded consultations (control n = 196; intervention n = 194) was coded by trained, independent, raters using a study specific checklist and the Behaviour Change Counselling Inventory. Intervention adherence and competence were examined relative to apriori benchmarks. Differentiation was examined by comparing control and intervention sessions (adherence, competence, non-specific factors, and dose), via multiple linear regression, logistic regression, or mixed-models. Results: Achievement of adherence benchmarks varied. The majority of sessions attained competence. Post-training consultations were clearly distinct from routine care regarding motivational and behavioural, but not generic, skills. Conclusions: Although what level of fidelity is “good enough” remains an important research question, findings support the real-world feasibility of integrating EAT into dietetic consultations with HNC patients and provide a foundation for interpreting treatment effects.

Randomized clinical trial comparing the effectiveness of two dietary interventions for patients with hyperlipidaemia

1998 ◽  
Vol 95 (4) ◽  
pp. 479-487 ◽  
Author(s):  
Cliona NÍ MHURCHÚ ◽  
Barrie M. MARGETTS ◽  
Viv SPELLER
Keyword(s):  
Body Weight ◽  
Body Mass ◽  
Behaviour Change ◽  
Serum Cholesterol ◽  
Dietary Habits ◽  
Dietary Advice ◽  
Lipid Levels ◽  
Dietary Interventions ◽  
Dietary Knowledge ◽  
Behaviour Change Counselling

1.Intervention trials in free-living populations have shown relatively small reductions in risk factors for cardiovascular disease, including lipid levels, and have led some to question whether diet is an effective treatment for hyperlipidaemia. However, behaviour change is a complex process and it is possible that standard intervention methods fail to motivate people sufficiently to comply with dietary advice. 2.This study applied motivational interviewing, a style of behaviour change counselling, to dietary education for people with hyperlipidaemia. One-hundred and twenty-one patients with hyperlipidaemia who had been referred to a hospital dietetic department for dietary advice were randomized to receive either standard or motivational dietary interventions for a period of 3 months. Outcomes assessed included dietary knowledge, stage of change, dietary intakes, lipid levels and body mass indices. 3.From baseline, both methods of dietary intervention resulted in self-reported changes in dietary habits and knowledge, statistically significant reductions in intake of total fat (from 32.8% to 28.4%), saturated fat (from 11.4% to 9.2%) and energy intakes [-239 ;kcal (-999.98 ;kJ)/day], and in body mass indices (-0.45 ;kg/m2). Serum cholesterol did not change significantly in either intervention group. 4.Motivational and standard dietary interventions achieved statistically significant changes in reported dietary knowledge and behaviour, and led to a reduction in body weight, but not serum cholesterol. Whether this lack of effect is real or due to subjects overestimating true dietary change cannot be determined. Change in body weight was associated with a reported change in energy intake; this provides some support for there having been a real change in intake.

scholarly journals Training physicians in motivational communication to improve behaviour change counselling competency: A behavioural medicine approach to NCD prevention and management

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
K Lavoie
Keyword(s):  
Behaviour Change ◽  
Skill Acquisition ◽  
Assessment Tool ◽  
Health Behaviours ◽  
Evidence Based ◽  
Training Dose ◽  
Face To Face ◽  
Behaviour Change Counselling ◽  
Communication Competencies ◽  
The Impact

Abstract Background Despite the importance of changing health behaviours in the context of preventing and managing non-communicable chronic diseases (NCD's), physician use of evidence-based behaviour change counselling (BCC) is low, and BCC skills competency is generally poor. Motivational communication (MC) is a patient-centred, evidence-based BCC approach used by healthcare providers, designed to increase patient motivation to adopt a healthy lifestyle. MC-based approaches improved a range of health behaviours (smoking, diet, physical activity) in patients with NCDs, leading to increased demand for physician training. Despite the widespread dissemination of training programs, data on their efficacy in achieving competency among physicians is limited. This is likely due to a lack of consensus on the core communication competencies to be achieved, and in the absence of acceptable, valid and reliable tools to measure skill acquisition. Results Using an integrated knowledge translation (iKT) approach that engaged 199 international physicians, behaviour change experts and health administrators, we have identified 11 core evidence-based communication competencies that physicians should acquire in the context of NCD prevention/management. They have been incorporated into a basic 4 hr face-to-face MC training program called “LEARN THE BASICs”. To assess MC competency, we have also developed a reliable, engaging, efficient, 'user-friendly' case-based digital assessment tool called the MC-Competency Assessment Test (MC-CAT). Conclusions Strategies for optimizing and tailoring this program, including finding the most cost-effective training dose, the impact of supplemental training components (e.g., in person vs. digital coaching; booster sessions), and delivery modes (e.g., face-to-face vs digital/online), will be discussed in the context of optimizing implementation success.

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