Using health promotion theory with patients

Nova Corcoran, University of South Wales will be leading this week’s ENB twitter chat on Wednesday the 18th of February between 8-9pm focusing on ‘5 Quick ways to use health promotion theory with patients’. Participating in the twitter chat requires a Twitter account; if you do not already have one you can create an account at www.twitter.com. Once you have an account contributing is straightforward – follow the discussion by searching links to #ebnjc @EBNursingBMJ, or better still, create a tweet (tweets are text messages limited to 140 characters) to @EBNursingBMJ and add #ebnjc (the EBN chat hash tag) at the end of your tweet, this allows everyone taking part to view your tweets.

5 Quick ways to use health promotion theory with patients by Nova Corcoran

Many nurses view health promotion theory as something they vaguely remember from university and very few would claim to use health promotion theory in practice. Here’s the good news – you don’t need to remember a whole theory to use theory? There are many common elements in health promotion theories that can be incorporated in day to day practice. Here are five quick ways to use health promotion theory with patients.

Promote the benefits of change –not just the health benefits

We tend to focus on changing behaviour being ‘good for you’ but often patients find it difficult to quantify health benefits that are twenty years or more down the line. Benefits are recognized in a number of theoretical models and tangible benefits can include saving money, losing weight, not smelling of smoke or making new friends. Use resources to help you promote the short term benefits, for example websites that calculate how much money you save by quitting smoking (refer to resources list).

Promote patient behavioural control

A feature of a number of health promotion models is the role of self-efficacy or behavioural control. This is the patients’ perception of their own ability to be able to achieve something. Patients with low self-efficacy are much less likely to change. Be positive with your patients; tell them they can achieve their goal. Focus on small goals for example swapping instead of stopping. Change4life has good ideas for nutrition smart swaps (refer to resources below). Equally swaps could be in other lifestyle areas for example alcohol by swapping higher to lower strength beers.

Identify barriers to change

Numerous theoretical models acknowledge that barriers stop many behaviour change efforts. Ask patients what they think will stop them achieving a behavior, for example quitting smoking and how they plan to overcome this barrier. For example barriers to quitting smoking include peer pressure from friends, habit and cravings. If the response can be planned relapse is less likely. You might suggest a distractor app for iPhone/android phones such as the Filter Distractor app (refer to resources below) or Nicotine Replacement Therapy (NRT).

Recognize the wider environment

The environment is an important element of behaviour change. Safety, traffic and aesthetics can discourage exercise outdoors and unfriendliness, unfamiliarity and embarrassment can discourage exercise indoors. If you wanted to encourage a patient to exercise more then you need to be able to signpost them to friendly, safe spaces. Become familiar with your local area; which physical activity groups are easy to access? Does your leisure centre run special classes for teenagers or older people? and which green spaces are safe?

Tailor information to the patient

If you work with children you probably communicate health information use simple words or pictures. The same tailoring ethos should also apply to other patients; for example providing information in a different language or large print. Recognize that patients are at different stages of change. For example does your patient have all the information they need? Are they very knowledgeable? Have they tried to change before? What is stopping them from changing? Being a good signposter can help you tailor information. If a patient wanted support to change a behaviour i.e. diet some patients would prefer a group, some would prefer a website and others might just want to do it by themselves. Ask the patient what they would prefer and signpost accordingly.

You do not need to be an expert in health promotion theory to do any of these five things – just think small changes, short term goals and know the assets in your local area that will support your patient when they are back at home.

Can you think of any more quick ways to include theory in practice?

Resources

Change4life (2014) Smart Swaps available at http://www.nhs.uk/change4life/Pages/smartswaps.aspx

NHS (2014) Smokefree calculate the cost available at http://gosmokefree.nhs.uk/quit-tools/calculate-the-cost/

Filter (2014) Distractor app available at http://thefilterwales.org/distractor-new-free-app-smoking/#.VNfLCizLJJM

A useful online resource for nursing theories is available at http://currentnursing.com/nursing_theory/

References

Addition information on theoretical models can be found in Corcoran N (2013) Health Communication; strategies for health promotion, Sage, London.

A good overview of different theories for nurses in behaviour change can be found in is Davies N (2011) Healthier Lifestyles: behaviour change. Nursing Times 107 23 20-23 available at http://www.nursingtimes.net/Journals/2012/03/30/a/m/d/110614Lifestyle.pdf

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