Mentored Activity: Work with the patient towards health behavior change

Identifying a patient for the health behavior change project

Choose a personable, receptive patient with lifestyle health related issues such as obesity, sedentary lifestyle, smoking, diabetes, hypertension, etc., who can benefit from an improvement in lifestyle behavior. Use the 5-A model to define the stage of change - your ideal patient should be between the ‘contemplation’ and the ‘preparation’ stages.

If you are not actively working in a permanent clinic, you may choose a friend or a relative for the entire project (or an occasional patient for each step that fits the same description).

Introduce the patient to the project and ask whether he/she would like to join you for this journey that aims at improving his/her health but also your skills to help patients. If the patient agrees to participate then continue to the next step.
Set a meeting with your patient (between 20-30 minutes).
  1. Search the medical records, interview your patient about his/her medical history and perform a physical with an emphasis on lifestyle risk factors.
  2. The wellness-health wheel: Replace the wheel titles with health issues such as exercise, healthy nutrition, stress, sleep, smoking, social life and relationships, career satisfaction, etc.  You can download a picture of the “health wheel” from Google or draw one for your own use.  Ask your patient to fill in the degree of satisfaction (1 - low, 10 - high) for each of these health issues.
  3. With your patient, have a look at the wheel. Ask how he/she feels about his/her health? Which health achievement provides the most satisfaction? Perform an Appreciative Inquiry.
  4. Then ask what he/she would like to change? This personal decision predicts a higher adherence to the process of change. This is an opportunity to prepare a mutual agenda to keep the patient active and enthusiastic.
  5. Prepare an ACTION PLAN according to S.M.A.R.T. principles: Use materials from the module, for example from the Centre for Excellence in Primary Care and the University of California, San Francisco.  Remember to choose one small step at a time. Do not attempt large steps as this will increase the probability of failure.
  6. Assess ‘Importance’ and ‘Confidence’.
  7. Ask your patient to visit or phone weekly to report on his/her Action Plan, Successes and Challenges. Adapt the plan as needed.
  8. Use motivational interview tools such as Open-ended questions, Affirmations, Reflective listening, etc., in order to enhance the probability of success.
  9. Write a summary of the visit and ask for your mentor’s reflections on it.