E ngagement The Lines the Box and the Circle Presenters name Workshop Outline 19112013 Slide 2 About the Ida Institute Goals for today Why motivation Background and the Motivation Tools ID: 1041801
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1. Tools to Support Motivational Engagement:The Lines, the Box and the CirclePresenter’s name
2. Workshop Outline19.11.2013Slide 2About the Ida InstituteGoals for todayWhy motivation?Background and the Motivation ToolsMy Ida Moment
3. The Ida Institute as a Change Agent19-11-2013Slide 3An independent non-profit organisationFunded by the Oticon Foundation since 2007Work with co-creating change toward patient-centered practice in audiology
4. Ida Institute MissionTo foster a better understanding of the human dynamics associated with hearing loss19.11.2013Slide 4
5. The Ida World (www.idainstitute.com)19-11-2013Slide 5Output from Ida World SeminarsIda WorkshopsGlobal CommunityToolsHvid tekst med hvidPublic Awareness
6. Goals for Today19.11.2013Slide 6Better understanding of Motivation Tools:How to determine the patient’s readiness for changeUncover core patient issues and motivationsProvide the information patients need to facilitate their movement through the stages of change
7. Motivational EngagementA means to identify where the patient is in their journeyBuild a dialogue and reach core issues in limited timeLet the patient do the talking to uncover internal motivation19-11-2013Slide 7
8. Why Motivational Engagement?19.11.2013Slide 8Some examples from current practice:…………
9. The Wider Medical ContextProfessionals often try to persuade patients to change their habits by:Giving informationMaking recommendations “Hearing aids will improve your quality of life”“You should wear your aids every day”“An FM system is just what you need”
10. How Successful is the Change?Information and recommendations rarely work wellPatient fails to follow recommended practicePatient may even drop out of treatmentProfessional feels frustration and dissatisfactionIt is better to let the patient convince themselves of the need to changeThis is more effectiveIt has a longer-lasting impactIt utilises professional expertise and time more effectivelyBUT HOW??
11. Audiology:Using hearing devices Adopting effective communication strategiesPersonal:Losing weightTaking adequate exerciseMedical:Taking vital medicationControlling sugar intakeKnowing is not automatically followed by doingThe Problem: It’s Hard to Change HabitsWe often fail to do what has been recommended, even if we know it is for our own benefit.
12. Changing habits is fundamental in audiologyPeople follow a well-recognised pattern when changing any habitsSome simple tools can support the change processTwo lines……a box……and a circleThe Process of Changing Habits
13. Ida Motivation ToolsA means to structure patient-centred dialogue Track record in other health care areasWell-established theoretical framework19.11.2013Slide 13
14. History of Motivation ToolsEarly roots in Carl Rogers non-directive counselling (1953)Based on the transtheoretical model of intentional behaviour change (Prochaska and DiClemente,1993)Early work: smoking cessation, obesity, drug addictionExamination and resolution of ambivalence is central 19.11.2013Slide 14
15. Today...WHO Collaboration Centre for Evidence Based Health Promotion in Hospitals uses the tools as an approach to managing chronic health conditionsSuccessfully implemented and used within the Danish Health Care System since 199019.11.2013Slide 15Applicable in a variety of medical contexts e.g. nursing, surgical medicine, audiology, and occupational therapy
16. A Transtheoretical Model of Behavior Change An integration of theories and evidence of intentional behaviour change from:1. Evidence from successful self-changers and2. Across different schools of thought within psychology i.e cognitive psychology, behavioural psychology and psychoanalysis (Prochaska et al, 1991,Babeau et al 2004) 19.11.2013Slide 16
17. Transtheoretical Model of Intentional Behavior ChangeWhen and how shifts in attitude occurCyclical pattern of movement Common set of processesSystematic integration of stages and processes of changeDistinct and measurable stages ( Prochaska, DiClemente, Norcross, 1993)19.11.2013Slide 17
18. 19.11.2013Slide 18The Circle
19. Let the Patient Tell You.....Which best describes you?I am not ready for hearing aids at this time (Pre-contemplation)I have been thinking that I might need hearing aids (Contemplation)I have started to seek information about hearing aids (Preparation)I am ready to get hearing aids if recommended (Action)I am comfortable with the idea of wearing hearing aids (Maintenance) (Babeau, Kricos et al, 2004)19.11.2013Slide 19
20. Identify the patient’s views with respect to:How important it is to change their habitsHow strongly they believe in their ability to changeThe Lines
21. How important is it for you to improve your hearing right now?0 = not at all 10 = very muchHow much do you believe in your ability to use hearing aids, assistive listening devices or communication strategies? 0 = not at all 10 = very muchThe Lines
22. The Core Part of the DialogueASK: What is the reason for giving yourself 6 and not 1? RESPONSE: The patient begins to articulate their reasons, perhaps thinking deeply about this for the first timeYou are always more likely to be convinced by listening to your own arguments and voice
23. Don’t Stop There...Typical follow-up questions:ASK: What would it take to increase the importance from 5 to 9? ASK: What would it take to increase your belief in your ability to change habits from 3 to 8?ASK: What can I do to help you to go from 1 to 7?
24. The Box: Decisional Balance1) What are the advantages of continuing as you do today?2) What are the disadvantages of continuing as you do today?3) What are the disadvantages of taking action on your hearing?4) What are the advantages of taking action on your hearing?Adapted from Janis and Mann 1977‘Status quo’: Making no change in respect of hearing situation‘Change’: Adopting instruments/strategies to hear better
25. The Box: Costs and Benefits of Change1) What are the advantages of continuing as you do today?2) What are the disadvantages of continuing as you do today?3) What are the potential costs of taking action? 4) What are the potential benefits of taking action?Adapted from Janis and Mann 1977‘Status quo’: Making no change in respect of hearing situation‘Change’: Adopting instruments/strategies to hear betterI look normalI’ll be able to join in family conversationPeople will know I’m deafI feel left out and isolated
26. MotivationIdentify and mobilise client’s intrinsic valuesMotivation is elicited from the patient, not imposed from withoutFor increased motivation:Elicit, clarify, resolve ambivalence and Perceive costs and benefits associated with change19.11.2013Slide 26
27. Resistance and DenialReadiness to change is not a trait, but a product of interpersonal interactionResistance and denial are often signals to modify motivational strategiesEliciting and reinforcing the patient’s belief in their ability to achieve a specific goal19.11.2013Slide 27
28. How I Use Motivational Engagement in My Work...For presenter: Share your own experience using the Ida tools 19.11.2013Slide 28
29. Good PracticeListenSupport the patient in doing the talkingRepeat the last word like a questionOffer clear informationReflect (so, on one side you say that …)Do not argue with the patient, or counter their viewsLet them hear their own answersLet them convince you … and themselves
30. My Ida MomentWhat surprised you about what you heard today ?19.11.2013Slide 30
31. www.idainstitute.com