Healthy Conversation Skills To Support Lifestyle Behaviour Change
Healthy Conversation Skills To Support Lifestyle Behaviour Change
Dr Wendy Lawrence, Associate Professor of Health Psychology and Dr Mary Barker, Associate Professor of Psychology, University of Southampton discuss Healthy conversation skills to support lifestyle behaviour change: an introduction at the Maternity, Midwifery and Baby London forum.
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good morning um I’m amazed to see so many people in one room it’s a long time since I’ve seen this many people certainly that’s not that many people attend the new lectures I normally give and so Wendy and I here to talk about a development that we have been working on for some time in our team in Southampton at the University of Southampton with the Medical Research Council and the skills that Wendy’s going to demonstrate and run the workshop on this afternoon ah we developed to support our work to improve the diets and nutritional status of young women and I’m going to tell you why we’re so obsessed with supporting young women to live well to eat better and to look after themselves better so today we’re facing an epidemic of life threatening chronic diseases a hundred years ago people were most likely to die from infectious disease things like ammonia or tuberculosis today the number one killers as we all know are chronic diseases lifestyle related diseases heart disease cancer and the complications caused by diabetes so this is a map which shows the numbers of people suffering in 2013 from diabetes around the world and in 2013 you can see there were already 382 million people suffering from diabetes by 2015 we anticipate that this will be nearly doubled this number will be approaching double this number between seven and ten percent of the world’s population will have diabetes a rise of fifty five percent as you can see the numbers are going up everywhere but then particularly going up in the poorest parts of the world this is due of course in part to the rising prevalence of obesity but what it’s also due to is the way that women around the world are able to nourish and grow their fetuses and their babies and this is where you guys come in and this is why we think why we’re here today and why it’s hope is of interest to you so during your lifetime from the time the firk the sperm fertilizes the ovum the human body goes through fifty five complete cell divisions to go from egg and sperm through two fully grown human the amazing thing is that 45 of those 55 cell divisions happen before even born all our organs systems functions are laid down in the nine months before we arrived in the world and we know that how you grow in those nine months determines or we now know that how you grow in those nine months determines your lifelong risk of those chronic diseases we were talking about heart disease diabetes stroke and some cancers and the most important thing that determines how you grow as a fetus in your mother’s uterus is her ability to nourish and nurture you the person who first made this observational discovery was David Barker and he worked at the University of Southampton and devoted the last thirty years of his working life to exploring this process and to understanding the connection between what happens to you and how you grow in new trous and the way your mother is able to nourish and know and and nurture you and your lifelong risk of these diseases and he was my father by the way that’s the family connection and he used to use this lovely homely metaphor to explain how this he felt this process worked and why it was so important he used to say that human beings are like motorcars and they break down break down being a euphemism for acquiring a chronic disease or becoming very ill they break down either because they’re driven on very rough roads they have poor life experiences or because they weren’t they were badly made in the first place rolls royce’s the point is that Rolls Royces don’t break down not even on rough roads no matter where they are driven and what we are trying to do now is to support women to grow rolls royce babies babies that don’t break down babies that don’t become chronically ill so if we want to improve to build better babies of you like rolls royce babies we have to support women to be better nourished and to be able to nourish their fetuses and babies better in the womb and in the first years of life what we also know is that by the time a woman becomes pregnant a lot of this is a little bit too late to influence the growth and the development of her fetus by the time that tiny fertilized egg is implanted in the uterus and between the moment of conception and implantation that that tiny little conceptus has read somehow magically and understood the nutritional environment into which it’s going to implant it’s already decided what patterned and speed of growth it’s going to adopt and kind of where it’s going to end up by the point of birth so what this in what this implies is that we need to support women too to look after themselves to eat better and to be better nourished before they become pregnant to enter pregnancy in a better State and we need to break a cycle that we have acquired of poor nutrition and poor health behaviors so we start that this is a cycle obviously so but if we start at the top the cycle that were talking about really involves women young women having poorer quality diets and we know that those young women who have poor quality diets are also more likely to be obese and to take less exercise or to take less exercise and to become Oh overweight and obese we know then that they enter pregnancy poorly prepared unless we’re able to sustain a healthy pregnancy and healthy growth and development of the fetus and we know from our work in Southampton we’re thousands and thousands of women becoming pregnant and going through pregnancy that they make relatively minimal changes to their diets throughout pregnancy so the diet do you enter pregnancy with tends to be the diet that you sustain throughout your pregnancy women then who have poorer quality diets before pregnancy as I said tend to have poor quality diets during pregnancy and they then passed these poor quality diets on to their infants again this is this is work that we’ve been doing in Southampton and around the world and we found these patterns repeating again and again in different populations in whom we’ve worked so these poorer the the so infants and small children have poorer quality diets that they’re introduced to and we have discovered that these poor quality diets by the time they’re age for the children have greater fat mass less lean mass so more fat and less muscle if you like and they tend to have by the age of four already lower IQ what we’re just working out now is the connection between lower IQ at age four and poorer educational attainment in in adolescents but we are we would expect and we hypothesized that we would see the children with lower IQ aged four to have poorer education entertainment and the children have poorer entered educational attainment and come from that the more disadvantaged communities than when we work then tend to have less healthy behaviors and take eat more poorly exercise less and become obese and so the cycle continues so how do we break this cycle well Wendy and I have spent many years talking to women about what stops them or what might stop them eating well and the four pinky red strange looking squares in the middle are what we have identified as four key factors which predict or which influence women’s ability to eat well and look after themselves well these are these are observations major in focus group discussions that we’ve then confirmed in survey work so women struggle with a lack of social support for eating well their partners and their children and that quote illustrates or one of the things that we heard women say their partners and their children don’t particularly want to eat well and therefore it makes it very difficult for them to feed themselves well and to feed their family as well they haven’t found it difficult difficult in a busy hectic and pressured and and chaotic lives to give food a high priority it’s easier to focus on other things or other things are just much more pressing that your children’s safety your housing needs etc are more important to you in the immediate term than how you eat there is a limit to which people tend to believe that eating well is a good thing anyway you can apparently be too healthy and ultimately and underlying all of these things there is a sense that we detected particularly amongst disadvantaged women of lower sense of self efficacy this is less belief that they can control events in their life less belief that they can achieve the things that they want to do and in the context of our work this would be to feed themselves and their families well so and I should also say that in all the discussions we had with women there was of course a lot of discussion about the cost of food and the difficulty of feeding people on a budget but actually interestingly when we tested this quantitatively in our survey work it we discovered it not to have independent or its own effects on women’s quality of diet that weren’t somehow mediated through these are these other important factors so we’re going to support women to eat better we have to do something we believe to enhance women’s sense of self efficacy this sense that they can control events in their own lives and one thing we know for sure and I suspect all of you know too is that giving people information doesn’t make them change the thing we know is that if you tell young women that they have to eat better no matter for what reasons you explain that they have to eat better and they have to look after themselves better this is simply not enough and it’s simply not going to support change certainly not at the scale and to the quantity that we expect and this lovely quote is actually from a woman who worked in one of the show star children’s centers in Southampton where we did a lot of our early research and it seems to epitomize to us the challenge that we all face as people who are concerned to look after nurture and nourish women better so with this in mind how do we support young women to eat better what can we actually do and this is the point which I’m going to hand over to my I want to say glamorous assistant but that would be entirely unfair associate professor Wendy Lorenz who is going to tell you more about healthy conversation skills training which is our approach to tackling this issue thank you okay I don’t have a I’ll just use this cool so this is the point which I said I was going to ask a volunteer to has who has thought of something they’d like to change because I’m just going to demonstrate to you two different ways that you might talk to someone and how they affect the sort of chances of someone making a change so has anyone that’s near enough to me and you can be at the back if you want if you can run fast is there anyone that would like to volunteer to pop up here and speak to me for four minutes if you yep I have someone that’s already jumped out of their seat run like the wind okay while we’re having this let’s come around to the end here while I’m having this conversation I’d like you to think about what I’m doing in the first two minute conversation under the steps and what I’m doing in the second one and then I’m going to talk through about the intervention after that so just see what you might notice thank you very much for volunteering I’m Wendy you are I’m Zara Zara right we need to get nice and close to the microphone nice say hello to these lovely people hello everyone okay right I also have a glamorous assistant in the front row that’s going to time to two minute conversations for me okay and you’ve got a behavior you like to change and you’re ready to talk to me about it and share in front of all these people yes excellent so yes if you know am i starting the two minutes so can you tell us what the behavior is that you’d like to change my eating habits your eating habits there’s always something we want to change our eating habits isn’t there so it would be good if you could tell me what the eating habit is that you’d like to change well I like sweets a lot sweets I know and it’s just what’s in case yes that’s fine too and we’re now at the new year it’s a really good time to be making a news resolution to cut out sweets and cakes and things so clearly as you see from a lot of the study in the work that’s going on you know we need to be mindful of things that we eat and the way we look after our bodies and all those things that’s a really good thing that you’re trying to do so so today would be a good day to start I think so cut out those sweet cakes today I’m sure there’ll be lots of healthy foods available today and then and then I guess it’s just making sure that you stick with that really isn’t it so good idea to make a plan yeah so I plan to kind of cut out the sweets and then think about something you could replace the sweets with it’s usually a good strategy isn’t it when people are trying to change their diets and think about the things that they like to do that have low calorie stuff yeah well I don’t know you know I think sometimes just sort of replacing you know that you know your sweet things with fresh fruit and vegetables it’s not so much wrong about calories is it it’s just thinking about the healthier things a big diet yeah so thinking about those things yeah so it would be good to get started and other thing people do sometimes put off you know starting these things so um so yeah so think about maybe replacing you know your sweet things with carrot sticks or at all so I posed a good of course maybe apples that would be quite a nice thing to change to so do you think you can get that sort of started this week maybe try and today you’re gonna be good everybody who’s going to keep an eye out for Sarah make sure she’s not eating any cakes in the break everyone have a good lip that’s my two minutes thank goodness right so could you tell me for another two minutes and I’m gonna have another go at that okay so are we gonna do that again so Sarah what is the behavior that you’d like to change well I’d like to eat better okay so what kinds of things do you think you’d like to eat more of I think more fruits more fibers or fiber okay and what’s makes a vote motivating you to think about that at this point what I think my health okay what what signs or symptoms noticed or what concerns well I’ve lost quite a bit but I used to buy a suffering Percy itis some back problems and I’ve had knee to knee surgery so all of those have really made me think about my health more and how it impacts hadley impact on me as I’m growing order in creating you everywhere so what things what specific things do you think you’d like to change what things would you like to eat less of what I think as I said there sweets tried sort of cut back on those I’ve tried sometimes not very successfully but at least I’m working on it so what happens when you successfully cut them out what things need to sort of happen well I think just remember okay so motivation motivation so how can you how can you sort of remember there that’s basically try and avoid buying things like that groceries when you go grocery shopping just don’t look at those aspects trying it more for a bit more fruit in and maybe sometimes and how did the tree and how difficult is it when you go shopping to avoid buying those kinds of things then what makes it difficult for you well does a lot of branding isn’t there and if the way that’s that’s you know and it’s easy to eat and he’s he’s delicious so what do you think you need to do next what’s your first step well I’ve already start the first step first step is just to avoid them as much as possible would go towards their grocery cart grocer was the fruits and legend okay so that was our two minutes on that so Zara thank you hope hang shut up again over lunch Thank You Derek volunteering so those two conversations might have felt a little bit different to you I haven’t really got time in this session to ask you but I would hope that you might talk about that perhaps in the coffee break or when you see me about what the two different things though that you were seeing and so I’m just gonna describe the training and a little bit more detail so it’s one picot at the bit about what was going on there so we’ve developed and delivered and evaluated healthy conversation skills and I’m the lead on this and we have delivered this through a range of health care and social care practitioners I’m gonna be very fast healthcare practitioners in the UK and in various places across the world and there are four competencies that we focus on and what you’d have seen me doing there was a lot of the first one it’s asking those open questions and listening more than talking I hope you all thought that I listened more than I did in the first one or I didn’t awful lot of talking and the idea that practitioners reflect on their practice and also actually you need to get to the point where you support someone to make a goal if people can come up with their own solutions think about their own barriers and make their own goals for change and commit to them and think about how they’re going to put them into practice they’re much more likely to achieve them then if you come up with suggestions and ideas for what things that might work for them as you probably saw in those two types of conversation so we have I’m just going to show you very quickly two bits of evaluation so we asked trainees to respond and they’re some of my lovely trainees to some statements such as there are lovely vegetables and what we saw was that before the training they were making lots of suggestions so the blue bar on the left hand side of the slide shows you how many suggestions people make this is the typical response when you want to help somebody somebody says I don’t know what to do I’m doing this I want to do that we go into fix it mode we don’t just have to be health and social care practitioners to do that we all do it with family friends you want to fix them and actually what we want to do is shift people to be much more exploratory and at time too you can see people asking a lot more of those open questions exploring people’s worlds find out what works for them find out what their first steps can be not what you think their first steps might be and much more empowering you hear that word a lot today I’m sure a much more empowering approach to be able to support people to make so that was straight after the training but up to a year later when we looked at staff in two different areas one trained one not trained we can see that for the all of our major are our competencies there were significant shifts but the one that was least less shifting was smarter but that was getting close to it so that they’re asking they are asking more questions they are listening more they are some supporting planning and spending quite a lot of their time asking these questions so this training can have a real impact on our staff and from what they’ve said to us this has been really valuable for their their practice and how they’ve enjoyed and gained in job satisfaction we currently have a child running at the moment our spring trial which will involve six hundred pregnant women we’re about halfway through recruitment for that and we’re going to be looking at whether where our research staff are trained in healthy conversations and have these kinds of discussions with them throughout their pregnancy asking them what issues they’d like to think about what kind of changes they want to make how that might impact on the health behaviors they adopt during and after pregnancy so we’ve got a couple more years of recruitment on that trial but we’re already ready running some process evaluation and getting to understand what the nurses and the people taking part in our study feel about this approach while they’re pregnant so this runs alongside their routine care and our research nurses don’t offer advice they literally walk just encourage the woman to think about what she would like to do and this obviously is our approach to thinking about how we break that cycle that Mary spoke about so the idea that just giving people information is not sufficient people need to be engaged people need to be thinking about their worlds people need to own the first step that they want to make so we need to think all the time about how do we reach the populations that are out there we know how to reach is a not a great term to encompass all the diversity of the people that don’t necessarily engage with services and what we feel is if we train frontline practitioners in these skills it’s a way it’s a mechanism to engage with those populations so any opportunity to ask somebody what matters to them what they want to do next just ask those questions it’s something that we train our practitioners to think about doing and therefore break this cycle and we just have questions for you really some of you will see in our workshop this afternoon which is an another opportunity to some of our activities and to give us some feedback you’re the workforce out there you have this enormous role with supporting young women either in between pregnancies or during their pregnancy this is such a vital time in their lives to be thinking about these issues so I’m interested and will be interested if you see us today please come up to us what you think about this kind of approach um how we can engage with these this these this population including young women who are well we have a you know of a well population free living how do we get to them how do we get them thinking about their diets how can we use existing services to reach these populations and target them and how can we explore how feasible and acceptable and cost effective this is so getting service commissioners to think about the skills that might be useful to start for staff to have to support these women and I think that’s the next slide so thank you very much okay just about ..