Topic 5 notes:

Communication skills

- Phases of Interview (Cabatan, 2015)

o Preparation
o Opening
o Body
o Closure
- Four important skills
o Attending
o Listening
o Questioning
o Responding
- Communication Tools
o Prompters
o Clarifications
o Reflection or echoing
o Paraphrasing
o Summarizing

Coaching skills:

ASCA

- Coaching Theory / Practical Coaching

- Fundamental coaching skills
o Teaching/coaching skills
o Supervising/organization skills
- Teaching skills
o 5-step approach in teaching a skill (Novice)
 Name the skill to be learnt
 Demonstrate the skill two or three times
 Identify two or three points for the athlete to focus on
 Demonstrate the skill a number of times again (look for key points)
 Give opportunity to practice
o For “advanced” or complex skills
 Collection of less complicated parts which have been learnt previously
 Part-whole method; “Chaining”
 “shaping” = process of smoothing the sometimes slightly disjointed parts so
they flow in the whole movement/skill
o Feedback should be
 Specific
 Constructive
  Immediate
 Clear
 Positive
o 3-step approach to giving feedback
 Simple positive phrase
 Positive reinforcer
 Corrective reinforcer IF NEEDED
o Goals in selecting a teaching method
 Expediency
 Progression
 Safety
 Enjoyment
Health coaching

- Carmonas Teres 2015

o “Originates from Argyris’ Action Theory (
o Behavioral intervention to facilitate patients to adopt and sustain their own health
related goals, change attitudes, decrease unhealthy habits, improve management of
chronic conditions and generally increase health-related quality of life” (Olsen 2010)
- Kivela 2014 SR
o Single patient education, fresh, new, not well-defined
o “Health coaching is the practice of health education and health promotion within a
coaching context, to enhance the wellbeing of individuals and to facilitate the
achievement of their health-related goals.” (Palmer, 2003)
o Emerged from Motivational Interviewing (Miller & Rollnick)
o Coach = help patients weigh options, make choices, plan and identify challenges to help
them change for the better.
- IMPACT trial
o Based on behavior change theory, aims to encourage and support healthier lifestyle
choices (Oliviera; Kivela; Huffman)
- Ammentorp
o Differentiated Health vs Life coaching
- Wolever et al SR
o A service in which providers facilitate participants in changing lifestyle-related
behaviors for improved health and quality of life, or establishing and attaining health
promoting goals (Butterworth et al, 2006)
o National Consortium for Credentialing Health and Wellness Coaches (NCCHWC)
 Client-centered process to


o Aimed to define health coaching omg
-
Self-management

- Lorig & Holman (2003)

o 3 self-management tasks
 Medical management
 Role management
 Emotional management
o 6 self-management skills
 Problem solving
 Problem definition
 of possible solutions
 Solution implementation
 Decision making
 Px must have knowledge / key messages necessary to meet common
challenges, foster appropriate decision making
 Resource utilization
 How to use resources
 Where to find the many resources/guides
 Formation of a patient-healthcare provider partnership
 Healthcare before was for treating acute illness  HCP is for Dx & Tx
 Healthcare Generation now, chronic disease prevails  HCP is a
teacher, partner, professional supervisor
 Action planning / Taking action
 Goal setting
o Short duration (Timebound)
o Specific
o Realistic / “Doable”
o Confidence
 *Self-tailoring
 Px should learn principles of changing behaviors and self-management
o Self-efficacy – one mechanism through which self-management interventions work
 Self-efficacy theory:
 “perceived self-efficacy refers to beliefs in one’s capabilities to organize and
execute the courses of actions required to produce given attainments.”
 4 ingredients of efficacy enhancement
 Performance mastery / Skills mastery
o i.e. Taking action
 Modeling
o Written and video materials; reflecting the population for which
they are developed
o Peers
o People
 Reinterpretation of symptoms
 o Symptoms (e.g. fatigue/pain) should be explained to have
multiple causes  px have reasons to try multiple self-
management behaviors
 Social persuasion
o Behaviors of those around u  you are more likely to follow
- Jonkman et al (2016)
o Operationally defines “Self-management interventions”
 Aim to equip px with skills to actively participate and take responsibility in
management of their chronic condition in order to function optimally through:
 At least knowledge acquisition +
 Independent sign/symptom monitoring
 Enhancing problem-solving and decision-making skills
 Self-treatment
 Resource utilization
 Stress/symptom management
 Changing behavior
- Lawn & Schoo (2010)
o Describes common approaches to self-management support
 Stanford, Flinders, 5A 5R, MI, Health coaching
- Chronic Care model: http://www.improvingchroniccare.org/index.php?
p=The_Chronic_Care_Model&s=2
-

Battersby et al (2010)

12 Principles for Implementing Self-Management Support (SMS)

1. Brief assessment to guide SMS:

a. Clinical severity, functional status, patients’ problems and goals
b. Needs, preferences, behaviors, readiness, barriers to self-management
c. *Yellow flags?
2. Information alone is insufficient, should have skill-based training; evidence guides shared
decision making
3. Use a nonjudgmental approach
4. Collaborative priority and goal setting
a. Collaborative problem definition
b. Setting realistic goals
c. Personalized care plan
5. Collaborative problem solving
a. Problem solving therapy (PST)
6. Diverse providers can offer SMS
7. Diverse formats: individual-, group-, telephone-, and self-instruction
8. Enhance patient self-efficacy
9. Active follow-up
 10. Guideline-based
11. Linked to evidence-based community-based programs
12. Multifaceted

Role of px in chronic illness management

- Lawn & Schoo

o “People with chronic conditions are the principal care-givers, health care professionals
should be consultants supporting them in this role.” (Bodenheimer et al 2002)
- Jonkman
o “Patients with a chronic condition have contact with their health care providers only a
fraction of their life, whereas nearly all patient outcomes are mediated through their
daily behavior” (Glasgow, 2003)
- Huffman
o “It is estimated that 95% to 99% of chronic illness care is provided by the person who
has the illness” (Funnell, 2000)
- Battersby
o “Optimal self-management is the product of a partnership between the patient, the
family, and health care providers.”

NOTE TO SELF:

- Difference of:

Self-management tasks? Self-management education

- How one manages day-to-day care of Self-management interventions
their own health Self-management support (SMS)
Self-management skills
- Life skills + Health behavior Maybe more closely related to:
maintenance Health coaching?

More related to: Life skills

From Topic 3:

Life skills = abilities for adaptive and positive behavior, that enable individuals to deal effectively with
the demands and challenges of daily life.

 Decision making (d177), Problem solving (d175), Creative thinking, Critical thinking
 Self-awareness
 Empathy
 Coping with emotions, managing stress (d240)
 Communication skills (d3)
 Interpersonal relationship skills (d7)

Self-efficacy:
- BELIEFS (e.g. Personal factor) that individuals hold about capability to carry out action in a way
that will influence the events that affect their lives.