Brief interventions

Every time a person is at the clinic, talk with them about issues or concerns they have about healthy lifestyle, or other health business. These short chances (as little as a couple of minutes) are ‘brief interventions’

  • Brief interventions work — people are more likely to consider changing if health care workers talk with them about their issues and concerns
  • Talk about any behaviour (good or bad) that affects health
    • Eating well, being more active
    • Drug use (eg smoking, marijuana, alcohol)
    • Looking after a chronic disease
    • Home problems (eg family violence)
  • Person needs to want to change before any steps will be taken. You can’t force people to change but you can raise awareness, share information, get person thinking about making changes, and support good choices and attempts to change
  • The type of brief intervention provided depends on how ready person is to change
  • Have printed material to support what you talked about — they may look at this at home 
  • If problem is severe — probably need more than a brief intervention, may need specialist services (eg counselling)

Communicating with clients

The way that practitioners communicate with their clients is an important part of brief interventions and helping people change behaviour

  • Try to gain the person’s trust and establish a relationship. Particularly important when working with pregnant women as this is a very sensitive time
  • Conversational approach is best as lecturing and telling people what to do will not help to get the message across
  • Important not to judge person — makes it harder to talk with them

Stages of change

Determining stage of change

There are 4 steps to use when doing a brief intervention about any issue

  • Step 1 — Raise issue you want to talk about
  • Step 2 — Ask if they have thought about changing
  • Step 3 — Decide on their stage of change based on what they tell you in step 2 — Table 11.2 — do brief intervention to suit. Record in file notes — stage of change and advice given
  • Step 4 — Next time you see them, ask how they are doing. Reinforce positive changes, do another brief intervention if you think stage of change different

Relapse

  • Going back to previous behaviour (relapse) is common
  • Help person not to be down on themself, not to see this as a big failure
  • Encourage person to learn from setback and get back to positive behaviour again

Table 11.2 Stages of change and brief interventions to suit — using alcohol as example  

FRAMES

FRAMES is a set of 6 elements shown to make brief interventions more effective. FRAMES provides a useful checklist for planning how to do brief interventions better. The elements are

  • Feedback — provide assessment results to person in positive way
  • Responsibility — talk about person’s responsibility for making changes
  • Advice — give clear relevant advice about reducing harm, improving health and wellbeing
  • Menu — work with person to create range of alternatives, options
  • Empathy — use empathy as a counselling style
  • Support self-efficacy — encourage person to be optimistic, and to believe that they can change
Other important ways of supporting change
  • Goal setting — need to set realistic goals for changing problem behaviour
  • Follow-up — reinforce behaviour change, make sure strategies are appropriate
  • Timing — very important. Motivation is there when person thinking about change. People make changes when time is right for them

5As approach — Ask, Assess, Advise, Assist, Arrange

Table 11.3  5As approach — using smoking as example 

Getting messages across in other ways

  • Display information about healthy lifestyles in clinic. Try to use local language in displays
  • Keep and display useful phone numbers and/or addresses for people to find help for themselves
  • Consider clinic policies that promote healthy lifestyle — smoke-free areas, dog-free clinics
  • Consider example you set for people you work with and in community