Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton SO16 6YD, UK; NIHR, Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
Global Health Research Institute, School of Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK.
Perspect Public Health. 2022 May;142(3):158-166. doi: 10.1177/1757913920977030. Epub 2021 Feb 15.
The NHS Long Term Plan has a prevention focus and ambition to support patients to self-manage disease through improving health behaviours. An essential requirement of self-management is behaviour change, but many practitioners have not been trained in skills to support behaviour change. 'Healthy Conversation Skills' (HCS) training was developed at the University of Southampton for this purpose. This article reports on a pilot study that aimed to assess the feasibility of primary care practitioners adopting HCS in their routine practice. It describes their experiences and level of competence post-training.
Health Education England (Wessex) commissioned HCS training for 18 primary care practitioners. Fifteen of these practitioners were subsequently observed in their consultations at one or two time points; face-to-face semi-structured, reflective feedback interviews were conducted immediately following the observations. Practitioners' HCS competence was assessed from the observations and interviews using a previously developed and published coding rubric. The interview data were analysed thematically to understand practitioners' experiences of using the new skills.
Practitioners demonstrated competence in embedding the skills into their routine practice following HCS training. They reflected on how patients liked being asked questions, the usefulness of setting SMARTER (Specific, Measured, Action-oriented, Realistic, Timed, Evaluated and Reviewed) goals and the power of listening. They could also identify facilitators of skill use and ways to overcome challenges such as patients with competing priorities and organisational constraints. They found the skills valuable as a way of empowering patients to make changes to manage their own health.
HCS are acceptable to primary care practitioners, can be readily adopted into their routine consultations and are a helpful strategy for supporting patients to make changes. HCS training has the potential to be a sustainable, scalable and effective way of contributing to the prevention agenda by supporting disease self-management, and hence of addressing today's epidemic of lifestyle-related conditions.
NHS 长期计划注重预防，并致力于通过改善健康行为来支持患者自我管理疾病。自我管理的一个基本要求是行为改变，但许多从业者没有接受过支持行为改变的技能培训。“健康对话技巧”（HCS）培训就是为此目的在南安普顿大学开发的。本文报告了一项试点研究，旨在评估初级保健从业者在常规实践中采用 HCS 的可行性。描述了他们在培训后的经验和能力水平。
英格兰卫生与保健卓越研究所（Wessex）委托 HCS 培训了 18 名初级保健从业者。其中 15 名从业者随后在一个或两个时间点在他们的咨询中被观察；观察后立即进行面对面的半结构化、反思性反馈访谈。从业者的 HCS 能力是根据观察和访谈使用以前开发和发表的编码量表来评估的。对访谈数据进行了主题分析，以了解从业者使用新技能的经验。
从业者在接受 HCS 培训后，在将技能融入常规实践方面表现出了能力。他们反思了患者喜欢被提问的方式、设定 SMARTER（具体、可衡量、面向行动、现实、有时限、评估和审查）目标的有用性以及倾听的力量。他们还可以确定技能使用的促进因素和克服障碍的方法，如患者有竞争的优先事项和组织限制。他们发现这些技能很有价值，可以帮助患者改变自己的健康状况，从而增强他们的能力。
HCS 受到初级保健从业者的欢迎，可以很容易地融入他们的常规咨询中，并且是支持患者做出改变的有效策略。HCS 培训有可能成为支持疾病自我管理的一种可持续、可扩展和有效的方法，从而解决当今与生活方式相关的疾病流行问题。
