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Defining the Activity Defining taxonomy and domain knowledge Abrahams and Michie Taxonomy (what are you doing to change behaviour) What competences do staff have ( The National Training Centre & Michie Paper) * – 94 competences identified (71 individual and 23 group *Michie S, Churchill S, West R (2010) Identifying Evidence-Based Competences Required to Deliver Behavioural Support for Smoking Cessation Annals Behaviourial medicine
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Developing MDS Standards
Bronze, Silver and Gold Standard
Basically
• Process evaluation (inputs, activities and big numbers (reach))
• Outcome evaluation (changes in the smokers knowledge, attitude, motivation, behaviour and beliefs. Quit rate and efficacy
• Impact evaluation (bigger picture-public health (reach x efficacy) long-term prevalence rates, de-normalisation of tobacco use
Defining the Activity
• Defining taxonomy and domain knowledge• Abrahams and Michie Taxonomy (what are
you doing to change behaviour)• What competences do staff have ( The
National Training Centre & Michie Paper) *– 94 competences identified (71 individual and 23
group
*Michie S, Churchill S, West R (2010) Identifying Evidence-Based Competences Required to Deliver Behavioural Support for Smoking Cessation Annals Behaviourial medicine
Specific focus on behaviour (B) addressing motivation (M)Provide information on consequences of smoking and smoking cessationBoost motivation and self efficacyProvide feedback on performanceProvide rewards contingent on successfully stopping smokingProvide normative information about others' behaviour and experiencesPrompt commitment from the client there and thenProvide rewards contingent on effort or progressStrengthen ex-smoker identityIdentify reasons for wanting and not wanting to stop smokingExplain the importance of abrupt cessationMeasure carbon monoxide (CO)
Specific focus on behaviour (B) maximising self-regulatory capacity/skills (S)Facilitate barrier identification and problem solvingFacilitate relapse prevention and copingFacilitate action planning/ help identify lapse triggersFacilitate goal settingPrompt review of goalsPrompt self-recordingAdvise on changing routineAdvise on environmental restructuringSet graded tasksAdvise on conserving mental resourcesAdvise on avoidance of social cues for smokingFacilitate barrier identification and problem solvingFacilitate relapse prevention and copingFacilitate action planning/ help identify lapse triggersFacilitate goal settingPrompt review of goalsPrompt self-recordingAdvise on changing routineAdvise on environmental restructuringSet graded tasksAdvise on conserving mental resourcesAdvise on avoidance of social cues for smoking
Promote adjuvant activities (A)Advise on stop-smoking medicationAdvise on/facilitate use of social supportAdopt appropriate local procedures to enable clients to obtain free medicationAsk about experiences of stop smoking medication that the smoker is usingGive options for additional and later support
General aspects of the interaction (R) focusing on delivery of the intervention (D)Tailor interactions appropriately Emphasise choice
General aspects of the interaction (R) focusing on information gathering (I)Assess current and past smoking behaviourAssess current readiness and ability to quitAssess past history of quit attemptsAssess withdrawal symptoms
General aspects of the interaction (R) focusing on general communication (C)Build general rapportElicit and answer questionsExplain the purpose of CO monitoringExplain expectations regarding treatment programmeOffer/direct towards appropriate written materialsProvide information on withdrawal symptomsUse reflective listeningElicit client viewsSummarise information / confirm client decisionsProvide reassurance
Performance Numbers
• Performance indicators• Performance measures• Performance targets
Bronze
• Demographic data• Reason for calling• Length of call• Outcomes- service
given• Media (where seen?)• Resources posted
Silver
• Demographic data• Biographical data• Addiction data• Motivation data• Self-efficacy data• Media (Where seen?)• Length of Call• Outcomes (in detail )• Service User Satisfaction
Gold
• Silver List Plus +• Anthropomorphic (BMI)• Biochemical- Lipids Glucose• Ethnicity• Relapse prevention data• 52 week efficacy• Service user satisfaction• Service-reuse ( after relapse)• Cost per quitter
Diamond!
• Life-long national record (travels with smoker from physician to physician)
• Longitudinal study 10 year results (Richard Doll & Peto)
• Linked to prevalence data (national surveys)
The future
Monkeys in an Orange Grove –Henri Rousseau