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The Measurement and Acquisition of Skills in Behaviour Change Counselling

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The Measurement and Acquisition of Skills in Behaviour Change Counselling The Measurement and Acquisition of Skills in Behaviour Change Counselling Claire Alice Lane Doctor of Philosophy Viva passed 14th December 2005 Corrections approved 12th January 2006 coleg meddygaeth < o 0) c college of medicine Ca r d if f UNIVERSITY PRIFYSGOL C a e RDY[§> UMI Number: U201852 All rights reserved INFORMATION TO ALL USERS The quality of this reproduction is dependent upon the quality of the copy submitted. In the unlikely event that the author did not send a complete manuscript and there are missing pages, these will be noted. Also, if material had to be removed, a note will indicate the deletion. Dissertation Publishing UMI U201852 Published by ProQuest LLC 2013. Copyright in the Dissertation held by the Author. Microform Edition © ProQuest LLC. All rights reserved. This work is protected against unauthorized copying under Title 17, United States Code. ProQuest LLC 789 East Eisenhower Parkway P.O. Box 1346 Ann Arbor, Ml 48106-1346 DECLARATION This work has not previously been accepted in substance for any degree and is not being concurrently submitted in candidature for any degree. Signed .............................................................. (Candidate) Date ........................................................................................... STATEMENT 1 This thesis is the result of my own investigations, except where otherwise stated. Othepsources are acknowledged by footnotes giving explicit references. A bibliography is appended. Signed (Candidate) Date STATEMENT 2 I hereby give consent for my thesis, if accepted, to be available for photocopying and inter-library loan, and for the title and summary to be made available to outside organisations. Signed (Candidate) Date Dedication I would like to dedicate this thesis to my late grandmother Iris Ellen Sheppard. Thank you for your love and for the good times. I hope you are looking down and you can see what I have achieved. Acknowledgments Firstly, I would like to acknowledge the support of my supervisor Professor Stephen Rollnick, for his guidance when writing drafts of this thesis. Thank you for enabling me to develop from novice to researcher, and thank you for your friendship during this period. I would also like to thank all members of the Department of General Practice for their assistance undertaking this work - especially Dr Kerry Hood, who has shown me that it is in fact possible to say ‘stats’ and smile simultaneously. A very special thank-you to Joanne Sloan and Anne Cable for the administration and practical support during the workshops - I greatly appreciate how our teamwork kept everything running smoothly, and I want express my appreciation to you both for ‘carrying’ me through the second workshop when my health was far from good! Thank you also to Dr Gary Rose for coming all the way from the US to assist Steve in the delivery of those workshops. Thanks also to Michelle Huws-Thomas (nee Boycott) for her initial work towards the development of BECCI, which gave me a springboard from which to work. Thank you to Karen Edwards, Janette Moran and Tom Fowler for giving up their time to be raters in the development of BECCI. I would also like to express my gratitude to Tom “Barth, Chris Butler, David Rosengren and Gary Rose for assisting with the content validity stage of BECCI. I would also like to acknowledge the support and friendship of Susan O’Connell during the writing of this thesis. Your being there has made a huge difference. Finally, I would like to thank my husband, Dr Graham Feeney, for the advice while writing up, for reading drafts of chapters, and for being there to give me a hug (and far too much chocolate!!!) when I really needed it. I know he didn’t acknowledge me in his thesis, but like the Murphy’s, as they say, I ’m not bitter. Summary Although mortality from diseases such as coronary heart disease, chronic obstructive pulmonary disease, cancer, liver disease and type-two diabetes is decreasing, morbidity and premature death is increasing. These conditions are related to a number of risk factors, including health behaviours (smoking, diet, lack of physical activity and alcohol consumption). In an attempt to modify patients’ lifestyles, the delivery of a number of complex psychosocial interventions has been attempted by healthcare practitioners in clinical practice. However, in many cases interventions are not adequately described, and there has been very little information regarding how practitioners were trained, and indeed how well they were able to deliver the intervention. This makes evaluation of the efficacy and effectiveness of these interventions difficult. There is a lack of studies that evaluate which training methods lead to the best levels of skill acquisition. One intervention that has shown promise in helping patients to make changes to their lifestyles is behaviour change counselling (BCC), an adaptation of motivational interviewing. As with other complex interventions, the evaluation of skill competence and training methods has been generally poor. The studies in this thesis aim to tackle the issues of measuring skill acquisition in BCC. An instrument - the Behaviour Change Counselling Index (BECCI) - was developed to measure practitioner skill competence in delivering BCC. The Experiential Practice Experiment was conducted to discover whether the use of simulated patients, rather than role-play with fellow trainees lead to enhanced skill acquisition in BCC. Participants also provided ratings of their practice sessions within their experimental conditions. There was no significant difference in BECCI scores or ratings of practice sessions between practitioners who practiced skills with simulated patients in comparison to those who performed role-play. There may be a relationship between participants’ feelings regarding the practice sessions and BCC skill acquisition, but results were inconclusive. Contents Part I - The Background 1 Chapter 1: Introduction 2 1.1 Clinical, non-specialist interventions to change behaviour ......................... 6 1.1.1 Major trials of lifestyle interventions ........................................... 7 1.1.2 Reviews of lifestyle intervention studies ..................................... 10 1.1.2.1 Smoking Interventions .................................................. 10 1.1.2.2 Physical Activity ........................................................... 12 1.1.2.3 Alcohol Consumption ................................................... 14 1.1.2.4 Diet................................................................................ 16 1.1.2.5 Multiple Lifestyle Interventions .................................... 18 1.1.3 Summary ................................................................................... 19 1.1.4 The integration of behaviour change interventions into clinical practice ..................................................................................... 19 1.2 Behaviour Change Counselling: its origins and characteristics ............... 20 1.2.1 What is motivational interviewing? .......................................... 21 1.2.2 How does behaviour change counselling differ from its parent method? .................................................................................... 24 1.2.3 Evidence that motivational interviewing and behaviour change counselling may be effective in facilitating lifestyle change ................ 29 1.2.4 Issues in the evaluation of AMIs ................................................. 33 1.3 The measurement and acquisition of skills in behaviour change counselling .......................................................................................................... 35 v Part II - The Development of the Behaviour Change Counselling 36 Index (BECCD Chapter 2: Introduction 37 2.1 The Importance of Measurement ................ ................................................ 37 2.2 Existing measures ......................................................................................... 42 2.2.1 Existing measures relevant to the BCC construct ......................... 43 2.3 A Measure of Practitioner Skill in BCC - Pilot Work ................................. 46 2.4 Aims of the Study ........................................................................................ 49 Chapter 3: Methods 51 3.1 Data Used in the Development of BECCI ................................................... 53 3.1.1 Workshop Data .............................. 55 3.1.1.1 Consent of Research Participants .................................. 56 3.1.1.2 Collection of the Workshop Data .................................. 57 3.1.2 Training Course Data ................................................................... 58 3.1.2.1 Consent of Research Participants .................................. 59 3.1.2.2 Collection of the Training Course Data ........................ 59 3.1.3 Real Consultation Data ................................................................. 60 3.1.3.1 Consent of Research Participants .................................. 61 3.1.3.2 Collection of the Real Consultation Data ...................... 61 3.2 Analyses ...................................................................................................... 62 3.2.1 Validity .......................................................................................... 62 3.2.1.1 Item Piloting and Content Validity ................................ 63 3.2.1.2 Construct Validity ......................................................... 64 3.2.1.3 Face Validity
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