Steps To Influence Decision Making To Improve Compliance

To get an individual to change substantially you need to create a shift in their decision making processes

You often want your patient to do you an exercise or commit to a prescribed program and they are resistant. The process I’m about to describe is excellent for implementing behaviour change through influencing the decision making process. Particularly where the patient won’t get immediate perceived benefits.

To get an individual to change substantially you need to create a shift in their decision making processes. At the same time you want to reduce any internal psychological barriers.

One of those barriers is often the negative self talk that convinces them of the benefits of staying they way they currently are.

Clinical Example

1. What do you want your patient to do (in some cases, not do)?

They have a chronic discogenic problem and you want them to get up from sitting every hour.

2. Find out what their EXTERNAL BARRIERS or physical, environmental, or constraints are. 

This could be that the chair doesn’t move easily, remembering to get up, or the lounge is difficult to get out of etc.

For this example, at the very least, standing up is no big deal, but perhaps the seat they are sitting in is difficult to get out of.

3. Figure out what their INTERNAL BARRIERS for behavioral change are. 

These could be misperceptions of alternatives, negative attitude towards what you are suggesting, lack of awareness, thinking that what THEY do will have little consequence etc.

In this example, your patient might think that standing up wouldn’t really make much of a difference. Another possibility is that he or she finds getting up and down frequently to be inconvenient and distracting.

4. What are their decision processes? 

Your aim is to shift their decision making processes.

There are a lot of factors when it comes to making a decision. Things like hierarchy of values, beliefs, fear, previous experience etc. 

You can often boil the process down by asking two questions:

“How will doing this (getting up hourly) cause them PLEASURE?” and “How will not doing this cause them PAIN?”

Reward and Consequences.

5. Unfreeze their habitual decision processes by including a new problem/or saying it’s the social norm now.

In this example, where you are asking the patient to stand up every hour, you can say that people who are successful in managing chronic bak pain and who return to doing the things they love, get up from sitting frequently (social norm). 

In terms of a negative consequence, by not getting up every hour this will increase their back pain and impede their ability to engage in other activities that are important to them (creating a new problem). 

Your message needs to be impactful.

NOTE: If you’ve asked someone to do something and they have said no, try adding additional information to your request because they are not clear on the benefits or reasons behind your request. Or perhaps you could ask them what they don’t like about your suggestion. Then follow this up by asking their ideas on how you can improve your suggestion to better suit their needs.

6. The message needs to reflect reality and not the point of view of the message sender. 

In this example, you wouldn’t say, “I want you to get up so that you put less pressure in your disc and the muscles and ligaments get tight with constant sitting.” This reasoning is of little value to the majority of patients.

You might say, “Because you want to (insert their goal), you might want to get up regularly from sitting to help you achieve your goal.”

The reality must be that of the patient you are talking to which means it will change from patient to patient.

7. If possible, ask the patient to get publicly involved. 

An interesting way to do this is by getting your patient to tell someone else why your request is helpful and how it will benefit them in the long run. 

They might ask for their support in what ever way is helpful to them. For some people by making a public commitment, the person becomes more accountable for the decision they’ve made.

In this example, you could get the patient to tell his/her work colleague how getting up every hour from sitting is beneficial to both their back and their overall productivity.

Preparation is the key

If you are going to try this formula on a resistant patient, write down what you are going to say with each of the steps above before the consult. Your previous subjective assessment is likely to have provided helpful information that can be used for both creating the reward and consequences.

At the very least, becoming aware of both the patient’s external and internal barriers will help in the negotiation of potential solutions.

Framing those solutions in terms of norms and avoiding a new problem will help in influencing the decision making process.

To learn more about motivational tools through effective communication download my eBook:

“Improving Patient Motivation In Physiotherapy”

I wrote this eBook in response to the most common question I get asked and that is “How do I motivate my patients?”

If you would like to fine-tune your communication skills when working with resistant patients, you might consider working with a coach or mentor.

Or perhaps your staff would benefit from training in this area.

Contact us, and find out more about what we can offer you.

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