How to Deliver Brief Advice for Health

Delivering Brief Advice is easy when you know how. Follow the simple structure below to get it right first time, but before that check you know how to listen, question and reflect.

LISTEN with all your attention and don't load up solutions, questions and answers whilst you are listening. Make a note of these for later, but for now listen without judgement, listen for clues, listen for repeated words, listen for feelings, listen with your whole body and signal for encouragement. Listen some more and then listen again. Push yourself to get used to uncomfortable silences and pauses. You may feel awkward, but your client is using this space as valuable thinking time in which they will be able to self-reflect and start to come up with their own solutions. This thinking space is crucial as people are much more likely to make changes if they are the ones solving their own problems.

Don't ask too many QUESTIONS. Questions redirect the conversation somewhere else and if you're the one asking all the questions then guess what? You're directing the conversation. This is particularly hard for healthcare professionals as they have been taught to be the expert and question, question, question. This means they often fall into the expert trap and stop clients spending as long as they need to on the finer details of the subject that's being discussed and ultimately thinking for themselves. Within a 5 minute conversation you shouldn't be asking more than 3 questions.

REFLECT as much as possible. Reflecting back what someone says to you is one of the most powerful things a listener can do. This tells the speaker 3 things. First it shows you are actually listening and not thinking about your commute or what to have for dinner. It shows that you are fully present, in that moment for that person, walking side by side. Even if you reflect back the wrong meaning the speaker will correct you and will see that you are trying to understand what they are saying at a deeper level. The second thing reflection does is enable the speaker to hear what they have said to you. When we speak we don’t tend to really listen to what we are saying, so when someone repeats back to us what we’ve said it can often feel like the first time we’ve heard the thing we said. When you get really good at reflecting your client will often think you are the one coming up with all the answers and doing all the problem solving, when in fact you have simply built verbatim and complex reflections into your conversation at a level that feels natural and not forced or repetitive. The third thing reflecting does is encourage your client to elaborate. By repeating back what someone has said to you (and the trick is to know what bits are important and worth repeating back) you are pushing the topic back to them so they can explore their thoughts and feelings more fully than if you kept firing question after question at them. And when you reflect and pause? Well, that’s when the magic happens.

Brief Advice Framework (10-20mins)

Start with an Affirmation – “You’ve recently started exercising…you’ve cut down on fizzy drinks…you haven't drunk alcohol for 6 months...you've maintained your tenancy for well over a year...”

Ask Permission – “Do you mind if we talk…is now a good time...it's says in your support plan that you have a Type 2 Diabetes, would you like some information about how physical activity can regulate blood sugar levels?”

Initiate a Change Talk – “What would you like to see different about your current situation? How would reducing alcohol benefit you…are you happy with the amount you smoke...if I could wave a magic wand what would be your perfect weight?”

Reflect Back – “You would like to smoke less…you’re unhappy with how alcohol affects relationships…you're concerned about your health...you think your weight might be an issue...you've become more concerned about not being active enough.”

Question Change Scales – “On a scale of 1-10 how important is this change? On a scale of 1-10 how committed are you to making this change? On a scale of 1-10 how ready are you to start making this change today?” Be prepared for each scale to be different and when your client gives you their score don't try and push it up immediately as this will undermine the score they gave you. Ask them what makes it a 5, ask them what the score was last week and if anything has changed. This will provide insight into wider issues they might be dealing with and other motivating factors or barriers to making the change.

Ask Open Ended Questions – “How have things been with…what have you found challenging...what's been your biggest achievement this week...what are you most proud of?”

Normalize Fears – “Many people make several attempts…lots of people struggle to quite the first time.” Be careful with your tone here. It doesn't matter if thousands of people have struggled before, the person in front of you is struggling for the first time.

Encourage Self Belief – “Tell me about a time you’ve made a successful change…give me an example of something you are proud of...tell me about something you enjoy doing.”

End with an Affirmation – “It’s clear that you’re committed to this…this is obviously something that is very important to you...this change really means something to you.” Learn the difference between an affirmation and praise. Praise is paternalistic and wrapped up in your own judgement. Saying "well done, or, I'm proud of you" sounds fine to most people but for someone who is struggling to make a change to their identity or lifestyle praise may put too much pressure on them to succeed, which is a higher place to fall from when relapse occurs. It will also remind them of the power imbalance between them as the 'client' and you as the 'professional'.