‘A healthy conversation takes place opportunistically between at least two people, and involves an individual being encouraged to consider their lifestyle and health with a view to identifying small but important changes.’ (PHE and RSPH, 2015)
Who can have ‘healthy conversations’?
Dietitians in the acute NHS sector: you will have the opportunity to talk with patients in most outpatient situations and some ward situations in most specialties
Dietitians in the community NHS sector: you will have the opportunity to talk with patients in most primary care clinics, specialist outreach clinics, after or before some group education situations and during some domiciliary visits
Freelance dietitians: you will have the opportunity to talk with patients in some clinics and before and after some group education sessions.
Student dietitians: on your clinical placements you will have the opportunity to have healthy conversations with patients in ward, outpatient and clinic settings
How to have a healthy conversation
Healthy conversations between patients and clinicians have several elements to them:
A hook which enables the patient/client to raise a subject with the AHP, or vice versa
The brief intervention
Signposting to follow up / specialist support services
What is a brief intervention?
The intervention may only take 5 minutes and can include one or more interventions. Using the example of smoking, the brief intervention may include one or more of the following:
- simple opportunistic advice to stop (linked to the likelihood of becoming ill as a result of continuing the behaviour).
- an assessment of the patient’s commitment to quit.
- provision of self-help material and referral to more intensive support such as the NHS Stop Smoking Services.
When and where to have a healthy conversation
You can initiate the healthy conversation in the following places. The patient may raise an issue with you in these places too:
- In outpatient clinic.
- At bedside during the last meeting with patient prior to discharge from hospital.
- In patient’s home.
- During specialist dietetic clinic.
- Before or after an educational group.
There is some training available on line and free to access:
- BDA CED Communication course.
- BMJ’s Motivational Interviewing: http://learning.bmj.com/learning/module-intro/motivational-interviewing.html?locale=en_GB&moduleId=10051582.
Making Every Contact Count
Making Every Contact Count (MECC) is a widely recognised approach for increasing healthy conversations within health and care services.
MECC encourages conversations based on behaviour change methodologies (ranging from brief advice, to more advanced behaviour change techniques), empowering individuals to make healthier lifestyle choices and exploring the wider social determinants that influence all of our health.
The MECC approach is consistent with the evidence based approach recommended in NICE guidance https://www.nice.org.uk/guidance/ph49
To access free online learning on MECC: http://www.makingeverycontactcount.co.uk/
MECC is already mandatory in many NHS organistions. Your nutrition and dietetic department may need to implement this approach as well as demonstrate that you are doing it through audit and evaluation.