How to Facilitate Lifestyle Change

Applying Group Education in Healthcare

Amanda Avery, Kirsten Whitehead, Vanessa Halliday

• Publisher: Wiley-Blackwell
• Year: 2016
• Print ISBN: 9781118949917
• eBook ISBN: 9781118949894
• Edition: 1
• Topic: Medicine
• Subtopic: Nutrition, Dietics & Bariatrics

Group work and patient education are vital aspects of improving health outcomes in all settings, by supporting patients and clients to manage their conditions, as well as to promote and support behaviour change for improved health.

Concise, accessible, and easy-to-read, this new title in the popular How To series is designed to support nutritionists, dietitians, nurses and other healthcare professionals to facilitate healthy lifestyle change through group education.  How to Facilitate Lifestyle Change covers the entire group education process, from initial planning, to delivery and evaluation.  Topics include agreeing aims and objectives and structuring a session, to considering practical aspects such as setting, managing challenging group members and participant expectations, as well as evaluating and refining a session plan for future use.  It also provides an overview of the key evidence base for group learning, relevant theories and models, peer support, and e-learning opportunities.

Including case studies to illustrate the real-life application of each topic, practice points, helpful checklists, and a range of practical tips, How to Facilitate Lifestyle Change is the ideal resource to support anyone involved in group patient education and facilitation of health behaviour change.

Chapter 1
Introduction

Amanda Avery

1.1 Overview

This introductory chapter sets the scene explaining why there is a need to find scalable and effective solutions to both prevent and manage the increasing number of non‐communicable diseases, such as obesity and type 2 diabetes (T2DM), which result from poor lifestyle habits. Group education, if delivered well, has the potential to provide a solution but the group participant needs to be empowered to feel able to make the desired lifestyle changes. Evidence of successful group education is provided and key characteristics of the successful groups highlighted in the form of ‘Top Tips’. These features are then discussed in more detail in subsequent chapters.

1.2 The need for lifestyle change

Non‐communicable diseases (NCDs) are the major cause of both mortality and morbidity globally, killing more people each year than all other causes combined. Of the 56 million deaths that occurred in 2012, more than two thirds (68%) were due to NCDs, comprising mainly of cardiovascular diseases, cancers, type 2 diabetes and chronic respiratory disease. Liver disease, resulting from both alcohol abuse and non‐alcohol fatty liver disease, is increasingly contributing to this list of NCDs. The combined burden of these conditions is greatest in low and middle income populations, where they impose large avoidable costs in human, social and economic terms. Despite this inequitable distribution in prevalence, much of the human and social impact caused through NCDs could be reduced. This could be by both primary and secondary prevention and through a better understanding of cost effective and feasible interventions that acknowledge the socioeconomic determinants of health (WHO, 2014).

NCDs are, in the main, caused by four behavioural risk factors that represent modern day lifestyles:

• tobacco use
• unhealthy diet
• insufficient physical activity/sedentary behaviours
• the harmful use of alcohol (WHO, 2010).

These four behavioural risk factors are discussed in more detail as they are likely to be the focal topics for group education.

Tobacco use

Smoking tobacco and the exposure to second‐hand smoke is estimated to cause about 71% of all lung cancers, 42% of chronic respiratory disease and nearly 10% of cardiovascular disease. Smoking also increases the risk of diabetes and premature death (WHO, 2012).

Unhealthy diet (and malnutrition)

The World Cancer Research Fund estimated that 27–39% of the main cancers can be prevented by improving diet, physical activity and body composition (WCRF/AICR, 2007). Approximately 16 million (1.0%) disability‐adjusted life years and 1.7 million (2.8%) deaths worldwide are attributed to a low fruit and vegetable consumption (Wang et al., 2014). An adequate intake of fruit and vegetables reduces the risk of cardiovascular diseases, stomach cancer and colorectal cancer (Bazzano et al., 2003; Riboli and Norat, 2003). The consumption of high energy processed foods, high in fats and sugar, increase the risk of obesity compared to low energy dense foods such as fruit and vegetables (Swinburn et al., 2004).

The amount of salt consumed is an important determinant of blood pressure levels and overall cardiovascular risk (Brown et al., 2009). It is estimated that reducing dietary salt intake from the current 9–12 g per day to the globally recommended 5 g for adults would have a significant impact on reducing blood pressure and cardiovascular disease (He and MacGregor, 2009).

Besides the amount of fat in the diet being important, so is the type with the replacement of saturated fats with unsaturated fats considered for many years to be beneficial in reducing risk of coronary heart disease (Hu et al., 1997). A Mediterranean style diet, where the fat is mainly unsaturated, is perceived as being a diet we should aspire to.

Many people have a diet that is too high in free sugars, which can lead to weight gain and poor dental health (SACN, 2015). The main sources of free sugars in our diet include soft drinks, table sugar, confectionery, fruit juices, biscuits, cakes, pastries, puddings and breakfast cereals all of which can be replaced by alternatives with a lower sugar content. The alternatives are also likely to have a healthier overall nutrient profile. Free sugars provide no other important nutrients other than being an energy source. The important relationship between healthy teeth and gums and being able to consume a healthy, varied diet is often overlooked.

Whilst the amount of free sugars in most people’s diet is too high, the average intake of dietary fibre is too low in developed countries. Dietary fibre is important for colorectal health and alongside a healthy fluid intake and sufficient physical activity, can help to reduce the prevalence of constipation. In the UK the recommended daily amounts for adults have increased from 18 g/day to 30 g/day (SACN, 2015).

Having an adequate intake of micronutrients is also an important aspect of a healthy balanced diet. Micronutrient deficiencies, for example iron, calcium, iodine and vitamin D, are still common, particularly among vulnerable populations. The European Food and Nutrition Action Plan (2015–2020) aims to reduce the prevalence of anaemia in non‐pregnant women of reproductive age by 50%. Group education which ensures that naturally iron rich foods are chosen in the diet will be important to ensure that this target can be achieved in such a large group of women.

People and families with lower incomes (in developed countries), generally have a less healthy diet with a lower intake of fruit and vegetables and a higher intake of processed high energy dense junk foods (McLaren, 2007). Whilst many people may be aware of what a healthy balanced diet includes, there is a need to make this diet more accessible and affordable and attractive as well as to support people to develop the skills and confidence needed to prepare healthier foods.

Insufficient physical activity

Insufficient physical activity is the fourth leading risk factor for mortality (WHO, 2009). People who are insufficiently physically active have a 20–30% increased risk of all‐cause mortality compared to those who engage in at least 30 minutes of moderate intensity activity on most days of the week (WHO, 2010). The estimated risk of ischaemic heart disease is reduced by 30%, the risk of T2DM by 27% and the risk of breast and colon cancer by 21–25% through participation in 150 minutes of moderate physical activity each week (WHO, 2010). Additionally, physical activity reduces the risk of stroke, hypertension and depression and, given its key role in energy expenditure, is fundamental to energy balance and thus weight management. In 2010, 23% of adults aged over 18 years were insufficiently active, having less than 150 minutes of moderate intensity physical activity or the equivalent per week (WHO, 2014). The prevalence of insufficient physical activity actually rises according to the level of country income with higher income countries having more than double the prevalence compared to lower income countries for both men and women. Almost 50% of women in high income countries do not get sufficient physical activity (WHO, 2009).

Alcohol

In 2015 the latest data suggests that the harmful use of alcohol, hazardous and harmful drinking, was responsible for 3.3 million (5.9%) deaths per year worldwide (WHO, 2015). More than half of the deaths occurred as a result of NCDs, including cancers, cardiovascular disease and liver cirrhosis with both morbidity and mortality occurring relatively early in life. In the 20–39‐year age‐group approximately a quarter of total deaths are alcohol related with more men than women affected. An estimated 5.1% of the global burden of disease, as measured by disability‐adjusted life years, is caused by the harmful use of alc...

Table of contents

• Cover
• Title Page
• Table of Contents
• Foreword
• Preface
• Acknowledgements
• Chapter 1: Introduction
• Chapter 2: Behaviour change
• Chapter 3: What makes a good facilitator?
• Chapter 4: Planning and organization
• Chapter 5: Delivering the session
• Chapter 6: Resources
• Chapter 7: Evaluation
• Chapter 8: Managing group interaction and how to overcome challenges
• Chapter 9: Personal development in group facilitation skills
• Index
• End User License Agreement