Teaching practitioners Healthy Conversation Skills 

By Wendy Lawrence, University of Southampton

The main causes of death and disease in society today are influenced by our lifestyle choices, and there is a growing focus on ways to improve health behaviours. Front-line practitioners, particularly those working in health, social and community care roles, are a key resource for supporting behavioural change. Routine appointments offer opportunities to initiate conversations about behaviour change every week, but many practitioners feel that they lack the knowledge and skills necessary to provide behaviour change support. This can reduce our confidence for having conversations with clients or patients about potentially sensitive topics, including smoking, weight loss or alcohol intake.

Healthy Conversation Skills is a training programme based on social cognitive theory and behaviour change techniques, which promotes empowerment and patient-centred care. It was developed by a multi-disciplinary team at the University of Southampton in consultation with local health and social care organisations. Healthy Conversation Skills is an effective, evidence-based approach that uses practical, easy-to-apply skills to help people identify their own important behaviour change challenges and solutions. All health care professionals can use Healthy Conversation Skills, even within brief consultations.

People do not adopt or change behaviours in isolation. They are influenced by their social world, their physical environment and by other elements outside their control. We need to understand these factors in order to support effective behaviour change. By focusing on finding out more about people’s lives and circumstances, you will be better placed to offer appropriate support and effectively promote health behaviour changes. One tenet of Healthy Conversation Skills is therefore to start by asking people about their priorities, understand their motivation and challenges, and what they feel is the most important thing to focus on.

The programme also encourages practitioners to reflect on the value of asking questions, listening and supporting goal-setting, as opposed to telling people what to do, giving advice or providing information. We can make more effective use of the time we have available to support individuals to improve their health and well-being by using supportive conversations that take the time to listen, learn about and explore people’s worlds, and using this shared understanding to plan first steps to behaviour change. Below are some practical takeaways from Healthy Conversation Skills that you can put to use today.

Practical recommendations

  1. Ask open discovery questions. These questions generally begin with “What” or “How”, and invite someone to reflect on their own issues, barriers, solutions and first steps for change. For example, “What would you like to change? What is getting in the way of you making that change? How could you overcome that? What would be a good first step for you?” By asking these questions you can find out a lot about someone and support them to identify the skills and resources they need to make a change.
  2. Avoid giving advice or telling people what to do. Just giving advice assumes that people do not already know what you are telling them about the importance of health lifestyle behaviours. This can feel patronising and be disempowering if the individual does not feel capable of changing.
  3. Listen and embrace silence. People need time to think, so once you have asked a question, do not rush to fill any silence. Instead, give the person space to formulate their answer, and see silence as thinking. Simply allowing someone the opportunity to speak their mind can be hugely beneficial. It might be the first time they have been listened to in a while, which can feel supportive and empowering. Listening shows that you value their views, and you will learn lots about them, which can help you to help them.
  4. Support SMARTER goal-setting (Specific, Measurable, Actionable, Realistic, Timed, Evaluated and Reviewed). People frequently set themselves goals with limited planning as to how they will achieve these. We say, “a goal without a plan is just a wish”! If you try and fail, you are likely to give up. If you try to achieve something smaller and succeed, you are likely to stick with it. After someone has identified a change they would like to make, ask them these SMARTER questions:
    • What exactly do you want to do?
    • How often or for how long do you want to do that?
    • What do you need to do to get started?
    • How confident are you that you can achieve this, e.g., on a scale of 1-10?
    • When do you want to start?
    • How will you know you have been successful?
    • What will you do if you have not reached your goal?
  5. Reflect on your conversations and how empowering these are. Taking just a few minutes to look back on how we interact with people, what works and what does not, is a valuable use of time. It helps identify what we do well and where we could improve, and ensures that we are giving our best every day. Ask yourself these questions:
    • How well did I support that person to identify a solution to their issue?
    • What could I have done differently?
    • What will I do next time?





  1. オープンディスカバリーの質問をします。質問は「何を」または「どのように」で始まり、相手に自分の問題、障壁、解決策、および変化の最初のステップについて考えてもらいます。たとえば、「何を変えますか?その変更を行う上で何が邪魔になっていますか?どうすればそれを克服できますか?あなたにとって良い第一歩とは何でしょうか?」といった質問をすることで、相手のことをよりよく知ることができるだけでなく、彼らが変化を起こすためにどのようなスキルやリソースが必要かが分かるようになります。
  2. アドバイスや指示はしないでください。アドバイスをするということは、あなたが話そうとする健康的なライフスタイルの重要性をクライアントや患者がまだ知らないことを前提としています。これは、変えたいと思わない人に対しては、甘やかしになり、やる気を失わせるおそれがあります。
  3. 耳を傾け、沈黙を守ります人は考える時間を必要とします。よって一度質問をしたら、急いで沈黙を埋めようとしないでください。代わりに、その人に答えを形にするためのスペースを与え、沈黙イコール思考と考えてください。心の内を語ってもらう機会を与えるだけでも非常に有意義です。じっくりと話を聞いてもらったことは今までなかったかもしれませんが、こうした時間を通して自分は支えてもらっている、自分はできると感じることができます。聞くことはあなたが相手の考えを尊重していますよと伝えることであり、相手のことをよく知ることで彼らを助けるあなたを助けることができます。
  4. SMARTER目標設定Specific:具体的、Measurable: 測定可能、Actionable: 実行可能Realistic: 現実的、Timed: 時間指定、Evaluated: 評価、Reviewed: レビュー)をサポートします。我々は目標設定をする際にどのように達成するかについて十分な計画を立てていないことがよくあります。 「計画のない目標は単なる願望です」と私たちは言っています!挑戦し失敗したらあきらめてしまうおそれがあります。もっと小さな目標を設定し達成出来たら、努力を継続しやすくなります。変えたいことを定めたら、SMARTERな質問をしてみましょう。
    • 正確には何をしたいのですか?
    • どのくらいの頻度で、またはどのくらいの期間、それを行いたいですか?
    • 始めるために必要なことは何ですか?
    • 達成できる自信は、1〜10のスケールでどのくらいですか。
    • いつ始めたいですか?
    • 達成したことをどうやって知ることができますか?
    • 目標を達成できなかったらどうしますか?
  5. あなたの会話を振り返り、どれほど励ませてたか評価してください。誰かと言葉を交わしたら、ほんの数分でいいのでうまくいったこと、いかなかったことを振り返ってください。短時間でもとても重要な経験となります。自分の得意なことや改善点を明確にしたり、日々最善を尽くしていることに気づかせてくれます。自分に次のような質問をしてみてください。
    • クライアントや患者が問題の解決策を探すのをどのくらいサポートできただろうか?
    • 別の方法で何かできなかっただろうか?
    • 次回は何をしよう?

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