Lifestyle Medicine. Ifeoma Monye
questions about his diagnosisConfront the patient on his lack of progressSummarize the patient’s comments to show how negative he isThe doctor sets goals for patients to facilitate their behaviour change
47 In the precontemplation stage of health behaviour change, it is most appropriate to do which of the following?Ask the patient to identify the major obstacle to completing goal and strategy to overcome itElicit the patient’s level of confidence in achieving a specific goal (1–10 with 10 being extremely confident)Ensure goals are specificGive general advice on benefits of leading a healthy lifestyle
48 Action plans are lifestyle prescriptions tailored to the individual patient. Which of these is most appropriate to consider when drawing up action plans?AbilityFamilyNeighbourhoodSocial connections
49 Lifestyle prescriptions are best based on which of the following?Current level of activityMay be adjusted as the patient’s situation changesThe patient’s readiness for changeScientific evidence
50 Which of the following is best considered in relapse prevention plans?Develop plan at the precontemplation stageFixed to ensure stabilityRechecked with the patient as life situations changeShould not be planned in anticipation of a relapse
51 At which of these points is Cognitive Behavioural Therapy (CBT) most useful?At the precontemplation stage of changeThe patient is experiencing feelings of courageThe patient is feeling out of controlWhen the patient is succeeding with his goals to prevent him from getting too comfortable
52 Which of these most accurately describes relapse?Relapse is a sustained period when an action plan is not followedRelapse is easier to address before it becomes a habitRelapse is more likely to occur if an action plan is written downRelapse needs to be addressed as a continuation of the previous action plan
53 Which of these most accurately describes lapse?Lapse is a short period when an action plan was not followedLapse is more likely to occur if an action plan is written downIt can take less energy to re‐start an action plan if allowed to lapse for a long timeIt is easier to deal with a lapse by allowing some time to pass before revisiting the issue
54 Which of the following is the most appropriate to address in a relapse prevention plan?Disclosing the frequency of lapse occurrence in the populationThe patient identifying when a lapse is likely to occur and what to do thenWhat occupation predisposes the patient to lapsesWhat the patient’s neighbours frequently engage in that can cause a lapse
55 Which of these is the most appropriate self‐management strategies for lapse prevention?Digital and live exploration of triggersFrequent exposure to lapse triggersMaking use of the friends’ recommended social media sitesSupport with digital self‐help apps
56 Danny started smoking again after three months of abstinence. He now wants to quit smoking again. Which of these is the most appropriate advice for him?Create a backup plan at the time of any relapse to enable you stay on track.Encourage a significant other to help remind you of your action plan when they notice a lapseFrequent exposure to your smoking buddies to develop toleranceReach out to your care provider when you find yourself off action plan for more than a few months
57 As a care provider, your most appropriate next step in facilitating your client’s action plan is to:Emphasize the importance of a verbal action planEnsure action plans are completed based on readiness for appropriate behaviour change Keep a copy of the action plan in the medical archivesReview action plans every year
58 Which one of these is best avoided by the coach during follow‐up visits?Confront the patient’s lack of progressCongratulate the patient on the progress madeDiscuss barriers and develop solutionsDiscuss the progress made by the patient
59 Which of the following is best avoided during follow‐up?Failures should be discussed firstHave a patient’s action plan in front of youReflect back what the patient has reported to show an understandingSuccesses should be discussed first
60 Lifestyle prescriptions are best described by which of the following?Evidence‐basedSpecific to the patient’s peculiar health issueTailored to the patient’s abilitiesThe same as action plans
61 What is the next best step using motivational interviewing techniques in a patient who wants his chest to get better but does not want to stop smoking?The interviewer needs to discuss an action plan with the patientThe interviewer should develop discrepancy between where the patient is and what he wantsThe interviewer should withhold empathy to demonstrate the seriousness of the issueThe patient’s resistance is a cue to the interviewer to insist on a quit attempt
62 Which of the following statements most appropriately describes cognitive behavioural techniques?It assists with deeper understanding of underlying challengesIt is the counsellor’s job to generate the solutions as the expertPatient ambivalence is accepted as a natural part of change processPatient resistance is decreased using non‐confrontational methods
Answers
1 A In the Action stage of behaviour change, the person has been making a change in the last six months (Hashemzadeh et al. 2019; Selçuk‐Tosun and Zinci, 2019).
2 C Governmental policies do not play a key role in the Health Belief Model. The model explains that before one will seek preventative measures, he must first believe there is a threat to his health and a preventative measure that is accessible and low risk that will enable him to avoid the health threat (Stokols and Zmuidzinas 2000; LaMorte 2018; Sheppard and Thomas 2020).
3 B Intrapersonal factors like one’s knowledge, attitudes, beliefs, and personality influence their health behaviour in addition to other influences like interpersonal factors, community factors, and public policies (LaMorte 2018; Beauchamp et al. 2019).
4 B Any change being contemplated within six months is at the contemplation stage (Hashemzadeh et al. 2019; Selçuk‐Tosun and Zincir 2019).
5 A For a person at the precontemplation stage, you can only discuss the health benefits of a healthy lifestyle in general terms (Hashemzadeh et al. 2019; Selçuk‐Tosun and Zincir 2019).
6 C The person at the action stage has been making a change within the past six months (Hashemzadeh et al. 2019; Selçuk‐Tosun and Zincir 2019).
7 C Making available a readiness assessment for patients to complete in advance in the waiting room, documenting behaviour change plan in every patient’s health records at each visit and reviewing the patient’s completed readiness assessment form to prioritize lifestyle areas which the patient is most ready to address are tips a clinician could use to facilitate health behaviour change (Kelly and Shull 2019, p. 41; Tips Box 2.1).TIPS BOX 2.1 Factors Influencing Health BehaviourA person’s health behaviour is influenced by:Intrapersonal factors such as his knowledge, attitude, beliefs, and personalityInterpersonal factors such as influence of peers, health providers, friends, and familyInstitutional factors such as the community norms and public policiesSource: Kelly and Shull (2019).
8 B Social Learning theory explains ‘reciprocal determinism’ in which the patient, the behaviour, and the environment all influence each other (Chen et al. 2015; Beauchamp et al. 2019).
9 B Self‐efficacy as well as motivation, beliefs about risks and benefits of change and Social Norms are things key behaviour theories have in common (Kelly and Shull 2019, p. 40).
10 B Positive psychology, Motivational Interviewing, and Cognitive Behaviour Techniques are useful skills in facilitating the behaviour change process. Motivational Interviewing is most helpful at the early stages of change (Miller and Rollnick 2012; Soderlund 2018).
11 A In the precontemplation stage, the patient is not thinking about making a change at all now or within the next six months (Hashemzadeh et al. 2019; Selçuk‐Tosun and Zincir 2019).
12 B Stage‐matched interventions must be appropriate to the person’s readiness to change to encourage adherence (Crespo et al. 2019; Hashemzadeh et al. 2019; Selçuk‐Tosun and Zincir 2019; Tips Box 2.2).
13 D