[GRAPHIC: Brief intervention]
PRESENTER [Piece to camera] So, Step 1 on the Physical Activity Pathway
is Assessment.
Step 2 is Brief Advice and Step 3 is Brief Intervention.
[GRAPHIC: Brief Intervention]
PRESENTER [Piece to camera] A Brief Intervention aims to motivate and
support a patient to become more physically active.
It takes a bit longer than Brief Advice, allowing you to explore in more detail your patient's
own particular needs, preferences and circumstances.
As with Brief Advice, it can be helpful to have a simple structure in your head.
[GRAPHC:  Highlighting benefits
 Exploring barriers  Identifying solutions]
PRESENTER [Piece to camera] This could follow the same lines of highlighting
the benefits, exploring barriers and identifying solutions.
It's important to remain supportive and positive throughout the conversation, it might be the
first time the patient has discussed their physical activity with a healthcare professional.
This way they will relax and feel more confident about embracing change.
Remember Susan, who we saw being assessed by her Endocryne Consultant?
She is now with Sally, the Clinic Dietician for a Brief Intervention.
[DRAMA SCENARIO]
DIETICIAN: So Susan, I know you have already met with
Dr Green today, did she mention why she was asking you to come and have a chat with me?
SUSAN: Well, I've been told recently that I have
diabetes, and she said it might have something to do with not being active, but I didn't
think that had anything to do with it!
Of course I'm quite happy to come and chat to you about it if that helps, but it's all
a bit confusing right now, I mean, I've got these new tablets to take and everything.
DIETICIAN: I can hear you're a bit overwhelmed, which
is totally understandable and I am glad that we have the opportunity today to talk about
some of the recommendations for physical activity around diabetes.
SUSAN: I always thought it had more to do with your
diet?
DIETICIAN: Well diet is one of the things that's linked
to type 2 diabetes, as well as genetics, but the one thing that we do know is that low
physical activity levels can double the risk of being diagnosed with type 2 diabetes.
I don't know Susan, do you have any idea of the current physical activity recommendation?
SUSAN: I think the doctor said a 2 hours or was it
2 and a half?
I just know that I'm a long way off that.
DIETICIAN: And how does that make you feel?
SUSAN: Well, I knew I probably could be doing a bit
more, but to be honest I never really gave it much thought up until today...I certainly
had no idea it would have anything to do with me getting diabetes.
I'm also feeling a bit guilty I guess, my family are worried about me having to come
up to the hospital, so I just hope I haven't left it too late.
DIETICIAN: Absolutely not, a lot of our new patients
aren't aware of the links between diabetes and physical activity Susan, so you are not
alone with that one.
Hopefully if we can highlight the importance of physical activity for managing your diabetes,
it will enable you to take charge in managing your own condition a bit more.
SUSAN: I want to do whatever I can, all I am really
doing at the minute is taking these blooming tablets, so anything I can do would be great
DIETICIAN: Yes, from what you've been saying it sounds
like your finding it quite difficult being on the new tablets.
But one of the things we do know if we can encourage you to be a bit more physically
active, it may be that we are able to reduce your medications or even stop them.
SUSAN: Oh, that would be great.
I really don't like taking these.
Makes me feel like an old woman.
DIETICIAN: So that's one reason you've come up with already
as why doing more is a good option.
Are there any other benefits you can think of for being more physically active?
SUSAN: Well I know it helps the heart, but that's
about it.
DIETICIAN: You're right Susan, that it's really important
for patients with diabetes to keep their heart healthy.
It's also important to reduce some of your other risk factors, such as high blood pressure
and high cholesterol.
And the great thing is getting more physically active can tackle all of these things at once.
SUSAN: That's good to know.
I've always been worried about that, because my mum had angina.
Had I known that before I might never have given up my tennis.
I used to love playing that, but it's 20 years ago since I've done it.
DIETICIAN: So it sounds like you used enjoy doing though.
Can you remember what it felt like when you were more active?
SUSAN: It was great fun, I used to play doubles with
my husband.
He still plays with friends occasionally, but as I said it's been years since I've played
DIETICIAN: Do you remember any other good things from
when you used to play tennis?
SUSAN: Well I used to be bit trimmer, I remember
that.
Maybe if I took it up again I might lose a few pounds?
DIETICIAN: Well I sounds like we've identified some really
great reasons for you to be a bit more physically active.
We know it's going to protect your heart, It might mean we can reduce some of your medications
and the added bonus is it might make you a wee bit trimmer.
Is there anything at all Susan that you think might make it difficult for you to become
more physically active?
SUSAN: It's such a long since I have done anything,
I wouldn't feel confident of taking up something new just now, I mean I've never been in a
gym in my life!!
DIETICIAN: Well I can assure you that becoming more physically
active definitely doesn't mean you have to go to the gym.
It's basically about just trying to do a little bit more and try to spend less time sitting
down.
You've already shown some really good motivation for becoming more active.
Can you think of any other ways that you could do this?
You mentioned earlier that your family were worried about you having diabetes, is there
anything you could do maybe with them?
SUSAN: Well my daughter usually goes to the park
on Saturday or Sunday with my wee grandson, she takes their dog too and goes for a bit
of a walk.
I went with her once or twice and really good afternoon.
But I don't suppose that wouldn't count, would it?
DIETICIAN: Of course it would.
Doing something you enjoy is a fantastic way to start becoming more physically active.
If it's something you enjoy you're much more likely to keep it up.
Also spending more time with your grandchild can't be a bad thing, can it?
SUSAN: No, he's just turned 3 so he's a real tear
away, keeping up with him alone would keep me fit!
DIETICIAN: Fantastic, well it sounds like we've identified
a few ways of you starting to become more physically active.
Is there anything else you can think of?
SUSAN: Hmmm, nothing really springs to mind.
DIETICIAN: I remember you told me you used to enjoy playing
tennis.
Is that something you feel you could maybe get back to?
SUSAN: Well, that was years ago, like I say, I haven't
picked up a racquet in about 20 years!
I did love it though.
DIETICIAN: Well maybe after you get a wee bit more confident,
it's something that we could consider settings as a longer term goal?
SUSAN: Yes, I think it would be nice to get back
to playing tennis with my husband.
And if I told him it would be good for my diabetes I think he'd like that.
He feels a bit helpless I think.
But I don't know what else I could do though.
DIETICIAN: Don't worry, I think you've already identified
some really realistic ways to start becoming more physical active.
Remember, the recommendations for physical activity is 30 minutes 5 times a week and
I know you probably feel that you're a long way off at this stage, but it's really important
to just make a start, and remember doing something is always better than nothing.
SUSAN: Yeah that's good to know, because I'm still
not sure if I'll manage at first, but from what you have told me I really want to try.
DIETICIAN: Changing habits can take time so please don't
feel disheartened if you have the odd setback.
The most important thing to do is just remember some of the points we've covered today and
we can cover further issues when I see you again in 3 months time.
But there are some other ways to get support in the meantime.
I've got an information booklet here which reiterates the guidelines for physical activity.
I don't know if you have any internet access at home?
SUSAN: Yes, my kids gave me a new smartphone for
Christmas so I'm getting all techy!!
I love it!
DIETICIAN: Fantastic, well there's some information that
gives you a web address in here for Active Scotland, and if you key in your postcode
and it will give you some information about activities that are taking place in the local
area.
It might even have something on tennis and walking for you.
SUSAN: Oh right.
That sounds great...
DIETICIAN: I hope you find it helpful along with some
of the other he possibilities we've discussed today.
I don't know if you'd find it helpful if we just summarised some of the points we have
been talking about.
SUSAN: Yes that would be good.
DIETICIAN: So from what you've been telling me, it sounds
like you have some really good reasons to start becoming more physically active.
You particularly mentioned in regards to taking control of your diabetes, as well as improving
your heart health.
It sounds like there are some achievable goals, which you'll be able to make in the short
term, for example starting to go for more walks in the park with your grandchild, taking
things nice and slowly to begin with.
And your longer term goal might be to get back playing tennis with your husband.
He might like that as well as it would involve him in your diabetes management.
SUSAN: I think so maybe by next summer I could try
and try and get some games with him.
After all I have heard I really want to do what I can to help my diabetes.
It's great to know that I can take some control of things.
I'll just try and build up slowly.
DIETICIAN: Fantastic.
That sound like a great idea and it's been really lovely getting to know you today.
I'm looking forward to catching up in about 3 months' time and maybe you can give me an
update on how things are going then.
PRESENTER [Piece to camera]: That's a really good example of a brief intervention
in practice, as you can see the impact it can have for an individual.
In just a few minutes, Susan's apprehension surrounding her recent diagnosis of diabetes
has been eased, and she now has added motivation and support to take some control of her condition.
You may have noticed how throughout this intervention the dietician applied the motivational interviewing
principles of open-ended questioning, affirmations, reflective listening, and summarising.
[GRAPHIC: Motivational Interviewing]
PRESENTER [Piece to camera]: These techniques can enhance a brief intervention,
making it even more effective.
If you haven't had this type of training yet, you can still explore the patient's individual
circumstances in your own way.
Encouraging your patient to identify how they will benefit from physical activity is an
essential way to get them on board, and understand why this is so important for their health.
[GRAPHIC: Highlight Benefits]
PRESENTER [Piece to camera]: Helping them to come up with their own solutions
to barriers they have identified is key.
[GRAPHIC: Overcome Barriers]
PRESENTER [Piece to camera]: This approach, along with setting realistic
goals, will build the confidence of your patients.
A short conversation can really make a lasting difference to a patient's health and happiness.
[END OF TRANSCRIPT]