Document Detail


When smokers are resistant to change: experimental analysis of the effect of patient resistance on practitioner behaviour.
MedLine Citation:
PMID:  16042648     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
AIMS: In the field of motivational interviewing, practitioner confrontational behaviour has been associated with lower levels of patient behaviour change. We set out to explore whether resistance to change among smokers affects practitioner confrontational and other behaviours. DESIGN: Experimental manipulation of levels of patient resistance in a role play. SETTING: The study was conducted at the start of a 2-day health behaviour change workshop. PARTICIPANTS: Thirty-two practitioners who had registered for the workshop. INTERVENTION: The practitioners were assigned randomly to interview a standardized patient (actor) who portrayed a smoker who had been briefed to display either high or low levels of resistance to change. MEASUREMENTS: Interviews were audiotaped and transcribed. Practitioners and standardized patients completed interview ratings at the end of each interview. After listening to each taped interview practitioners were assigned a global score for confrontation, empathy and expert instructional style. Interviews were then submitted to a qualitative analysis. FINDINGS: Higher levels of practitioner confrontational behaviour were observed in the high resistance group. This was evident both from the global scores (median 2 versus 0, P = 0.001) and the qualitative analysis. Global scores for empathy and expert instruction were not significantly different. Qualitative analysis also suggests a pervasive negative impact on other practitioner behaviours. CONCLUSIONS: Higher patient resistance probably leads to an increase in confrontational and other negative behaviours in health professionals attempting to promote behaviour change. This challenges important assumptions about the influence of practitioner behaviour on patient behaviour and subsequent health-related outcomes.
Authors:
Nick Francis; Stephen Rollnick; Jim McCambridge; Chris Butler; Claire Lane; Kerenza Hood
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  Addiction (Abingdon, England)     Volume:  100     ISSN:  0965-2140     ISO Abbreviation:  Addiction     Publication Date:  2005 Aug 
Date Detail:
Created Date:  2005-07-26     Completed Date:  2005-12-13     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  9304118     Medline TA:  Addiction     Country:  England    
Other Details:
Languages:  eng     Pagination:  1175-82     Citation Subset:  IM    
Affiliation:
Department of General Practice, Cardiff University, Cardiff, UK. francisna@cardiff.ac.uk
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MeSH Terms
Descriptor/Qualifier:
Adult
Clinical Competence / standards*
Communication*
Female
Health Behavior
Humans
Interviews as Topic
Male
Middle Aged
Physician-Patient Relations*
Smoking / prevention & control*,  psychology
Smoking Cessation / psychology*
Comments/Corrections
Comment In:
Addiction. 2006 Jul;101(7):1057   [PMID:  16771899 ]
Addiction. 2006 Jan;101(1):137; author reply 137-8   [PMID:  16393201 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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