Public Health in Practice

Brief Interventions
 Introduction

 More than 50% of premature deaths in western

countries are attributable to lifestyle

 Nurses have a key role in minimising the impact of

illness, promoting health and function (capabilities),
and helping people maintain their roles at home, at
work at leisure and in their communities (RCN, 2012)
 Brief Interventions to change
behaviour

‘Brief interventions involve giving opportunistic advice,

discussion, negotiation or encouragement in supporting
adults to make healthy lifestyle changes’

‘The effect on health and well-being of brief interventions

relating to behaviour or lifestyle habits is well known NICE
recommends that primary care workers use brief
interventions in several disease and health areas’
(Hayes, 2010)
An overview of Brief Interventions

Definitions vary:

 ‘Simple advice’ or ‘short term counselling’

 Structured conversation between patient and nurse

designed to motivate patients to change behaviour

 Discussions which support raising health consciousness

 Context

Brief Interventions are used in many areas of health

promotion

They usually take 3-30 minutes depending on the time

available and the expertise of the professional

The shortest interventions are often called ‘brief advice’

and use the three A’s
 The 3 A’s

 Ask- raise the issue

 Advise – increase awareness of risk and benefits

related to behaviour

 Assist – help the patient to identify a negotiated

SMART goal related to behaviour change and
signpost if appropriate
Brief Interventions do work…..

 Effectiveness seems to be even greater if the intervention is

delivered at a particularly ‘timely’ moment in patients lives for
example:

A patient with alcohol dependency having sutures removed from a

facial laceration sustained during a period of heavy drinking

 Timing is everything brief interventions work best when

individuals are faced with the consequences of their actions and
are more receptive to the suggestion of behaviour change
(Bridgeman et al, 2012)
 Cost effective?

 They can be opportunistic and incorporated into routine clinical work

without the need for additional costs

 Worthwhile use of a nurses time & are therefore cost effective

(Tariq et al, 2009)

 Could save health and social service providers £124.3m in England alone
during the next 30 years

(Bridgeman et al, 2012)

NICE 2014 guidance on behaviour
change

Recommends that HCP’s should select interventions that motivate and support
people to:

 Understand the consequences of their health related behaviours

 Feel positive about the benefits of health enhancing behaviours and
changing their behaviour
 Plan the changes in easy steps over time
 Recognise that their social contexts and relationships may affect their
behaviour and identify, plan for situations that might undermine the
changes they are trying to make
 Plan explicit coping strategies to prevent relapse
 Make a commitment to adopt health-enhancing behaviours, in particular
contexts over time
 Share their behaviour goals with significant others (NICE 2014)
 Why nurses?

Nurses are best placed to deliver brief interventions for a

variety of reasons:

 They often have a natural rapport with patients that

doctors sometimes do not
 Patients are known to respond to nurses because they see
them as non-threatening and approachable
 Providing a brief intervention is simply an extension of this
role

(Mistral & Velleman, 1999)

 The intervention

 Starts as a normal conversation

 This conversation develops and the patient engages with the nurse and the
discussion

 At this point the patient realises that there is a structure to the conversation and
an agenda

 At the point of realisation it is important for the nurse to re-evaluate the

engagement of the patient

 It is often at this point that full realisation dawns on the patient and the process
of intervention can truly begin
(Bridgeman et al, 2012)
Brief interventions are………….

 Recommended in NICE guidance

 Lord Darzi’s work highlighted the need to put

prevention first

 Marmot Review February 2010 has an objective ‘to

strengthen the role and impact of ill-health
prevention’
Raising health consciousness using
brief interventions

Example of key messages:

 30 minutes physical activity per day 5 times per week

 Maintain a healthy weight for your age and height
 Alcohol: 14 units per week for women and men with
at least 2 alcohol free days per week
 If you are not ready to give up smoking, try and have
a smoke free home to protect your loved ones
 The role of the nurse

 Identify cues and permission

 Provide opportunistic information
 To be enthusiastic about the benefits of change
 Respond accordingly
 Signposting/referral to appropriate services
 Top tips

 Listen for the indications that people would like

information or advice

 Listen uncritically- brief intervention is not about being

critical but recognising that people may not be ready for
change yet but the information given may be helpful in the
future

 Reframing; reflecting; clarifying – ensuring understanding

of the individuals needs and clarifying what the issues are
for them and give useful information
 top tips

 Acknowledging feelings without agreeing or disagreeing- it

is important to remain impartial to enable the individual to
open up

 Exploring – seeking suggestions to enable individuals to

find their own solution

 Acknowledging – seeking clarification of what they would

like information on
 Avoid

 Approaching people directly

 Giving detailed specialist knowledge
 Telling them what to do
 Setting goals for them
 Talking about your own personal issues
 References

Bridgeman, K., Shepard, J., Jordan, P., Jones, C. (2012) Brief Interventions for Alcohol Misuse, Nursing
Times.net

Hayes, S. (2010) Brief Interventions to Change Behaviour. Practice Nurse 2010;39(6)

Mistral, W., Velleman, R. (1999) Are Practice Nurses an underused resource for managing patients
having problems using illicit drugs? A survey of one Health Authority in England. Journal of Substance
Use; 4:2, 82-87

NICE public health guidance (2014) Behaviour change: individual approaches

nice.org.uk/ph49 Issued: January 2014

Royal College of Nursing, (2012) Going upstream: nursing's contribution to public health: prevent,
promote and protect RCN guidance for nurses London: RCN

Tariq, L. (2009) Cost effectiveness of an opportunistic screening programme and brief intervention for
excessive alcohol use in primary care. PLos; 4: 5, e5696