Behaviour Change Supports to Promote Self-Management in Chronic Disease:
Just How Important Are They?

Michael Vallis, PhD R Psych Associate Professor, Dalhousie University Halifax, Canada

I am a Psychologist, so I will put a psychological lens on this not rhetorical question. We all know the basics of personality. Personality is a set of behavioural, cognitive and interpersonal traits that persist over time and across situations. In other words, personality is stable. How is this relevant to outcomes for those living with chronic diseases? Well, think about the person who dislikes exercise, who is impulsive and lives in the moment, or who is a self-described chocoholic? This person is likely to develop a chronic disease. This person is unlikely to “discover” the value of health behaviours (daily exercise, meal planning and minimizing sweets) on their own. Those who are disinclined toward healthy behaviours because it is their longstanding pattern often do not develop the motivation to change until something bad happens (such as a medical event). Self-management is core to positive outcomes and people who aren’t naturally inclined toward healthy self-management can benefit from a behaviour change support relationship with a healthcare provider. Behaviour change support has the potential to speed up the process of change (no more “waiting to hit rock bottom” to change). I think this is a shared responsibility (at least possibility) for all healthcare providers. Training is necessary to promote the development of competency in behaviour change support counselling. T4H is explicitly developed to provide this training.

If I may make one other point, it is the following. We know that individuals living with chronic diseases have contact with multiple providers. They visit general practice physicians, specialist physicians, nurses, pharmacists, dietitians, physiotherapists, occupational therapists, social workers, psychologists, and more. Currently, there is no standardized language for communicating about chronic disease management. Individuals with chronic disease routinely experience profound confusion because of the different messages sent by these different providers for their same condition (the patient and condition do not change but the provider and the message received does). T4H and similar initiatives provide a common language for how to manage behaviour change issues. A framework that helps the person address health literacy (understanding), motivation, behaviour change and sociocultural adjustment by receiving a coherent conceptualization has huge potential to improve care (so the messages sent correspond across providers).

I look forward to this journey toward successful integration of behaviour change counselling into chronic disease management.