Starting the Conversation (STC): Guide to Implementation, Scoring, and Counseling for Diet, Physical Activity, and Smoking

Note: these instructions relate to the version of the tools designed for implementation in practice and available on the web at: http://www.ncpreventionpartners.org/startingtheconversationtools/

Structure of STC tools:

Note the direction of the folds are important! Fold zig-zag/accordion style NOT side panels into the middle. The questions should line up next to the relevant tips.

¨ Front Panel: Stage of Change question to determine readiness to tackle behavior change

¨ First set of questions and tips: current behaviors (flip open front cover)

¨ Second set of questions and tips: barriers to change (flip open back cover)

¨ Back panel: final pep talk and referral info: options for additional local sources

Responses (üs) to the current behaviors and barriers questions

- üs in the far left column indicate target behavior

- üs in the middle column indicate need for improvement

- üs in the far right column indicate significant need for improvement

1) Assessment: patient answers the questions (Stages, current behaviors, barriers)

Ask patients to complete the questions on tools while waiting for appointment

(might ask person at check-in desk to do this)

“While you’re waiting, please fill out these quick forms. Please check the boxes with your answer to this question on the front, and then the questions next to the large numbers. There are no right or wrong answers. The more honest you are the more the doctor can help you work on healthy habits”

2) Brief Counseling

Identify Stage of Readiness to Change:

Ø Review stage of change question to get an idea of how “ready” the patient is to start making changes. If the answer is “We’re not interested in changing the ……at this time” do not proceed with counseling but, but take a minute to explain the health risks and ask if they would be interested in discussing at another visit.

Scan responses to the behavior/barrier questions and counsel accordingly:

· Point out (left column üs) where the patient is doing well – reinforce

· Identify areas in the right column (and/or middle depending on how many things are checked and which column) and point out that this is where things could be improved.

Ask patient to identify 2-3 of areas that need improvement that they would be willing to work on between now and the next visit. Check the “Tips” box for each of these items and then review the specific tips below, embellishing as you feel comfortable.

Suggest that the patient can review additional tips on their own at home.

3) Pep-talk, referral, and follow-up

Turn to back panel

- Review generic tips: Talk to your Doctor and……!

- Point out additional resources or potential referrals

- Follow-up per usual procedures

Scoring the STC tools

We have a very simple scoring system for the STC tools (the same as what we use in the longer Dietary Risk Assessment and Physical Activity Assessments that are part of the New Leaf intervention materials). Any answer in the far right column for any of the questions is scored 2, the middle column is 1 and the left column is O. Therefore the higher the score, the more atherogenic/unhealthy the diet, or more sedentary for physical activity, etc. We validated the longer DRA using this scoring system against the Keys equation (ref below) and are in the process of comparing STC scores with longer diet assessments and biomarkers. With so few questions, I think we will be lucky to see a correlation. The main purpose of the instruments is to guide counseling rather than as a measurement tool….though counselors could use a reduction in score to reinforce behavior change efforts.

Ammerman A, Haines P, DeVellis R, Strogatz D, Keyserling T, Simpson R, Siscovick D. A brief dietary assessment to guide cholesterol reduction in low income individuals: design and validation. JADA 1991;91:1385-1390.

Starting the Conversation (STC): Guide to Implementation and Counseling

(Speedy version)

1) Ask patient to answer question on front panel and questions inside

2) Check readiness to change

3) Scan columns

Ø reinforce positive behaviors

Ø identify areas that need improvement

Ø ask patient to identify 2-3 goals for next visit and check the boxes

Ø use tips to provide brief counseling on each goal

4) Turn to back panel for “Pep Talk” and referral information