‘Making Every Contact Count’ with Healthy Conversation Skills: supporting behaviour change and self-management in individuals with chronic musculoskeletal conditions

: (Alternative Format Thesis)

Abstract

The prevalence of individuals living with long-term musculoskeletal (MSK) conditions and pain is increasing. There are, however, known modifiable risk factors, including physical inactivity, obesity, stress, and smoking, that are associated with the onset and exacerbation of these conditions. Physiotherapists are well placed to deliver brief interventions such as ‘Making Every Contact Count’ to target modifiable risk factors, support behaviour change and enhance self-management in their routine practice with patients presenting with MSK conditions. Healthy Conversation Skills (HCS) is the main training component of the Wessex approach to Making Every Contact Count (MECC). HCS principles draw from literature focusing on self-management in chronic conditions, and Social Cognitive Theory, and its approach to training and delivery is underpinned by the Taxonomy of Behaviour Change Techniques (BCTs). Training aims to build self-efficacy in healthcare professionals for supporting behaviour change in routine practice. BCTs learned during training are then employed by healthcare professionals with the aim of building self-efficacy in patients for behaviour change. Despite its potential for promoting MSK health and wellbeing, there is currently no evidence to support the implementation of MECC HCS within services that commonly treat individuals with MSK conditions. The overarching aim of this thesis was thus to evaluate, for the first time, the Wessex model of MECC HCS for physiotherapists and patients with MSK conditions and pain.

I conducted a scoping review to firstly map and synthesise the available evidence for both MECC and HCS, addressing the impact and perceived acceptability of these interventions for staff delivering and patients/ service users receiving them. It was found that, for staff across health and social care professions, HCS training had a positive impact on competence and confidence in supporting behaviour change in practice. Benefits for patients and service users following exposure to HCS were additionally highlighted, including them feeling empowered to take control of and change their health behaviours. High acceptability of HCS was reported for both staff and patients/service users across studies. The findings of this scoping review highlighting HCS as a promising and consistent approach to MECC, and the gap in the literature for evaluating MECC HCS within physiotherapy care for patients with MSK conditions and pain informed the remaining chapters of this thesis. I conducted i) a sequential explanatory study exploring the use and perceptions of MECC HCS for physiotherapists already trained in and delivering the brief intervention with patients, ii) a before and after study exploring the impact of MECC HCS training on the perceptions and practice of physiotherapists who had not previously been trained in the brief intervention, and iii) an exploratory, qualitative study assessing the acceptability of MECC HCS from the perspective of patients with chronic MSK conditions and pain, and the mechanisms through which this brief intervention could facilitate behaviour change in these patients.

Collectively, my findings suggest that MECC HCS is highly acceptable to both physiotherapists and patients with MSK conditions and pain. Physiotherapists feel that this brief intervention improves their practice and facilitates a holistic, person-centred approach to supporting behaviour change that promotes prevention and self-management in patients. Moreover, training in MECC HCS increases both their competence and confidence in supporting behaviour change in a way that is relevant to the context and agenda of their patients, thus, making behaviour change more likely. Findings from patients with MSK conditions suggest that delivery of MECC HCS within their physiotherapy care can empower them to identify and take steps to productive behaviour change, increase their motivation and self-efficacy to self-manage, and address other psychosocial factors associated with chronification of musculoskeletal pain, including fear avoidance and mental wellbeing.

The findings of this thesis and conclusions drawn have important implications for future research and clinical practice. Further roll out of MECC HCS, for example, might provide an important opportunity to upskill physiotherapists in supporting behaviour change and self-management in patients with MSK conditions, aligning with the agenda of the Office for Health Improvement and Disparities (previously Public Health England) for improving MSK health and reducing associated health inequalities. System-level, organisational barriers to engaging in MECC HCS must, however, be addressed to enhance future implementation of this brief intervention within physiotherapy services and increase its sustainability. Increasing patient access to support groups following physiotherapy treatment must also be considered, in order to facilitate long-term behaviour change and self-management in individuals with MSK conditions and pain.

Date of Award	29 Mar 2023
Original language	English
Awarding Institution	University of Bath
Supervisor	David Wainwright (Supervisor), Nicholas Townsend (Supervisor), Elaine Wainwright (Supervisor), Em Rahman (Supervisor) & Wendy Lawrence (Supervisor)