| I – Preparation |
Self-determination theory [27,37] |
Clinicians change mindset to address three fundamental patient motivational needs: competence, autonomy and relatedness. Clinicians prepare to shift from a hierarchical to an egalitarian, collaborative interaction. Prepare to structure interactions in ways that optimize satisfaction of person's motivational needs. |
A focus on personal autonomy and self-direction to satisfy needs and enhance effective behavioural change. Emphasizes that the individual, not the clinician, is the autonomous agent of change. |
| II – Relationship building |
Empowerment-based communication [10,11,19] |
Focus on person's values to explore areas for self-identified change. Examine their thoughts, meanings and feelings, leading to a five-step behavioural change protocol: explore the problem, clarify feelings and meanings, develop a plan, commit to action and evaluate results. |
Strategies to help a person self-identify areas for change through clarifying values and exploring feelings and motivations. |
|
Motivational interviewing (MI) [34,38] |
A clinician-directed approach to drive a person's ambivalence toward the direction of change by exploring and resolving ambivalence for and against taking action. A seven-step system of questioning called DARN-CAT can be used (desire to change, ability to change, reasons to change, need to change, commitment to change, activation to change, steps toward change). |
Clinicians drive change by fostering ambivalence: identify factors that foster change vs. factors that foster maintaining the status quo. Roll with resistance and initiate ‘change talk’ to tilt the ambivalence toward change. |
|
AASAP [39] |
Collaborate with the person to label and normalize underlying affect, and show how their feelings drive their actions. |
Clinicians identify and label affect to help people understand how their feelings and emotions drive their management behaviour. |
|
Common-sense self-regulatory model [40] |
Clinicians help individuals examine their personal beliefs and subsequent emotional responses to illness, especially those beliefs related to disease control, the identity of the condition itself, the anticipated consequences, and the cause of the disease. |
A focus on basic beliefs and cognitive perceptions about disease and its management. How people think about disease impacts how they manage it. |
| III-Behavior change tools |
Cognitive-behavioral tools [41, 42] |
A broad range of tools based on cognitive-behavioral theory, including highly structured action plans, goal setting, shared decision-making, education, obstacle identification, and a variety of decision aids. Little if any emphasis on motivation, or support for autonomy. |
Emphasis on actions regarding specific types of defined behaviour change using highly structured cognitive/behavioural methods. |
|
Mindfulness [43,44] |
Training to enhance the acceptance and non-judgemental awareness of experience in the present moment to identify internal stressors and states of being that block behaviour change, increase rumination and stimulate over-reactions to disease events. |
Training to be aware and accepting of internal emotional states to facilitate decisions around action. |
|
Diabetes Education (DAFNE, DESMOND) [45,46] |
Delivering information about diabetes and its management, most often delivered in a group setting. |
Providing information delivery. |
|
Web-based, wearable, and other electronic information storage and delivery systems [47,48] |
Personalized web-based or worn devices that generally are used to prompt or monitor disease management behaviours over time, e.g. exercise, diet, medication taking. Easily accessed and portable, sometimes linked to clinician support and contact. |
Electronic prompting, monitoring and data storage of specific behaviors. |
