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A guiding and directive approach

A guiding approaching

Communication techniques

Below are some ideas for how practitioners can use a guiding approach (and support parents’ autonomy, competence and relatedness). Most importantly, this approach is about getting to know the parent and family (i.e. their lifestyle, preferences, constraints), coming from their perspective (i.e. what does it feel like to be them?) and helping them set appropriate goals that fit within their lifestyle (i.e. tailoring support to the individual).  It is also about learning what is going on in their lives that may interfere with their plans to change (and how you can work together to try to overcome these barriers).

After reading each technique, ask yourself how much you currently use this and how you might implement it into your practice. For some practitioners these techniques will come naturally, or you may be practicing in this way already.  If this is you, the following section may simply affirm what you are doing and provide you with confidence in your approach. For other practitioners, these techniques may be new and may appear a daunting task. If this is you, be reassured by the fact that many people feel this way.  We think communication should be easy but in fact can be very challenging. Rather than trying to implement these techniques all at once, perhaps pick one or two to try out first. Then once you are comfortable with them, come back to the module and move onto some more techniques. 

Talk the parent through consultation:

Talking the parents through the consultation involves explaining things like what will happen in the consultation e.g. we are going to start by talking about X, and then we will talk about; clearly talking through any resources you may hand out e.g. infographics, growth charts. 

Asking open questions:

Open-ended questions are questions that cannot be answered with limited responses (i.e. ‘yes’, ‘no’, ‘tomorrow’, ‘five’). Open-ended questions can help individuals investigate and explore their own thinking, and helps to move practitioners away from telling an individual what to do. Open-ended questions encourage parents to have a say in conversation and do most of the talking, allowing them to come up with their own goals or answers, thus helping them feel more autonomous. People are more likely to make changes when they hear themselves making the arguments for change, and feel that the change is their choice. 

Reflective listening:

Reflective listening involves paraphrasing what an individual has said and repeating it back in your own words. This conveys that you have heard what they said and makes sure that you heard what you think you heard. This can be particularly useful if someone is upset or angry.

Offer choice:

A key component of developing autonomy is parents feeling that they have a choice in what they’re doing. This can be done by asking them if they are happy to discuss their child’s weight, or their lifestyle. Then going on to ask them to come up with ideas for changing their child’s diet or physical activity. If they are looking for guidance from you (which parents often are), you could offer ‘guided choice’, which involves providing parents with some appropriate options and asking them to choose amongst those options (see module on behaviour change techniques for techniques for involving parents in goal setting).

Ask permission to give advice or personal questions:

we all want to help the parents we are working with, but before jumping in with advice it is important that you ask the parent e.g. ‘is it okay if we go through X’ or ‘could I make some suggestions’. This feels less like you are telling the parent what to do and makes they feel that they have some control (autonomy) over the situation. It is also important to do this when asking questions about personal or sensitive information. 

Provide meaningful rationale for activities and lifestyle changes:

People feel much more motivated to do something if they understand why it is important (rather than just being told to do it). It is important that whenever you are making suggestions to parents about their lifestyle changes you explain how this will benefit their child and their family (the more personally relevant the explanation the better).

Offer specific praise and feedback:

Make short positive statements (e.g. ‘you’ve come up with some really good ideas here’) to help individuals acknowledge their positive behaviours and strengths, helping them develop confidence in their ability to change (thus enhancing the need for competence). Through highlighting someone’s positive steps you can both acknowledge the difficulties they face whilst supporting their strengths. This can convey respect and understanding towards the person you are working with.

Use summarising statements:

Summarising statements involve providing an overview summary of what you have discussed so far (e.g. the family’s lifestyle, preferences, any goals set).  Summaries can be useful if you “get stuck” at any point in the conversation, or at the end of the interaction to remind parents what you have talked about and what the next steps are. These demonstrate that you have heard what they have to say, and gives the participant chance to correct anything that you may have misinterpreted.

Give the parent space to ask questions or request clarification:

It is important to allow parents some time to ask any additional questions they may have or seek clarification on any of the topics you have discussed. You can do this by letting the parent know you’re happy to answer any questions, or go over anything again at any time. This is a useful technique as it helps to ensure that the parent has understood you. 

A directive approach

It is important to minimise the use of any directive communication techniques as these can reduce the persons feelings of autonomy, competence and relatedness. A number of directive techniques are outlined below:

Use jargon, or technical terms that a parent might not understand:

It is important not to use jargon or technical terms that the parent may not understand. If a parent doesn’t understand the words you are using they may feel too intimidated to ask you to clarify, and will therefore not take away the messages form the consultation that you are conveying. 

Tell the parent they 'must' or 'should' do something:

Telling parents what they need to do to change reduces their feeling of autonomy and subsequently their likelihood of making changes. The things you might think the parent needs to change most may not be their priority or feasible within their current means or lifestyle. 

Use forceful 'if, then' language:

If a practitioner uses forceful “if, then” language during a consultation this appear to parents that they will only see gains if they do things in a certain way, or unless “do something”, they will see a negative consequence, for example, ‘you’re going to have to work if you want to see improvements’, ‘if you don’t do something about this your child’s weight will continue to increase’. 

Activity – complete the worksheet attached for examples of when and how to use the techniques outlined above.

Below are the links to two videos. In these videos the ‘practitioner’ is using a different approach to discuss a child’s weight with their parent. One uses a directive approach and one uses a guiding approach. 

Activity - While watching the videos use the checklist provided, mark what techniques the practitioner used during their consultation with the parent. What effect did this have, how did this make you feel. Note any thoughts you have in the space provided in the checklist. Watch the videos again if you need to.


A guiding approach

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A directive approach

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Think about
  • How much did the practitioner learn about the parent in each of the consultations?
  • Did you notice any differences in how the parent responses between the two consultations?

For further explanation of the consultation, watch the videos below where Daisy will discuss how the consultations can affect the parent’s autonomy, competence and relatedness.

Activity - Reflect on your own practice, use the checklist as comparison, what do you do already? What could you do more of?

When can you raise a child's weight with family?

Example situations:

GP: If a child is bought in to see you for a health problem that may be exacerbated by their weight

Health visitor: at a health visitor drop in clinic

Nursery nurse: at a 2 year check you notice sugary snacks around the house, or are concerned about the child’s weight

Practice nurse: during pre-school vaccinations

Children’s centre staff: if you see a child having unhealthy snacks

Dealing with resistance

Resistance may come across as:

  • If a parent is resistant to change they may present repeated barriers/obstacles as to why they are unable to change

If someone is resistant to change it is important not to jump in and try and tell them what to do. This can be hard because often you can see how changing will be beneficial for the parent and their child. Doing this can sometimes backfire and often people are unable to see both side of the argument, or perceive too many barriers to change. Lecturing them about change could risk sending them in the opposite direction. By using the techniques outlined above (a guiding approach) you will be able to structure the conversation in a way that encourages the parent to voice the positives of changing themselves (e.g. through open questions, reflective listening and asking permission). When people hear themselves making these arguments and discussing the positives of change they are more likely to carry out these behaviours.