Guiding and directive approaches
Communication techniques to try out
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).
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. People 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 the consultation:
It can help put a parent at ease by talking them through what to expect from the consultation. For example, how long it will last, what you will talk about, and what they can expect from the time you are together. It is useful once you’ve explained this to ask “how does that sound?”, which gives them an opportunity to raise any concerns or add anything they would like to say.
Ask open-ended questions to find out about the parent's needs:
Open-ended questions are questions that encourage parents to talk and cannot be answered with a one word or short response (questions that lead to a limited response, such as ‘yes/no/a little bit’ are called “closed questions”). Open-ended questions often start with words such as ‘how’ or ‘why’ or might use phrases such as ‘tell me about’. Open-ended questions can be used to explore families’ current lifestyles (e.g. ‘tell me about your child’s current physical activity’), motivations (e.g. ‘what are your reasons for coming here today?’) and to help them come up with ideas for chang (e.g. ‘how might you be able to help your child be more active?’). In turn this will help parents feel more autonomous and will move practitioners away from telling an individual what to do. People are more likely to make changes when they hear themselves making the arguments for change, and feel that the change is their choice.
Reflect back what the parent has told you to acknowledge their needs and demonstrate you are listening (reflective listening):
Reflective listening involves paraphrasing what an individual has said and repeating it back in your own words (e.g. Parent: ‘I’m really struggling with this right now’; Practitioner: ‘you’re finding things a bit challenging’). 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 the parent opportunity to have a choice in any areas of change (e.g. physical activity and diet):
A key component of developing autonomy is parents feeling 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 further information on 'guided goalsetting' with parents).
Ask permission to give advice or ask personal questions:
Despite your good intentions to help, parents may perceive advice negatively (or switch off) if it is delivered in a directive manner. Before jumping in with advice it can be helpful to ask permission from 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 gives them some control (autonomy) over the situation.
Provide meaningful rationale for suggestions (e.g. physical activity and diet):
People feel much more motivated to do something if they understand why it is important (rather than just being told to do it). When making suggestions to parents (e.g. about physical activity or diet), try and explain your rationale and how these suggestions will benefit their child and their family (the more personally relevant the better).
Offer meaningful and specific praise/feedback:
Making short positive statements (e.g. ‘you’ve come up with some really good ideas here’) can help individuals acknowledge their positive behaviours and strengths and help them develop confidence in their ability to change (thus enhancing feelings of competence). 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. This demonstrates you have heard what they have to say, and gives the parent chance to correct anything you may have misinterpreted.
Give the parent space to ask questions or request clarification:
It is important parents understand all aspects of the conversation and feel comfortable enough to tell you if they don’t. You can raise this at the start of the consultation (e.g. “if at any time you don’t understand something please ask”), during (e.g. “does that make sense / do you have any questions?”) and after the consultation (e.g. “are there any further questions you’d like to ask about what we’ve discussed?”).
A directive approach
It is important to minimise the use of any directive communication techniques as these can reduce the parent's feelings of autonomy, competence and relatedness. A number of directive techniques are outlined below:
Use jargon, or technical terms that the 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 from the consultation that you are conveying.
Tell the parent they 'must' (not) or 'should' (not) do something:
Telling the parents they must or should do something 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 may appear to parents that they will only see gains if they do things in a certain way, or unless they “do something”, they will see a negative consequence, e.g., ‘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’.
Activities to help develop a guiding approach
Activity - practising techniques
Activity - identifying communication strategies
As you’re watching each video, use the checklist provided and mark what techniques the practitioner is using with the parent. What effect did this have for the parent? How did you feel watching this? Note any thoughts you have in the space provided in the checklist. Watch the videos again if you need to.
Below are the links to two videos. In each video the practitioner is using a different approach to discuss a child’s weight with their parent. The first video uses a directive approach and the second video uses a guiding approach.
A guiding approach
A directive approach
Interested in what’s going on in these consultations? In the videos below Daisy discusses how components of each consultation either support or diminish the parent’s autonomy, competence and relatedness.
Activity - reflecting on your own practice
Now you have watched the different communication styles, use the checklist to reflect on your own practice. What do you do already? What could you do more of?
When can you raise a child's weight with parents?
The opportunities you have to raise child weight issues will depend on your professional role and types of contact with pre-school children and their parents. The communication strategies in this module can be incorporated within any “guiding” conversation with a parent, whether it takes place informally in a children’s centre, or in a GP’s surgery. One of the most challenging things however can be making that first step and knowing what to say to raise the child’s weight or lifestyle issue. Some specific examples are provided in the roles and responsibilities module to guide different professionals on bringing up weight in different situations.
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 difficult 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 sides 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-ended 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.
The skills in this module draw on a motivational interviewing approach. For further information about motivational interviewing, you might wish to access the following BMJ learning module.
Below is a short quiz containing questions on what you have learnt throughout this module. If it takes a number of goes to get all of the questions correct, please note down each score in your logbook in the space provided. The main purpose of this quiz is to embed learning, and provide you with the opportunity to evaluate your learning. Please remember that we are focusing on the effectiveness of this website and not auditing your practice.
Once you have all the questions correct you will be provided with a certificate of module completion.
Communicating with parents
Start the quiz
1. Why is communication important when discussing health promotion with families?
a) Because discussing a child’s weight is a very sensitive topic
b) Having a good relationship with parents can help weight-related discussions and outcomes
c) Good practitioner-parent interactions can have positive effects on health and wellbeing
d) All of the above
2. Which of these describes autonomous motivation?
a) Motivation that comes from external influences (e.g. a GP, family member)
b) Motivation that comes from environmental influences (e.g. green spaces)
c) Motivation that comes from the self (e.g. valuing the importance of what you are changing)
d) None of the above
3. If a parent feels pressure from a family member to change their child’s diet, what kind of motivation are they experiencing?
a) Controlled motivation
b) Autonomous motivation
c) Self-determined motivation
d) None of the above
4. Which of the following is not one of the three universal needs of Self-Determination Theory (SDT)
5. Which of the following environments is most likely to enhance the parent’s autonomous motivation?
a) A doctor who greets the parent by their name, asks them about their current lifestyle and praises them for the positive things they are already doing
b) A doctor who emphasises the importance of changing now (otherwise the child will suffer) and gives the parent some advice on how to change
c) A doctor who focusses first on understanding the child’s current lifestyle, then asks permission from the parent to make some suggestions
d) a & c
6. Which of the following are not part of a guiding communication approach?
a) Ask open-ended questions
b) Tell the parent what they ‘should’ do
c) Ask permission to give advice and provide meaningful rationale
d) Offer specific praise and feedback
7. What would be the most appropriate way to support a parent who is resistant to change?
a) Tell them what they need to change anyway
b) Tell them the consequences to theirs and their child’s health if they don’t change
c) Use a guiding approach to structure the conversation so that the parent voices the positives of changing for themselves
d) Use forceful ‘if, then’ language
8. Which of the following is not an “open-ended question”?
a) Talk me through your child’s typical day
b) Does your child eat a lot of chocolate?
c) How does your child feel about their weight?
d) What are your reasons for coming here today?
Thanks for taking part!