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Motivate Healthy Habits

A Mutual Aid and Self-help guidebook for you, your family and friends with learning exercises, examples and stories.
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Motivational Practice

A guidebook for lay health guides & professionals. Learn professional skills for everyday life.
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"Be the change that you wish to use in the world"


Meet the Author

I have developed a blend of learning methods (online programs, workshops, telephonic sessions, etc) for training the general public, lay health guides and health care practitioners about motivating healthy habits. I also work with organizations and their leaders to create synergistic, top-down and bottom-up approaches that promote healthy habits, both inside and outside of organizations. I look for opportunities to work outcome researchers in evaluating complex process innovations. Read on to learn more about my background and my fascination with resistant behavior.

I am a family physician (25-years in practice), process researcher, trainer (online/offline) and motivational guide. After graduating from Nottingham Medical School (1972-1977) and completing my vocational training in general practice in England, I moved to the U.S.A. in 1982 and became a Board-certified family physician. I have been a Professor of Family Medicine and Nursing at the University of Rochester, New York since 2001. I have given presentations on motivating health behavior change in over 16 countries

Beyond My Fascination with Resistant Behaviors

My fascination with resistant behaviors began early in my career, with a special interest in the secondary prevention of alcohol problems. I became curious about why people inflict harm on themselves despite the apparent absence of benefits. But this judgment represented my perceptions and values, not the patient's perspective.

Beyond Professional Judgment

To avoid being judgmental about patients, I tried to see the world through their eyes. I listened to my patients to discover the benefits of their unhealthy behaviors. In contrast to my perceptions and values, patients commonly maximized the benefits and minimized the harm of their unhealthy habits. I remain fascinated in the determinants of, and the driving forces for unhealthy behaviors, such as unconscious emotions (e.g., acting out suppressed anger in self-destructive ways) and avoidance of feelings (e.g., using alcohol to treat social anxiety).

Beyond Our Addiction to the "Disease" Care Systems

Like drug addicts, we are addicted to our disease care system for quick fixes (interventions to cure diseases) at the expense of preventing diseases in the first place. We really do not have a health care system. Our disease care system was never designed to promote health and address unhealthy habits in a population-based manner: giving slim hopes of ever reversing these behavioral epidemics.

In the "quality chasm" era of patient safety and error prevention, we have overlooked the greatest threat to patient safety: a disease-producing culture that promotes unhealthy habits. These habits develop for many cultural, community, family and individual reasons. Resistance to change at macro, meso and micro levels perpetuates these behavioral epidemics.

Behavioral resistance is a much greater problem than drug resistance. And yet, a much greater emphasis is placed on treating diseases than on promoting health, despite the fact that preventing diseases is more cost-effective than treating them. To reverse these epidemics of unhealthy habits, we need to develop a health-promoting culture that supports the development of a health care system that can work with intersectoral approaches and grassroots movement to deliver individualized interventions in a population-based manner.

Beyond Scientific Rationality

Giving information and rational advice to patients about changing unhealthy behaviors is on a par with the placebo impact of 19th-century drugs. The use of this "drug" over and over again, when it is clearly not working, could be regarded as a medical error.

To move beyond the limits of scientific rationality, practitioners need to learn how to adopt new roles and develop new skills: addressing patients' perceptions, emotions, values and their so-called " irrationality." This work moves beyond predictable, linear world of rational science and evidence-based guidelines to experience-based practice and the unpredictable, nonlinear world of human emotions. Don Schon described this shift as a move out the ivory towers of academia to the swampy lowlands of practice.

The shift from the controlled world of research to the messy, real-world practice means that practitioners cannot solely rely on scientific rationality to guide them on how they can work with patients. This shift beyond scientific rationality to experience-based practice requires reflective learning from personal experience, for both practitioners and patients.

Beyond the "Fix-it" Role

Practitioners are predominantly trained in the "fix-it" role, which is suitable for treating diseases. In addressing health behavior change, practitioners typically give information and advice, make recommendations and set goals for their patients.

For example, according to the current U.S. tobacco cessation guidelines, the 5A's model works at best with only 12.8% of patients. Any drug that worked with only that percentage of patients would be considered totally unacceptable for treating diseases. This fix-it role is ineffective for the vast majority of people.

Learn how to change from the "fix-it" to the motivational role before developing motivational skills: in other words, change yourself (professionally and personally) before helping others. This strategy will help you

  • Engage your patients more effectively in dialogues about change
  • Develop individualized interventions to meet their changing needs over time.
  • The interdisciplinary book Motivational Practice: Promoting Healthy Habits and Self-care of Chronic Diseases will help you to initiate this lifelong learning process.

Beyond Professional Resistance

Practitioners resist changing their professional role for many legitimate reasons. Without understanding and lowering their resistance, practitioners will struggle to learn how to motivate patients. The topics of resistance and motivation receive scant attention in professional education. For this and many other reasons, busy practitioners are highly unlikely to adopt a motivational role, unless the health care system develops a team approach for implementing behavior change and disease management programs.

Beyond Mechanistic Metaphors

When practitioners have been trained only to use hammers (give information and advice), we tend to treat every patient as a nail. We need to move beyond mechanistic metaphors and static programs to ecological metaphors and dynamic programs that evolve over time. Practitioners work most effectively with patients when they act as gardeners: cultivating the soil, fertilizing the ground and planting seeds. The gardener metaphor embodies the motivational role.

At micro level, behavioral innovations must become as sophisticated and individualized as the 21st century advances in the genetic treatment of diseases at the one extreme. At the macrolevel, we need to develop dynamic, ecological to reverse these behavioral epidemics.

Beyond the Healthcare System

The magnitude of behavioral epidemics far exceeds the capacity of the health care system. To address these overwhelming epidemics, we need intersectoral approaches that engage people in mutual aid and self-help approaches. This top-down approach of planting seeds in the community can work synergistically with bottom-up approaches: developing grassroots movements. To plant these seeds on fertile ground, we need to create health-promoting organizations and cultures.

Beyond the Dark Side

The dark side of marketing emotionally manipulate people's behavior, without individuals being fully aware of their influences. They mass produce disease (e.g., caused by tobacco use and obesity) and direct consumer-driven health care into high-profit centers of no or marginal benefit.

According to Paul Zane Pilzer, the wellness revolution is expected to become the next trillion dollar business (www.thewellnessrevolution.com). This revolution will bring out the good, the bad and the ugly. But high-integrity marketing can be used for social good with high impact: bringing light to the dark side.

Blending marketing and academia is like mixing vinegar and oil. With too much vinegar (all hype and no substance), the process is distasteful to academics. With too much oil (all substance, no hype), the process is unpalatable for the general public. But in the right proportions, they can work effectively together.

Dr. Rick Botelho,
MHH Publications
85 Eastland Ave.,
Rochester, NY 14618

ph: 585-442-6114


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