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Table 4 Description of conversational practices used

From: Communication practices for delivering health behaviour change conversations in primary care: a systematic review and thematic synthesis

Type of HBCT Description of HBCT Patient response Recommend strategy
Conversational strategies used for initiating health behaviour change talk
 1. Direct questions Health behaviours are raised as a direct question, targeting a specific health behaviour, such as ‘do you smoke?’ Undesirability of health behaviour may be acknowledged ?
 2. Linking to a medically relevant concern Health behaviours are linked with an associated, medically relevant, concern Varying efficacy. Potential for strong resistance X
 3. Patient initiated discussions Health behaviour change discussions are initiated by a patient Receptive to subsequent health behaviour change talk
Conversational strategies used during health behaviour change talk
 1. Generalised HBCT Not tailored to specific patients’ concerns or conditions. HBCT is framed as relevant for ‘patients in general’. Avoids potential for resistance but does not implicate patients to engage in future action. ?
 2. Personalised HBCT HBCT was tailored to individual patient, and often involved patients in decision making and elicited their views Facilitates patient engagement. Can be perceived as intrusive. Potential to implicate patient action.  
  a. Collaborative HBCT Inviting and accommodating a patient’s perspective and presenting decisions as the patient’s choice Displays of uptake
  b. Goal setting and assessment HBC goals are set and reviewed Potential for resistance if biomedical outcomes, rather than changed behaviours, are prioritised.
 3. Managing resistance to behaviour change talk Addressing or avoiding patient resistance displays. Patient response depends on strategy used (below)  
  a. Pursuing health behaviour change talk Continuing with HBCT despite patient resistance displays. Patient response depends on strategy used. ?
  b. Initiating a change in topic Clinicians avoid addressing displayed resistance, and change the topic Unlikely to result in further resistance
Conversational strategies used for closing health behaviour change talk
 1. Non-specific Advice HBCT is vague, non-personalised, and lacks a next action step No overt resistance, but no evidence for effectiveness in facilitating behaviour change X