Health PEI supports realistic behaviour change for Islanders living with chronic disease


This story is part of a collection featuring improvements from the Atlantic Healthcare Collaboration for Innovation and Improvement in Chronic Disease (AHC).

The Challenge

In Atlantic Canada, as well as other parts of the country, a combination of lifestyle and environmental factors are leading to an increase in chronic disease and straining healthcare systems. Sedentary behaviours, stress, poor diets, smoking and excessive alcohol consumption are fuelling growing rates of obesity, heart disease, Diabetes and high blood pressure among Canadian adults. In light of this trend, healthcare organizations are being pressed to adapt the way services are designed and delivered.

Health PEI developed a system-wide approach focused on reducing health risks by supporting self-managed care. The premise is simple: providing support to individuals and communities can improve health and reduce reliance on the healthcare system. Twelve thousand Islanders responded to a province-wide survey in 2011. One quarter of respondents reported living with at least one chronic condition for which they were rarely or never able to self-manage their care plan, or were unaware of what they had to do to manage their health after a doctor’s appointment. These results made it clear that the patient-clinician encounter was not engaging patients to proactively improve their own health. Health PEI recognized an opportunity to provide clinicians across the Island with training to better support their patients in care self management.

The Solution

Working with the Canadian Foundation for Healthcare Improvement (CFHI) through the AHC, Health PEI standardized training sessions in chronic disease self-management to train their primary healthcare workers.

Health PEI:

  • Standardized the training sessions to two day sessions, offered one month apart for clinicians in community-based care who work with patients long term.
  • Designed and implemented a half-day session for acute care providers.
  • Built in evaluation about three to six months after the training for health providers who sought to leverage their participation toward professional development.

The redeveloped “Supporting Realistic Behaviour Change” program is now a training package based on well-established theories that include:

  • Prochaska’s five stages of change (Precontemplation, Contemplation, Preparation, Action and Maintenance)
  • The Five A’s (Ask, Advise, Assess, Assist, Arrange)
  • The Five R’s (Relevance, Risks, Rewards, Roadblocks and Repetition)

Realistic behaviour change means “realistic” from the patient’s point of view. A clinician may see the goal as exercising, but the patient’s goal is being able to breathe better. Telling them to get out and walk is not going to work. Paradoxically, to change a patient’s behaviour requires changing how clinicians interact with them. To this end, Health PEI clinicians who use the approach in their practice also act as peer trainers and the organization has developed a standardized training package, including a facilitator manual and a participant manual. Health PEI is working to train staff in their work teams so they can support and mentor each other as they practice.

The Results

Supporting Realistic Behaviour Change helps guide and define the patient visit. It gets to the key health issues – identifies and names ‘the elephant in the room’ without blame. It strengthens the patient-provider relationship and builds on previous patient accomplishments.


“Clinicians are also learning about the importance of building relationships with their patients, who need to know they will be supported.”


To date, a total of 187 primary healthcare providers, more than half of whom are nurses, have completed the two-day training. The goal over the next three years is to train approximately 1,000 healthcare providers on PEI. Clinicians are shifting from giving guidelines for healthy living to encouraging patients to get involved in a discussion about their options and choices. Clinicians are also learning about the importance of building relationships with their patients, who need to know they will be supported. Health PEI is developing awareness materials that encourage patients to participate in setting their own goals and to ask their provider for support and guidance.

As a result of the training, clinicians report feeling more confident in their skills as well as changing their practice and attitudes. The training is equipping providers with greater skills and confidence to deliver self-management support to patients and their families. Results show that participants finished the training on both days with significantly greater confidence in their abilities. Participants were also able to identify tangible changes to practice, with the most commonly reported changes being:

  1. Asking more questions and doing a better job of listening
  2. Assessing a patient’s readiness to change and being non-judgmental
  3. Setting goals with patients and identifying barriers to change
  4. Using the tools provided with the training

At this stage in implementation, patient outcome measures have not yet been collected, but will be collected in the next phase – an essential follow-on to ensure the training is leading to meaningful improvements in the health and care of patients and their families.

The Spread

The Supporting Realistic Behaviour Change initiative is an excellent fit with Health PEI’s focus to support self-management of chronic conditions and person-centred care. A steering committee and working group are ensuring the initiative reaches its target of 1,000 providers, with communications activities supporting this scale-up. Evaluation continues to demonstrate change in practice and outcomes.

Plans are also in place to develop a certification program for peer facilitators, a refresher course for clinicians, and a community of practice for practicing facilitators and clinicians. The cost of this initiative is being shared among all program areas, with managers at Health PEI absorbing the cost of training, including staff travel and training time, back-filling, space rental and catering, when needed. Patient awareness materials in development will help create greater awareness and support the scaling of this initiative.

TheHealth PEI team shared their results from the collaborative at the June 2015 National Health Leadership Conference (NHLC) and intends to publish their results in a peer-reviewed journal. The team also participated in the Better Health and Lower Costs for Patients with Complex Needs (Triple Aim) improvement collaborative that ended in June 2015.

Donna MacAusland
Primary Health Care Program
Development Lead
Health PEI