Listed below are practical ways to improve participation in education sessions using the principles of behaviour change.

• Advise participants not to attempt too many changes at once – as this can decrease confidence and lead to inaction and non-adherence
• Create ‘menus of options’, i.e., a smorgasbord of ideas for action in each treatment and lifestyle area
• Whiteboard the things that the participants think would be beneficial to work on and what they are already doing. A different set of tasks or actions may be relevant to each participant
• Incorporate education about health behaviour change into education content. Highlight the principles of successful health behaviour change that participants can apply to their own lifestyle
• Before leaving the end of the meeting, ask participants to write down the things they intend to do before the next session. Consider formally setting goals and creating action plans or perhaps simply have a group discussion about the types of things participants intend to do as a consequence of attending
• At the next education session, discuss as a group or in pairs how participants went got on with their task lists and action plans
• When providing patients with exercise plans, check that each person is willing to do the required exercises (importance) and believes they will be able to do them regularly (confidence)
• Before the end of the program, discuss strategies to maintain the skills and behaviours learned throughout the program

For tips on delivering the health education component of group education see Tips for delivery of education topics in a group

Recruitment to groups (see columns 1 and 2 in the table below)

Sometimes, situational barriers prevent people from attending programs, such as prior commitments or lack of transport. However, often there are avoidable factors that result in a patient choosing not to attend because of low motivation. Common patterns of thinking, which become barriers, include:

• Denial of the seriousness of cardiac disease – ‘My heart isn’t that bad; I don’t need to come’
• Not seeing how the program will benefit them –‘I wouldn’t enjoy talking to/exercising with a bunch of other patients’, ‘Turning up to that program won’t help me’
• A negative expectation of the program – ‘They will make me do some really hard exercise’

Retention of participants (see column 3 in the table below)

If participants are not staying in the program, it could mean they do not perceive any benefits of attending, or that the program itself is not enjoyable. Clinicians can gain feedback about the participants’ experience to identify any factors affecting the drop off rate. It may be useful to contact participants who drop out of programs to find out why they have done so.

Evaluation and sustainability of outcomes (see column 4 in the table below)

Clinicians commonly find that participants do not continue to engage in the relevant behaviours or skills once the program has finished. This could reflect a lack of emphasis on supporting self-regulation and maintenance after completion of the program. Clinicians should ensure that participants have the skills to continue with what they have learned after the program. Some clinicians invite participants in the final session to create a ‘survival kit’ containing individualised tips for them to get back on track if their new lifestyle and treatment habits taper off at any stage.

Table 1: Questions to consider asking to help improve participant involvement

©2012 HCA. Reproduced with permission from Health Change Australia (from training materials)