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Wednesday the 15th of June, 2011 at 11:07PM : Where does it fit?

Last week I wrote about the future I would choose for One of the things I wrote was that “would be filling a gap that currently exists either because of a lack time or expertise.” I thought I might explain what I meant by this.

As a health professional I know the value of motivating the patients I see to make decisions and take actions that will improve their health and wellbeing. Before they see me these “healthy” decisions and actions may not have been important to them or they may not have had the confidence to do them. The techniques that I try and use are designed to increase both of these factors: importance and confidence. These are the same techniques that we use on the website. By making a decision or action more important and helping people to be more confident that they can do it greatly increases the chances of positive change. The techniques are based on those of Motivational Interviewing and there is a growing body of evidence that they work in a range of different settings. So what’s the problem? The problem is I don’t always have the time to use them and when I do I don’t always use them well! As a GP my appointments are only ten minutes long and there’s already a lot to cover! And as a GP I have to be a jack of all trades which means I am a master of none. I try my best but to be honest sometimes it’s easier to tell someone that they “really should stop smoking” or “really should drink less” even though I know that this will probably make very little difference if change isn’t important enough or if the person sat in front of me doesn’t have enough confidence! Sometimes it will be enough to nudge them into action but usually it does the opposite and creates resistance. The other thing that often happens is that we have a conversation where I suggest what they could do and they tell me why it “wouldn’t work for them” or how they have “already tried it” and why it didn’t work! There I am making all these helpful suggestions and they just don’t play ball! This is referred to as the “righting reflex” and again is known to cause resistance not action! The problem is as a member of the caring professions my “righting reflex”, my desire to make people better is very strong. I do it all the time. I’m a doctor....It’s my default option!
So that’s where fits in. I refer patients to it for “motivation”: to build up the importance of change and confidence to take action. It fills the gap created by my lack of expertise or because of a lack of time. It adds to the “tools” I have at my disposal. What do my patients think? Well in a recent survey they said it was simple and easy to follow. They liked the idea of doing it in their own time. Did it work? Well 70% of those that used it to think about smoking ended up in our quit clinic! Whether they end up quitting cigarettes this time around is largely down to them but at least this time they haven’t fallen into the gap!

Dr David Julien

Wednesday the 16th of February, 2011 at 12:01PM : What does success look like?

I have been thinking about this question recently. This is sometimes referred to as the miracle question: “if by some miracle you woke up tomorrow and all your goals, ambitions and dreams had come true.....what would have happened?”. We use it to help us think about what we want and then how to get there. It is a key element of solution focussed therapy but has been used across a number of different settings. So when thinking about if by some miracle I woke up tomorrow and all my dreams had come true....what would have happened? Well would be available to everyone across the country. It would be filling a gap that currently exists either because of a lack time or expertise. Health care professionals would value the site and refer patients to it as a normal part of their care. It would be advertised in every GP surgery or dentist waiting room. It would be helping motivate people to make decisions that they were comfortable with that would improve their health and well being. We would have a large group of site users that would be benefitting from the simple and easy to use approach. They would have shared their journeys and stories to help others. They would be healthier and happier than before they used the site. would have expanded to cover a range of common lifestyle choices such as diet and exercise and also cover some areas that aren’t looked at anywhere else such as exercising with arthritis, living with chronic pain and preventing diabetes. We would have a wide range of journey guides and resources for people to use. We would have made a difference. It’s clear to me that we have a long way to go but at least we know what future we would choose. Of course there are no guarantees but if we make the right choices along the way we have a better chance of getting to where we want to be.
So what about you? is about discussing the way you live to get the future you choose. What future do you choose? If you’re not sure ask yourself the miracle question and see what you come up with! Once you know getting there is largely down to you but perhaps can help!

Dr David Julien

Wednesday the 9th of February, 2011 at 4:25PM

The way I live...the future I choose.

I read an article this week in the Telegraph* that made me think about the way I live and the choices I am making.

My only aunt died of breast cancer when I was in my teens. The effect was and continues to be devastating for all of our family and yet, I suspect, like many of us, it wasn’t until I hit the big 50 that I thought I needed to take better care of myself.
I used to like the occasional cigarette, still love a glass or two of red and was in denial about being pleasantly plump but reading the article made me stop and reflect about the risk factors that maybe I could control.

Note to self:
• I have more time behind me than I do ahead. I adore my family and want to be with them for as long as I can.
• There is only me that can do it but by maintaining some small healthy changes i.e. keeping a tighter rein on that red wine, never smoking again, adopting a lower fat diet and use the cross trainer as it was intended and not as a clothes horse, I may be able stick around a bit longer and with all my bits in tact!

That's the future I choose!


Mrs Debbi Forsythe

Thursday the 3rd of February, 2011 at 12:34PM

How safe is your “normal drinking”?

Over the last couple of weeks I have talked to over one hundred GPs and Practice Nurses about the health effects of alcohol. The talks were part of the educational work that we do at First Contact Clinical encouraging health professionals to be aware of the impact of “normal drinking” on the health of our society. What is normal drinking? We are all too aware of the disastrous impact of very heavy drinking. We have all seen the “alcoholics” in the park and the teenage “binge” drinkers causing problems at weekends. It is easy for us to think that alcohol related harm is not relevant to us because we drink a “normal amount”. But how safe are we? Alcohol related health problems are reaching epidemic proportions. Whilst 80% of the population enjoy a drink more than ten million people drink above the governments recommended safe drinking limits (use the site to find out what these are for you). An estimated 25% of men and 15% of woman drink alcohol in a way that is already or will be affecting their health and well being in some way. Contrary to what you might think most of this harm comes from patterns of drinking that has become accepted as "normal". Over the last decade it has got easier to drink more. The drinks are stronger, the measures bigger and the taste nicer! A unit of alcohol has never been more available or affordable. A glass of wine “whilst relaxing when the kids are in bed” is often three units. A pint of lager “at the end of a long day” is at least three units. A bottle of wine with dinner can be 12 units. A four pack watching the football on the telly is 12 units. The thing is it’s become “normal” to have a glass of wine most nights. Everyday at work is a long day and Fridays are even longer. One bottle just isn’t enough these days and football is on the telly every night. Before you know it the units have added up and your health is at risk. Or perhaps it’s already being affected. Sleep disturbance, stress, anxiety, high blood pressure, weight gain, indigestion and feeling tired all the time are all things I see a lot of as a GP. They are all more common in people who drink more than the recommended daily amounts. But when I ask, most of my patients tell me they drink “just a normal amount”!

So what can you do? At we don’t believe in telling you what to do. What we do believe in is making it easier for you to make your own mind up: discussing the way you live to get the future you choose! Use the site to find out where you are now and decide where you want to be. Register an account and we’ll help you get there!

Dr David Julien

Thursday the 20th of January, 2011 at 5:05PM

“I want to change but don’t think I can......I’m stuck!”

We hear this all the time. People are unhappy with themselves and a part of their life but don’t have the confidence to make a change. This is a common situation for smokers. National evidence has shown that most smokers want to quit. So why not? Well change is hard. Whether it’s having a go for the first time or trying again, it’s hard. The most important thing is having the confidence to start. Just before Christmas we performed a small study looking at the effect of on smoker’s motivation to change in a GP Practice. Whilst the numbers involved were very small the study did show that using the website increased the confidence of smokers to be able to quit by 40% and more than 70% of them decided to go to the stop smoking clinic after using the site. We are looking to repeat this study with more people but are very excited by the initial findings.

So will stop you smoking? NO! Only you can do that. But using the website can certainly help!

Wednesday the 12th of January, 2011 at 11:01AM

“Another year over.......and a new one just begun....”

January is often the time of year when people decide to make a change: their new year’s resolution. What is it about this time of year that triggers people to start on that difficult journey of change? I think people are more aware of time at this time of year than at any other. Time seems to slip past so quickly these days that we don’t seem to realise its passing. But the change in the year is a benchmark that we can’t ignore. As 2010 changes to 2011 we find ourselves once again at a cross roads with the opportunity to change direction. We are forced to think about things that are perhaps easier to ignore at other times. So whilst this is a great time of year to make a change what do we usually do? We set ourselves goals without much thought or perhaps much hope of success. We set off almost expecting to fail before the end of January. It’s a bit of fun, a tradition and at least we had a go! Unfortunately every time we try and fail we erode our confidence and make having another go harder. There is a price to pay for unrealistic expectations and lack of preparation.....

So what about doing things a bit differently this year? With the help of you can make the most of your annual motivation boost. Use the website to think about which change you want to make and why. Get some great ideas that other people have used. Set yourself realistic goals that you can achieve and make a plan of exactly how you will do it. Research has shown that approaching change in this way means you are much more likely to succeed. A New Year’s resolution that’s that makes a healthy change!

Thursday the 6th of January, 2011 at 4:42PM

That Makes a Healthy Change! has gone live from the 8th of December 2010. We are very excited by the new look and feel. We have kept all the best bits of the scipit website and added in some new features. Whilst the site is live we are continuing to test it. Please check out the new site and let us know what you think. All your codes and accounts have been saved and transferred over so there should be no problems for existing users. If there is, as always, let us know.

Monday the 13th of December, 2010 at 12:41PM

Name Change

SCIPit is undergoing an image change! In the next couple of weeks we will be changing the name and look of the site and adding some new features. Please keep an eye on things.

Wednesday the 29th of September, 2010 at 12:12PM

Motivational Interviewing or not?

This week I read an extremely interesting article in the British Medical Journal (BMJ) about Motivational Interviewing (MI). The lead author was Stephen Rollnick (Ph.D.) one the originators of Motivational Interviewing. Motivational Interviewing was first described by William.R.Miller (Ph.D.) in 1983 in an article in the scientific journal Behavioural Psychotherapy. It was based on his work with problem drinkers. A more detailed description of the fundamental concepts and clinical procedures was published in 1991 by Rollnick and Miller. They defined it in 1995: “Motivational interviewing is a directive, client-centered counseling style for eliciting behavior change by helping clients to explore and resolve ambivalence.”

Since that time Motivational Interviewing has been used in a wide range of settings and with a number of different behaviours. There is a growing body of evidence to support its effectiveness in eliciting change. It is not surprising that MI has been adapted and modified into a number of different techniques each designed to be used in a specific circumstance. Motivational Enhancement Therapy, Motivational Consulting, Brief Motivational interviewing and Brief Interventions to name but a few. Both Rollnick and Miller have been involved in the development of these techniques whilst being wary of diluting what they refer to the “spirit” of Motivational Interviewing.

The article reinforced my belief in the benefits of Motivational Interviewing but left me with an unanswered question: Is SCIPit Motivational Interviewing?

From the original article I followed a trail of research papers, articles and reviews. In 1994 Miller stated that MI is an “interpersonal style” not a technique or set of techniques that are applied to or “used on” people. It would be difficult for an online resource to have a “personality” and so I cannot claim that we have developed an “interpersonal style”. However in the recent BMJ article Rollnick refers to a “guiding style”: this is compared to giving instructions or advice (the directing style). They emphasise the need to work collaboratively, allow the person to make their own decisions and develop their own motivations for change. SCIPit provides information but not as instructions or advice. The information provided acts as a prompt and at each step the user’s views and thoughts are asked for. I think this is a guiding style.

The authors go on to describe a menu of different strategies” that are available to “elicit the motivation to change from the patient”. This is in keeping with the original “spirit” statement that “motivation to change is elicited from the client and not imposed from without”. The strategies described are:

Agenda Setting: presenting the client with a list of options and allowing them to pick rather than the interviewer choosing. The SCIPit homepage has this covered!

Exchange Information: the article describes the “elicit – provide –elicit” technique of sharing information and clarifying the personal implications of that information. SCIPit provides information about the risks of the chosen behaviour, the benefits of changing and some change strategies that other people have found useful. Users are able to decide if this information is relevant or interesting to them by selecting it. They are then offered the option of explaining why they have selected it – what are their personal implications. We keep our prompt lists short so that users can create their own too.

Making Decisions about Change: the article describes using a guiding style to encourage the client to set their own goals. They describe how “helpful suggestions” are often met with “yes but” statements. The “I” of SCIP stands for Ideas and that’s just what they are. Users can select those that are interesting if they wish but are encouraged to come up with their own. The “P” of SCIP stands for Plan. Armed with ideas and contact information of other helpful resources users are asked to create their own Goal and three step plan that will deliver it.

Assess importance and confidence: using simple scaling questions. SCIPit uses scaling questions and follow up questions to “motivate” users to overcome any ambivalence or concerns about ability that they have.

Eliciting change talk: this is the ability to respond to what a client says and encourage them to talk about why or how they might change. SCIPit can’t do this! But then neither can most health professionals. We do use short summary statements but these are reflective and not responsive.

Rolling with resistance: Arguing with a client creates resistance and it might just be better to “back off” and talk about something else. SCIPit allows the user to stop at any time – either for a break or to think about something else. Everything is saved in the users own account and they can start where they left off at anytime.

So is SCIPit Motivational Interviewing? Well it is client centred, it does promote self efficacy (empowering people to do it themselves), it is influenced by the cycle of change method and it is motivational. It is not directive. I can’t imagine that in 1993 Rollnick and Miller envisaged the world wide web and its impact of peoples behaviour. There is a growing body of evidence to support the effectiveness of online versions of talking therapies. There is an email address with the BMJ article for Dr Rollnick. I think I will email him. Is SCIPit Motivational Interviewing? I’ll ask him.

Dr David Julien

Tuesday the 3rd of August, 2010 at 12:09PM

SCIPit Takes First Prize!

We are delighted to announce that last night the SCIPit website won first prize in the Software & IT category of the 2010 Bright Ideas Awards. The award was presented by Professor Steven Singleton of the Strategic Health Authority at an Oscars style ceremony at the Hilton Hotel in Gateshead. It was a glamorous affair that members of First Contact Clinical and the Website Lab enjoyed together. We met a number of other innovators and heard about all kinds of ideas that are making a real difference. We are of course thrilled to have won and are delighted that SCIPit is ranked amongst the best ideas to emerge this year. We genuinely feel that the website can help people make positive lifestyle changes that will have lasting benefits and represents an accessible, cost effective addition to local treatment systems. Last nights award suggests that we are not the only ones to think so!

Thursday the 27th of May, 2010 at 11:20AM

Best Evidence Yet for Web-Based Alcohol Self Help

Combining a randomised trial with a real-world test, studies of the Dutch
Drinking Less programme have gone further than any others to establish the beneficial impacts of web-based alcohol self-help interventions. These
have the potential to improve public health and offer change opportunities
to many thousands of people who would not attend alcohol treatment

View the original article:

Monday the 24th of May, 2010 at 12:13PM

NHS Bright Ideas Awards 2010

SCIPit is a finalist in this years awards. The awards will be announced next Wednesday so fingers crossed. I'll let you know how we get on!

Thursday the 20th of May, 2010 at 7:21PM

SCIPit goes live

SCIPit will be going live form Friday 21st of May. We are all very excited and hope to get a lot of hits. Please let us know what you think.

Thursday the 20th of May, 2010 at 7:20PM