Table 2 Mapping communication strategies to the ‘5A’ framework and self-determination theory

ASK

Using Open-Ended Questions

“Tell me”/“What”/”How” are useful terms when asking questions, as they allow the patient to elaborate on his/her story. Example: “What kind of things are you doing to alleviate the pain at the moment”

Relatedness

Using Single Questions

Avoid asking multiple questions at one time. Instead, ask one question and wait for a response before asking a second question.

Relatedness

Staying Silent

Allow the patient to complete sentences and finish speaking before following up with further questions.

Relatedness

Paraphrasing

After listening to the patient, summarize your perception of the main points. Examples: “So what I am hearing is that…” or “It sounds like …”

Relatedness

Empathizing

Show the patient that you understood the emotions that went along with the issue being discussed. Examples: “I can see this upsets you” or “That must be very frustrating”.

Relatedness

Gauging Patient Readiness to accept advice

Ask the patient if he or she is ready to consider advice regarding activities outside the clinic. Example: “There a number of things you can do that will help … would you like to hear a few suggestions?”

Autonomy

ADVISE

Catering for Different Learning Preferences

Use a selection of methods (aural, visual, kinesthetic) to educate the patient (during session and take home materials); these methods cater for multiple learning preferences.

Competence

Closing the Loop

Ask patients to paraphrase/demonstrate information that had been provided. Provide corrective feedback as required, and re-test understanding. Example: “To be sure that I was clear, could you please tell me, in your own words, your understanding of the …”

Competence

Providing a Rationale

Explain to the patient the rationale behind your advice. Example: “As we discussed earlier, your back needs support from the muscles around. So, if you can do these exercises, you can really provide your back with extra support …” or “Research shows that PA, such as walking, is a great way to…”

Autonomy

Providing Opportunities for Patient Input or Choice

Ask the patient to provide input or make choices when providing advice. Example: “Getting some physical activity –like going for a walk, riding your bike or swimming – is really good for your back. Is there a type of exercise that you prefer?”

Autonomy

Using Autonomy Supportive Phrases Instead of Controlling Language

Support and encourage the patient to accept personal responsibility for his/her recovery. Avoid coercion or guilt inducing phrases. Examples: “Here are some things that will help you overcome…” or “If you complete these exercises then you’ll strengthen your back and it will be less likely to give you pain”, instead of “Do this for me” or “You have to…” or “You must…”.

Autonomy & Competence

AGREE

Employing SMART Goal Setting

Agreed on goals that are Specific, Measurable, Achievable, Recorded, and Time-based. Example: Earlier you mentioned that you are finding it hard walking for long periods. For this week we could set a target of 15 minutes walking per day, how many days do you think you couldachieve that target in the next week?”

Competence

Ensuring Active Patient Participation in Goal Setting

Ask the patient for his/her opinions/comments during goal setting.Take into account patient’s subjective history (e.g. family/work commitments). Example: What time of day would suit you best for these exercises?

Autonomy & Competence

ASSIST

Identifying Barriers and Obstacles

Discuss at least one likely barrier to following treatment advice. Example: “Is there anything you can think of that might stop you from accomplishing your exercise goal?”

Competence &Autonomy

Identifying Solutions and Obstacles

Brainstorm with the patient ways to overcome this barrier (e.g. ‘identifying enablers’ and ‘cognitive restructuring’). Examples: “Walking can be a fun and social activity that doesn’t seem like hard work. How would you feel about walking with a friend/neighbor?” and suggest changing thoughts from “I am too out of shape to walk to the shop” to “If I take it nice and easy and remember to breathe, relax and take a rest when I need one, I will be able to walk to the shop.”

Competence & Autonomy

ARRANGE

Providing a Rehabilitation Diary

Provide the patient with a rehabilitation diary to help him/her keep track of home-based rehabilitation (e.g., exercise, physical activity).

Competence & Autonomy

Following-Up

Suggest a specific follow-up appointment, provide guidance regarding when an appointment should be arranged (e.g., no more than 2 weeks later), or inform the patient that no follow-up appointment is needed.

Relatedness & Competence

Offering Contact

Invite the patient to contact you in the event of difficulties or questions.

Relatedness & Competence