Table 4 Description of conversational practices used
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 |