with small to medium changes in behaviour (d+= 0.40). Interestingly, self-monitoring
of behaviour (e.g. amount of physical activity) helps with changing that behaviour but
has little effect on goal achievement (e.g. weight loss). While, in contrast, monitoring
progress towards a goal like weight loss helps with achieving this goal but has no effect
on behaviour change. The development of various electronic devices (such as smart-
phones) that help such monitoring may considerably aid self-monitoring-based
interventions. We have also seen how questionnaires can be used to deliver change
techniques, including if-then planning (Godin et al., 2008; van Dongen et al., 2013).
A recent meta-analysis (Wood et al., 2015) suggests that self-prediction questions may
result in small changes in behaviour including health behaviour patterns. This is a
potentially low-cost delivery method. Application of such techniques and new delivery
methods has the potential to produce changes in health behaviour patterns as diverse
as smoking, physical activity and healthy eating that could enhance public health and
be both effective and cost-effective.
Interventions to change the participation of patients in consultations have shown
some promising results (Harrington et al., 2004; Chapter 10). Further work on the pre -
paration of patients for consultations (e.g. through web-based interventions) has the
potential to enhance the health promotion impact of consultations and thereby increase
their cost-effectiveness. Similarly, noting the potential effects of placebo treatments
(Stewart-Wiliams, 2004) and evidence that cognitive and emotional care may maximize
health benefits (Di Blasi et al., 2000), further work is needed on what type of
consultation is most effective for which groups of patients. If health care practitioners
can be trained to maximize anxiety reduction and self-efficacy enhance ment this could
improve patient satisfaction, adherence and, thereby, consultation effectiveness. Such
benefits may be especially important for patients with long-term illnesses and those for
whom there is no obvious pharmacological intervention. For these patients, longer
appointments and a greater focus on quality of life outcomes may be crucial to
effectiveness. Behaviour change interventions have been successful in promoting
greater self-care (e.g. Glazier et al., 2006) and in prevention of long-term illnesses
(Knowler et al., 2002). Extensions of this work to other areas could be of great benefit
to patients, while simultaneously enhancing the cost-effectiveness of health services.
There is also a need to evaluate policy interventions aimed at change. For example,
how effective is the traffic-light, food-labelling system introduced by the Food
Standards Agency (www.eatwell.gov.uk/foodlabels/trafficlights) in shaping consumer
choice? How does it compare to other labelling systems? Similarly, the web-based NHS
Direct service has been found to elicit 90 per cent satisfaction in public surveys and it
is estimated that it recoups half of its running costs by encouraging more appropriate
use of NHS services (National Audit Office, 2002). It would be interesting to know,
however, whether services like this reduce consultation rates and/or promote health
behaviours and whether we can improve their capacity to do so.
ROLES AND REQUIRED COMPETENCIES FOR HEALTH
PSYCHOLOGISTS
We have seen how health psychologists (HPs) have developed and tested theories
explaining motivation and behaviour change and applied such theory to the design of
260 RELATING TO PATIENTS