“Lifestyle” is usually based on long-standing behavioural patterns that are maintained by the social environment. Individual and environmental factors impede the ability to adopt a healthy lifestyle, as does complex or confusing advice from caregivers. Friendly and positive interaction enhances the individual’s ability to cope with illness and adhere to recommended lifestyle changes (“empowerment”). It is important to explore each patient’s experiences, thoughts, worries, previous knowledge and circumstances of everyday life. Individualized counselling is the basis for motivation and commitment. Decision-making should be shared between the caregiver and the patient (including also the individual’s spouse and family) [1-3]. Use of the principles of effective communication  will facilitate treatment and prevention of CVD.
|Principles of effective communication to facilitate behavioural change|
|Spend enough time with the individual to create a therapeutic relationship - even a few more minutes can make a difference.|
|Acknowledge the individual's personal view of his/her disease and contributing factors.|
|Encourage expressions of worries and anxieties, concerns and self-evaluation of motivation for behaviour change and chances of success|
|Speak to the individual in his/her own language and be supportive of every improvement in lifestyle.|
|Ask questions to check that the individual has understood the advice and has any support he or she requires to follow it.|
|Acknowledge that changing-life-long habits can be difficult and that sunstained gradual change often more permanent than a rapid change.|
|Accept that individuals may need support for a long time and that repeated efforts to encourage and maintain lifestyle change may be necessary in many individuals.|
|Make sure that all health professionals involved provide consistent information.|
In addition, caregivers can build on cognitive behavioural strategies to assess the individual’s thoughts, attitudes and beliefs concerning the perceived ability to change behaviour, as well as the environmental context. Behavioural actions such as "motivational interviewing" increase motivation and self-efficacy . Previous unsuccessful attempts often affect self-efficacy for future change. A crucial step is to help set realistic goals combined with self-monitoring of the chosen behaviour . Moving forward in small, consecutive steps is key to changing long-term behaviour . Communication training is important for health care professionals. The “ten strategic steps” listed in Table 9 :
|Ten strategic steps to facilitate behaviour change|
|1. Develop a therapeutic alliance.|
|2. Counsel all individuals at risk of or with manifest cardiovascular disease.|
|3. Assist individuals to understand the relationship between their behaviour and health.|
|4. Help individuals asses the barriers to behaviour change.|
|5. Gain commitments from individuals to own their behaviour change.|
|6. Involve individuals in identifying and selecting the risk factors to change.|
|7. Use a combination of strategies including reinforcement of the individual's capacity for change.|
|8. Design a lifestyle-modification plan.|
|9. Involve other healthcare staff whenever possible.|
|10. Monitor progress through follow-up contact.|
Combining the knowledge and skills of caregivers (such as physicians, nurses, psychologists, experts in nutrition, cardiac rehabilitation and sports medicine) into multimodal behavioural measures can maximize preventive efforts [2,6,7].
Multimodal behavioural measures are especially recommended for individuals at very high risk [2,6,7]. These measures include promoting a healthy lifestyle through behaviour changes, including nutrition, physical activity, relaxation training, weight management and smoking cessation programmes for resistant smokers [6,7]. They help cope with the illness and improve adherence and cardiovascular outcome [8,9]. Psychosocial risk factors (stress, social isolation, and negative emotions) that may act as barriers against behaviour change should be addressed in tailored individual or group counselling sessions [6,7]. There is evidence that more extensive/longer measures lead to better long-term results with respect to behaviour change and prognosis . Individuals of low socio-economic status, older age or female sex may need tailored programmes in order to meet their specific needs in terms of information and emotional support [6,10,11].