A Wee Blether; Healthy Conversations and Making Every Contact Count.

A wee blether, a chit- chat, a catch up, a quick word. From the Forth Bridge to Fort William, conversations happen all the time. But what makes a good Conversation?

In everyday life it’s not always something we have to think about. If we get stuck we can always have a blether about the weather.

This week, in NHS Fife, the Nutrition and Dietetic department are supporting the British Dietetic Association’s Dietitians Week. Today the theme is, “Healthy conversations and making every contact count”


In Scotland the Health Promoting Health Service (HPHS) concept is that ‘every healthcare contact is a health improvement opportunity’. HPHS is a settings-based health promotion approach which aims to support the development of a health promoting culture and embed effective health improvement practice within NHS Scotland http://www.knowledge.scot.nhs.uk/home/portals-and-topics/health-improvement/hphs.aspx

The underlying principles of this approach are equity, participation, empowerment and sustainability.

As health professionals, Dietitians are experts in communication. A good conversation is key if we want to successfully translate the science of nutrition into practical advice. Only then can we help support individualised diet and lifestyle changes.

A healthy conversation can be defined as:

‘healthy conversation takes place opportunistically between at least two people, and involves an individual being encouraged to consider their lifestyle and health with a view to identifying small but important changes.’

(PHE and RSPH, 2015)

In NHS Fife there are approx 65 clinical members of staff within the Nutrition and Dietetic department. We are a relatively small fish in the big pond of the approximately 8850 staff that make up NHS Fife’s workforce.  However in a typical day the department initiates literally hundreds of healthy conversations. These may be in the more traditional settings such as a one to one outpatient clinic or on a hospital ward but you’ll also find these conversations happening at education group, in peoples’ homes or using more innovative e-health tools such as social media and Lync. As British Telecom said many years ago, it’s good to talk.

Healthy conversations between patients and clinicians have several elements to them:


In NHS Fife, as a department, we have produced several resources to support brief interventions. One such example is the brief intervention tool for weight management.


This tool enables non Dietetic health and social care staff to feel confident to raise the issue of weight and have a healthy conversation.  A brief intervention is often a ‘5 minute chat’.

For example a patient may have popped along to see the practice nurse to have their bloods taken. Whilst the nurse is doing this they mention they feel they’ve really put on weight, ‘piled on the pounds since Christmas’.  This can be the cue, the hook, for the health professional to raise the issue of a healthy weight. Equally the health professional may notice from the healthcare records the patient’s weight has changed significantly. Having a brief intervention tool helps staff feel more confident to raise the issue of weight. They can be confident they are providing evidence based advice and signposting to trusted information. This tool does not replace the Dietitian but is designed to fit into a 5 minute ‘chat’.

This year’s overall theme for Dietitians week is Dietitians Do Prevention. All four nations of the UK have identified improving prevention and public health as key to the ongoing sustainability of health services.

Like the nurse having a healthy conversation about weight, whilst taking the patients bloods, Dietitians don’t always just discuss diet and nutrition. When Dietitians do prevention, they discuss related issues that impact on health like exercise, smoking and social factors.

In Fife the Dietitians are fortunate to have strong links with the council and 3rd sector organisations. We have a range of options from Fife Sports and Leisure, Fife Council and groups such as the Ramblers Association to discuss and signpost to around exercise.

WalksDietitians in Fife have all been trained to use advanced motivational interviewing techniques to assess motivation. They can then appropriately signpost to programmes such as Active Options 2 or Bums Off Seats programme and not forgetting options such as the stunning Coastal path that sits on our doorsteps.

Scotland’s 2020 vision talks about having a healthcare system where there is a focus on prevention, anticipation and supported self-management. Healthy conversations are one part of building the healthcare system discussed and making every healthcare contact is a health improvement opportunity.

So don’t wait; next time don’t just talk about the weather, use the tools below to improve and gain confidence in healthy conversations and like Dietitians, you too can ‘do prevention’.


screen-shot-2016-10-10-at-18-16-23Written by: Joanna Teece, Dietitian, NHS Fife.



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