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How to Facilitate Lifestyle Change

Applying Group Education in Healthcare

Amanda Avery, RD

Senior Fellow of the Higher Education Academy
Assistant Professor in Nutrition and Dietetics
Division of Nutritional Sciences
University of Nottingham
Loughborough, UK

Kirsten Whitehead, PhD, RD

Senior Fellow of the Higher Education Academy
Assistant Professor in Dietetics
School of Biosciences
Division of Nutritional Sciences
University of Nottingham
Loughborough, UK

Vanessa Halliday, PhD, RD

Senior Fellow of the Higher Education Academy
Lecturer in Public Health
School of Health and Related Research (ScHARR)
The University of Sheffield
Sheffield, UK

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Working and learning together within a small group is a less resource intensive and a more accessible and acceptable form of education for many individuals. Groups can be considered to be very much like teams where there are people taking part who have similar ambitions and needs, aiming to achieve similar goals.

The publication of this guide is timely, with the current highest emphasis on prevention and health improvement this century. The Five Year Forward View, published by Simon Stevens (Chief Executive of NHS England) last year, states that the future health of millions of children, the sustainability of the NHS, and the economic prosperity of Britain all now depend on a radical upgrade in prevention and public health. The World Health Organisation, the European Platform for Health and the USA Centers for Disease Control and prevention all also recognize that many of the non‐communicable diseases, which are contributing to health and societal burden, are preventable or better managed through improved self‐care. Chapter 1 provides startling global statistics of the need for lifestyle change to be championed and delivered at every opportunity through a range of scalable solutions using a life‐course approach. The principles of behaviour change then set the scene for the reader to walk through the stages of group education with the three authors.

Today, the range of professionals delivering lifestyle advice is wider than ever before, as we embrace concepts such as Making Every Contact Count. The skills that lifestyle educators and health professionals require in order to deliver effective group education and support are clearly transferable from other interactions, such as one to one consultations, but require adaptation and a broader focus. This concise and highly practical resource guides the reader through each stage requiring consideration; from planning to delivery of a session with appropriate resources through to evaluation.

Groups have additional advantages over the traditional one‐to‐one approach in that the participants can become committed and motivated to help others. Facilitators can harness peer support and encourage the lay person, with training and support, to facilitate groups as a critical and effective strategy for lifestyle change, as well as ongoing health care and the benefits being cascaded at a local community level.

I trust that as you utilize this resource, you will be inspired and better informed about how to implement group education and that this additional competence will contribute to your ongoing personal development. The advice offered for overcoming challenging situations and the ambivalent group member, will be best reflected upon in practice!

Additionally, and most importantly, I hope that your group participants will benefit from your best practice and the motivating power and extra resolve developed through peer support facilitating sustained behaviour change. I celebrate the publication of this book with the authors, who are all outstanding dietetic practitioners, communicators and educators.

Dr Fiona McCullough
Director of Dietetics, The University of Nottingham
Principal Fellow of the Higher Education Academy
Chair of the British Dietetic Association


The prevention and management of non‐communicable diseases, that are being seen across all societies and which result from poor lifestyle habits, requires scalable and effective solutions. Small changes, in the healthier direction, to improved dietary habits, increased physical activity levels, decreased sedentary behaviours, safer alcohol intake and a decreased number of people smoking may considerably reduce the prevalence of the major non‐communicable chronic diseases. These include obesity, type 2 diabetes, cardiovascular disease and many cancers. Group education is likely to provide a better option for scalability when compared to individual one‐to‐one consultations and may also be more effective through the facilitation of a supporting environment that encourages changes in behaviour.

Published literature demonstrates that group education can provide benefits in terms of knowledge, self‐efficacy and health outcomes. Self‐management support through the provision of group education, focussing on behaviour change, can help to improve self‐efficacy. This in turn can have a positive impact on people’s clinical symptoms, attitudes and behaviours, quality of life and patterns of health care resource use. Well‐delivered group education, including the peer support, aims to help people learn how to manage their own care more effectively.

There is much to consider when planning and organizing group education. Is the session to be delivered to other healthcare professionals or lay trainers who are going to cascade the information to patient/community groups or is it going to be to the patient/community group themselves? Where is the most appropriate setting to deliver the group? Is it going to be accessible to all those who you are targeting? Does the venue have appropriate facilities? How are you going to meet your overall aim and objectives with the group participants achieving the desired learning outcomes? How are you going to make sure that every group participant is engaged and feels included rather than excluded? What might be different if you are facilitating a group for children rather than adults? How do you make sure that the content and format is appropriate for all groups of society from different ethnic and cultural backgrounds? What resources might be required? There is so much to consider.

This book aims to cover all of these areas so that the facilitator of group education can feel more confident about their approach. It starts by looking at some successful examples of group education, some of the underpinning theory of behaviour change before considering the practical aspects of planning, delivering and evaluating group sessions. The evaluation cannot be overemphasised given the need to prove cost‐effectiveness and appropriate use of healthcare resources. Although some people are more naturally effective at facilitating groups and have certain personal qualities, facilitation skills can also be acquired. A good facilitator needs not just to be well prepared but also to be flexible to the needs of an individual group – no two groups are going to behave in the same way! The facilitator needs to be able to think creatively and use a variety of techniques. The effective facilitator does not directly tell people what to do but, instead, provides the nurturing environment whereby they are able to come up with their own personal solutions to maintain optimal long‐term health. They are good listeners and skilled at summarizing. They are also good at establishing ground rules for the group.

It is hoped that the reader will find the practice points, top‐tips, checklists and practical examples helpful when preparing, facilitating and evaluating groups themselves. We have aimed to include diversity with examples from across the life‐course, different settings, different presenting health conditions and different lifestyle changes being targeted. Much of the content is drawn from our own experiences of what we have found most helpful to our practice over the years. We acknowledge that all group facilitators can continue to develop skills and continue to reflect on what went well and what we might do differently next time. We all need to consider our continuing professional development and we hope that this book will be a resource to support that development for all of those who read it.


We would like to acknowledge the support of our families during the writing of this book.

We would like to give special thanks to Ruth Stow for reading the draft and offering suggestions for improvements.