Mr Meng Xiankun, Assistant Manager, SingHealth Centre for Person-Centred Care
Dr Loo Yu Xian, Head & Consultant, Post-Acute & Continuing Care, Outram Community Hospital
Dr Kenneth Tan, Family Physician, Kenneth Tan Medical Clinic

General practitioners (GPs) face the dual challenge of addressing complex medical issues while nurturing patient engagement. Discover a simple conversational framework – designed to support busy clinicians in their practice – that can empower patients to take ownership of their health, to achieve the best possible outcomes.
 

INTRODUCTION

In alignment with Singapore’s transformative Healthier SG strategy — a national initiative to shift healthcare from reactive treatment to proactive prevention — effective communication emerges as a critical lever for empowering individuals to take charge of their health.

Central to this reform is the mobilisation of general practitioners (GPs) as frontline advocates for preven-tive care, tasked with fostering patient engagement and co-creating personalised health plans.¹

However, in today’s fast-paced clinical environments, GPs face the dual challenge of addressing complex health issues while cultivating patient engagement. Traditional directive approaches often fall short, leaving patients feeling unheard or overwhelmed.

Healthy Conversation Skills (HCS) bridges this gap as a brief, structured communication that empowers patients to take ownership of their health. Designed for efficiency, HCS balances time constraints with ac-tionable outcomes, making it ideal for busy clinicians.
 

HEALTHY CONVERSATION SKILLS FRAMEWORK

HCS is a very brief, evidence-based public health intervention,² designed to equip healthcare profes-sionals with time-efficient skills to opportunistically engage individuals to identify person-centred health improvement goals.³

Its concise framework focuses on empowering in-dividuals to make positive changes to their health and wellbeing by exploring their own context and developing personalised strategies.

Originally developed in Southampton, United Kingdom to address barriers in health-related behaviour change among mothers, it has since been adapted globally for diverse settings.⁴

HCS is built upon four core principles that aim to increase self-efficacy in individuals by shifting from advice-giving to a more empowering approach. A ‘healthy conversation’ guides individuals to explore their unique circumstances and derive motivation through developing their own path forward.

The keys to this approach are:

1. Open discovery questions (ODQs): Facilitating quick problem-solving and goal setting with focused, open-ended prompts such as ‘how’ or ‘what’ questions.

2. Active listening: Prioritising patient-led dialogue over directive advice that fails to consider patients’ unique circumstances.

3. SMARTER goals: Co-creating specific, measurable, action-oriented, realistic, timed, evaluated and reviewed plans. ‘Evaluated’measures progress toward the goal, while ‘reviewed’ involves a structured check-in to discuss the evaluation and adjust plans as needed.

4. Reflective practice: Encouraging practitioners to self-assess and refine their approach.
 

Case Example: Managing Type 2 Diabetes

Mr Tan is a 52-year-old information technology manager with type 2 diabetes (HbA1c 7.5%, fasting glucose 8.1 mmol/L).

Blood pressure: 138/88 mmHg

Lifestyle: Sedentary, works 10-hour days

Family history: Paternal type 2 diabetes, maternal hypertension

Current medications: Metformin 1g twice daily; refused increase in metformin dosage or additionof new medications
 

TYPICAL COUNSELLING Focusing on Telling and Suggesting

GP: "Mr Tan, your HbA1c remains elevated. We really need to get it under control. Since you are not keen to adjust your medication regimen, shall we make changes to your diet? Are you still consuming sugary drinks?"

Tan: "I know I need to cut down, but I rely on sweetdrinks to stay alert during long workdays."

GP: "You should eliminate sugary drinks and replace them with water. This is non negotiable. Have you tried switching to sugar-free alternatives?"

Tan: "I did, but the cravings are strong, especially when I’m stressed."

GP: "Your health is at stake. If you don’t stop, you’ll need more diabetic medications soon."

Tan: Kept silent...

GP: "I know this is not easy, but many of my patients are able to do it for the sake of their own health. You can too! By our next consultation, no more soft drinks or sweetened beverages."

Tan: "I’ll… try. It’s just hard with work pressure."

GP: "Ok, that’s the plan. We’ll review in three months."
 

OUTCOME

Mr Tan leaves feeling even more stressed from his consultation and is frustrated with his stress and the state of his health. He views the advice as unrealistic and struggles to find motivation to make lifestyle changes. Over the next three months, his HbA1c remains unchanged, and he is undecided whether to attend the follow-up appointments.
 

Counselling Using HCS APPROACH

The same patient was then engaged using HCS. This non-directive approach using ODQs and active listening empowers individuals to discover their own solutions and collaboratively set SMARTER goals.

GP: "Mr Tan, your HbA1c remains elevated. How have you been managing your diabetes with dietary changes?”

Tan: "I know I drink too much Coke, but it helps me relieve stress during stressful workdays. It’s really tough to quit."

GP: "Perhaps quitting is too difficult in your current circumstances (Active listening). What is one change that you could make?" (Specific)

Tan: "Maybe, I want to reduce the amount of mysoft drinks for the start."

GP: "How much soft drinks are you drinking currently and how much do you want to reduce?" (Measurable)

Tan: "Erm... most days I can drink up to four bottles of Coke. Maybe I can cut down to two bottles in a day."

Consider the above interaction and how using ODQs, active listening and engaging the individual to set clear realistic goals and identify simple strategies can quickly move the conversation forward without making the person feel judged. Let us continue with the brief conversation.

GP: "What is likely to challenge you in achieving your goal? (Realistic)

Tan: "I am afraid that I will feel cranky and cannot concentrate when I don’t have my drink. I crave the instant energy boost, especially in the afternoon."

GP: "How would you ensure that you can keep to your goal?" (Action-orientated)

Tan: "Maybe I’ll alternate between drinking CokeZero and Coke."

GP: "That’s a good start! How will you ensure you stick to this plan?" (Evaluated)

Tan: "I'll stock up twice as much of Coke Zero and I will record my daily glucose count to know that I am on track."

GP: "When would you like to start?" (Timed)

Tan: "Tomorrow morning."

GP: "When and how should we review your progress?" (Reviewed)

Tan: "In three months, and we can do another HbA1c."
 

OUTCOME

Mr Tan is engaged to design his own solutions. At follow-up, he had reduced sugary drinks by more than 50%, leading to a 0.2% HbA1c drop. Motivated by visible progress, he is more likely to commit to sustaining these changes.
 

BENEFITS OF HCS

• Time-efficiency in practice: Delivers impactful outcomes through brief, focused consultations, reducing lengthy advice-giving while enhancing patients’ self-efficacy. 
• Overcoming barriers: Addresses practitioners’ skill gaps in behaviour change conversations. 
• Enhanced health behaviours: Patients set more goals and adopt sustainable dietary/activity changes
• Improved communication: Strengthens practitioners’ ability to motivate and empower patients.
   

HOW GPs CAN SIGN UP FOR HCS TRAINING

Designed for rapid skill acquisition, practitioners of all clinical backgrounds can quickly master HCS through concise, two-half-day training sessions. Minimal time investment ensures seamless integration into busy schedules.

The SingHealth Centre for Person-Centred Care (CPCC), in collaboration with the SingHealth Community Health Office of Learning (SCHOOL), will be offering the HCS programme for primary care providers such as GPs to adopt this evidence-based and easy-to-use communication tool to empower patients to take ownership of their health.

For more details on HCS training, please visit https://www.singhealthacademy.edu.sg/Pages/healthier-sg.aspx
 

REFERENCES

1. Ministry of Health, Singapore. (2022). White Paper on Healthier SG.

2. Parchment, A., Lawrence, W., Perry, R. et al. Making Every Contact Count and Healthy Conversation Skills as very brief or brief behaviour change interventions: a scoping review. J Public Health (Berl.) 31, 1017–1034 (2023).

3. Health Education England, NHS. (n.d.). Healthy Conversation Skills Training Manual.

4. Hollis, J. L., et al. (2021). The impact of Healthy Conversation Skills training on health professionals’ barriers to having behaviour change conversations. BMC Health Services Research, 21(1), 880.

To find out more about Healthy Conversation Skills and theSingHealth Centre for Person-Centred Care, GPs can email to cpcc@singhealth.com.sg.
 

Mr Meng Xiankun is an assistant manager at the SingHealth Centre for Person-CentredCare. His work involves analysing performance gaps, designing targeted interventions and integrating learning strategies with operational improvement.

Dr Loo Yuxian is a Consultant and Medical Director at Outram Community Hospital. He is a qualified family medicine physician with a special interest in palliative care, and currently serves as the Director of Supportive & Palliative Care Service for SingHealth Community Hospitals.

Dr Kenneth Tan is a solo general practitioner passionate about comprehensive, holistic family care. He actively pursues postgraduate training and contributes to medical education.