| Key clinician behaviors | Examples/comments |
| Collaborative and supportive approach: |
- Communicate respect for and acceptance of the patient and their feelings.
| - "If it is ok with you, let's talk a little more about sex during this part of the visit."
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- Establish a nonjudgmental, collaborative relationship.
| - "I have patients of all gender identities or sexual orientations. It is important that we speak honestly so I can offer the best medical advice."
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- Express empathy through reflective listening.
| - "It sounds like you have been worried about people's reaction to the fact that you are attracted to all the genders and do not identify as heterosexual."
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| | - Allow for 10 or more second pauses, especially when discussing sensitive information or disclosures.
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- Compliment rather than denigrate
| - "You have been making healthy decisions; good for you!"
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- Support self-efficacy and optimism – Focus on patient strengths to foster hope that is needed for change.
| - "I appreciate you sharing this with me. I know it might seem uncomfortable but sexual health is an important aspect of overall health."
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- Provide support throughout the process.
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- Discuss behavior change but affirm that change is up to the patient.
| - "I know that you don't like the way condoms change how sex feels, but using a condom would cut down on your risk for getting an infection. This is something that you need to consider and decide if you want to use more regularly."
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| Promote behavior change: |
- Note discrepancy between the patient's goals or values and current behavior, helping them recognize the discrepancies between where they are and where they hope to be.
| - "I know you feel badly about being diagnosed with chlamydia. What would you do differently that might make it less likely be exposed or infected in the future?"
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- Avoid argument and direct confrontation – These are core characteristics of power struggles.
| - "I hear that you don't want condoms or PrEP. Let's table that and talk about it again sometime in the future."
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- Roll with resistance – Adjust to, rather than oppose, patient resistance.
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| Key strategies | Examples/comments |
- Ask open ended questions. They allow for more expansive responses.
| - "Tell me a little about how you identify in terms of gender identity? In terms of sexuality? Who are you attracted to?"
- "What sorts of sexual activities have you explored?"
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- Listen reflectively. This involves demonstrating that you have heard what the patient has said by periodically repeating or paraphrasing what they have said.
| - "I hear you sounding like you are worried about what your parents might think?"
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- Summarize. Periodically summarize what has transpired in a particular visit, including discrepancies that are presented.
| - "So it sounds like you identify as pansexual but have not explored being actively sexual with any partner for now?"
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- Affirm. Support and comment on the patient's strengths, motivations, intentions, and progress.
| - "You are really smart to ask that question and request STI screening. We can do that here today."
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- Elicit self-motivational statements. Have the patient voice personal concerns and intentions, rather than try to persuade them.
| - "What would you like to do next regarding preventing pregnancy or contraception? What are your ideas?"
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- Assist with planning. Ask questions to help the patient make a behavior change plan (identifying the change that they want to make, reasons for doing so, first steps, obstacles, and solutions).
| - "It sounds like you are wanting to set up an appointment for an IUD. Let's make that happen sooner rather than later."
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