All AHPs Level 1 Columbo MECC

Set the scene

Sometimes you may have the opportunity to set the scene for MECC. This can be by putting up posters in your waiting rooms which invite people to think about adopting healthier lifestyle behaviours, or by showcasing a national campaign e.g.

"This week we are raising awareness about back pain.....I'm not sure if you are aware just how common back pain is...?"

Use "It's OK to ASK" posters to invite your clients to ask you about healthy lifestyles and how to manage back pain.

Now have a look at "Columbo" MECC. It is called Columbo MECC because Columbo never missed an opportunity to say something pertinent, even if he was on his way out of the door! So, look for opportunities to start the conversation about LBP

A typical MECC conversation follows the pattern ASK, ADVISE, ASSIST

Here is a sample Columbo MECC


"Before you go, can I just take this opportunity to ask whether you would like some information about keeping healthy and independent as you get older?"   Or

"Before you go, we want to make sure that all our patients are aware of how to reduce their risks of developing back pain. Did you know that 8 out of 10 people experience back pain at some point in their lives?"  Or

"Do you experience back pain?"


"Exercising and keeping generally active is the best way to manage back pain."

REMEMBER! Use this simple way of remembering the content of your advice

ACKNOWLEDGE that back pain may be uncomfortable

ACTIVITY is the best way to manage back pain. It is important to keep active even when the symptoms have abated

ANALGESIA can be used to help manage the back pain. It is best to use on a regular basis.


"Why not take this leaflet which explains all about back pain. It's got some great Top Tips to manage back pain and to help you if you do experience back pain at any time"

You don't always have to deliver MECC as someone is heading out of the door!

Look for "door openers" to a quick chat for change:

A door opener may be a news item, a national campaign, something you have noticed about the person, something they mention to you….it may be  ANYTHING that presents you with an opportunity to have a chat for change.

eg:  something that's been in the news that week about health behaviours

"Did you hear on the radio last week about how common back pain is, and how we can all do simple things to lower the risk of getting back pain?".

e.g: a national campaign 

"It's Back Care Awareness Week next week. Were you aware of that?"

e.g: something you have observed

"I can see it's a struggle for you to walk very far today. Are you experiencing any pain?".

Back pain, of course, is not a health behaviour, but a symptom, which may be linked to health behaviours (e.g. unhealthy eating habits, lack of physical activity) or to issues happening in people's lives (e.g. stress, pregnancy, depression) or to the context they live and work in (e.g. sedentary work, driving etc). These may all be potential door openers to a MECC chat.

ASK: " I'm not sure if you are aware of the benefits of having a healthy lifestyle....

ADVISE: " Did you know that how much you exercise, what you weight, whether or not you smoke....these can all affect your risks of developing cardiovascular disease, diabetes and musculo-skeletal conditions such as back pain. 

ASSIST: May I give you a leaflet...? if you want any information about how to prevent these conditions then it's OK to ask at any time...."

Start the conversation…

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