19 - Interventions Flashcards
What are the three individual approaches to behaviour change?
Motivational Interviewing
Problem solving approaches and implementation plans
Modelling and behavioural practice
Describe the motivational interviewing approach to individual behaviour change
Person-centred method for enhancing intrinsic motivation to change by exploring and resolving ambivalence
Considered to be effective for people who are reluctant to engage in change.
MI is collaborative, non-confrontational and non-authoritative
What are the key elements and strategies of motivational interviewing?
- Expressing empathy by the use of reflective listening
- Supporting self-efficacy and optimism for change
- ‘Rolling with resistance’ rather than confronting or opposing it
- Developing an awareness of the discrepancies between the client’s current behaviours and their values/goals
Is motivational interviewing effective?
Goal of MI is to motivate people to consider change
Most studies focus on whether it can alter behaviour, but it might not be most effective measure of MI
MI in drug use more successful than no intervention, limited difference with other treatments
Comparing Mi with confrontational interviewing in substance users. MI was more acceptable and less stressful for both counsellors and clients than confrontational approach
Describe the problem solving and implementation planning approaches to individual behaviour change
“Problem orientated”
Focuses on issues at hand, in the here and now
Three phases;
- problem exploration and clarification
- goal setting
- facilitating action
Counsellor does not act as expert solving persons problems, rather mobilise individuals own resources to identify problems and arrive at solutions
Are problem solving approaches and implementation planning effective methods for individual behaviour change?
- Despite generally acknowledged effectiveness of problem focused counselling styles- surprisingly little examination of effectiveness
Gomel et al. (1993) risk factors for heart disease study:
- 3 groups: risk education; problem focused counselling; no intervention
- Problem solving intervention had greatest effect»_space; greater reductions in blood pressure, BMI, smoking than in education only or no intervention groups
Why is the implementing plans and intentions (facilitating action) stage of problem solving approaches to behaviour change considered to be a key element?
Facilitating action; developing plans and strategies through which these goals can be achieved.
Like HAPA and implementation intentions, planning is an important determinant of behavioural change.
Positive results in interventions for; increased fruit intake, cervical cancer, quitting smoking and weight loss
Describe the modelling and behavioural practice approaches to individual behaviour change
Optimal learning and increases in self efficacy can generally be achieved through observation of people similar to the learner succeeding in relevant tasks
Actual practice of new behaviour
Solutions to problems and skills needed to achieve change can be worked out and taught in an educational program
»Increasing skills and self-efficacy
Why are problem focused and planning strategies to behavioural change sometimes not effective?
Problem focused and planning strategies can help- BUT achieving change can still be difficult
Particularly where individual lacks skills and confidence in their ability to cope with demands of change
Potentially overcome by learning skills or appropriate attitudes from observation of others performing them- vicarious learning
Describe the method and results from Sanderson and Yopuk’s (2007) study on condom use through modelling
30 min condom promotion video (+ve attitudes about condom use, modelling appropriate strategies for negotiating use; male vs female presenter versions)
Waitlist control
Intervention (video) participants reported:
- stronger intentions to engage in protected sex
- higher self-efficacy in refusing to have unprotected sex
- higher levels of condom use four months after seeing the videos
- Both male & female students benefited more (condom use behaviour) from viewing the female presenter’s version
Why are mass media campaigns commonly used as a population approach to behaviour change?
- Print advertising, television advertising, radio, billboards, online
- Potential to reach hundreds of thousands/millions
- May be of short duration or extend over long periods
- May be stand alone or linked to other organised program components (e.g. clinical outreach, new products/services, policy changes)
- Multiple methods of dissemination may be used in some initiatives
- Potential benefits
“The great promise of mass media campaigns lies in their ability to disseminate well defined behaviourally focused messages to large audiences repeatedly, over time, in an incidental manner, and at a low cost per head”.
What are some challenges facing mass media campaigns?
- Campaign messages can fall short (or even backfire)
- Exposure of target audience may be suboptimal
- Funding may be inadequate/ceased
- Inappropriate or poorly researched format may be used (e.g. age inappropriate content)
- Homogeneous messages might not be persuasive to heterogeneous audiences
- Campaigns might address behaviours that audiences lack the resources to change
Are mass media campaigns successful based on research from the RTA marketing?
“Speeding. No one thinks big of you” (Pinkie) campaign
- 53% of young males (17-25 years) said that they would be more likely to comment on someone’s driving as a result of seeing the ‘Pinkie’ campaign.
- 63% of young male drivers, believed the campaign to have some effect in encouraging young male drivers to obey the speed limit.
- 75% of young males revealed strong recognition of the anti-speeding message
What about actual speeding behaviour?
- Almost halved the risk of high risk speeding infringements and almost halved teenage deaths.
- Increased in awareness change and driving behaviour
What did Wakefield’s (2010) review of mass media campaigns reveal about smoking?
Controlled field experiments/population studies show mass media campaigns associated with:
- Decline in young people starting smoking
- Increase in number of adults stopping smoking
Although more effective when integrated with programs/policies (e.g. tax, smoke-free policies, school programs)
- Hard to determine actual effectiveness because of lack of formal control groups
What did Wakefield’s (2010) review of mass media campaigns reveal about alcohol use?
Mass media campaigns to lessen alcohol intake have had little success (other than drink driving campaigns)
Most campaigns target young people-
- overshadowed by widespread unrestricted alcohol marketing strategies and the view of drinking as a social norm
Safe drinking campaigns sponsored by alcohol companies have been ineffective in changing drinking behaviour
- messages are viewed as ambiguous by recipients
No assessments have been conducted of whether the publicising of alcohol drinking guidelines affects alcohol related harm
What did Wakefield’s (2010) meta-analysis conclude regarding increasing the success of mass media campaigns?
Likelihood of success increased by:
- Application of multiple interventions
- Target behaviour being one off or episodic (e.g. screening, vaccination) rather than habitual or ongoing (e.g. healthy food choices, physical activity)
- Availability of / access to key services and products
- Creation of policies that support opportunities for change
How should health behaviour change interventions be evaluated? (Based on House of Lords Science and Tech Committee report)
- Evaluation should be considered throughout the intervention design process
- Interventions should be evaluated against relevant outcome measures
- The evaluation should consider whether the intervention has resulted in long term behaviour change
- Sufficient funds should be allocated for evaluation
What are the three methods to maximise effectiveness of mass media campaigns?
- Appropriate use of fear messages
- Information framing
- Specific targeting of interventions
Decribe the appropriate use of fear messages to increase effectiveness of mass media campaigns
Witte (1992) proposed threatened individuals can take two courses of action:
- Danger control: reducing the threat- actively focusing on solutions
- Fear control: reducing the perception of risk, often by avoiding thinking about the threat
For danger control to be selected:
- person needs to consider that an effective response is available (response efficacy)
- they are capable of engaging in the response (self efficacy)
»> Otherwise fear control will become dominant coping strategy
Most persuasive messages;
- arouse fear
- increase sense of severity if no change is made
- emphasise the ability of individual to prevent feared outcome
Decribe the ways information framing can be used to increase effectiveness of mass media campaigns
Health messages can be framed in either positive (stressing positive outcomes associated with action) or negative terms (emphasising negative outcomes associated with failure to act)
Negative frames may be more memorable, but positive frames may enhance information processing
Conflicting results of studies
- Some suggest positive framing is better
- Others suggest negative framing is preferable
Cannot make a priori judgement about effect of +/- information framing, should aim to test intervention as a pilot before public launch
Decribe the ways targeting the audience can increase the effectiveness of mass media campaigns
Mass media campaigns may ‘dilute’ the message
It is more effective to target your audience
Media campaigns can be targeted on several factors:
behaviour, age, gender, socio-economic status, sexuality, psychological factors such as their motivation to consider change
How can you use the environment to change behaviour?
Behaviour and behaviour change do not occur in isolation from the environment in which they occur.
The environment may contribute directly to risk for disease.
It can also indirectly influence health by influencing the ease with which health promoting or health damaging behaviours can be conducted.
An environment encouraging healthy behaviours should:
- provide cues to action – or remove cues to unhealthy behaviours
- enable health behaviours by minimising the costs and barriers associated with them
- increase the costs of engaging in health damaging behaviours
e.g. cigarette interventions
