2. Health behaviour change

Question 1

What is the number one cause of preventable illness and death?

Answer 1

Smoking

Question 2

On average, how many years younger do cigarette smokers die than non-smokers?

Answer 2

10 years younger

Question 3

What proportion of men and women are overweight or obese?

Answer 3

• 7/10 men

* 6/10 women

Question 4

Why are we getting fatter?

Answer 4

• Genetic predisposition to have a higher weight
• Medical conditions (e.g. thyroid conditions) can contribute)
• Social factors, contributing to how much we can afford to eat
• Societal influences - emotional eating

Question 5

What are the 5 modern day killers?

Answer 5

• Dietary excess
• Alcohol
• Lack of exercise
• Smoking
• Unsafe sexual behaviour

Question 6

What is health behaviour?

Answer 6

• Any activity for the purpose of preventing disease, or detecting it at an asymptomatic stage
• Undertaken by an individual believing themselves to be healthy

Question 7

At what 3 levels are behaviour change interventions often offered at?

Answer 7

1) Population level e.g. NHS nationwide programmes - cervical screening
2) Community level e.g. weight-loss programme in a London borough
3) Individual level

Question 8

What type of health education works and doesn’t work?

Answer 8

• Campaigns now focus on positive emotions e.g. confidence, lack of judgement etc.
• Earlier campaigns focused on negative emotions e.g. guilt, shame and embarassment
• This didn’t work

Question 9

What are the cues for unhealthy eating?

Answer 9

• Visual (sweets at checkout)
• Auditory (ice cream van)
• Olfactory
• Locatory (couch)
• Time (end of TV programme)
• Emotional

Question 10

Give examples of the following which encourages eating food:
• Positive reinforcement
• Negative reinforcement
• Punishment

Answer 10

• +ve R - praise for preparing a high-fat meal for the family
• -ve R - avoid painful emotions by comfort eating
• P - preparing a low far meal is criticised

Question 11

What are stimulus control techniques for over-eating?

Answer 11

• Keep danger foods out of the house
• Keep biscuits in a different cupboard to tea + coffee
• Only eat at the dining table
• Use small plates
• Do not watch TV at the same time as eating

Question 12

Give a question as an example of counter conditioning for over-eating

Answer 12

Can you think of something other than eating that makes you feel better?

Question 13

What is contingency management?

Answer 13

Operant conditioning by stimulus control and positive reinforcement

Question 14

What are naturally occurring reinforcers to controlling food intake?

Answer 14

• Positive - improved self-esteem

* Negative - reduction in symptoms of breathlessness

Question 15

How are incentives effective at reducing smoking compared to encouraging weight loss?

Answer 15

Smoking cessation schemes are most effective, and weight-loss are the least effective

Question 16

What are the limitations of reinforcement programmes?

Answer 16

• Does not improve overall health behaviour - lack of generalisation
• Poor maintenance - once reinforcer is removed => rapid extinction of desired behaviour
• Impractical and expensive

Question 17

When teaching on the negative effects of certain health habits, is it better to induce no, low or high fear?

Answer 17

Low fear - will have the highest change in behaviour (but not no fear at all)

Question 18

Who has the greatest influence of adolescent smoking?

Answer 18

Best friends, followed by peer groups

Question 19

Using the flu vaccine as an example, give quotes as examples of the following in the Health Beliefs Model:
• susceptibility
• seriousness
• benefits
• costs
• cues

Answer 19

• Susceptibility - “a lot of people I know have got flu
symptoms”
• Seriousness – “It’s not something to really worry
about”
• Benefits – “The vaccination will stop me getting sick”
• Costs - “The injection will be painful and it
might make me ill for a while”
• Cues – “Doctor strongly advises to have it”

Question 20

Give examples of how you can use the health beliefs model for smoking cessation, by exploring the following:
• cues to action
• perceived susceptibility and severity
• perceived benefits and barriers

Answer 20

• Cues - “has anything made you think about giving up smoking?”
• Susceptibility and severity - “how do you think it’s affecting your health?” + “what would it be like if you got cancer?”
• Benefits and barriers - “what are the pros and cons of it for you?” + “is anything stopping you from quitting?”

Question 21

What is outcome efficacy?

Answer 21

Individuals expectation that the behaviour will lead to a particular outcome

Question 22

What is self efficacy?

Answer 22

Belief that one can execute the behaviour required to produce the outcome

Question 23

What 4 factors influence self-efficacy?

Answer 23

• Mastery experience - if engaged with a behaviour successfully before
• Social learning
• Verbal persuasion or encouragement
• Physiological arousal - being nervous weakens self-efficacy

Question 24

In the theory of planned behaviour, what was postulated to be the main predictor for behaviour?

Answer 24

Intention

Question 25

In the theory of planned behaviour, what was initially thought to influence intention, and what 2 factors have been added to this influence?

Answer 25

• Attitudes to behaviour

• Perceived behavioural control
• Subjective norm

Question 26

What are the stages in the transtheoretical model?

Answer 26

(• Pre-contemplation)
• Contemplation
• Preparation
• Action
• Maintenance
• Relapse

Question 27

Which stage of the transtheoretical model is a patient in if they say that they love to smoke and have no intention of quitting?

Answer 27

Pre-contemplation

Question 28

Which stage of the transtheoretical model is a patient in if they say that they are worried about their health due to smoking?

Answer 28

Contemplation

Question 29

Which stage of the transtheoretical model is a patient in if they begin to research resources and are referred to a smoking cessation programme?

Answer 29

Preparation stage

Question 30

Which stage of the transtheoretical model is a patient in if they try to reduce smoking?

Answer 30

Action stage

Question 31

Which stage of the transtheoretical model involves providing patients with support?

Answer 31

Maintenance