21 Interventions - Individual and Public Health

Question 1

What are the individual approaches to behaviour change?

Answer 1

Informing people of their risks for certain disease may lead to them engaging in long term risk protective behaviour

Question 2

What are the three individual ways to promote change?

Answer 2

1. Motivational interviewing
2. Problem-solving approaches and implementation planning
3. Modelling and behaviour practice

Question 3

What is the traditional method?

Answer 3

Prescription and advice -> people don’t change because they are told to change, they change when they find their own reasons to change

Question 4

Describe the motivational interviewing approach to individual behaviour change

Answer 4

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-confrontantional, non-authoritative

Question 5

What are the key elements and strategies of motivational interviewing?

Answer 5

• Expressing empathy through 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

Question 6

What is the goal of Motivational interviewing?

Answer 6

To motivate people to consider a change

Question 7

Is motivational interviewing effective? Explain the effects of the meta analysis

Answer 7

Successful, but not significantly different to other treatments -> more acceptable and less stressful for clients and counsellors

MI in drug use more successful than no intervention, limited difference with other treatments (Smedslund et al., 2011)

Comparing Mi with confrontational interviewing in substance users. MI was more acceptable and less stressful for both counsellors and clients than the confrontational approach (Schneider et al., 2000)

Question 8

Describe the problem solving and implementation planning approaches to individual behaviour change

Answer 8

Problem-Oriented -> role of counsellor not to act as an expert but rather to mobilize the individual’s own resources to identify problems and facilitate goals

Question 9

What is the focus of problem-solving approaches?

Answer 9

It focuses on issues at hand, in the here and now

Question 10

Name the three distinct phases in problem-solving approaches?

Answer 10

1. Problem exploration and clarification
2. Goal-setting
3. Facilitating action

Question 11

What is the role of the counsellor in problem-solving approaches?

Answer 11

Not to act as an expert solving person’s problems -> rather mobilize the individual’s own resources to identify problems and arrive at solutions

It is important to deal with stages sequentially and thoroughly

Question 12

Explain the problem exploration and clarification phase in problem-solving approaches?

Answer 12

Detailed exploration of problems the individual is facing: breaking ‘global insolvable problems into carefully defined solvable elements

Question 13

Explain the goal-setting phase in problem-solving approaches?

Answer 13

Identifying how individual would like things to be different; setting clear, behaviourally defined, achievable goals

Question 14

Explain the facilitating action phase in problem-solving approaches?

Answer 14

Developing plans and strategies through which these goals can be achieved

Question 15

Are problem-solving approaches and implementation planning effective methods for individual behaviour change?

Answer 15

• Despite generally acknowledged effectiveness of problem-focused counselling styles-> surprisingly little examination of the effectiveness

Gomel et al. (1993) risk factors for heart disease study:
- Problem-solving intervention had greatest effect&raquo_space; greater reductions in blood pressure, BMI, smoking than in education only or no intervention groups

Question 16

Why is the implementing plans and intentions (facilitating action) stage of problem-solving approaches to behaviour change considered to be a key element?

Answer 16

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

Question 17

Describe the modelling and behavioural practice approaches to individual behaviour change

Answer 17

Potentially overcome by learning skills or appropriate attitudes from observation of others performing them -> known as vicarious learning

Question 18

What is the optimal learning condition in modelling change?

Answer 18

Optimal learning and increases in self-efficacy can generally be achieved through observation of people similar to the learner succeeding in relevant tasks

Question 19

What does the practice of a new behaviour provide in modelling change?

Answer 19

Actual practice of a new behaviour provide solutions to problems and skills needed to achieve change taught through the educational program -> increase skills and self-efficacy

Question 20

Explain the research relevant to modelling change inn reducing certain behaviours

Answer 20

Sanderson and Yopuk (2007) - intervention video
- stronger intentions to engage in protected sex, higher self-efficacy and higher levels of condom use

Kelly et al (1994) -> reducing risky sexual behaviours

• Included risk education, training in condom use
• More effective than standard education-based intervention in improving rates of condom use

Question 21

Why is problem-focused and planning strategies to behavioural change sometimes not effective?

Answer 21

Problem-focused and planning strategies can help- BUT achieving change can still be difficult

• Particularly where an 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

Question 22

Why are mass media campaigns commonly used as a population approach to behaviour change?

Answer 22

They are used to raise awareness of health issues rather than change behaviour

Question 23

What are the population approaches to behaviour change?

Answer 23

Print advertising, TV ads, etc potential to reach thousands of people; however do not have a significant impact on health behaviour

It is appropriate to use of fear messages, information framing and specific targeting of interventions

Question 24

What type of exposure is mass media campaigns?

Answer 24

Exposure generally passive - resulting from incidental, routine use of media

Question 25

What has Wakefield et al., (2010) found as the benefits of mass media campaigns?

Answer 25

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

Question 26

What are some challenges facing mass media campaigns?

Answer 26

• Campaign messages fall short or backfire
• Exposure of the target audience may be suboptimal
• Inadequate funding
• Inappropriate or poorly researched format
• a single message that is not tapping into the group you want to change
• Might address behaviours that audience lack the resources to change

Question 27

What tendencies do advertising campaigns have?

Answer 27

The tendency to consider advertising campaigns as successful purely based on awareness and attitudes is hugely problematic

Question 28

Are mass media campaigns successful based on research from RTA marketing?

Answer 28

Good reach - effective message and recognised the campaign

Speeding - no one thinks big of you campaign
- P plater deaths fell by 45% and high-risk speeding infringements

Question 29

Is a single intervention effective in decreasing behaviours?

Answer 29

Also very difficult to attribute decreases in behaviours to single intervention alone and often part of a much larger, coordinated, multifaceted effort

Question 30

What did Wakefield’s (2010) review of mass media campaigns reveal about smoking?

Answer 30

Controlled field experiments/population studies show mass media campaigns associated with:

• Decline in young people starting smoking
• Increase in the 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

Question 31

What did Wakefield’s (2010) meta-analysis conclude regarding increasing the success of mass media campaigns?

Answer 31

Likelihood of success increased by the application of multiple interventions, target behaviour being one-off or episodic (e.g. screening, vaccination) rather than habitual or ongoing (e.g. health food choices, physical activity), availability of/access to key services and products and creation of policies that support opportunities for change

Question 32

How should health behaviour change interventions be evaluated? (Based on House of Lords Science and Tech Committee report)

Answer 32

• 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

Question 33

What are the three methods to maximise the effectiveness of mass media campaigns?

Answer 33

1. Appropriate use of fear messages
2. Information framing
3. Specific targeting of interventions

Question 34

Are single media campaigns effective?

Answer 34

Despite the potentially limited effect of single media campaigns remained an attractive and frequently used means of influence&raquo_space; reach large numbers of people with relative ease

Question 35

Describe the appropriate use of fear messages to increase the effectiveness of mass media campaigns

Answer 35

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

Question 36

Which method to maximise the effectiveness of mass media campaigns the most popular?

Answer 36

Appropriate use of fear messages

Question 37

Where high levels of threat effective in behavioural change in the appropriate use of fear messages method?

Answer 37

High levels of threat proven relatively ineffective engendering behaviour change e.g. fear-arousal campaigns for HIV/Aids
- HIV increased anxiety but did not increase knowledge

Question 38

What needs to happen for danger control to be selected?

Answer 38

• Person needs to consider than effective response is available (response efficacy)
• They are capable of engaging in the response (self-efficacy)
• Otherwise, fear control will become the dominant coping strategy

Question 39

What did Witte argue as that persuasive messages must possess in the appropriate use of fear messages method?

Answer 39

Arouse fear - e.g. unsafe sex increases your risk of getting HIV

Increase the sense of severity if no change is made - e.g. HIV is a serious condition

Emphasise the ability of the individual to prevent the feared outcome (efficacy) e.g. here’s how you engage in safer sex practices

Question 40

What happens if the ability of the individual to prevent the feared outcome is not emphasised?

Answer 40

Any fear messages may actually inhibit behavioural change

• Such messages may increase resistance to the message
• Lead to denial that it applies to the individual
• Increase engagement in the targeted risk behaviour

Question 41

What do health messages frequently emphasize?

Answer 41

Health messages frequently emphasize vulnerability and severity and neglect efficacy

Question 42

Describe the ways information framing can be used to increase the effectiveness of mass media campaigns

Answer 42

Health messages can be framed in either positive (stressing positive outcomes associated with action) or negative terms (emphasizing negative outcomes associated with failure to act)

Question 43

What are the effects of positive/negative framing from the information framing method?

Answer 43

Negative frame more memorable, positive may enhance information processing

Question 44

What are the results of the studies relevant to the information framing method?

Answer 44

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 the public launch

Question 45

Describe the specific targeting of interventions method

Answer 45

Mass media campaigns may dilute the message -> it is more effective to target your audience. They can be targeted on several factors:
- Behaviour, age, gender, socio-economic status, sexuality, psychological factors such as motivation to consider a change

Question 46

Explain the environmental influences on healthy behaviour

Answer 46

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

Question 47

What should enviroment encouraging healthy behaviour do?

Answer 47

• Provide cues to action
• Or remove cues to unhealthy behaviours
• Enable health behaviours by minimizing the costs and barriers associated with them
• Increase the costs of engaging in health-damaging behaviours