314 - MT2 Flashcards
cost effectiveness of healthy lifestyles
- occurs through…
less costly than treatment of disease
- occurs through indiv efforts, interaction (env shapes behav) w medical syst, mass media and legislation
Health enhancing vs health compromising behaviours
Health enhancing: exercise, eating healthy, sleep»_space; promote health
Health compromising; excessive drinking, smoking, drug use, unsafe sex, risk-taking behaviours»_space; undermine or harm current/future health
health and behaviour factors
- disease pattern change?
- deaths
- most preventable cause of death
- patterns of disease in North America have changed from acute infectious disorders to “preventable” disorders
- half of deaths are caused by preventable behaviours
- obesity/lack of exercise»_space; about to overtake tobacco as most preventable cause of death
obesity
- BMI + risk
- 1994 to 2013 change
- biological links?
- countries involved?
- age/gender
- eating disorders
- overweight if BMI is 25+, obese if body mass index (BMI) is 30 or higher»_space; measure of adult’s weight in relation to height»_space; disease risk increases as BMI increases beyond normal level
- age adjusted prevalence of obesity and diagnosed diabetes among US adults»_space; went from 14% in 1994 to more than 26% in 2013 (very high!)
- correlation is not causation! but there are biological links
- obesity not limited to the US»_space; rates are high in US/Mexico, medium in Canada (nearly 1/3 of CAD are obese!) /European countries, and low in Asian countries
- age also plays a role»_space; mostly 55-64yo are obese compared to other age groups
- more men obese than women
- eating disorders are also prevalent (BMI < 18.5)
health advocates (3)
- want calorie counts on menus (became part of legislation in Ontario, 2017)
- advocate for tax on sugary drinks (did not pass, but normal sales tax was added)
- want to take vending machines away
Health habits (3)
- change?
- how do they happen?
- when are they developed?
- predictors
- attitude/beliefs
- health-related behaviour»_space; firmly established, stable, but can change over time
- often automatic»_space; occurs outside awareness
- often developed in childhood»_space; typically stabilize around age 11-12
- health behaviours are not strongly tied to each other»_space; doing one does not predict doing others
- health behaviours are not governed by single set of attitudes or beliefs
eg. social encouragement: dieting, seat belts
eg. people changing: experience, peer pressure
socialization influences early health habits (3)
- window of vulnerability
- parents: model»_space; brushing teeth, wearing seatbelt
- social institutions: increase physical activity required, encourages healthy snacks at school
- peers
Window of Vulnerability: adolescents may ignore early training
- adolescents are particularly vulnerable (body changes = feeling awk = less exercise)
- poor diet, smoking, alcohol/drug use, risky sexual behaviour, low phys activity
Targeting at risk ppl
- prognosis
- tailoring
- problems (3)
- early identification may benefit prognosis
- knowledge helps monitoring»_space; tailor to high risk ppl
problems:
- most ppl don’t always perceive risk correctly
- most ppl are unrealistically optimistic ( difficult to target those who are at risk because they think it won’t happen to them)
- stress»_space; don’t stress out the ppl ur trying to help by scaring them!
teachable moment
2 examples
certain moments are better than others for teaching particular health practices
eg. emphasize teeth brushing at dentist visit
eg. stopping smoking during pregnancy
percentage of death
- 1960s vs now
- why?
in the 1960s it was mostly (50.6%) CVD»_space; heart disease, stroke»_space; now its mostly cancer (28%)
- result of behaviour risk factor modifications/medial treatment
health behaviour
- well behaviour
- symptom-based behaviour
- sick-role behaviour
- breast cancer health behaviour
- any activity trying to maintain/improve health, regardless of if it works
well behaviour: maintain/improve health or avoid illness
- depends on motivational factors»_space; perception of threat of disease (if you’re not sick you won’t try to be especially healthy»_space; good diet, exercise, etc)
symptom behaviour: ill person tries to determine and fix problem»_space; complaining, seeking help
sick role behaviour: treat illness»_space; adjust lifestyle
- sick ppl have a special “role”»_space; exempt from obligations/tasks»_space; stay home from school/work to recover
breast cancer health behaviour: women ages of 50-69 should get mammogram every 2 years (self/physician check not effective)
Illness prevention
- clean teeth example
- primary, secondary, tertiary prevention
Example: having clean teeth
- behavioural influence (brush teeth)
- environmental measures (put fluoride in the water supply)
- preventative medical efforts (repair cavities)
- primary prevention: actions to avoid disease/injury
- secondary prevention: actions to identify/treat illness or injury»_space; stop/reverse problem
- symptom-based behaviour
eg. physical examinations yearly - tertiary prevention: actions to contain damage done by serious injury/progressed disease»_space; prevent disability/reoccurrence + rehab
problems in promoting wellness
- individual (3)
- interpersonal
- community (+ problems)
Individual: health behaviours are less appealing and less convenient than unhealthy behav
- little incentive to change immediately, especially if healthy
- hard to change habits, need knowledge, planning skills and self-efficacy
- being sick/on drugs affects mood/energy/cog resources/motivation
Interpersonal: social factors»_space; marriage partners adopt each other’s behaviours»_space; family dynamics may get interrupted (eg. they go eat out when you’re on diet)
Community: more likely to do if gov’t/healthcare systems encourage
problems: insufficient funds for research, hard to adjust to diff age/sociocultural backgrounds, lacking safe spaces for exercise, fast food restaurant, health insurance
Reinforcement
+/-
Extinction
results in desirable state of affairs
- positive reinforcement: reward added
- negative reinforcement: bad thing removed
extinction: if consequence of behaviour is eliminated, response tendency is weakened gradually
modeling and antecedents
modeling: learning vicariously (observational learning)
antecedents: internal/external stimuli that precede and set occasion
for behaviour»_space; habits
eg. coffee with cigarette after breakfast
conscientiousness association
dutiful, organized»_space; associated with practicing health behaviours (fitness, healthy diet, taking prescribed meds, etc)
optimistic beliefs
- ppl who partake in health behaviours
- health professionals
- ppl have feelings of invulnerability at all ages
- ppl with health behaviours feel less at risk for health problems»_space; unrealistically optimistic»_space; unlikely to take preventative action
- health professionals implement programs to make ppl see risks realistically
A. Health belief model
- definition
- barrier examples (3)
- perceived threat factors (3)
- sum
- shortcomings (3)
taking preventive action depends on assessment of threat to person and weight pros(benefits to health)/cons (barriers»_space; perceived costs) of taking action
eg. financial, psychological (embarrassing), or physical (distance to doctor’s office too far)
perceived threat factors:
- perceived seriousness (if left untreated)
- perceived susceptibility (likelihood of development)
- cues to action (reminders)
sum = benefits - barriers: extent to which taking action is more beneficial than not
Shortcomings:
- does not take into account habitual health behaviours (eg. brushing teeth)
- no standard way of measuring components
- perceived susceptibility/seriousness
- diff surveys used to measure - assumes that ppl think about risks in a detailed manner
B. Theory of Planned Behaviour
- intention (barriers, env, health goals)
- attitude
- subjective norm
- perceived behavioural control
- support for theory
- shortcomings (4)
ppl decide their intention in advance»_space; intentions are the best predictors of what ppl will do (goals make it much more likely)»_space; linking attitudes and intentions directly to behaviour
intention: do I intend to change my behaviour?»_space; just intention alone may not be enough
- barriers (like time, other business) get in the way
- environmental factors (eg. weather/seasonal effects)
- health goals are especially hard since you have to change complex habitual behaviour
- attitude regarding the behaviour (is it a good thing to do?)
- based on the outcome, and whether it would be rewarding (what will happen if I change my behaviour?) - subjective norm (impact of social pressure/behaviour’s appropriateness»_space; based on other’s opinions (env) and motivation to comply
- perceived behavioural control (self-efficacy)»_space; expectation of success
- judgements combine to form intention»_space; leads to performance
- If you have all 3 it will likely result in the intended behaviour!
support: empirical evidence for ToPB across a broad spectrum of health behaviours: flossing, phys activity, fruit/veg consumption, seat-belt use, and breast self-examination»_space; all based on separate long-term longitudinal studies and clinical trials with N>100 participants
shortcomings:
- intentions and behaviour are not strongly correlated»_space; ppl don’t always do what they claim to decide »_space; intentions can change
- incomplete»_space; does not take experiences with the behaviour into account»_space; more likely to do again if done before
- assumes that ppl think about risks in a detailed manner
- does not account for habitual health behaviours
Theory of planned behaviour
- planning»_space; mental simulation
a) action plans
b) coping plans
planning: the bridge between goals (recommendations»_space; in order to maintain/see it through) and behaviour»_space; key variable in health behaviour
- beyond intention
- a mental simulation commits the indiv to perform a behaviour once the critical situation is encountered
a) action plans: plans regarding the initiation of behaviour (when, where, how structure)»_space; break it down into actionable units
b) coping plans: plans regarding the maintenance of behav in the face of barriers»_space; plan B instead of dropping behaviour
C. Stages of Change Model
- what does it do?
- 5 stages
- importance of timing
readiness to change
- help people advance: describe in detail how to carry out change, plan for problems that may arise»_space; provides a framework for a wide range of potential interactions by health promoters (if they have a negative response, you need to talk to them about their failures/obstacles)
- the model identifies a number of stages which a person can go through during the process of behav change
stages:
- precontemplation: not considering changing»_space; refuse/not thought about it
- motivational enhancement strategies - contemplation: aware that a problem exists»_space; considering changing, not ready
- assessment and treatment matching - preparation: plan to pursue behaviour goal
- action: active efforts to change behav
- maintenance: maintain successful changes
- relapse prevention/management
- important to know where they are at so that you can tailor the message to suit their needs
eg. if theyre already committed you dont want to bore them by trying to convince them
eg. if you try talking about obstacle management but they don’t even know the risks yet, you will miss the opportunity to bring them in
gender and health
- who lives longer?
why?
- hormones (stress, estrogen)
- health compromising behaviours
- work
- consulting
- women tend to live a few years longer than men, but women have higher rates of acute diseases
- physiological reactivity (blood pressure/stress hormones) affect men more
- estrogen delays CVD»_space; reduces cholesterol
- men smoke, drink, do drugs, eat unhealthily, become overweight and partake in risky sexual behaviours more than women
- work env for men is more hazardous»_space; more fatalities
- women more likely to consult a physician
Sociocultural factors and health
- relevance
- social status
- immigrants
- biological factors
- cognitive/linguistic factors
- social and emotional factors
relevant on national and international levels
- social status: lower SES (eg. minority groups) = poorer health habits
- immigrants: adopt health behaviours of new culture (acculturation)
- biological factors: differ in physiological processes/stress reactivity
- cognitive/linguistic factors: diff ideas of illness causes, diff pain perception, language difference impairs ability to communicate
- social and emotional factors: differ in stress experienced (physiological reactivity) and coping; social support differs
Methods for promoting health
- providing info (3)
- features to enhance motivation (4)
- motivational interviewing»_space; decisions
- behavioural/cognitive methods»_space; prevention
Providing info: what to do, when, how, where
- mass media»_space; negative consequences
- internet»_space; websites
- medical settings»_space; Dr office»_space; advantages (once a year, respect for professionals) and disadvantages (tight scheduling, lack of expertise, dr may be intruding on personal life)
Features to enhance motivation:
- use tailored content»_space; specific to indiv
- educational appeals»_space; non-tailored, general info
- fear appeal»_space; motivated by fear to protect health
- message framing»_space; emphasize physical/social consequences , provide instructions
Motivational interviewing: resolve ambivalence in changing behav»_space; decisional balance and personalized feedback
Behavioural and cognitive methods: enhance ppls performance of preventive act»_space; manage antecedents and consequences»_space; enhance self-efficacy