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Behavioural Science > 4. Behaviour Change > Flashcards

4. Behaviour Change Flashcards

1
Q

What behaviours interest dentists?

A
  • cleaning teeth
  • diet
  • smoking
  • general health
  • self-management
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2
Q

What is the assumed model of communication?

A
  • accurate info about the risk/impact of behaviour and benefit of change
  • understanding
  • appropriate behaviour change
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3
Q

Behaviour change messages in dentistry

A
  • limit sugar intake and restrict it to mealtimes if possible. Too much sugar causes tooth decay and other health problems
  • brush your teeth twice a day for 2 minutes with fluoride toothpaste
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4
Q

Self Efficacy Theory - Bandura

A
  • a change in behaviour is predicted by confidence a person has that they can carry out behaviour
  • so experience of doing it, observation of others carrying out behaviour, persuasion and feeling good/calm after behaviour leads to self-efficacy judgement then the behaviour or performance
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5
Q

Theory of Planned Behaviour - Ajzen

A
  • people have behavioural and control beliefs which interact with each other and normative beliefs
  • this affects attitude, subjective norms and perceived behaviour control
  • changes intention and the behaviour
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6
Q

Behaviour change requires …

A
  • intention to change
  • importance and confidence
  • ability to translate this intention to new behaviours
  • knowledge of what to do, plan how to do it
  • tailored to individuals needs
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7
Q

What is the intention-behaviour gap?

A
  • phases of behaviour change
  • motivational phase - leads to intention
  • volitional phase - leads to initiation and maintenance of new behaviour
  • this last phase affected by maintenance self-efficacy, action planning and action control (self-monitoring)
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8
Q

Implementation Intention Theory - Gollwitzer

A
  • likelihood of a person performing behaviour is increased by making explicit action plan about where and when the behaviour will happen
  • action plans function as cues that remind a person to perform behaviour
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9
Q

Explain a MAP for behaviour change

A
  • motivation, action and prompt
  • careful communication is essential for individual, patient-centred conversations about each element
  • made by Dixon, Diane and Marie Johnston
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10
Q

Role of motivation in behaviour change

A
  • how important it is to the person to change
  • if a number of changes are to be made, which would they prioritise?
  • do benefits of continuing behaviour outweigh the benefits?
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11
Q

Tips from Motivational Interviewing - Rollnick

A
  • practice guiding rather than directing style
  • develop strategies to elicit patient’s own motivation to change
  • refine listening skills and respond to encouraging change talk from patient
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12
Q

Stages of Change Model or Transtheoretical Model of Change

A
  • Prochaska and DiClemente in field of addictions
  • different interventions for people at different cycle points
  • pre-contemplation, contemplation, planning, action, maintenance (this is where relapse can happen and cycle begins again)
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13
Q

Questions which must be asked at the action stage of Stages of Change model?

A
  • does person feel confident and ready?
  • what precise steps will need to be taken? is it better to do it all at once or in small steps?
  • do they need to develop new skills to help make change?
  • are there barriers to change? (affordable, fit with routine, social circumstance)
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14
Q

Patients should set … goals, which are …

A

SMART
- specific, measurable, achievable, relevant, timed

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15
Q

Explain prompts for behaviour change

A
  • reminder to carry out behaviour
  • planned in advance when and where
  • physical reminders like sticky dots or elastic bands
  • linked to other activities like meals or washing hands
  • electronic reminders
  • can be sorted at appointments
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16
Q

Use of motivational interviewing in oral health

A
  • systematic review in 2014
  • 16 studies found using it
  • in 7, assessing impact of MI on periodontal health, 5 reported improvement in MI group compared to control. remaining 2 had no diff
  • in 4 studies assessing impact of MI on development of oral cavities, young children reported significant improvement. Improvements in severity of cavities and toothbrushing
17
Q

The best evidence suggests how should dentists influence oral health?

A
  • chair side oral hygeine about method and timing of toothbrushing
  • provide or reccomend use of powered toothbrush with rotation oscillation action
  • provide instruction on use of toothbrush
18
Q

What 2 psychological theories is brief intervention based on?

A
  • self-efficacy theory
  • implementation intention theory
19
Q

NICE guidelines for behaviour change

A
  • having considered commonly used models of health behaviour, the PDG concluded evidence did not support one model
  • training should focus on generic competencies and skills rather than specific models
  • practitioners should design valid/reliable interventions and programmes that take accoutn of social, environmental, economic context of behaviours
  • identify and use clear and appropriate outcome measures to assess changes in behaviour
  • employ a range of behaviour change methods and approaches, according to best available evidence
20
Q

Explain using an implentation plan

A
  • university students given dental floss and advised of recommendation to floss for 5 minutes daily
  • filled in online questionnaires
  • one group asked to make plan for when they were going to floss. took around a minute
  • planning group reported more flossing and used more floss than control group
21
Q

Explain COM-B model

A
  • psychological models provide a structured theoretical framework
  • behaviour affects capability, motivation, opportunity and vice versa
  • we use this framework to assess potential needs of individuals or communities
  • plan interventions designed to address needs
  • evaluate and learn from results of intervention
22
Q

Phase 1 of designing intervention

A
  • define problem in behavioural terms
  • what behaviours need to change to resolve problem - by who? where?
  • define one or two target behaviours (things that are easy to change, large impact if changed behaviours)
  • specify target behaviour in as much detail as possible (who needs to do it? what, when, how often etc?)
  • identify what needs to change (in environment, attitude, skills)
23
Q

What’s the behaviour change wheel?

A
  • capability - ability to enact the behaviour (psychological and physical)
  • motivation (reflective and automatic)
  • opportunity (physical and social environment)
24
Q

Example of a behaviour wheel for…
Encouraging parents of young children to support toothbrushing at home

A
  • capability psychological - might not have skills to maintain routine when busy and physical - might not have co-ordination
  • motivation reflective - might not think it’s important and automatic - might trigger stress
  • opportunity physical and social env - family may not agree it’s imp to brush teeth
25
Q

Phase 2 of designing an intervention

A
  • identify intervention functions e.g education, persuasion, restriction, training, coercion
  • identify policy categories - what policies would support delivery of intervention
  • consider full range of intervention functions
26
Q

Phase 3 of designing an intervention

A
  • identify exactly what you are going to do
  • how to do it
  • psychological theory behind it
  • how you’ll evaluate it to see if intervention is successful
27
Q

How would phase 1,2,3 of an intervention look for improving exercise in obese adults ?

A
  • they think they can’t do it - self efficacy and implementation intention
  • they are worried they look stupid - subjective norm theory of planned behaviour
  • use training (ps provided structured exercise plan tailored to level of fitness) or environmental restructuring (closed gym sessions arranged for ps with obesity)
  • modelling (link to above theories) - ps have access to video clips of people similar to them completing structured exercise and ps have access to community forum to share experiences and ideas with similar people
28
Q

How to evaluate behaviour change?

A
  • what info do you need?
  • how do you know the change was as a result of the intervention?
  • need to comment on what could have been better
29
Q

Compare arguing for change and having a conversation

A
  • arguing can trigger patient to voice other side of argument, most will have heard it before and can feel unproductive to both patient and clinician
  • conversing gives opinions both sides, behaviour more likely to be influenced by what they say than clinician and impact of reflecting ambivalence (roll with resistance)
30
Q

Explain simple reflection

A
  • repeat back what the person has said
  • can be a direct repetition of the last few words accompanied by appropriate nonverbal signs
  • slight rewording
  • demonstrates you are listening and hearing what they say
31
Q

Explain summary reflection

A
  • paraphrases last few sentences the person has said
  • gives opportunity for them to agree and see you’ve paid attention or to correct things you haven’t fully understood
32
Q

How can scaling questions work?

A
  • on a scale of 0 to 10
  • how important is the change
  • why did you choose this number
  • what would increase your chance to a higher number
  • what can we do to make it more likely
33
Q

Explain ‘rolling with resistance’

A
  • uses person centred skills for good active listening (reflections, clarifications, summaries)
  • based on observation that people have usually rehearsed both sides of an argument (will respond with the one they aren’t given)
  • doesn’t try to persuade or direct patients
  • acknowledges change may not be a priority right now
  • maintains a sense that professional is listening but maintains a good relationship for further future conversation

Behavioural Science (4 decks)

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