4 - Health Behaviour Change Flashcards
Causes of death now
- disease with a behavioural contribution (e.g. cancer, circulatory disease, respiratory disease) are now the major causes of death.
What is the number one cause of preventable illness and death?
smoking
smoking stats
About half of all persistent cigarette smokers are killed by their habit—a quarter while still in middle age (35-69 years).
Smoking is the number one cause of preventable illness and death.
On average, cigarette smokers die about 10 years younger than non-smokers.
Current prevalence of 19% in UK adults (45% in mid 70s)
-66.4% of men and 57.5% of women in England are overweight
5 modern day killers
- dietary excess
- alcohol consumption
- lack of exercise
- smoking
- unsafe sexual behaviour
Tackling disease = changing behaviour
What is important in terms od tackling disease?
Tackling disease = changing behaviour
Health Behavior
“Any activity undertaken by an individual believing himself to be healthy, for the purpose of preventing disease or detecting it at an asymptomatic stage”
Kasl & Cobb (1966)
The Alameda Stedy
- 6,928 residents of Alameda county, CA, completed a list of 7 health behaviours they practised regularly- not smoking, eating breakfast, not snacking, regular exercise, getting 7-8 hrs sleep, moderate alcohol, moderate weight.
- At 10 year follow-up the mortality rate in individuals who practised all seven behaviours was less than 1/4 of that in individuals who practised three or less.
How can we help people to adopt health behaviours?
- Population level intervention (social media campaigns, television)
- Community level (e.g. cardiac rehabilitation, e.g. working with a culturally diverse group)
- Individual level
Motivational interviewing
- a type of questioning method that…
Smoking Education in Schools Nutbeam et al (1993)
- A programme of education about the effects of smoking was conducted in 39 comprehensive schools in England & Wales; it had a goal to reduce smoking behaviour.
- The programme involved specially trained teachers providing teaching sessions spread over a 3 month period
- Outcomes: a self report questionnaire combined with a saliva test before teaching, immediately afterwards and at 1 year follow-up
-> knowledge is not necessarily enough;
The role of education
- Information does have an important role and is most effective for discrete behaviours (eg getting a child vaccinated)
- Messages tailored to a particular audience are more effective (eg complete abstinence Vs condom use to reduce teenage pregnancy)
- But often people need more than knowledge to change habitual lifestyle behaviours, particularly addictive behaviours (eg social & psychological support, skills to change)
Learning Theory and Health Behaviour
Visual (eg. fast food signs, sweets at checkout)
Auditory (eg. ice cream bell)
Olfactory (eg. smell of baking bread)
Location (eg. the couch or car)
Time (eg. evening)/ Events (eg. end of TV programme ) Emotional (eg. bored, stressed, sad, happy).
Reinforcement Contingencies and health behaviour
Positive reinforcement:
- Dopamine (feel good), filling an empty void/boredom.
- Praise for preparing a high-fat meal for the family.
Negative Reinforcement:
- Avoid painful emotions by comfort eating.
Punishment:
- Preparing a low fat meal is criticised
Limited/delayed positive reinforcement for healthy eating:
- Efforts at dietary change/weight loss go unnoticed by others; Avoiding future health problems is too remote.
Food is often a source of numbing, we use it ti disturb ourselves.
Behaviour modification techniques
Stimulus control techniques:
•Keep ‘danger’ foods out of the house
•Avoid keeping biscuits in the same cupboard as tea & coffee •Eat only at the dining table
•Use small plates
•Do not watch TV at the same time as eating.
Counter conditioning:
•Identify ‘high-risk’ situations/cues (eg stress) and ‘healthier’ responses:
–Eg Can you think of something other than eating that makes you feel better? Maybe something relaxing or exercise?
Examples of contingency management:
Involve significant others to praise healthy eating choices Plan specific rewards for successful weight loss
Vouchers for adherence to healthy eating & weight loss.
Naturally occurring reinforcers:
Improved self-esteem (positive reinforcement).
Reduction in symptoms of breathlessness (negative reinforcement).
Positive reinforcement intervention
- Kegels et al (1978)
Positive reinforcement intervention
Kegels et al (1978)
Children given a talk on dental hygiene and then received one of three types of follow up:
- No further input
- Discussion session
- Reward for compliance with mouthwash programme
Outcome: Compliance with the mouthwash programme assessed over 20 weeks.
Evidence for using incentives to change health behaviour (Marteau, 2014)
Five year review – incentives used in smoking cessation schemes were most effective those aimed at weight loss were the least effective.
E.g. Successful scheme in Dundee offered cash to expectant mothers for giving up smoking - over 90% of the 52 participants quit throughout pregnancy and for 3 months after.
Limitations of reinforcement programmes
- Lack of generalization (only affects behaviour regarding the specific trait that is being rewarded).
- Poor maintenance (rapid extinction of the desired behaviour once the reinforcer disappears)
- Impractical and expensive.
Does fear arousal work?
- Janis & Fesbach (1953)
- 50 high school students given one of three different lectures on dental health.
- Lectures designed to induce low, moderate or high fear.
- Effect on subsequent dental hygiene behaviour was measured with self-report questionnaires one week later.
- worst response with high fear group. If information is too intense people turn off/
- low arousal was most effective to induce change behaviour.
Peer Influences on Adolescent Smoking (Kobus, 2003)
Adolescents are particularly susceptible to social influences given their developmental stage and the importance of school and peer groups.
Substantial peer group homogeneity with respect to adolescent smoking.
Best friends have the greatest influence on adolescent smoking, followed by peer groups.
The Waterloo Smoking Prevention Project (Flay et al 1983)
- High school students allocated to a smoking prevention or control condition.
- The programme consisted of 6 sessions including rehearsing skills to build confidence in ability to resist peer pressure to smoke.
- Significant effect in reducing number of children starting smoking, especially amongst those with family members who smoked.
Expectancy-value principle
The potential for a behaviour to occur in any specific situation is a function of the expectancy that the behaviour will lead to a particular outcome and the value of that outcome”
Rotter (1954)
Health Beliefs Model
- the likelihood of behaviour change is significantly influenced by perceived threat which in itself is perceived susceptibility and perceived seriousness.
Decision to get a flu vaccine - health beliefs model
- 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/barriers - “The injection will be painful and it might make me ill for a while”
- Cues – Doctor strongly advises to have it.
Smoking Cessation using the HBM
• Explore Cues to Action:
Has anything made you think about giving up smoking? • Explore perceived susceptibility and severity:
How do you think smoking is affecting your health? What would it be like if you got it (eg lung cancer)?
• Explore perceived benefits and barriers:
What are the pros and cons of smoking for you?
Is there anything stopping you from quitting?
Efficacy Beliefs
• Outcome efficacy - Individuals expectation that the behaviour will lead to a particular outcome
• Self Efficacy - Belief that one can execute the behaviour required to produce the outcome
- confidence and competence in ourselves to be able to make a difference health behaviour.
- Bandura (1977)
Factors influencing self-efficacy
- Mastery experience
- Social learning
- Verbal persuasion or encouragement
- Physiological arousal
Bandura, 1997
The Theory of Planned Behaviour
- Ajzen 1991
- Beliefs about outcome, Evaluation of outcome -> attitude towards behaviour
- Beliefs about important others’ attitudes towards the behaviour -> subjective norm
- Internal control factors, External control factors -> perceived Behavioral control
➡️ intention ➡️ behavior
Smoking Cessation using the TPB
Explore attitudes towards smoking:
What do you think about smoking?
Is smoking a good or bad thing for you?
Explore the norms of important people around her:
What do your friends/family think about you smoking? Would you like to quit for [person]?
Explore whether she intends to quit smoking:
Have you ever thought about quitting? Do you intend to quit in
the next few months?
Explore how much control she thinks she has:
Do you think you can quit? What makes you think that you can’t?
Transtheoretical (Stages of Change) Model
- pre-contemplation
- contemplation
- preparation
- action
- maintenance
- either permanent exit from cycle or relapse and restart of the cycle.
COM-B: The Behaviour Change Wheel
- look at slide
