adherencepart2 Flashcards
• Behaviors undertaken by people to enhance or
maintain their health.firmly est and performed automatically
health behaviors
– Single set of factors to explain adherence for
everyone
Continuum (broad category of theory of adherence)
-diff factors ar eimportant depending on what stage a person is in
stage (2nd category of theory)
– The degree to which the person perceives a personal health threat • Perceived susceptibility • Perceived severity – The perception that a particular behavior will effectively reduce the threat • Perceived benefits • Perceived barriers
whether or not a person practices a health behavior depends on these [Health belief model]
theory that People will adhere to behaviors if they:
1. believe they can initiate and carry out this behavior
(self-efficacy)
2. believe that the behavior will produce valuable
outcomes (outcome expectations)
self efficacy theory
theory of planned behavior:
-link health attitudes directly to behavior
-a health behavior is direct result of a behavior intention
behavioral intentions made up of attitude toward action, subjective norms, and perceived behavioral control
why models arent as good at predicting health behaviors?
- ppl distort msgs (unrealistic optimism)
- diff models needed to explain behaviors to diff diseases/behav
- other factors(public policies, poor health habits, relationships)
- methodolocigal limitations in measurement
- may instil motivation to change but doesnt provides steps/skills to make change
theory of planned behavior:
• Moderate ability to predict health behaviors such
as mammogram use, condom use, physical
activity, illicit drug use, and binge drinking
alcohol
• Past behavior is a better predictor than these
models (e.g., adherence)
• Not a huge improvement over the Health Belief Model
How well do these models predict
health behaviors?
• If the models include self-efficacy, they can
predict perceived behavioral control, subjective
norms, attitudes, and intentions
• Attitudinal approaches don’t explain long-term
behavior change very well
• Don’t explain spontaneous behavior change
• Communications can provoke irrational,
defensive reactions
cognitive-behavioral approaches
- focus to target behavior
- self observation/monitoring
- classical conditioning (pair ucr with cs to produce cr)
stimulus control
Understand antecedents
– Discriminative stimulus signals positive
reinforcement
– Stimulus-control interventions
• Rid environment of discriminative stimuli
• Create new discriminative stimuli for a new
response
• Behavioral Theory: Operant conditioning
– Pairs a voluntary behavior with systematic
consequences
– Key is reinforcement
– Behavior → positive reinforcement or withdraw
punishment → ↑behavior
– Behavior → withdraw reinforcement or punishment→
↓behavior
– Reinforcement schedule (continuous vs. intermittent)
– Often used to modify health behaviors
– Start with continuous & then make it harder
(progressive)
- Positive reinforcement (adds a desired factor)
* Negative reinforcement (removes an aversive factor)
reinforcement
- Positive punishment (adds an unpleasant stimulus)
- Negative punishment (removes a pleasant stimulus)
- Positive works somewhat better than negative
- Works better if coupled with reinforcement techniques
punishment
covert self control
Recognizing internal monologues – Cognitive restructuring: modifying internal monologues – Self-talk: adaptive ways to talk to oneself in stressful situations
behavioral assignments
– Client becomes involved in treatment
– Client analyzes behavior to plan intervention
– Client is committed by contractual agreement
– Client assumes responsibility for behavior change
– Homework increases client’s self-control
Goals
– Reduce social anxiety
– Introduce new skills for dealing with anxiety-provoking
situations
– Provide alternative behavior for poor health habit
associated with social anxiety
Skills Training
– Social skills
– Assertiveness
motivational interviewing
– Interviewer is non-judgmental and encouraging
– Client talks as much as counselor
– Goal: get client to think through reasons for and against
change
– Mixture of techniques from psychotherapy & behavior
change theory
– Works well for those who are wary about change
• Broad-spectrum cognitive-behavior therapy
– Combine multiple behavior change techniques
– Tailored to individual
– Don’t overload
– Most effective
• Relaxation training
– Deep breathing
– Progressive muscle relaxation
More likely when people are depressed, anxious,
under stress
– Particular problem with addictive disorders of
alcoholism, smoking, drug addiction, obesity
(rates between 50% and 90%)
– Abstinence violation effect – feeling loss of control
with one lapse in vigilance
relapse
transtheoretical model stages
- precontemplation
- contemplation
- preparation
- acton
- maintenance
– In this stage, the person is not aware of a problem
– Family and friends may be aware and push for
treatment
– The individual often reverts to old behaviors if
treatment does occur
stage 1) precontemplation
– Aware that a problem exists – No commitment to take action – Weighing the pros and cons of action – If a decision for change is made, then there are favorable expectations
stage2) contemplation
– Intention to change behavior has been made
– May not have begun to change behavior or may have
modified the target behavior somewhat
• smoking fewer cigarettes each day
stage3) preparation
– Commitment of time and energy
– Stopping the behavior
– Modifying lifestyle and environment to get rid of cues
associated with the behavior
stage 4) action
– Works toward preventing relapse
– Consolidating gains that have been made
– Has been free of the addictive behavior for more than
6 months
– Relapse may occur, causes the cycle to repeat before
the behavior is successfully eliminated
– Conceptualized as a spiral
stage5) maintenance
importance of transtheoretical model:
Captures the process that people actually go through • Illustrates that change – Doesn’t happen all at once – May not occur on the first try • Explains why many interventions aren’t successful – People are not in the “action” phase
The Precaution Adoption Process
Model (PAPM)
• 7 Stages
• Each stage represents a qualitatively different
pattern of experience, beliefs, and behaviors
• The transitions between stages are predicted
by different factors that depend on the stage
- unaware of issue
- unengaged by issue
- deciding about acting/not to act
- decided to act
- acting
- maintenance
precaution adoption process model stages (weinstein and sandman)
• Combines continuum and stage theories
• Two general stages:
– Motivational Phase - includes outcome expectations,
risk perceptions, self-efficacy, and intention
– Volitional Phase - includes planning and action
Health action process approach (schwarzer)
• Some health behavior theories suggest that
people’s intentions are predictive of people’s
behaviors
– However, research has shown that people often
intend to behave in one way but do not
intention-behavior gap
-ppl may intend to behave in one way but forget about their intentions in the moment
- a person’s motivation at a given moment to engage in a risky behavior
– Teens especially may be prone to engage in risky
behaviors due to their social image
behavioral willingness
• Planning is an important factor for translating
intention into behavior
– _____ _____ are specific plans that
people make that identify what, where, when, and
how they intend to engage in a behavior
• May help people’s pursuit of their goals become more automatic
• May help people be less likely to forget their intentions
implementation intentions
Behavioral Strategies to Improve
Adherence
• Prompts
– Reminders to initiate health-enhancing behaviors
• Tailoring the regimen
– Fit the treatment to habits and routines in daily life
• Pill organizers, simplify dosage regimen, match to stage of change
– Motivational interviewing
• Graduated regimen implementation
– Shaping of desired behavior like exercise, diet, smoking
cessation, etc.
• Contingency contract
