Behaviour modification for cardiovascular and respiratory health

Question 1

what is the biopsychosocial approach

Answer 1

How psychological and social factors are involved in disease processes
Psychological consists of behavioural factors and cognitive factors
eg Cardiovascular (24%) and respiratory (20%) diseases are leading causes of death in UK
Strongly influenced by lifestyle
Can have significant psychosocial impacts

Question 2

what does the biopsychosocial approach involve

Answer 2

lifestyles
psychosocial factors
environments
health services

Question 3

what is the IMB model

Answer 3

Simplest summary of 3 key elements needed for behaviour change
Components may be multifaceted
info > motivation and behavioural skills > behaviour

Question 4

what is the TTM

Answer 4

pre-contemplation > contemplation > preparation > action (relapse) > maintenance

Question 5

what are the components of health promotion

Answer 5

Info/knowledge
Beliefs
Motivation + persistence (to overcome setbacks)

Skills
Plan
Opportunities
Habits (healthy and unhealthy)

Feedback and rewards
Support
Environmental context

Question 6

how can healthier choices be facilitated by smack, shove and nudge

Answer 6

Smacks eliminate choice eg legislation (smoking ban, drinking age limits)
Shoves restrict choice
Eg fat tax, sugar tax, minimum unit pricing
Eg banning take aways near schools
Central government legislation can improve health and health outcomes
Nudges guide and enable healthier choices
Eg change ‘choice architecture’ to make healthy options more visible, easier, cheaper or the default options = effective ways to change diet
Local government action is important to promote and facilitate healthier lifestyles

Question 7

what are individual cognitive factors

Answer 7

Contemplation and planning
Identify important cognitive and affective factors
Develop required skills for initiation and maintenance
Eg info,
perceived susceptibility, severity, benefits, barriers (and actual barriers)
attitudes
normative beliefs – descriptive/injunctive
self-efficacy
motivation (and maintenance)
behavioural skills

Question 8

what are action and maintenance

Answer 8

cues to action (but not just shocking images, boundary conditions and habit)
monitoring progress (rewards to accomplishments, material and psychological
managing relapse
learning from relapse and strengthening skills and motivation

Question 9

what are multi component interventions

Answer 9

one to one, group and pharmacotheraoy
provide info, motivation (initial and ongoing), skill development and peer support
Stoptober is a population level opportunity to change

Question 10

how effective are the NHS smoking cessation programmes

Answer 10

Effective for supporting smokers to quit in short and long term
Group interventions may be more effective than 1:1 interventions
Buddy systems may increase effectiveness of 1:1 interventions
Intensity oof intervention appears to be integral to efficacy

Question 11

what is relapse and recovery like for smokers

Answer 11

Relapse common among smokers who attempt to quit
Evidence strongest for interventions focused on identifying and managing behaviour therapy and strategies
Combing behaviour therapy and nicotine replacement may be most effective

Question 12

what is psychosocial impact of CVD

Answer 12

Symptoms of depression, anxiety, PTSD distress more likely in those diagnosed with CVD
Psychosocial distress is more likely among people who
Perceive more serious consequences of CVD
Less coherent understanding of their condition
Have stronger initial emotional response to MI or stroke

Question 13

what did interview based studies find out about the psychosocial impact of CVD

Answer 13

Synthesis of interview based studies revealed that patient finds experience a big change to an unfamiliar identity
They had to find new limits as they sought to achieve a new normal in a lifestyle that was also worth living
Poorer psychological wellbeing predicts
Poorer adherence to medication or behaviour change
Poorer prognosis

Question 14

how can psychosocial interventions benefit CVD

Answer 14

alleviate stress (and lead to better outcomes)
Cultivating resilience and adaptive responses to stressful situations has been identified as a important part of secondary prevention
Eg group intervention focused on knowledge, coping skills, stress management, counteracting anxiety and depression, relaxation techniques and improving social relations and social support 
Reduce likelihood of premature death by 1/3 over a 7 year follow up

Question 15

Lifestyle and behavioural impact of CVD

Answer 15

Cardiac rehabilitation is effective and cost effective

Reduce overall mortality and cardiac mortality

Question 16

Patients less likely to attend rehabilitation if:

Answer 16

Less chest pain or other symptoms
Less understanding of their condition
Less belief that their condition is controllable
Lower income
Living alone
Perceive health professionals to downplay importance of exercise
Believe mediation more important for health
Around ½ drop out of rehab programs

Question 17

how long are lifestyle changes maintained for

Answer 17

65% change to healthier diet but only ½ maintain after a year
60% smokers quit (but only around half stay for a year)

Question 18

how can risk of relapse be minimised

Answer 18

Plan to minimise risk of relapse
Note that its common
Plan how to manage triggers or temptations
Plan alternative responses

Importance of managing relapse (framing of it and learning from it)

Question 19

What can cardiac rehab involve

Answer 19

Health promo/education
Behaviour change (exercise, smoking, diet)
Stress management
Psychotherapy for depression or anxiety
Support groups

Question 20

what are SMART goals

Answer 20

Specific
Measurable 
Achievable 
Relevant/realistic
Time Limited 

For person who needs to believe that their current behaviour is bad for them, better off if they change or have a good chance of succeeding if they try

Question 21

what is motivational interviewing

Answer 21

1:1 approach

Helps to overcome ambivalence, enhance commitment and motivation to change, address barriers to change

Question 22

Facilitating self-monitoring and behaviour change in asthma

Answer 22

Patient centred interventions
Education and skills development – monitoring lung func and triggers
Developing action plans
Modifying unhelpful illness beliefs (eg lack of control)
Less hospitalisation and use of health care and less school/work absences

Question 23

an example of Interventions being delivered in various ways

Answer 23

Eg tailored text messages that can address illness perceptions and treatment perceptions to boost medication adherence (useful for those who find it hard to engage in face to face and effective and cost effective)