behaviour modification for CV 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, cognitive factors

Question 2

what is the IMB model?

Answer 2

• simplest summary of 3 key elements needed for behaviour change (information, motivation, behavioural skills)
• components may be multifaceted

Question 3

what are the components of health promotion?

Answer 3

• information/knowledge
• beliefs
• motivation and persistence
• skills
• plans
• opportunities
• habits (healthy and unhealthy)
• feedback and rewards
• support
• environmental context

Question 4

what are the 3 factors that facilitate healthier choices?

Answer 4

• smack
• shove
• nudge

Question 5

what are smack, shove and nudge?

Answer 5

• smack: eliminate choice (legislation)
• shove: restrict choice (eg: sugar tax)
• nudge: guide and enable healthier choices (effective way to change diet)

Question 6

what are the 3 individual cognitive factors?

Answer 6

• contemplation and planning
• action and maintenance
• multi component interventions

Question 7

what is contemplation and planning in terms of cognitive factors?

Answer 7

• identify important cognitive and affective factors
• develop required skills for imitation and maintenance
• information/knowledge
• perceived susceptibility
• perceived severity
• perceived benefits
• perceived barriers and actual barriers
• attitudes
• normative beliefs - descriptive/injunctive
• self-efficacy
• motivation and maintaining motivation
• behavioural skills

Question 8

what is action and maintenance in terms of cognitive factors?

Answer 8

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

Question 9

what are multi-component interventions in terms of cognitive factors?

Answer 9

• one-to-one
• group interventions
• pharmacotherapy
• provide: information, motivation, skill development, peer support

Question 10

what did the NHS smoking cessation show?

Answer 10

• effective for supporting smokers to quit in the short and longer-term
• group intervention may be more effective than 1:1
• buddy systems may increase effectiveness of 1:1
• intensity of intervention appears to be integral to efficacy

Question 11

what is relapse and recovery?

Answer 11

• relapse is very common among smokers who make a quit attempt
• systemic review of relapse prevention programs found support for programs overall, but little evidence to support the use of any specific behavioural interventions
• evidence is strongest for interventions focused on identifying and managing tempting situations and strategies
• combining behaviour therapy and nicotine replacement may be most effective

Question 12

what symptoms are more likely in people diagnosed with CVD?

Answer 12

• depression
• anxiety
• PTSD

Question 13

when is psychological distress in patients more likely?

Answer 13

• perceive more serious consequence of CVD
• have less coherent understanding of their condition
• have stronger initial emotion response to MI or stroke

Question 14

what does poorer psychological well-being predict?

Answer 14

• poorer adherence to medication or behaviour change

- poorer prognosis

Question 15

when are patients more likely to attend rehab?

Answer 15

• less chest pain or other symptoms
• less understanding of condition
• less belief that their condition is controllable
• lower income
• living alone
• perceive health professionals to downplay important of exercise
• believe medication is more important for promoting health

Question 16

what is the aim of rehab?

Answer 16

• plan to minimise the risk of relapse
• note that relapse is common: plan how to manage triggers/temptations, plan alternative responses
• important of managing relapse: framing of relapse, learning from relapse

Question 17

what can cardiac rehabilitation involve?

Answer 17

• health promotion/health education
• behaviour change
• stress management
• psychotherapy for depression/anxiety
• support groups
• choices should be tailored to needs and preferences of patients

Question 18

to be ready for SMART goals what does the patient need to believe?

Answer 18

• their current behaviour is bad for them
• they will be better off if they change
• they have a good chance of succeeding if they try to change

Question 19

what does SMART stand for?

Answer 19

Specific
Measurable
Achievable
Relevant
Time-limited

Question 20

what is motivational interviewing

Answer 20

a 1:1 approach that helps people:

• overcome ambivalence about behaviour change
• enhance commitment to change
• enhance motivation to change
• address barriers to change

Question 21

what do patient centred interventions do in asthma?

Answer 21

• educate and develop skills: monitoring lung function and triggers
• develop action plan
• modify unhelpful illness beliefs
• less hospitalisation or other use of healthcare
• less school/work absenteeism

Question 22

why are patient centred interventions good?

Answer 22

• can be delivered in various ways
• useful for people who find it difficult to engage face to face
• effective and cost effective