Behaviour Strategies Flashcards
___ Canadians are living with more than one chronic illness
1/5
Give four reasons for the increase of chronic diseases in Canadians
- People are living longer
- Earlier detection due to technology
- Nutrition Transition
- Less access to GPs, rural areas
Define health risk behaviours
Unhealthy behaviours capable of change
What are the four health risk behaviours which are related to chronic conditions?
- Lack of exercise
- Poor nutrition
- Tobacco use
- Excessive drinking
What causes a significant proportion of mortality from the leading causes of death?
Behaviour of individuals, which is modifiable and a key component in the management of most health conditions.
Define health behaviour change
Any activity undertaken for the purpose of preventing or detecting disease or for improving health and well-being
Give 3 example of health-behaviours
1) Medical service usage
2) Compliance with medical regimens
3) Self-directed health behaviours
Which self-directed health behaviour may set the stage for the achievement of other health behaviours?
Adequate sleep
Define self management
The individual who engages in activities which protect and promote health, monitor and manage their symptoms, and adhering the treatment regimens.
What is a key concept within self-management?
Tasks which gain confidence, and this confidence is known as self-efficacy
What is they key difference between self-management and efficacy?
Self-efficacy is required for successful self-management. It refers to the confidence one has in achieving self-management.
What are the 3 sub-sections of self-management?
- Medical management
- Role management
- Emotional management
Medical management?
Taking meds, monitoring symptoms, interacting with health providers
Role management?
Adapting to work or hobbies with pain or functional limitations, adapting to schedules imposed by new medication
Emotional management?
Dealing with anger, fear, frustration, depression and worries about the future
What are some objectives of self-management within the context of diabetes?
- Engage in education and support programs
- Healthy eating
- Integration to adhere to complex regime
What is the goal of self-management education in diabetes?
Prepare individuals with diabetes to change their behaviour to support improved outcomes.
What are some items that those with diabetes should self-manage?
- Healthy diet
- Regular exercise
- Optimum weight control
- SMBG
- Medication
Self-management often leads to better adherence to self-care regimen. How does this impact the individual?
- Decreased mortality and disability
- Improved quality of life
- Reduced health-care costs
What is the hardest part of self-management?
Sticking to the regime in the long-term, it is often difficult to embed into someones lifestyle.
Name 5 factors which influence and individuals ability to adhere to a healthier eating plan (within the context of chronic disease)
- Perceived risk
- Age and habits
- Mental and psychological adjustment
- Education level
- Perception of social norms.
What is perceived risk?
Whether the individual thinks there will actually be a negative effect if they don’t follow the nutritional intervention (i.e. - is it worth it?)
(T/F) When the patient is educated and has knowledge, they are always likely to have positive health outcomes
False, outcomes are often inconsistent pointing to the fact that people engage in unhealthy behaviours despite the knowledge of their risks.
(T/F) Those with diabetes and who knew their HBA1C values was sufficient to infer increased confidence and motivation to improve self-management
False, however they had a better understanding of diabetes self-management.
What must be considered when trying to achieve self-management and healthy behaviour changes?
Culture and ethnicity, as each culture often has a different perception of “health” the the health benefits of different foods.
What are 4 cultural factors to consider in diabetes management? (BLT-F)
- Beliefs about general health
- Lifestyles
- Traditional and religious beliefs
- Food and dietary preferences
What was the key finding in the systematic review of barriers and facilitators for T2DM management in south Asians?
There is a 50% higher probability of getting diabetes in South Asia
What were the 3 key reasons why it is more likely to develop diabetes in south Asia?
- Language and communication with HCP (didn’t understand diabetes education)
- Barriers and misconceptions to adopting diabetic diet
- Diet was not tailored to south asian cultural foods
What are the 3 facilitators in adopting a diabetic diet?
- Trust in care providers
- Use of culturally appropriate dietary advice
- Increasing family involvement
What are two cultural sensitivities in nutritional interventions?
- Cultural holidays, such as Ramadan
- Usual intake by region, such as country foods
Up to ___ of those living with chronic diseases will exhibit signs of depression
50%
Whats the issue with depression?
Pin-pointing behaviour changes can be difficult
What 4 conditions are associated with depression? (CAMD)
- CHD
- Arthiritis
- MS
- Diabetes
How does depression impacts disease self-management and health behaviours?
By altering perception
What was the major finding in the Interpret-DD study concerning those with diabetes and depression?
10.6% were diagnosed with depression, and 17% reported moderate to severe symptoms of depression
What was the major association in the Interpret-DD study concerning those with diabetes and depression?
Higher in women, low education, less exercise, higher levels of diabetes distress, previous diagnosis of depression
What is one of the top conditions that go undiagnosed and untreated?
Depression, there is still a stigma
What else do diabetic patients often report?
Diabetes-specific emotional distress
What emotional distress is associated with diabetes (3)
- Money to buy supplies and medications (25%)
- Feeling deprived of food (32%)
- Concerned with future complications of the disease (38%)
What are 4 strategies that HCP can do regarding depression and diabetes?
- Consider the possible signs of depression
- Screen for depression in initial assessment
- Consider referral for treatment
- Educate
What is the criteria for Major depressive disorder?
Depressed mood and/or loss of interest/pleasure plus 4 cardinal symptoms.
What are the 7 cardinal symptoms that are considered in a diagnosis of depression? (CLIFT-PI)
- Change in weight/appetite
- Lack of energy
- Insomnia or hypersomnia
- Feelings of worthlessness or guilt
- Psychomotor agitation or retardation
- Inability to make decisions
What does the successful treatment of depression contribute to?
Improved healthy behaviours and health outcomes
What is the single item question used when screening for depression?
Are you depressed most of the time?
Who is most responsive to the single item question?
Women
What 2 questions are used by the U.S Preventative Services Task Force for screening for depression? Who is more responsive to these questions?
1) During the past 2 weeks, have you felt down, depressed or hopeless?
2) Have you felt little interest of pleasure in doing things?
Men
What are some external factors that can help facilitate behaviour change?
- Access to health-care services and information
- HCP attitude, beliefs, knowledge and skills
- Overall social norms (de-stigmatizing)
What did Dietrich et al. uncover about physicians attitudes at time of diagnoses?
-Attitude was critical in developing patients attitude about disease, impacting self-management
What did IntroDia study uncover about early conversations between physicians and patients?
-Optimize early conversations which will have an impact on diabetes related distress, well-being and & adherence to diabetes self-care behaviours.
What are 2 positive conversational elements?
- Encouraging
- Collaborative
What is an example of an encouraging conversational element?
Telling the patient that a lot can be done to control diabetes, and that many people live long and healthy lives with diabetes
What is an example of a collaborative conversational element?
Ask patient how their work, family or social situation related to taking care of their diabetes. Consider their values and traditions when recommending treatments.
What is a discouraging conversational element which should be avoided?
Telling patients that diabetes gets harder to handle over time.
How can our attitudes or beliefs about T2DM as a HCP influence patient behaviour?
We must be reassuring, alongside setting realistic expectations.
When will our health promotion efforts and interventions more likely exceed? (2)
When there is a clear understanding of:
1) Targeted health behaviour
2) Environmental conduct
Define self-efficacy
One’s confidence in being able to successfully perform an action to prduce the desired outcomes (i.e. improved health).
What is Bandura’s S-E Theory?
A cognitive mediating process that determines behaviour
What are the 3 domains of Bandura’s S-E Theory?
1) Self-efficacy expectancy
2) Outcome expectancy
3) Outcome value
What is self-efficacy expectancy?
The belief and expectations about capacity to perform behaviours to achieve the outcome.
What is particular about the self-efficacy expectancy?
It is situation and behaviour specific, if someone has a high s-e for exercise it does not mean that they have a high s-e for eating healthy.
What is outcome expectancy?
Estimate of probability to lead to desired outcome or result. it is the assumed consequence of taking action (If I eat healthier, my blood sugars will improve).
What is outcome value?
The value we place on the outcome (i.e if we value healthy eating, the effort and persistance will be greater)
What often drives a person to change behaviours, and reach a desired outcome? (4)
- Self-efficacy
- Beliefs
- Strength
- Generality
What is generality?
The ability to generalize the behaviour to other similar behaviours
What often shapes outcome expectancies?
They physical, social and self-evaluative environment.
What is self-efficacy linked to?
Adherence
What plays an important role in self-management, and is a strong predictor of behaviour change?
Self-efficacy
What 3 things can efficacy predict?
1) Choice of behaviour
2) Amount of effort and persistence when faced with obstacles/adversity
3) Through patterns, emotional reactions
What are 4 outcomes of higher self-efficacy?
- Better pain tolerance
- Coping
- Less disability
- Adherence to medication and healthy behaviours
Within the context of diabetes, what are (3) items associate with increased levels of SE?
1) Less psychological distress
2) Greater use of self-care activities
3) Some improvement in metabolic parameters
In the Nutrition Efficacy Assessment, what is significant about the “7” rating?
If below 7, there is a very low chance of success without professional input
What are the 3 interrelated domains of self-efficacy and behaviour change?
Having ….
1) Tactic task knowledge & related skills
2) Sense of confidence, even when faced with barriers
3) Confidence to succeed and execute behaviours within the given context
What are the 4 strategies that may be used in increasing self-efficacy in our patient? (2P-RV)
- Performance accomplishments
- Persuasion
- Reinterpreting symptoms
- Vicarious experience (modeling)
What is performance accomplishment?
-Trying new things and accomplishing them, even small accomplishments and successes can boost SE.
What is vicarious experience/modelling?
Seeing/hearing success stories from those similar to you. Must show they obstacles and difficulties that they overcame.
What is reinterpreting symptoms?
Some people have high emotional arousal, which tends to cause stress/inefficacy. This lowers inhibitions and may lead to poor healthy behaviour.
What is persuasion?
Patients have encouragement and they hope and believe that they can a-chive goals. Affirmative words are better than praise
What is an example of an affirmative encouragement?
Recognizing an underlying quality: “You are strong to cope with so much”
What is a praise encouragement?
Someones judgement: “I think you are doing a good job”
How can the effectiveness of verbal persuasion depend on?
- Perceived expertness, trustworthiness or attractiveness of the source of information
Example of performance accomplishment?
-Break task into small tasks, setting realistic goals and providing feedback
Example of vicarious modelling?
Access to success stories, visual or video resources
Example of reinterpretation of arousal?
Patients may believe that comfort food is necessary to cope with -ve emotion. Try connecting with other items for joy rather than food, validate feelings, eat mindfully.
Example of verbal persuasion?
Start by encouraging small steps in behaviour change. Only in last resort should emphasize consequence of not changing behaviour.
When should stress management be used?
Should be combined with Behaviour Change Therapy.
