health behaviour

Question 1

recognise the role of behavioural contributions to disease *

Answer 1

the number of lifestyle diseases ie cancer, circulatory diseases, and resp diseases has increased

heart disease affected by diet and lifestyle

lung by smoking

stroke by diet and exercise

Question 2

describe the role of smoking adn death - Peto et al *

Answer 2

of smokers - 50% of their deaths are smoking related - 1/4 of these deaths are <70yrs - relatively young

smoking is number 1 cause of preventable illness and death

on average smokers die 10years younger than non-smokers

current prevalence of 19% in UK adults

Question 3

how is excess weight a concern *

Answer 3

leads to otehr health problems

proportion of overweight people are increasing

the proprotion of people at very high health risk is increasing

Question 4

why is society getting fatter *

Answer 4

we say that to avoid obesity you need to eat less and do more

however this depends on our activity env, our food supply, influence of genetics and ill health, and individual psychology - societal influences including media, education, peer pressure, culture

our ability to move and exercise is impacted by excess weight

worried about stigma so dont exercise

obesogenic society - always option to minimise movement eg using teh excalators instead of the stairs

as rates of transit ie walking and cycling increase - obesity is reduced - need to change behaviour from auto-dependancy

our calorie intake has increased - this accounts for obestity

Question 5

what are the 5 modern day killers and what does this mean *

Answer 5

dietry excess, alcohol, sedentary lifestyle, smoking, unsafe sex

therefore to tackle disease, we have to change behaviour

Question 6

what is health behaviour - Kasl and Cobb*

Answer 6

“Any activity undertaken by an individual believing himself to be healthy, for the purpose of preventing disease or detecting it at an asymptomatic stage”

Question 7

describe the alameda study - breslow and enstorm *

Answer 7

6928 residents compeleted a lsit of 7 health behaviours that they practiced regularly ie not smoking, eating breakfast, moderate alcohol, getting 7-8 hours of sleep, not snacking, regular exercise, moderate weight

at 10yr follow up - mortality rate of people who did all 7 was <1/4 of thosw who did 3 or less

Question 8

what are the 3 levels of behaviour change interventions *

Answer 8

population - media campaign/TV - health promotion

community - eg leaflets in different languages

individual - motivational interviewing - move the individual to place where they will readily make changes

Question 9

techniques used in health eduction *

Answer 9

address morality

Change 4 life - educate parents to feed children well - light hearted

Question 10

describe smoking eductation in schools - Nutbeam et al 1993 *

Answer 10

a program of eductation about the effects of smoking was conducted in 39 comprehensive schoolls

it involved trained teachers providing teaching sessions over 3 month period

did a self report questionnaire, saliva test before teachig and immediately afterwards and at 1 yr follow up

goal was to increase percentage of never smokers

significant differnce in knowledge between control and education

however, no significant difference in never smokers

they had more knowledge but this wasnt enough - especially for addictive behaviour like smoking - need intensive intervention eg motivational interviewing

Question 11

describe the role of education in changing health behaviours *

Answer 11

info does have an important role and is most important for discrete behaviours - eg getting child vaccinated - context important

messages tailored to specific audience are more effective eg condom use to reduce teenage pregnancy is better than trying to promote complete abstinence

often people need more than info - especially when addictive eg social and psychologicla support, skills to change

Question 12

what are the cues for unhealthy eating *

Answer 12

visual - fast food signs/sweets at checkout

auditory - ice cream bell

olfactory - smell of baking bread

location - sofa/car

time - evening/events - end of a TV program

emotion - usually -ve ie bored, stressed, sad but can be when people want to reward themselves - happy

Question 13

how does learning theory relate to unhealthy eating *

Answer 13

positive reinforcement - dopaimine, fill void/boredom, praise from family for preparing unhealthy meal

-ve reinforcement - avoid painful emotions by comfort eating

punishment - preparing low fat meal is critisised

limited/delayed positive reinforcement for healthy eating - efforts at dietry change/weight loss go unnoticed, avoiding future health problems is too remote

Question 14

4 behaviour modification techniques *

Answer 14

stimulus control techniques

counter conditioning

contingency management

naturally occuring reinforcers

Question 15

describe stimulus control techniques *

Answer 15

keep danger foods out of the house

keep biscuits away from tea/coffee - remove the association

only eat at table

use small plates

dont watch TV at same time as eating

Question 16

describe counter conditioning *

Answer 16

idnetify 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/exercise

Question 17

examples of contingency management *

Answer 17

involve significant others to praise healthy eating choices

plan specific rewards for successful weight loss - that dont involve food

vouchers for adherence to healthy eating and weight loss

Question 18

what are naturally occuring behavioural reinforcers *

Answer 18

imporved self esteem +ve reinforcement

reduction in symptoms of breathlessness -ve reinforcement

Question 19

describe +ve reinforcement intervention - kegels - dental hygiene *

Answer 19

children given a talk on dental hygiene and then recieved either no further input, discussion session, reward for compliance with the program

reward - most complience to mouthwash regieme - however effect still diminished over time

Question 20

what is the evidence for using incentives to change health behaviour - marteau *

Answer 20

incentives used in smoking cessation schemes were most effective, those aimed at weight loss were least effective - lack of generalisation - depends on what teh behaviour is

when cash was offered to expectant mothers to give up smoking 90% quit throughout pregnancy and 9months after

Question 21

limitations of reinforcement/incentive programs *

Answer 21

lack of generalsiation - only effects the behaviour regarding the specific trait that is being rewarded

poor maintenance - rapid extinction of desireded behaviour whan the reinforcer disappears

it is impractical and expensive - dont want to use public money in this way

Question 22

does fear arousal work to change health behaviour - janis and fesbach *

Answer 22

students given 1 of 3 lectures on dental health

induced low, moderate or high fear

behaviour change was the lowest in the highest arousal level - people switch off and dont want to hear about it

Question 23

how does social learning affect health behaviour *

Answer 23

as the number of people that a pupil lives with who smoke increases, the number of pupils smoking increases

adolescents are suseptible to influence at their developmental stage and teh importance of school and peer groups - therefore high peer group homogenity with resppect to smokinng - best friends have the greatest influence - followed by peers - adolescents want to separate themselves from their family

Question 24

describe the waterloo smoking prevention project - Flay *

Answer 24

students allocated to smoking prevention or control

had 6 lessons including practicing skills to build confidence in ability to resist peer pressure

there was a sig reduction of children who started smoking, especially among those whose family smoked

Question 25

what is the expectancy-value principle *

Answer 25

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

Question 26

describe the health-beliefs model *

Answer 26

teh liklihood of a behavioural change is defined by percieve threat

percieved threat depends on percieved suseptibility and percieved seriousness

background variables eg age, sex, ethnicity, personality and knowledge influences percieved suseptibility and seriousness

background variables also influence percieved benefits vs costs - benefit v cost also affect the liklihood of behaviourla change

cues to action alter percieved threat - for example MI might be the cue needed to change

Question 27

describe how the decision to get a flu vaccine fits into the health beliefs model *

Answer 27

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.

Question 28

how can you use the HBM to investigate the reasons for/not quitting smoking *

Answer 28

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?

Question 29

what is outcome efficacy *

Answer 29

Individuals expectation that the behaviour will lead to better outcomes

Question 30

what is self-efficacy *

Answer 30

belief that one can execute the behaviour required to produce outcome

ie the confidence in ourselves to be able to make a change

Question 31

what are the factors that influence self efficacy *

Answer 31

mastery experience - eg having lessons to empower you to be able to make the change

social learning - if not confident about the skill, having the opportunity to see other people do it first

verbal persuation or encouragement

physiological arousal - when try something new get flight/fight response - need to be able to appraise this and know it is normal, if people understand it to mean that their body is telling them that they cant do it - will prevent them doing new things

Question 32

describe the theory of planned behaviour - Ajzen *

Answer 32

intention/motivation to enact a behaviour is key

intention is underlyed by our attitude which is formed from our beliefs about the outcome and evalution of the outcome (expectancy and value of outcome)

intention and behaviour are also influenced by percieved behavioural control - influenced by internal and external control factors (self efficacy and percieved costs/barriers)

subjective norm influences intentions - subjective norm depends on beliefs about important other’s attitudes towards behaviour - ie if you wnat to eat healthy, important to have family members that also want to eat healthy

Question 33

how can we investigate smoking cessation using the TPB *

Answer 33

 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?
Do you think you can quit? What makes you think that you can’t?

Question 34

what is the theoretical stages of change model *

Answer 34

not the most successful model

pre-contemplation - does not recognise the need for change or is not actively considering change

contemplation - recognises problem and is considering change

preparation - is getting ready for change - seeing GP to get meds, give pt smoking cessation service referal

action - initiating change

maintenance - adjusting to change and is practicing new skills and behaviours to sustain change

relapse - cycle starts again, or permenant exit

Question 35

describe the behaviour change wheel *

Answer 35

taxonomy of behaviour change strategies

COM-B - capability, opportunity, motivation

includes the sources of behaviour, intervention functions nad policy categories that these relate to