Health Behaviour Change Flashcards
List 3 Health Behaviour Change theories
1) Health Belief Model
2) Theory of Planned Behaviour
3) Social Learning (Cognitive Theory)
4) Stages of Change (transtheoretical model)
5) Precaution adoption model
6) Diffusion of Innovation Theory
Describe the ‘Health Belief Model’ behavioural change theory
The Health Belief Model
theorises that an individual will only seek preventative measures if he/she BELIEVES there is a THREAT to their health AND if the PREVENTATIVE MEASURE is ACCESSIBLE and LOW RISK to allow him/her to avoid the health threat
List the 6 key constructs / elements associated with the Health Belief Model
6 constructs Health Belief Model (3 Ss and 3 Bs)
1) Perceived SUSCEPTIBILITY (perceived risk to self)
2) Perceived SEVERITY (perceived consequences)
3) Perceived BENEFIT (perceived effectiveness of preventative measures)
4) Perceived BARRIERS
5) Cues to action (STIMULI that induce readiness to change)
6) Self-efficacy (confidence in own aBility to make the necessary change)
Describe the Theory of Planned Behaviour
THEORY OF PLANNED BEHAVIOUR
Helps predict ones LIKELIHOOD of ENGAGING in a behaviour change based on MOTIVATION and PERCEIVED ABILITY. Identifies that health behaviour is INFLUENCED by own BELIEFS and ATTITUDE regarding the risks, benefits and their capability of achieving the desired health goal.
What are the 6 constructs involved in the Theory of Planned Behaviour?
SIX contructs Theory Planned Behaviour
1) Attitude (one’s +VE / -VE evaluation of the behaviour / outcome)
2) Behavioural intention (MOTIVATIONAL factors - most imp)
3) Subjective norms (perception of others’ beliefs)
4) Social norms (customary standards within a group)
5) Perceived power (one’s perceived control over factors)
6) Perceived behavioural control (PERCEIVED CAPABILITIES - how easy or difficult likely to be)
With which health behaviour change theory are the following terms associated:
Reciprocal determinism; Behavioural capabilities; Observational Learning; Reinforcements; Expectations and Self-efficacy?
Social learning (cognitive theory)
What is meant by Reciprocal Determinism in he social learning theory?
The person, the behaviour and the environment influence one another in reciprocal manner
What is meant by Behavioural capability in social learning?
The ability through knowledge and skill to complete a behaviour
What is meant by Observational learning (social learning)?
To learn from others’ experience as well as your own
To what is ‘reinforcements’ referring in social learning?
How behaviours are maintained or omitted through internal or external social reinforcements
In what way does expectation influence behaviour according the the social learning theory?
The anticipated consequences of behavioural change will either encourage or discourage that change
What is self-efficacy in relation to the social learning theory?
One’s level of confidence in their ability to to achieve a behaviour (influenced by environment and own behavioural capability)
List the 6 stages of change (transtheoretical model)
1) Precontemplation
2) Contemplation
3) Preparation
4) Action
5) Maintenance
6) Relapse
In what way do the ‘Stages of Change’ and ‘Precaution adoption model’ theories differ?
STAGES of change is a CYCLICAL theory of change whereas PRECAUTION ADOPTION (ranging from unawareness to maintenance) describes a linear process (i.e. individuals cannot go back to ‘unawareness’)
Describe the Diffusion of Innovation theory
Describes how the introduction of a behaviour moves through a population:
Innovators > Early Adopters > Early Majority > Late Majority > Laggards
What are the key principles all behaviour theories have in common?
a) beliefs about risks and benefits
b) motivation
c) self-efficacy
d) environmental influence (e.g. social norms)
What 4 intrapersonal features influence behaviour?
knowledge
attitudes
beliefs
personality
What 4 interpersonal groups influence behaviour?
family
friends
peers
health providers
What institutional factors might influence behaviour?
rules; regulations/laws; policies e.g. kcal on menus, laws regarding where you may smoke etc
non-adherence to meds is thought to occur how often in chronic illness is?
50-80% of the time
Provider as ‘expert’ comprises making medical ___, making specific ____ and ___ treatments
1) assessment
2) recommendations
3) prescribing
Provider as ‘coach’ involves discussing how to deal with ___ ___
behaviour change
Motivational interview is most beneficial at what stages of change?
Precontemplation and contemplation
What are the 4 key principles of motivational interviewing?
1) Expressing empathy
2) Support self-efficacy
3) Roll with resistance
4) offer pt where they are at vs where they wish to be without being judgemental and allow to draw own conclusions (discrepancy)
At what stages of change is CBT most helpful?
Preparation, action, maintenance
What does CBT help individuals to do?
problem-solve & improve understanding
What are the basic principles/approaches of CBT? (3)
Recognition of non-productive thinking & re-framing
Identification of underlying beliefs & emotions
Working through the ABCDs of behaviour change
What are the 7 red flags of non-productive thinking?
- All or nothing
- catastrophising
- discounting the positive
- overgeneralising
- mind reading
- fortune telling ‘this will never work’
- “should” or “must” statements
Reframing principles include what techniques?
- Eliciting thoughts that lead to non-productive emotions which might be getting way of behaviour change.
- Ask to try to see situation a different way.
- Help substitute more realistic interpretations in place of non-productive thinking.
- Ask pt to think of language that might self-support in difficult situations (e.g. reiterate outcome of behaviour change)
- Homework: new thinking strategies and more effective problem solving
- Assist in becoming more aware of emotions, encourage to consciously choose different thoughts
- Teach that changed thoughts can result in changed emotions and ongoing behaviours
What are the ABCD (Qs) of behavioural change?
how beliefs interfere with change
A: What action or event occurred?
B: What beliefs to you have about what occurred?
C: What are the consequences of those beliefs?
D: How can you dispute those beliefs that are distorted or unhealthy?
List the 6 benefits of Positive Psychology
1) Builds self confidence
2) Emphasizes current abilities
3) Reinforces autonomy / self-efficacy
4) Emphasizes positive pt actions
5) Enhances resilience
6) Increases positivity of pt:provider relationship
Name 3 different forms of social / environmental support
1) friends and family with whom pt has positive relationships
2) Support groups: teams, clubs, workplace, social networks/media
3) Behaviour change groups - peer to peer
What assistance can a Support Analysis Tool provide people in making behavioural change?
Identifies support groups and how each might be utilised to achieve goals e.g. child care during exercise sessions, peers to compare progress with to motivate and troubleshoot, assistance to get to supermarket / gym etc
When writing an Action Plan you must consider pt ___ to change, perceived level of ___ to make that change and ___ that it can be accomplished. Always pitch it at pt’s current ___ to complete it.
readiness
importance
confidence
ability
SMART goals are essential in action planning - what does it stand for?
Specific Measurable Achievable Relevant Timeframe
What are the 5 As of counselling someone to incorporate and monitor change?
(shown to aid in wgt loss)
Assess practices
Advise to change practices using personalised advice
Agree on focus of counselling / tx based on interest and willingness to change
Assist in setting goals / how to achieve
Arrange regular f/u and support
State 5 constructs available to assist with effective and sustainable self-management during change
1) CBT
2) Social support strategies
3) Community / employee programmes
4) Support with digital technology
5) Relapse prevention planning
Patients were more likely to achieve a good HbA1c if provider demonstrated more ____? (2011 paper)
Empathy
The optimal number of hours empathy training for providers is __ hours.
10 hours
HTN, glucose levels and functional status have all been shown to be related to patient-__ relationship
provider
Self-motivation is based on what 5 internal influential factors?
1) needs
2) perceived benefits of behaviour
3) values
4) vision
5) purpose / meaning in life
Self-efficacy is at the core of successful behaviour change. It is the confidence to successfully perform a change. Self___ and self___ play essential roles in development of self-efficacy
motivation and confidence
Reflection is frequently used in coaching to develop awareness and assist in analysis of health behaviours. What are the 4 types of reflection a coach may adopt to do is?
Types of reflection: Simple Amplified Double-sided Shifted-focus
What is a simple reflection?
Paraphrase or restate what pt has said without opinion or interpretation
What is a amplified reflection?
Reflection which maximises or minimises what pt has said to generate disagreement or evoke statements of desired change
What is a double-sided reflection?
Reveal more than one perspective at same time. e.g. comparison of pt’s verbalised readiness to change contrasted with their statement of resistance.
What is a shifted-focus reflection?
Redirect focus away fro statement of resistance to new area to create more space for change talk
Studies have shown that diet and exercise combined with what techniques lead to greater weight loss and maintenance? (social support greater still)
CBT
CBT techniques for weight loss and maintenance involve:
1) self-___ of diet and exercise
2) Setting ____ goals
3) ____ of healthy diet
4) ____ solving
1) monitoring
2) SMART
3) normalisation
4) problem-
When implementing behaviour change to achieve weight loss what is meant by ‘stimulus control’?
Power to have improved control over choices despite environmental factors e.g. in relation to food
Give 3 practical pieces of advice to help someone lose weight
1) change serving containers (size/shape)
2) reduce availability of unhealthy foods in the home
3) eat more slowly to improve digestion and awareness of satiety
Behavioural counselling in weight loss can help pts understand how weight is influenced by lifestyle choices including what lifestyle areas?
- Sleep hygiene - fewer hours assoc with weight gain
- Stress mx - wgt gain assoc with higher stress and wgt loss may be increased by stress mx
- Stress eating - foods eaten to reduce anxiety driven by chronic stress response
- Smoking cessation - approx 4.5kg may be gained after smoking cessation. best to quit THEN focus on wgt
What are the 4 levels at which weight loss psychosocial needs may be tackled?
- macro/public level e.g. public policy
- community/institution e.g. bike lanes / access health food
- interpersonal e.g. support from friends/family/comm
- intrapersonal e.g. reframing -ve thoughts/coping strategies
