Health beliefs and behaviour

Question 1

In the 1900s what was the major cause of death and how has this changed?
Why?

Answer 1

Infectious disease, now cancer is one of our biggest killers

- change in environment, access to medication and us living longer

Question 2

What is the number one cause of preventable illness and death?

Answer 2

smoking

Question 3

What is the prevalence of smokers in the UK?

Answer 3

19% of adults

Question 4

On average how many years earlier do smokers die?

Answer 4

10 years

Question 5

What is the prevalence of overweight/obese men and women?

Answer 5

7/10 men

6/10 women

Question 6

What can contribute to weight?

Answer 6

• genetic predisposition
• medical conditions
• food consumption increasing (social eating) so increased calorie intake
• activity levels
• environment

Question 7

Why are we eating more calories?

Answer 7

• easy to access
• advertising
• social factors

Question 8

What is auto-dependency and how may it contribute to obesity?

Answer 8

Inability to do general things without the access of a vehicle - obesity falls with walking, cycling etc.

Question 9

What are the 5 modern day killers?

Answer 9

dietary excess, alcohol consumption, lack of exercise, smoking and unsafe sexual behaviour

Question 10

What is health behaviour?

Answer 10

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 11

Describe the Alameda study

Answer 11

• 6,928 residents of Alameda county, CA, completed a list of 7 health behaviours they practised regularly
• This included not smoking, eating breakfast, not snacking, regular exercise, getting 7-8 hours of sleep, moderate alcohol, and maintaining moderate weight
• At 10 year follow-up showed that the mortality rate in individuals who practiced all seven behaviours was less than 1/4 of that in individuals who practiced three or less

Question 12

How can we help people to adopt health behaviours?

Answer 12

3 levels:
- POPULATION LEVEL (e.g. NHS nationwide programmes for specific populations, e.g. cervical)

• COMMUNITY LEVEL (e.g. weight-loss programme offered in a London borough)
• INDIVIDUAL LEVEL (e.g. direct implementation of intervention with a patient)

Question 13

How has health education changed?

Answer 13

• Earlier health campaigns focused on negative emotions (guilt, shame and embarrassment) which doesn’t work
• Campaigns now focus on positive emotions (confidence, positivity, lack of judgement)

Question 14

What was the smoking programme?

Answer 14

• A programme of education about the effects of smoking was conducted in 39 comprehensive schools
• The programme involved specially trained teachers providing teaching sessions spread over 3 months

Question 15

Is education important in changing health behaviours?

When is it most effective?

Answer 15

• Information does have an important role and is most effective for discrete behaviours (e.g. vaccination)
• Messages tailored to a particular audience are more effective (e.g. complete abstinence vs. condom use to reduce teenage pregnancy)
• But often people need more than knowledge to change habitual lifestyle behaviours, particularly addictive behaviours (e.g. social & psychological support, skills to change)

Question 16

In the learning theory, what are the cues for unhealthy eating?

Answer 16

• Visual (e.g. fast food signs, sweets at checkout)
• Auditory (e.g. ice cream bell)
• Olfactory (e.g. smell of baking bread)
• Location (e.g. the couch or car)
• Time (e.g. evening)/Events (e.g. end of TV programme)
• Emotional (e.g. bored, stressed, sad, happy)

Question 17

What are the positive, negative reinforcers, punishment for unhealthy eating?

Answer 17

Positive reinforcement: Praise for preparing a high-fat meal for the family. Dopamine (feel good), filling an empty void/boredom

Negative Reinforcement: Avoid painful emotions by comfort eating

Punishment: Preparing a low fat meal is criticised

Question 18

What is a positive reinforcer of healthy eating that may go unnoticed?

Answer 18

• Efforts at dietary change/weight loss go unnoticed by others, so the person may give up

Question 19

What are some behavior modification techniques to aid healthy eating?

Answer 19

Stimulus control techniques:

• Keep ‘danger’ foods out of the house
• Avoid keeping biscuits in the same cupboard as tea & coffee
• Eat only at the dining table
• Use small plates
• Do not watch TV at the same time as eating

Counter conditioning:

• Identify ‘high-risk’ situations/cues (e.g. stress) and ‘healthier’ responses
• Can you think of something other than eating that makes you feel better?
• Maybe something relaxing or exercise

Question 20

What are some naturally occurring positive reinforcers for healthy eating?

Answer 20

• Improved self-esteem (positive reinforcement)

- Reduction in symptoms of breathlessness (negative reinforcement)

Question 21

Give examples of contingency management for healthy eating

Answer 21

• Involve significant others to praise healthy eating choices
• Plan specific rewards for successful weight loss
• Vouchers for adherence to healthy eating & weight loss

Question 22

Do incentives work for every health problem?

Answer 22

Nope

- incentives used in smoking for most effective (e.g. cash) but those aimed at weight loss were not

Question 23

What are the limitations of reinforcement programmes?

Answer 23

• Lack of generalization (only affects behaviour regarding the specific trait that is being rewarded)
• Poor maintenance (rapid extinction of the desired behaviour once the reinforcer is removed)
• Impractical and expensive

Question 24

What is fear arousal and does it work in modifying health behaviour?

Answer 24

• inciting fear around a health problem
• 50 high school students were given one of three different lectures on dental health
• Lectures were designed to induce low, moderate or high fear
• Effect on subsequent dental hygiene behaviour was measured with self-questionnaires one week later
• The high fear group had the lowest percentage change in behaviour
• The LOW fear group had the highest percentage change in behaviour

Question 25

What is the effect of social learning in smoking?

Answer 25

- smoking status is strongly associated with the number of other smokers the subject lives with - adolescent are particularly susceptible - peer groups and best friends influence

Question 26

What is the Waterloo Smoking Prevention Project?

Answer 26

- High school students allocated to a smoking prevention or control condition - The programme consisted of 6 sessions including rehearsing skills to build confidence in ability to resist peer pressure to smoke - There was a significant effect in reducing number of children starting smoking, especially amongst those with family members who smoked

Question 27

What is the expectancy value principle?

Answer 27

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

Question 28

What is the health belief model?

Answer 28

- the stimulus pathway to induce a change in behaviour - include perceived susceptibility, seriousness, background variables, percieved threat, perceived barriers, cues to action etc.

Question 29

Give an example of the health belief model in a situation

Answer 29

For example, the decision to get a flu vaccine: 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 30

How would the HBM be used for smoking cessation?

Answer 30

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 (e.g. 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 31

What are efficacy beliefs?

Answer 31

Outcome efficacy – Individuals expectation that the behaviour will lead to a particular outcome Self Efficacy – Belief that one can execute the behaviour required to produce the outcome High self efficacy leads to a prediction of a greater degree of behaviour change

Question 32

What are the factors influencing self efficacy?

Answer 32

1. Mastery experience If we have engaged with a behaviour before (and it’s been done successfully), we are more likely to have higher levels of self-efficacy. 2. Social learning 3. Verbal persuasion or encouragement Particularly from our significant others. 4. Physiological arousal If we are nervous about performing a behaviour, self-efficacy is often weaker.

Question 33

What is the theory of planned behaviour?

Answer 33

Intention is the main predictor for behaviour. Intention is influenced by attitudes to the behaviour (belief about outcome and evaluation of outcome), subjective norm (norms that others have towards) and percieved behavioural control (internal and external control factors).

Question 34

What is perceived behavioural control?

Answer 34

This is one’s perception of being able to manage the behaviour. For example, if your friends are doing dry January, you might think that you should resist any peer pressure to go out and drink this month. Therefore, you feel a greater sense of control.

Question 35

How can smoking cessation by investigated using the theory of planned behaviour?

Answer 35

Explore attitudes towards smoking: What do you think about smoking? Is it a good or bad thing for you? Explore the norms of important people around: What do your friends/family think about you smoking? Explore whether they intend to quit: Have you ever thought about quitting? Do you intend to? Explore how much control they think they have: Do you think you can quit?

Question 36

What is the transtheoretical model? | smoking as an example

Answer 36

- This model was developed with the concept that when we look to make behavioural changes, we are likely to proceed through a series of stages - If a patient tells you that they love to smoke and have no intention of quitting, they are obviously in the pre-contemplation stage of this model - If the patient says they are worried about their health due to this habit, they are at the contemplation stage - If the patient is referred to a smoking cessation programme and they begin to research resources, they’re in the preparation stage - They then enter the action stage to try and reduce smoking - The maintenance stage is often overlooked, but this involved providing patients with support (particularly needed in the context of addictive behaviours) - We can expect to see relapse due to addiction - Some people exit the model completely when successful.

Question 37

How should health modifying behaviour changes be approached?

Answer 37

- Listen and validate patient’s experience. - Identify and remedy any gaps in knowledge. - Identify cues and reinforcers – modify if possible and plan rewards. - Identify and attempt to modify unhelpful beliefs. - Enhance self-efficacy. - Identify and problem-solve barriers to change. - Identify positive, relevant role models. - Encourage social support. - Tailor intervention to individual’s readiness to change.

Question 38

What are the parts to the transtheoretical model?

Answer 38

- Begins with pre-contemplation, contemplation, preparation, action, maintenance then exit/relapse - The behaviour may often go around the cycle a few times before the individual permanently exists the cycle and thus the unwanted behaviour