Health - Individual and population interventions Flashcards
Informing people of their risk for certain diseases may help them change their behaviour. Often people ______ to change, but it is hard for these changes to be _______. Some also will ____ change despite being told the risks. Hence, more _______ interventions have been developed to take into account people’s different levels of ________.
People change because they find their _____ reasons to change. Not because they are told to.
strive sustained not targeted motivation
own
What are the three individual approaches discussed in the lecture?
- motivational interviewing
- problem-solving approaches and planning
- modelling and behavioural practice
MOTIVATIONAL INTERVIEWING
This is a _________ method to enhance intrinsic _______ to change by exploring and resolving ________. The goal is to motivate people to _______ changing their behaviour.
This is effective for people who are _______ to engage in change. It is ________, non-confrontational and non-________.
Hence, the strategies used are:
- empathy
- supporting ________
- creating optimism for change
- rolling with ________ rather than confronting/opposing it
- developing awareness of the ________ between current behaviour and ______.
person-centred
motivation
ambivalence
consider
reluctant
collaborative
authoritative
self-efficacy
resistance
discrepancies
values/goals
MOTIVATIONAL INTERVIEWING
Name the three hallmarks or “spirits” of MI.
- collaboration - patient/practitioner partnership is crucial. Practitioner acknowledges the patient is an expert on themselves
- evocation - practitioner activates patients own motivations to change - connect change to meaning for the patient
- honouring patient autonomy - whilst informing the patient about change, they also acknowledge that the patient has the right to choose not to change if they don’t want to.
MOTIVATIONAL INTERVIEWING
Is it effective?
Meta-analysis found it was effective compared to no treatment for drug overuse, but not compared to other treatments. But the end point on this study was whether bx actually changed, not whether they intended to change.
Another study with drugs use compared MI with confrontation. Found both equally effective, but MI was more accepted and less stressful (which could mean more resources to fight the addiction)
PROBLEM-FOCUSED COUNSELLING
This approach is _______-oriented. It focuses on the issues at hand, here and now. It is not the role of the counsellor to _____ the person’s problem, but rather to _______ the individual’s resources to _______ problems and arrive at ________. There are _______ stages that occur _______.
problem solve mobilise identify solutions. three sequentially
PROBLEM-FOCUSED COUNSELLING
What are the three distinct phases? Give examples of each.
- Problem Exploration - breaking them down from insolvable to clearly defined solvable issues
- Goal-setting - identify how individual would like things to be different and set clear, defined, achievable goals.
- Facilitating Action - developing plans and strategies to achieve goals - key therapeutic element!
There are avoidant AND coping strategies.
…HAPA also identifies planning as important in behavioural change.
PROBLEM-FOCUSED COUNSELLING
There is _______ evidence on the effectiveness of this approach. But there have been some positive studies in _____ intake, cervical cancer ______ and decreasing ______.
little
fruit
screening
smoking
MODELLING CHANGE
Whilst problem-solving abilities can help, it does not target situations where the individual lacks the _____ and _______ in their ability to cope with the demands of _______.
This can be overcome by learning the _____ or appropriate _____ from observing others (AKA _______ learning). Usually this is done by observing a person similar to the learner ______ the task. Change can be achieved with an ________ program to increase _____ and self-efficacy.
skills
confidence
change
skills
attitudes
vicarious/observational
achieving
educational
skills
MODELLING CHANGE
Describe the Sanderseon and Yopuk (2007) study on condom use.
Participants watched a promo video on condom use that included modelling strategies for negotiating use. This led to stronger intentions to engage in protected sex and higher self-efficacy in refusing to have unprotected sex. Finally, higher levels of condom use were reported 4 months after watching the video.
MASS MEDIA CAMPAIGNS
These are ______-focused messages intended to reach a ______ audience repeatedly over time, in an _______ manner, at a ____ cost per head.
BUT they can fall short or backfire if not executed correctly.
- _______ to the intended audience is sub-optimal.
- insufficient ______
- audience was not _______ adequately
- poorly _______ - so format used was not correct (eg: older people and use of social media)
- ________ messages not persuasive for heterogeneous populations
- maybe campaigns are targeting behaviours that audiences don’t have the _________ to change.
behaviourally
large
incidental
low
exposure funding targeted researched homogenous resources
MASS MEDIA CAMPAIGNS
Are they effective? What are the issues to consider?
They do tend to reach people and increase awareness and attitude change. But studies should not be conducted using these outcome measures. We have to measure actual behaviour change. AND if there are changes shown, it is hard to attribute decreases to the campaign alone. They are often part of a larger, coordinated, multi-faceted effort
Speeding - no one thinks big of you. Reduction in deaths and speeding infringements BUT hard to rule out if it’s due to other factors. Maybe police were more vigilant?
MASS MEDIA CAMPAIGNS
What did Wakefield’s 2010 review find about smoking and alcohol use reduction using MMCs?
Smoking campigns overall found reduction in young people starting to smoke and increase in adults stopping smoking. BUT these were more successful when integrated with other programs/policies. Lack of control groups means hard to determine actual effectiveness.
Studies in alcohol found MMCs were not effective. Potentially because they were not combined with policies in marketing of alcohol and the social norms of drinking.
MASS MEDIA CAMPAIGNS
Wakefield’s (2010) review concluded that the likelihood of success of MMCs was due to:
- using _______ interventions
- target behaviour being ______ (or one-off) such as ______ or ______, rather than habitual, like _______ eating and ______ activity.
- ______ to services and products
- creation of _____ that support changes
Overall, it is difficult to estimate the effectiveness of MMCs in ________. Some individual studies report benefits and others do not, but aggregating these studies shows that MMCs are ________.
multiple episodic screening vaccination healthy physical access policies
isolation
successful
MASS MEDIA CAMPAIGNS
Evaluating health behaviour change intervention is ______. Evaluations should be conducted ______ the intervention design process. They should also include relevant _______ measures and consider whether the campaign will lead to _______ change.
difficult
outcome
long-term
