Health Promotion, Behaviour, and Improving the CVS

Question 1

Define health promotion and its role.

Answer 1

Programs designed to inform the public about health risks and methods to prevent or reduce them

Question 2

Summarise the common sense model of illness, and state where health promotion fits within that.

Answer 2

Refer to diagram on slide 5 of lecture on “Health Promotion, Behaviour, and Improving the CVS”.

Health promotion fits with the health messages, because health promotion often provides health messages in order to representation of health risks that patients might have (hence changing their coping procedures).

Question 3

Identify the main methods of health promotion.

Answer 3

• Providing information
• Enhancing motivation
• Behavioural methods
• Health behaviour maintenance
• Combined programs

Question 4

State some sources you can get health information from.

Answer 4

BBC, WHO, local GP, gym

Question 5

Describe some methods to “enhance motivation”.

Answer 5

– Tailored content (people are more like to pay attention if the information is more tailored to their risk factors)

– Framing: gain v loss (gain framed message is more likely to be successful to get individual to change behavior if the behavior is not perceived to have a risk associated with it (e.g. wear your seatbelt, less likely to be injured in a crash).
Loss framed messages are more likely to be successful if there is a perceived risk with the behavior in question (if you don’t go for cervical smear test, you might get a diagnosis once it’s late, i.e. the risk is the possibility of discovering you have cancer if you do the test).

– Cognitive behavioural therapy (“type of talking treatment which focuses on how your thoughts, beliefs and attitudes affect your feelings and behaviour, and teaches you coping skills for dealing with different problems” e.g. your cognition is that you cannot run because it will hurt your knees. You should run for 10 yards. They run for 10 yards, in which they do not get injured. Their cognition is being challenged, but may think it’s because they didn’t run for long. Next time, run more, etc. Until they find out their cognition was wrong.)

– Motivational interviewing (encourages to explore pros and cons of changing behavior, with the aim of eliciting change talk (e.g. ‘I suppose i can smoke 2 less cigarettes a day’). It’s not about advice.

Question 6

Give examples of behavioural methods (as an approach to health promotion).

Answer 6

– Training (e.g. cardiac rehab classes)
– Reminders
– Reinforcers (different types work better for different age groups, small children- stickers, older children- praise, adults- monetary reward)

Question 7

Describe what is meant by behavioral maintenance as an approach to health promotion, and give examples.

Answer 7

Once the patient has engaged in a new, healthier behavior, they need support to maintain this new behavior. In some cases, they will lapse (i.e. short term return to unhealthy habit). In such a case, support is needed to help them cope with said lapse, reduce the likelihood of future lapses, and reduce the chance that this unhealthy behavior will remain in the long term (i.e. relapse). For instance:

• CBT
• Motivational interviews
• Helping them avoid situations which might induce lapses

Question 8

Give an example of a combined health promotion program, detailing the different individual health promotion initiatives this makes use of.

Answer 8

SLIMMING CLUB (e.g. WW)

• Offer information (about what’s in a healthy diet, portion sizes etc.)
• Offer behavioral training (teach how to cook healthy meals)
• Enhance motivation to change (social support from other people in group)
• Help deal with potential lapse/relapse (and boost confidence)

Question 9

Distinguish between primary, secondary, and tertiary health promotion targets, giving examples of each.

Answer 9

Primary health promotion target:
-General population (people who may or may not have illness already)
E.g. wearing a seatbelt campaign, put children to sleep on their back

Secondary health promotion target:
-People who have an illness already (very early in the course of illness) or screening for risk factors

Tertiary health promotion target:
-Existing long term illness (reduce impact of illness or reduce likelihood of another event in the case of an MI for instance)

Question 10

Identify modifiable and non-modifiable risk factors for CVS disease.

Answer 10

• Non-modifiable:
– education
– social class
– gender

• Modifiable: 
– smoking
– obesity
– sedentary lifestyle 
– personality?

Question 11

Identify barriers to health prevention (/promotion) programs (especially in primary prevention).

Answer 11

– Not fun!
– Addictions
– Motivation (general population may not be ill so no motivation to change )
– Education (how do I change behavior ?)
– Social support (e.g. partner with same unhealthy habits)
– Cultural support (culture that doesn’t pride itself in being physically active or eating healthy food )

Question 12

Chef Nick Nairn asks an obese patient how to cut the amount of fat in his breakfast by half. Obese patient cuts the plate in half. Chef Nairn says:

• Toast the toast (instead of frying it)
• Grill the bacon (instead of frying it)
• Poach the eggs (instead of frying it)

Which kind of health promotions does this use, and which kind of prevention/promotion is this (primary/secondary/tertiary) ?

Answer 12

Primary prevention/promotion

Uses:

• Providing information
• Enhancing motivation (because expert advice)

Question 13

What are possible secondary prevention initiatives ?

Answer 13

BP

Cholesterol checks

Question 14

– School students at 2 American high schools screened for heart disease and diabetes risk factors including health history, lifestyle, physical risk factors and serum risk factors.
Students were then sent a health indicator report and, and they were categorized into into high, medium, or low risk.
If high, they were signposted to specific websites about their particular risk factor.
Thereafter, students go twice a week message about particular risk factor.
After 2 weeks, measurements were taken again (showing noteworthy improvements).

Which kind of health promotions does this use, and which kind of prevention/promotion is this (primary/secondary/tertiary) ?

Answer 14

Secondary prevention/promotion

This uses:

• Providing information (about their own risk factors, about what they can do about it)
• Enhancing motivation (tailored to their own risk factors + biweekly messages)
• Maintenance of behavior (biweekly messages)

Question 15

Describe the main points in the NICE guidelines for reduction of risk of CV disease, especially wrt dietary changes.

Answer 15

• Reduce total fat intake, saturated fats, and dietary cholesterol
• Replace saturated fats by mono-unsaturated (i.e. olive oil, rapeseed oil) and polyunsaturated fats
• Choose wholegrain varieties of starchy food
• Reduce their intake of sugar and food products containing refined sugars including fructose
• Eat at least 5 portions of fruit and vegetables per day
• Eat at least 2 portions of fish per week, including a portion of oily fish
• Eat at least 4 to 5 portions of unsalted nuts, seeds and legumes per week.

Question 16

Give an example of a tertiary prevention initiative.

Answer 16

Addressing personality of patients at risk

Question 17

Define personality.

Answer 17

‘a person’s cognitive, affective, or behavioural tendencies that are fairly stable across time and situations’ (fairly means you can change it)

Question 18

Explain how personality can impact on coronary heart disease.

Answer 18

Type A Personality: 
High competitiveness
High time urgency 
High hostility
More self critical 

Type B Personality:
Low competitiveness
Low time urgency
Low hostility

Type A seems to link with heart attack and/or CV disease. BUT high hostility is probably the factor that weight in heart disease
the most, not necessarily Type A as a whole.

Question 19

Explain how people with high hostility are more likely to have heart attacks/CV disease.

Answer 19

Having high hostility means one perceives their environment and people around thme as more stressful and hostile. In return these situations make them more hostile, so people interacting are hostile back. This can have physiological consequences.

Question 20

How do you assess Type A behaviour?

Answer 20

• Structured interview (focuses not only on the answers but also on the behavior shown during the interview e.g. talk slowly and see if they jump in)
• Questionnaires (self-report)
– Jenkins Activity Survey
– Framingham Type A Scale

Question 21

Describe treatment options wrt personality in the context of CV disease.

Answer 21

– Stress reduction strategies (identify which situations the person views as hostile and reduce exposure to them)
– Relaxation techniques (rather than avoiding situations the person views as hostile, reducing the level of hostility they experience in the situation and helping them cope)
– Anger management (reduce reactivity associated with that anger)

May use these techniques and see the effect on the person using ECG (e.g. looking at max ST depression, smaller/no depression better)