Helping Patients Change Behaviour Flashcards
What are health behaviours?
Behaviours that are related to the health status of the individual
What factors influence health behaviour?
Threat: awareness of danger or potential threat
Fedr: emotional arousal by perceived relevant threat
Barriers: preventing response/behaviour
Benefits: positive reward consequence
Subjective norms: the view of others + how relevant
Attitudes: evaluation/beliefs about behaviour
Response efficacy: perception of response in preventing threat
Cognitions: awareness of thoughts + perception
Intentions: plans to carry out response/behaviour
Cues to action: external + internal factors that influence decision making
Why do humans resist change?
Creatures of habit
Simply giving information ineffective (need dialogue)
Short-term vs long-term
(short-term difficulty -> long-term benefit)
Motivation
What is behaviourism?
Scientific study of how reward + punishment (stimuli) affect emotion + behaviour (response)
Empirical approach: vary contingencies of reward + punishment + measure effect on behaviour
Behaviour is a conditioned response occurring in presence of stimuli
If learnt, it can also be unlearned/modified through conditioned learning
What is operant conditioning? Explain the Skinner experiment to back this up.
Rats/pigeons hit food pellet in box by accident + was getting food so learnt to press it on purpose to get food
= we behave to get a reward
What is classical conditioning? Explain the Pavlov and Watson experiment to back this up.
Pavlov: dogs would salivate in presence of person presenting their food so started off ringing a bell (unconditioned) but then associated it with food -> even when food was took away, the bell made the dogs salivate
Watson: young child was not scared of cuddly white rat so they rang a loud + distressing noise when the rat was presented -> when bell was removed rat instilled fear in child
= associated learning
How is operant conditioning relevant to medicine?
Positive reinforcement vs punishment
Behaviour change: health care professionals
Unhelpful positive reinforcement e.g. chronic pain
What is the behaviour wheel used for?
Systematic way of designing + implementing interventions to support patients behavioural change -> if the intervention works we want to roll it out to the NHS and influence policy + guidelines
What is the COM B model?
States that Behaviour is influenced/influences 3 factors:
- Capability
- Opportunity
- Motivation
(they influence eachother too)
Don’t need to target all 3 in an intervention -> target one that is main resistance to change
What is capability?
Physical: ability to engage in behaviour e.g. movement exercises
Psychological: need to understand why they should change their behaviour
What is motivation?
Automatic: inner desire we have at subconscious level (innate)
Reflective: decision making aspect
Both heavily influenced by a wide variety of factors
What is opportunity?
Do they have opportunity to engage in behavioural change? Do they have access to interventions + the time? Where are the interventions?
What are the steps of behaviour change in practice?
- Define behavioural problem
- What target behaviour will address problem?
- A clear plan of when + how patient will perform target behaviours + exactly what they need to change? Who else is involved?
- Assess using COM-B framework i.e. capability, opportunity + motivation
- Reflect, evaluate, monitor + adapt if necessary (could be positive reinforcement e.g. you have not failed)
What are social cognition theories? What are the 3 types?
Attempt to explain relationship between social cognitions (e.g. beliefs, attitudes, goals etc.) + behaviour
- Health belief model
- Theory of planned behaviour
- Transtheorectical model
What is the Health-Belief Model (HBM)?
Perceived susceptibility + perceived severity -> perceived threat
Perceived benefits + perceived barriers -> perceived efficacy
Perceived threat + perceived efficacy -> influence health behaviour
How can you use the Health-Belief Model (HBM) in clinical practice?
Need to explore patients perceived susceptibility, severity, benefits + barriers
Use education for perceptions of threat + goal setting/action planning + problem solving to help overcome barriers
What is the Theory of Planned Behaviour (TPB)?
Behavioural beliefs + outcome evaluation -> behavioural attitude
Normative beliefs + motivation to comply -> subjective norm
Control beliefs + self efficacy -> perceived behavioural control
End points lead to behavioural intention + then behaviour
(perceived behavioural control can also directly influence behaviour not via behavioural intention)
How can you use the Theory of Planned Behaviour (TBP) in clinical practice?
TPB can predict 55-71% of intentions for following health related behaviours e.g. smoking, testicular self examination, exercise, diet + oral hygiene
What is the transtheoretical model?
AKA stages of change:
Pre-contemplation -> contemplation -> preparation -> action -> maintenance (relapse can happen at any stage + change may not happen in this directive way, it may bounce back + forth)
Starts with experiential, goes through processes of change + ends with behavioural change
What health behavioural models/theories is best?
There isn’t one - each one has advantages + disadvantages so they offer different perspectives; not in competition
