L19 - Interventions: Individual & Population

Question 1

What are the 3 strategies used to improve/change health on an individual level?

Answer 1

1. Motivational interview
2. Problem solving approaches and implementation planning
3. Modelling and behavioural practice

Question 2

Describe Motivational Interviewing

Answer 2

o Person-centred method for enhancing intrinsic motivation to change by exploring and resolving ambivalence
o The intervention generally considered most likely to be effective for people who are reluctant to engage in change
o Motivational interview (MI) is collaborative, non-confrontational, non-authoritative

 Collaboration: patient-practioner partnership; joint decision making. Practitioner acknowledge patient’s expertise about themselves
 Evocation: practitioner activates patient’s own motivation for change by evoking their reasons for change – connects health behaviour change to things patient cares about
 Honouring patient autonomy: whilst informing the patient, practitioner acknowledges the patient’s right and freedom not to change, ‘It’s up to you’

Question 3

Is Motivational Interviewing effective?

Answer 3

 Goal of MI is to motivate people to consider change
 Most studies focus on whether it can alter behaviour
 Meta analysis: Smedslund et al. (2011)
• MI in drug overuse setting more successful (substance use behaviour) than no intervention
• Limited differences with other active treatments
 Schneider, Casey & Cohen (2000)
• Compared MI with confrontational interviewing in persuading substance users to enter treatment
• At 3 and 9 months – equal % of groups had completed their treatment program and had made similar gains in reduced drug use
• HOWEVER, MI was more acceptable and less stressful for both counsellors and clients than confrontational approach

Question 4

Describe Problem Solving Approaches and Implementation Planning

What are the 3 distinct phases?

Answer 4

Focused on the issues at hand, in the ‘here and now’

Three distinct phases
 Problem exploration and clarification: detailed exploration of problems individual is facing; breaking ‘global insolvable problems’ into carefully defined solvable elements
 Goal setting: identifying how individual would like things to be different; setting clear, behaviourally defined, achieveable goals
 Facilitating action: developing plans and strategies through which these goals can be achieved

Question 5

Effectiveness of Problem Focused Counselling

Answer 5

 Despite generally acknowledge effectiveness of problem focused counselling styles – surprisingly little examination of effectiveness
 Gamel et al (1993) risk factors for heart disease study:
• 3 groups: risk education; problem focused counselling; no intervention
• Problem solving intervention had greatest effect&raquo_space; greater reductions in blood pressure, BMI, smoking than in education only or no intervention groups

Question 6

Describe Modelling and Behavioural Practice

Modelling change example (Sanderson and Yopuk 2007) - condom promotion video

Answer 6

o Problem focused and planning strategies can help – BUT achieving change can still be difficult
o Particularly where individual lacks skills and confidence in their ability to cope with demands of change
o Potentially overcome by learning skills or appropriate attitudes from observation of others performing them – vicarious learning

Sanderson and Yopuk (2007)
• 220 University students assigned to receive either:
o 30 minute condom promotion video (positive attitudes about condom use, modelling appropriate strategies for negotiating use; male vs female presenter versions)
o Waitlist control
• Intervention (video) participants reported:
o Stronger intentions to engage in protected sex
o Higher self-efficacy in refusing to have unprotected sex
o Higher levels of condom use four months after seeing the videos
• Both male and female students benefited more (condom use behaviour) from viewing the female presenters versions

Question 7

Describe Mass Media Campaigns as a population approach to behaviour change

Potential benefits

Potential challenges

Answer 7

o Print advertising, television advertising, radio, billboards, online
o Potential to reach hundreds of thousands/millions
o Exposure generally passive – resulting from incidental, routine use of media
o May be short of duration or extend over long periods
o May be stand alone or linked to other organised program components (e.g. clinical outreach, new products/services, policy changes)
o Multiple methods of dissemination may be used in some initiatives

Benefits
o The great promise of mass media campaigns lies in their ability to disseminate well defined behaviourally focused messages to large audiences repeatedly, over time, in an incidental manner, and at a low cost per head

Challenges
o Campaign messages can fall short (or even backfire)
o Exposure of target audience may be suboptimal
o Funding may be inadequate/ceased
o Inappropriate or poorly researched format may be used (e.g. age inappropriate content)
o Homogenous messages might not be persuasive to heterogeneous audiences
o Campaigns might address behaviours that audiences lack the resources to change

Question 8

Are Mass Media Campaigns successful?

Answer 8

o The tendency to consider advertising campaigns as successful purely based on awareness and attitudes is hugely problematic
o “Speeding. No one thinks big of you”
 An independent survey, commissioned by the RTA’s Road Safety Marketing, found:
• 53% of young males (17-25 years) said that they would be more likely to comment on someone’s driving as a result of seeing this campaign
• 63% of young male drivers, believed the campaign to have some effect in encouraging young male drivers to obey the speed limit
• 75% of young males revealed strong recognition of the anti-speeding message
 Influence on actual speeding behaviour?
• P-plater deaths fell by 46%, as did crashes and high-risk speeding infringements

Question 9

What are the 3 methods to maximise effectiveness of mass media campaigns?

Answer 9

1. Appropriate use of fear messages
    Popular approach
   • High levels of threat proven relatively ineffective in engendering behaviour change
   • E.g. fear arousal campaign for HIV/AIDS
   • Increased HIV/AIDS anxiety but did not increase knowledge or trigger behavioural change
    Witte argued that the most persuasive messages are therefore those that:
   • Arouse fear – e.g. unsafe sex increases your risk of getting HIV
   • Increase the sense of severity if no change is made – e.g. HIV is a serious condition
   • Emphasise the ability of the individual to prevent the feared outcome (efficacy) – e.g. here’s how you engage in safer sex practices
    If the ability of the individual to prevent the feared outcome is no emphasised, any fear messages may actually inhibit behaviour change:
   • Such messages may increase resistance to the message
   • Lead to denial that it applies to the individual
   • Increase engagement in the targeted risk behaviour
    Despite these results, health messages frequently emphasise vulnerability and severity and neglect efficacy
2. Information framing
    Health messages can be framed in either positive (stressing positive outcomes associated with action) or negative terms (emphasising negative outcomes associated with failure to act)
    Negative frames may be more memorable, but positive frames may enhance information processing
3. Specific targeting of interventions
    Mass media campaigns may ‘dilute’ the message
    It is more effective to target your audience
    Media campaigns can be targeted on several factors:
   • Behaviour
   • Age
   • Gender
   • Socio-economic status
   • Sexuality
   • Psychological factors such as their motivation to consider change