Lecture 3-Changing Health Behaviour using cognitions Flashcards
Name studies based on banning unhealthy behaviours E.g., banning smoking in workplaces / public places
Gomel et al, 1993
Workplace ban: reduced smoking at work, but no changes in smoking in general. No changes to numbers of smokers
Seo et al, 2011
University ban: Indiana University vs Purdue University – increased negative attitudes toward smoking and positive attitudes to bans at IU.
If you can increase Awareness, you can Change social norms
Name studies on deterring unhealthy behaviours E.g., banning cigarette advertising, preventing cigarette displays
Kim et al, 2013
Cigarette advertising: More cigarette adverts were associated with more positive attitudes about smoking. More cigarette promotions were associated with more current smoking.
Trumbo & Kim, 2015
E-cigarette advertising: positive reactions to adverts increased intentions to smoke – advertising may encourage uptake
Name studies on deterring unhealthy behaviours E.g., E.g., increasing taxes, increasing subsidies
Wagenaar et al, 2015
Increasing taxes on alcohol (2009) resulted in a reduction (28 months later) in road traffic accidents of 26% (10 per month) and similar rates of alcohol-related offences
Name the benefits of Public Health Messages
- Population-based
- Simple
- Cheap, easy
- Increase Awareness
Explain the Ashfield-Watt P (2006). Fruits and vegetables, 5+ a day: are we getting the message across? study
Aims: Two surveys to investigate the value of the 5+ a day campaign for fruits and vegetables in New Zealand
Household surveys 1999 – 200 ppts, 2000 – 520 ppts.
Results:
High awareness of campaign, high recognition of the logo,
High awareness of a need to consume more fruits and vegetables
Increased intentions to consume more fruit and vegetables
Intakes were not effected, but more effected by demographics
What are the negatives of public health messages?
No impact on knowledge
No impact on motivation
Although they can increase awareness they don’t have a massive impact on behavior
Long term- the more awareness the more people do change behaviour after a while
No impact on motivation
Explain Appleton KM (2016) study.
Participants saw either an Appearance based poster or a
Weight based poster about eating 5 a day
Appearance message works better for all 3 groups
Simple health promotion tools can work
Results:
Greater fruit selection following an appearance-based health promotion poster compared to a healthy based poster
Evidence suggesting some messages encourage behaviour better than others
explain this..
Gain-framed messages: tend to result in more desired behaviour for non-risky / preventative behaviours
Loss-framed messages: tend to result in more desired behaviour for risky / detection behaviours
Gain-framed messages: may be more effective for increasing existing behaviours
Loss-framed messages: may be more effective for one-off behaviours
What is a complex intervention?
Interventions that don’t simply aim to improve awareness and knowledge
Interventions that aim to improve a variety of cognitions, based on socio-cognitive models (they should be)
Explain the Richards et al. (2006) Motivating 18- to 24-year-olds to increase their fruit and vegetable consumption study
University based intervention based on the Transtheoretical Model:
Stages of change letter, 4 stage-based informational newsletters, 1 motivational interviewing session, 2 email contacts
Intervention resulted in increase in FV of 0.9 portions/day, control – no change
Explain the Di Noia et al. (2008) Computer-mediated intervention tailored on the transtheoretical model stages and processes of change increases fruit and vegetable consumption among urban African American adolescents. study
School based intervention based on the Transtheoretical Model
Method:
Computer programme – 4 x 30 min sessions based on stages of change
Results:
Intervention resulted in increase in FV of 0.9 portions/day, control – no change
What are the limitations of complex interventions?
- Expensive to implement
- Only available to certain individuals
- May not be cost-effective
- Individually tailored-if you are trying to target a specific group then they can be changed so that they meet that need (niche)
What are theory based interventions?
Interventions that don’t simply aim to improve awareness and knowledge
Interventions that aim to improve a variety of cognitions, based on socio-cognitive models
Based on only specific elements of socio-cognitive models
Social norm Interventions: Doesn’t work for all interventions, not a big enough change in behaviour or health.
Might work for something like smoking where the majority of people don’t smoke it doesn’t work for healthy eating as it is a too big issue.
Explain the Perkins & Craig, 2006, J Alcohol Studies study
Intervention to correct perceptions of alcohol consumption and binge drinking in student athletes
Results:
30% reduction in alcohol misuse – frequent personal use, high quantity drinking, high peak blood alcohol concentrations, negative consequences of drinking.
Explain the Thomas et al, 2017 study.
Intervention to state perceptions of vegetable consumption by other diners
- 3-7% increase in purchase of meals containing vegetables.
Benefits of Theory Based Interventions
- Cheaper, cost-effective
- Population-wide vs individuals
- More suitable for some behaviours than others.
Explain the set of steps to identify intervention
- Identify target behaviour and target population
- Identify the determinants of the target behaviour in the target population (What is it that people should be doing? Why aren’t they? Why are some people doing it?)
- Lit search or focus groups/interviews (Sometimes determinants can be different in varied ages/genders)
- Identify the salient determinants (predictors) / best predictors of target behaviour (Having identified all of the things in step 2 you need to expand your study and thinking to a wider audience)
- Questionnaires/surveys or focus groups/interviews
- Develop an intervention to target these salient determinants. (narrow down your determinants)
- If appropriate – use a socio-cognitive theory
- Repeated consultation with the target population
- Keep going back to target population- ask them are these still important beliefs? If not then change them!
Explain the Appleton, et al. study
Focus groups (4 groups, 28 participants) to elicit all reasons for eating and not eating fruit and vegetables
Questionnaire in 1000 (426) individuals to relate reasons for eating / not eating to actual intakes
Larger population but still within target demographic-trying to determine important beliefs
Best predictors: awareness of recommendations
liking for the taste of fruit and vegetables
Interventions to increase awareness
Interventions to increase liking
Explain Atkins et al. Parents don’t provide appropriate portions sizes for overweight children
Intervention based on the COM-B model Focus groups with parents Mixed methods research with parents Took predictors and mapped them onto the model Best Predictors: COM-B Model
Didn’t know correct portion sizes Psychological
Didn’t understand food packaging capability
Didn’t have time to read packaging Physical
Preferred to use household measures opportunity
Partners not always supportive Social opportunity
Lacked confidence in their abilities Reflective motivation
What should Interventions should focus on?
Intervention functions linked to the behavioural change wheel.
Intervention functions
COM-B Model
Psychological capability
Physical opportunity
Social opportunity
Reflective motivation
Explain the Intervention functions on the behaviour change wheel
- Education – Increasing knowledge or understanding
- Persuasion – Using communication to induce positive or negative feelings or stimulate action
- Incentivisation – Creating an expectation of reward
- Coercion – Creating an expectation of punishment or cost
- Training – imparting skills
- Enablement – Increasing means/ reducing barriers to 7. increase capability (beyond education and training) or opportunity (beyond environmental restructuring)
- Modelling – providing an example for people to aspire to or imitate
- Environmental restructuring – changing the physical or social context
- Restrictions – Using rules to reduce the opportunity to engage in the target behaviour
How does the COM-B model fit with intervention functions?
COM-B Model Intervention Function
Psychological Education / Training / Enablement
capability
Physical Restriction / Environmental opportunity Restructuring / Enablement
Social opportunity Restrictions / Environmental
Restructuring / Enablement
Reflective motivation Education / Persuasion / Incentivisation / Coercion
Explain the Nour et al (2019) study
Aim: Develop a smartphone app incorporating behaviour change techniques added gamification and social media- so you could link with your friends
Tested in 97 young adults
Results:
Some engagement with the app (64% users, 11 of 28 days)
Limited changes in vegetable consumption
Associations between vegetable consumption and app use
No effects of gamification or social media
Further work is needed to encourage app engagement
COM-B Model Behaviour Predictor
Psychological Knowledge of recommendations
capability and benefits
Awareness of own consumption
(self-monitoring and feedback)
Physical capability Cooking skills
Physical opportunity Time and cost of V preparation (taste)
Habits
Environmental triggers for V intake
Environmental challenges
COM-B Model Behaviour Predictor
Social opportunity Social support
Reflective motivation Beliefs and perceived barriers (taste)
Could potentially be psychological capability instead
Automatic motivation trying to get people to establish SMART goals for V intake
Value / benefits of V intake
Self-efficacy / confidence
Others’ approval
Behaviour Predictor Intervention Function
Knowledge of recommendations Education - information
and benefits
Awareness of own consumption Enablement / education -
(self-monitoring and feedback) self-monitoring, feedback
Cooking skills Training
Time and cost of V preparation (taste) Environment restructuring
Habits Training
Environmental triggers for V intake Environment restructuring
Environmental challenges Enablement
Behaviour Predictor Intervention function
Social support Enablement
Beliefs and perceived barriers (taste) Persuasion
SMART goals for V intake Enablement
Value / benefits of V intake Incentivization
Self-efficacy / confidence Enablement / modelling
Others’ approval Persuasion
Explain how to Develop your own intervention using COM-B model
- Choose a target behaviour
- Identify all the reasons you might / might not undertake the behaviour
- Identify the important reasons for you
- Match these to the COM-B model
- Identify the type of intervention you need from the
- Intervention functions
what is the AB design?
repeated measures- e.g. investigation of the impact of the smoking ban in UK
You make a change and then look at what happened before and whats happening now and then evaluate
What is the ABA design / ABAB design?
e.g. investigation of the impact of TV campaign – on for three months, off for three months
Make change and then look at it, and then go back again
Idea is that if something is there it will be present in both tests, also can see the influence of things outside of the test criteria (need to make sure you are testing for everything so that it allows for extraneous factors)
What is the ABAB intervention per individual – N-of-1?
e.g. investigation of the impact of daily instructions / motivational texts
used for things that change regularly
Different messages each day and theyre all treated like different ABAB tests
Look at the individual messages, what effect do they have? Ie over a 20 day period you alternate the texts, look at the patterns between the repeated tests
What are the advantages of Independent groups, repeated conditions e.g. impact of smoking ban in IU vs Purdue University
- Doesn’t suffer from time but does struggle with matching the conditions paticipating
- Doesn’t allow for other things having an effect which isn’t part of your test
- Big enough group that any differences (ie demographic/gender) will eliminate themselves
- Best but the most expensive/hard to implement
Independent individuals – randomised controlled trial
e.g. impact of health promotion poster on fruit consumption
Best type of test!
what do you need to consider to get the best quality of data?
- Study design
- Study size
- Study population
- Study measures
- Study analyses
- Study controls-accounting for variables having an effect that aren’t part of your trial
what is the purpose of Randomization and Allocation Concealment?
to try and stop researchers and participants knowing what is coming next
what is Intention to treat analyses?
include everyone who should be in the group regardless of if they are in the in the activity or not
what is a systematic review?
pre-specify databases, pre-specify search terms, use inclusion / exclusion criteria, include as much as possible, specific inclusion process, searches and inclusion process are conducted by at least 2 independent reviewers, specify outcomes of interest.
what is a meta analysis?
statistical combination of studies (usually based on study size), to give a combined effect size for all studies together
explain the Appleton KM et al. (2015) Systematic review and meta-analysis investigating a role for n3 polyunsaturated fatty acids in major depressive disorder. study
Cochrane methodology, published protocol.
Databases - The Cochrane Depression, Anxiety and Neurosis Review Group’s Specialised Registers, CINAHL and International Trial Registries
Search terms – n-3PUFAs x 12, depression x 6,
All years to May 2014
Inclusion criteria - randomized controlled trials; that provided n3PUFAs as an intervention; used a comparator; measured depressive symptomology, and were conducted in adults with MDD.
Outcomes - depressive symptomology; adverse events; risk of bias; Secondary outcomes - depression remission and response, quality of life and failure to complete studies.
results: 21 studies involving 1153 participants investigating the impact of n3PUFAs compared to placebo,
1 study involving 40 participants investigating the impact of n3PUFAs compared to antidepressant treatment.
Effect size - small-modest, unlikely to be clinically significant, high heterogeneity between studies.
Similar rates in intervention and placebo groups.
