Lecture 3-Changing Health Behaviour using cognitions

Question 1

Name studies based on banning unhealthy behaviours E.g., banning smoking in workplaces / public places

Answer 1

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

Question 2

Name studies on deterring unhealthy behaviours E.g., banning cigarette advertising, preventing cigarette displays

Answer 2

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

Question 3

Name studies on deterring unhealthy behaviours E.g., E.g., increasing taxes, increasing subsidies

Answer 3

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

Question 4

Name the benefits of Public Health Messages

Answer 4

1. Population-based
2. Simple
3. Cheap, easy
4. Increase Awareness

Question 5

Explain the Ashfield-Watt P (2006). Fruits and vegetables, 5+ a day: are we getting the message across? study

Answer 5

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

Question 6

What are the negatives of public health messages?

Answer 6

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

Question 7

Explain Appleton KM (2016) study.

Answer 7

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

Question 8

Evidence suggesting some messages encourage behaviour better than others

explain this..

Answer 8

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

Question 9

What is a complex intervention?

Answer 9

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)

Question 10

Explain the Richards et al. (2006) Motivating 18- to 24-year-olds to increase their fruit and vegetable consumption study

Answer 10

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

Question 11

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

Answer 11

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

Question 12

What are the limitations of complex interventions?

Answer 12

1. Expensive to implement
2. Only available to certain individuals
3. May not be cost-effective
4. Individually tailored-if you are trying to target a specific group then they can be changed so that they meet that need (niche)

Question 13

What are theory based interventions?

Answer 13

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

Question 14

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

Answer 14

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.

Question 15

Explain the Thomas et al, 2017 study.

Answer 15

Intervention to state perceptions of vegetable consumption by other diners
- 3-7% increase in purchase of meals containing vegetables.

Question 16

Benefits of Theory Based Interventions

Answer 16

1. Cheaper, cost-effective
2. Population-wide vs individuals
3. More suitable for some behaviours than others.

Question 17

Explain the set of steps to identify intervention

Answer 17

1. Identify target behaviour and target population
2. 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?)
3. Lit search or focus groups/interviews (Sometimes determinants can be different in varied ages/genders)
4. 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)
5. Questionnaires/surveys or focus groups/interviews
6. Develop an intervention to target these salient determinants. (narrow down your determinants)
   
   1. If appropriate – use a socio-cognitive theory
   2. Repeated consultation with the target population
7. Keep going back to target population- ask them are these still important beliefs? If not then change them!

Question 18

Explain the Appleton, et al. study

Answer 18

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

Question 19

Explain Atkins et al. Parents don’t provide appropriate portions sizes for overweight children

Answer 19

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

Question 20

What should Interventions should focus on?

Intervention functions linked to the behavioural change wheel.

Answer 20

Intervention functions
COM-B Model

Psychological capability
Physical opportunity
Social opportunity
Reflective motivation

Question 21

Explain the Intervention functions on the behaviour change wheel

Answer 21

1. Education – Increasing knowledge or understanding
2. Persuasion – Using communication to induce positive or negative feelings or stimulate action
3. Incentivisation – Creating an expectation of reward
4. Coercion – Creating an expectation of punishment or cost
5. Training – imparting skills
6. Enablement – Increasing means/ reducing barriers to 7. increase capability (beyond education and training) or opportunity (beyond environmental restructuring)
7. Modelling – providing an example for people to aspire to or imitate
8. Environmental restructuring – changing the physical or social context
9. Restrictions – Using rules to reduce the opportunity to engage in the target behaviour

Question 22

How does the COM-B model fit with intervention functions?

Answer 22

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

Question 23

Explain the Nour et al (2019) study

Answer 23

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

Question 24

Explain how to Develop your own intervention using COM-B model

Answer 24

1. Choose a target behaviour
2. Identify all the reasons you might / might not undertake the behaviour
3. Identify the important reasons for you
4. Match these to the COM-B model
5. Identify the type of intervention you need from the
6. Intervention functions

Question 25

what is the AB design?

Answer 25

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

Question 26

What is the ABA design / ABAB design?

Answer 26

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)

Question 27

What is the ABAB intervention per individual – N-of-1?

Answer 27

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

Question 28

What are the advantages of Independent groups, repeated conditions e.g. impact of smoking ban in IU vs Purdue University

Answer 28

1. Doesn’t suffer from time but does struggle with matching the conditions paticipating
2. Doesn’t allow for other things having an effect which isn’t part of your test
3. Big enough group that any differences (ie demographic/gender) will eliminate themselves
4. 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!

Question 29

what do you need to consider to get the best quality of data?

Answer 29

1. Study design
2. Study size
3. Study population
4. Study measures
5. Study analyses
6. Study controls-accounting for variables having an effect that aren’t part of your trial

Question 30

what is the purpose of Randomization and Allocation Concealment?

Answer 30

to try and stop researchers and participants knowing what is coming next

Question 31

what is Intention to treat analyses?

Answer 31

include everyone who should be in the group regardless of if they are in the in the activity or not

Question 32

what is a systematic review?

Answer 32

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.

Question 33

what is a meta analysis?

Answer 33

statistical combination of studies (usually based on study size), to give a combined effect size for all studies together

Question 34

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

Answer 34

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.