Models of behaviour change (Health psychology, behaviour change and smoking cessation) Flashcards
Give examples of health behaviours that impact on depression
- isolation
- risk taking behaviours
- lack of sleep
- smoking/alcohol/recreational drugs
- Exercise
- CBT/music therapy
- mindfullness
- having a job/good family ties
- participating in social groups
- compliance with treatments
Give examples of health behaviours that impact on cardiovascular disease/hypertension
- smoking/alcohol/recreational drugs
- exercise
- healthy diet
- stress/type A personality
- spending time with people with poor health behaviours
- poor diabetic control
- taking statins/ compliance with primary prevention
Give examples of health behaviours that impact on skin cancer
- using sunbeds
- not reviewing moles with a health professional
- not using sun cream
- not reading/educating oneself about how to identify skin cancer/how to pretect from the sun
- staying in the sun at midday
Name some models of behaviour change
- health belief model
- Theory of planned behaviour
- stages of change/transtheoretical model
- social norms theory
- motivational interviewing
- social marketing
- nudging
- financial incentives
Outline the health belief model
individuals will change if they:
- believe they are SUSCEPTIBLE to the condition in question eg heart disease
- believe that it has SERIOUS CONSEQUENCES
- believe that taking action REDUCES SUSCEPTIBILITY
- believe that the benefits of taking action OUTWEIGH the costs
Who created the health belief model and in what year?
Becker 1974
What are the additional features of the health behaviour model?
That DEMOGRAPHIC VARIABLES such as SES, gender, age and PSYCHOLOGICAL CHARACTERISTICS such as personality and peer pressure, influence peoples perceived susceptibility, perceived severity, perceived benefits and perceived barriers as well as HEALTH MOTIVATION
In addition, CUES TO ACTION can directly influence the endpoint which is likelihood of action
How are cues to action classified?
Internal and external cues to action
Give examples of internal cues to action
MI Angina leg pain headaches (possibly, though not mentioned in the lecture, feelings of guilt, regret)
Give examples of external cues to action
Reminders - ‘are you still smoking’
Advice from others
Are cues to action necessary for behaviour change?
No
What are the disadvantages of using the health belief model?
Alternative factors may predict health behaviour such as SELF-EFFICACY (the person’s belief in their ability to carry out preventative behaviour)
- Does not consider the influence of EMOTIONS on behaviour
- does not differentiate between FIRST TIME and REPEAT behaviour
- CUES TO ACTION are often missing in HBM research
What are the benefits of the health belief model?
- longest standing model of behaviour change
- successful for a range of health behaviours eg vaccinations, diabetes management, adherence to medication, cancer screening
- perceived barriers have been demonstrated to be the most important factor in addressing behaviour change in pts
Outline the theory of planned behaviour
Proposes that the best predictor of behaviour is INTENTION eg I intend to give up smoking
Intention is determined by:
1. ATTITUDE
2. SUBJECTIVE NORM
3. PERCEIVED BEHAVIOURAL CONTROL (use this exact terminology in the exam)
It is then ultimately intention that influences behaviour
Explain attitude, subjective norm and perceived behavioural control
- attitude- a person’s attitude to the behaviour
- subjective norm - the perceived social pressure (by people held in high esteem by the patient eg friends/family) to undertake the behaviour (the poor health behaviour OR the behaviour change to be made)
- perceived behavioural control - a person’s appraisal of their ability to perform the behaviour (ie the behaviour change to be made)
Who developed the theory of planned behaviour and in what year?
Ajzen, 1988
Give examples of statements related to each aspect of the theory of planned behaviour for someone trying to give up smoking
- Attitude - I do not think smoking is a good thing
- Subjective norm - most people who are important to me want to give up smoking
- Perceived behavioural control - I believe I have the ability to give up smoking
- Behavioural intention - I Intend to give up smoking
What does the theory of planned behaviour feel that the best predictor of behaviour is?
Intention
What are the ways that someone can bridge the gap between intention and behaviour, so that they don’t just intend to make the change but actually make it?
- Perceived control
- Anticipated regret
- Preparatory actions
- Implementation intentions
- Relevance to self
What does perceived control mean in terms of bridging intention and behaviour?
Recalled success predicted success in the task
ie believing that you are able to make a change
What does anticipated regret mean in terms of bridging intention and behaviour?
Feeling of regret from not making a change or continuing the behaviour
What does preparatory actions mean in terms of bridging intention and behaviour?
Dividing a task in to sub-goals
This increases self-efficacy and satisfaction when the behaviour is finally changed
What does implementation intentions mean in terms of bridging intention and behaviour?
‘if-then plans’
Eg when you make a cup of tea, take your medication
What does relevance to self mean in terms of bridging intention and behaviour?
(not sure as not explained, but could be about believing that the behaviour change applies to your circumstances)
What are the disadvantages of the theory of planned behaviour?
- it is a rational choice model, which does not take into account emotions such as fear, threat or positive affect which may all disrupt rational decision making
- habits and routines bypass cognitive deliberation and therefore may undermine the cognitive link between intention and behaviour
- does not explain how attitudes, intentions and perceived behavioural control interact with each other
- Assumes that attitudes, subjective norms and PBC can be measured
- not as successful at bridging the gap between intentions and behaviours
What are the advantages of the theory of planned behaviour?
- has been successful in predicting intentions for health behaviours eg diet, smoking, condom use
- takes into account the importance of social pressures and perceived behavioural control
Name a stages model for behaviour change
Transtheoretical model (also called the stages of change)
What are the 5 stages of change in the transtheoretical/stages of change model?
- precontemplation
- contemplation
- preparation
- action
- maintenance
In lay terms, what do the 5 stages of change mean?
- not ready yet
- thinking about it
- getting ready
- doing it
- sticking with it
Does the 5 stages of change model take into account relapse?
Yes- can relapse back at any stage of the model
Give examples of the 5 stages of change in relation to someone who is trying to give up smoking
• Precontemplation – no intention of giving up
smoking
• Contemplation – beginning to consider giving up,
probably at some ill-defined time in the future
• Preparation – getting ready to quit in the near future
• Action – engaged in giving up smoking now
• Maintenance – steady non-smoker,
i.e. state of change reached
(and relapse)
Is the transtheoretical model effective?
Yes for smoking, but for other things like weight loss and eating disorders it is less effective
What are the advantages of the transtheoretical model?
- acknowledges stages of readiness, so allows interventions to be tailored to patient’s stage
- accounts for relapse
- temporal element
- acknowledges that you don’t have to start from the first stage, can join at any stage
What are the disadvantages of the transtheoretical model?
- Not all people move thorough every stage, some people move backwards and forwards or miss some stages out completely
- Change might operate on a continuum rather than in discrete stages
- Doesn’t take in to account values, habits, culture, social and economic factors - ie doesn’t take into account factors that determine behaviour only the stages of change
Name some other models of behaviour change?
- motivational interviewing
- Nudge theory
What is motivational interviewing?
a counselling approach that initiates behaviour change by resolving ambivalence
When is motivational interviewing used?
alcohol dependence
What is nudge theory?
changing the environment to make it easier for people to make better health choices
Give examples of environmental nudges
placing fruit next to checkouts
How effective is the nudge approach?
Weak evidence for its effectiveness
What is the social norms theory?
States that behaviour is influenced by misperceptions of how our peers think and act.
How would you change health behaviours according to the social norms theory?
You would show the patient statistics for the actual norms, which the pt often underestimates
eg showing college students how much alcohol their peers actually drink to change their misperception
What important factors are missing from the above theories?
- impact of personality on behaviour change
- past behaviours or habits
- automatic influences on behaviour
- predictors of maintenance
How can we reduce obesity?
Always think of individual and population level interventions
individual
- advice from HCP
Population
- NHS health check
- reduce advertising
- public health campaigns - change for life
- park run
In terms of obesity, what questions would you ask a patient to encourage them to lose weight using the health belief model?
- do you believe that obesity makes you more susceptible to other conditions like heart disease and stroke?
- do you believe that your weight might have serious negative consequences on your health?
- do you believe that if you reduce your weight, you will be less likely to have serious consequences?
- do you believe that losing weight is more advantageous than the drawbacks of having to lose weight?
In the adapted version from Becker 1974, could also stage that you would look at their demographic factors (eg age, SES) and their psychological factors (eg personality, peer pressure) and consider previous cues to action
In terms of obesity, what questions would you ask a patient to encourage them to lose weight using the theory of planned behaviour?
- How do you feel about your obesity?
- Do you think that most people are overweight or obese?
- Do you think that you will be able to lose weight?
In terms of obesity, what questions would you ask a patient to encourage them to lose weight using the transtheoretical model?
- Have you thought about losing weight?
- Have you make any changes to try and lose weight or not yet?
- Do you feel ready to start to make steps to reduce your weight?
- Have you managed to lose weight recently?
- Have you managed to sustain your weight loss?
In terms of obesity, what questions would you ask a patient to encourage them to lose weight using the social norms theory?
- Do you think that most people are overweight or obese?
Why are transition periods important?
They are the times when behaviour change is most effective?
What the the transition periods?
- leaving school
- entering the workforce
- becoming a parent
- becoming unemployed
- retirement and bereavement
eg many people stop smoking in pregnancy
many people lose weight in retirement
In terms of obesity, what would you say to encourage them to lose weight using the health belief model?
- Obesity can lead to heart disease, stroke diabetes and cancer
- These conditions are very serious and can have long-term implications eg being on medicines with side effects for many years, being in hospital, having a heart attack and death
- But you can do something to change your weight and I have seen many patients like you who have lost weight
- You don’t have to spend lots of time doing vigorous exercise, so its not as time consuming as you may think, you can just start by making simple changes to your diet
In terms of obesity, what would you say to encourage them to lose weight using the theory of planned behaviour?
- Attitude - a bit hard to change
- 3/4 of people are not overweight or obese
- You can do something about it and it is attainable
What activities would a patient with obesity each stage of the transtheoretical model engage in?
pre-contemplation - simple advice and encouragement - have you thought about losing weight, NHS health check
contemplation - pt starts to ask for advice on how to lose weight, reads about how to lose weight
preparation - starts to make plans for exercise, buys healthier food
action - starts to exercise and eat more healthy
maintenance - continues to exercise and eat more healthy despite set backs and pressures
What do the models mean on a practical level when having conversations with patients?
we need to explore a person’s beliefs and reasons why they engage in particular behaviours before developing a plan for behaviour change
