PAS WEEK 2_LIFESTYLE DISEASE, RISK AND BEHAVIOURAL CHANGE

Question 1

What are leading causes of death in Australian adults?

What is important about the risk factors for CVD?

Answer 1

Ischaemic heart disease, dementia inc Alzheimer disease, CVA(cerebrovascular event), Lung & trachea cancers, COPD.
CVD risk factors are amenable to behavioural change.

Question 2

List some characteristics of chronic conditions:

Answer 2

• complex and multiple causes
• gradual onset (may have acute onset or acute stages)
• Long term and persisiten, gradual deterioration in health
• Can comprmise quality of life- limitations
• Not usually life threatening in themselves but lead to untimely mortality
• occur across lifespan more often on older people

Question 3

List some determinants of chronic disease?

Answer 3

biological factors:
- genetics and ageing
social factors
- education; employment; wealth; relationships; culture
- behavioural factors;
- smokin; drinking alcohol; physical activity; diet
- Environmental factors:
- air quality; sanitation; natural and built environment (housing); spread of pesticides and other chemicals etc.

Question 4

What is the prevalence of following risk factors:
smoking
obese or o/wt
not enough fruit
alcohol
insufficient exercise
inadequate veg

Answer 4

What is the prevalence of following risk factors in chronic diseases:
smoking: 13%
obese or o/wt: 63%
not enough fruit: 50%
alcohol: 17%
insufficient exercise: 56%
inadequate veg: 93%

significant costs associated with alcohol misuse

Question 5

SNAP factors make up 31% of total burden of disease. What are their individual burdens of disease?

Answer 5

smoking 9%
nutrition 5.5
alcohol 5.1% (light or moderate reduces disease burden by 2.8%)
Physical inactivity 5%

SNAP campaigns:
“Swap, don’t stop”- 1 less cigarette
or have a gls H2O b/w drinks

Question 6

List some determinants of behaviour: context of the person

Answer 6

• Personality
• compulsive/excessive
• coping and social learning (habits learned from those you’ve grown up around)
• condition/ reinforcement: important to give positive affirmations for things going well in their life and things that have worked for them.
• genetics and physiology (these determine some biology)

Nb. Be aware, some of the poeple we may deal with will have very little decision making abilities, ie, they will be relying on external powers to create their change. They may not even be able to recognise they are able to change this behaviour.

Question 7

Social Cognitive Theory (Bandura 1986):
behaviour arises out of:
What is strongly effected by self efficacy?

Answer 7

-Behaviour arises out of:
-previous experience (less likely to do s/t that hasn’t worked in the past)
anticipation of the future( where are you going, how can we help you get there?)
- learning (may not know about their own body)
-being able to set own standards (may be extrinsically motivated, so may be difficult for some time.
- reflecting and evaluating behaviour

Strongly effected by self efficacy(perceived ability to undertake an action):

• experience
• perception of personal competencies (confidence)
• reaction to persuasion
• response to present situation

Question 8

Transtheoretical model- stages of change

Answer 8

Precontemplation
- increase awareness of need to change

Contemplation
- motivate and increase confidence in ability to change
Preparation- Negotiate a plan (Ask, Assess, Advise, Assist)

Action
- Reaffirm commitment and follow-up (may lead to relapse)(Ask, Assess, Advise, Assist, Arrange)

Maintenance
- encourage active problem-solving
Termination (Ask, Arrange)
OR
Relapse- assist in coping (may lead to pre-contemplation or contemplation
nb. Change happens over time, relapse can occur at anytime; work through barriers with people.

Question 9

List some questions you may ask to see if someone is in or past pre-contemplation (conscious raising, including feedback and education):

Answer 9

• Have you ever thought about this?
• What’s your willingness to talk about…?
• Sounds like you’re having a lot to drink, this might be causing health problem
• How would you feel about discussing…?

Question 10

When a patient is at the planning stage of making a change, how could you help them?

Answer 10

Sit down with them and try to get a firm start by:

• Helping them set a date
• Work out what else they need to begin
• What short term goals can be reached?

Question 11

If someone is ready to action their change, what kinds of things could you discuss with them?

Answer 11

Help them with self-efficacy:

think about bumps in the road, discuss challenges that may or are causing them a problem. Take blood tests.

Question 12

What are the 5 As of the 5 As approach?

Answer 12

1. Ask
   - identify patients with risk factors: determine where they are on stages of change.
2. Assess
   - Level of risk factor or relevance to indiv.
   - Readiness to change/motivation
3. Advise
   - Provide written information
   - Brief advice and motivational interviewing
4. Assist
   - pharmacotherapies
   - support self monitoring
5. Arrange
   - Referral to specialist services: social support groups; phone info/counselling services; follow-up