Section 2 - Fundamentals of Health Behavior Change

Question 1

Transtheoretical Model Stages of Change

Answer 1

Precontemplation - Lack of awareness, “I don’t need to change”

Contemplation - Considering makng a change in the next 6 months, “I may change”

Preparation - Aware of the need to change, “I will change”

Action - Started making changes or engaged in behavior less than 6 months, “I am changing”

Maintenance - Goal achieved, sustained more than 6 months

Termination - No temptation to return to previous unhealthy behavior, “I wont’ return to my old habit”

Question 2

Rate of Non Adherence to Chronic Illness Med

Answer 2

50-80%

Question 3

Motivational Interviewing(MI)

Answer 3

Best for Precontemplation and Contemplation

4 Principles:
- Express Empathy, show understanding of px situation
- Support self efficacy i.e. px confidence to succeed
- Roll with resistance, avoid resistance by remaining nonjudgemental, listening well, and encourage px to share
- Show discrepancy b/w what px is and what px wants. Hold it up so px can draw their own conclusion

Question 4

Cognitive Behavioral Therapy(CBT)

Answer 4

Best for preparation, action , and maintenance stages

Question 5

Principles of CBT

Answer 5

1. Recognize Non Productive Thinking
2. Reframe Non Productive Thinking
3. Reframe Thoughts and Self Talks to support behavior change
4. Recognize underlying beliefs that can interfere with behavior change

Question 6

Cognitive distortions (Types of non productive thinking)

Answer 6

1. All or nothing - there’s no in between. Either one way or the other.
2. Overgeneralization
3. Mental filter
4. Mind reading - having certainty what other is thinking without having to ask
5. Fortune Telling: “Knowing THIS will happen”
6. Magnification/Minimalization
7. Personalization and blame - You/others are responsible for the good or bad that happens to you
8. Emotional reasoning - your feelings don’t lie. “I feel like an idiot, so I really must be one”
9. Labeling/mislabeling - habitually defining ourselves or others with descriptive terms. “I’m an unorganized person!”
10. Disqualifying the positive - Acknowledging the good, appearing to be objective, but believing the good side has no value.

Question 7

How to Reframe Non Productive Thinking

Answer 7

• Make px aware of their non productive thoughts, and how they lead to negative emotions
• Teach them to adjust their thoughts
• Use Dr. Albert Ellis ABCDE:
  1. what ACTION or even occured?
  2. What BELIEFS do you have about what happened?
  3. What are the CONSEQUENCES of those beliefs?
  4. How can you DISPUTE those beliefs that seem to be distorted?
  5. What EFFECT does this new way of thinking have on how you feel?

Question 8

Positive Psychology

Answer 8

Should be utilized in all stages of change (Section 10)

Question 9

Score Confidence

Answer 9

1-10

If more than 7, px is more likely to accomplish their goal

Question 10

SMART Goals

Answer 10

• Specific (identify exact behavior to be addressed)
• Measurable (how one will know when the goal is reached)
• Attainable (the goal is achievable and can be accomplished)
• Relevant (goal is aligned with specific behavior change)
• Timebound (timeframe for achieving that goal)

Question 11

Step by step maintenance of action plan

Answer 11

1. Reiterate provider’s role in supporting px efforts to improve health and work of plan
2. Review and update diagnosis and lifestyle recommendations
3. Review px action plan from prior visit
   -Ask px to discuss successes and challenges
   -Ask px to summarize overall experience
4. Listen intently, reflect, summarize to show understanding
   5 Use positive psychology and affirm px strenghts and progress made.
   - Ask benefits gained from changes made
   - Things learned from challenging areas
   - How he/she feels about situation
   - Which behavioal goals ready and willing to master by next visit?
   - Summarize and clarify the new goals.

Question 12

3 Health Behavior Change Theories

Answer 12

1. Health Belief Model
   - Perceived Susceptibility
   - Perceived severity
   - Perceived benefit
   - Perceived barriers
   - Cues to action
   - Self efficacy
2. Theory of planned behavior: attitude, behavioral intention, subjective norms, social norms, perceived power, perceived behavioral control
3. Social cognitive theory
4. Transtheoretical model (pre-contemplation, etc)

Question 13

Key construct for effective, sustainable self management

Answer 13

1. Cognitive behavioral techniques
2. Social support
3. Community and employee programs
4. Support with digital technology, telehealth,etc.
5. Focus on skill power, not willpower

Question 14

Lapse vs Relapse

Answer 14

Lapse - short term period when action plan is not followed
relapse - sustained period when action plan is not adhered to

Question 15

Relapse prevention plan

Answer 15

1. When might a lapse occur
2. Under what circumstances
3. With whom
4. How to notice a lapse before it becomes a relapse
5. who to turn to during a lapse, relapse

Question 16

Follow Up

Answer 16

Follow up in person, by phone, or digital medium

• Congratulate on progress, discuss barriers, etc

Question 17

5As in Corporate Health Visit

Answer 17

1. Assess practices in context of health risks
2. Advise changing practices
3. Agree on focus of counseling treatment based on px interests and willingness
4. Assist px in achieving goals
5. Arrange for follow up and support

Question 18

Self motivation vs Self confidence

Answer 18

Self motivation - autonomous or internal motivation. Comes from withina person

Self confidence - trust a person has in their reasoning, capabilities, and qualities

Question 19

How to Foster self motivation and self confidence

Answer 19

1. Tell px can commit to change and master change
2. Clean ones mind of noise in order to listen to px with full attention
3. Be emphatic, warm, caring, accepting, open, compassionate
4. Focus and affirm the positive as much as possible
5. Share personal or anonymous examples if beneficial
6. Encourage px to take charge, decide, commit to wellness plan
7. View obstacles and setbacks as necessary parts of behavior change and path to success
8. Look for teachable moments

Question 20

Coaching Process

Answer 20

1. Help develop awareness, establish goals, create action plan
2. Emphasize working on areas where px will see quick success with little to some effort
3. Engage in reflection

• Simple reflection - paraphrase or restatement of what the px has said without added opinion or interpretation
• Amplified reflection - provide accurate, direct, and more exaggerated form of patient statement to evoke statement of desired change
• Double sided reflections - reflection that reveal more than one perspective at the same time
• Shift focus if there is resistance, re framing also works to see different perspective

Question 21

one of the simplest and most effective ways to evoke change talk—a patient’s own statements that favor change—is to ask open-ended questions for which the answer highlights the patient’s desire, ability, reasons and/or need for change.

Question 22

According to Albert Bandura, mastery experiences have the strongest influence on self-efficacy. Mastery experiences occur when a patient attempts and is successful in completing a task or skill related to his or her health behavior change goal.