techniques of behaviour change

Question 1

how can we change the nature of medicine *

Answer 1

“We must reach and be meaningful to people in the lives that they are leading”

Question 2

summarise the COM-B models *

Answer 2

comprehensive view of the models in the literature

highlights the heterogenity of health behaviour models that depend on the behaviour

behaviour is influenced by capability. motivation and opportunity and motivation is influenced by capability/opportunity

Question 3

source fof behaviour in the COM-B model *

Answer 3

capability - physical ie can pt walk to get healthy food, psychological - have tehy got the information to make an informed choice

opportunity - social ie do peers and family support the change, phsycial ie finance etc

motivation - reflective ie conscious process eg making pros and cons, automatic ie how life long eating pattern and relationship with food influences motivatio

Question 4

what is the middle section of the behaviopur change wheel *

Answer 4

used to identify the interventions atht would be useful

Question 5

what is the outer section of the behaviour change wheel for COM-B *

Answer 5

the policies that inform interventions

for example if funding for marketing - promotion for heathly eating could occur as part of campaign

Question 6

what are behaviour change techniques *

Answer 6

a systematic strategy used in attempt to achange behaviour

Question 7

what is the difference between a behaviour change technique and intervention *

Answer 7

technique - specific

intervention - broad, encompassing lots of techniques

Question 8

examples of behaviour change techniques *

Answer 8

provide info on consequences

promote specific goal setting

prompting barriern identification

modelling the behaviour - eg getting parents to model a healthy lifestyle for their child

planning social support - ask a partner to help eg by putting medication out every day

Question 9

describe behaviour change taxonomy *

Answer 9

Michie and collegues completed an analysis to distal the different techniques in behaviour change literature into concise summary for various health behaviours

it made a common language to describe techniques to make an intervention depending on the behaviours trying to target

Question 10

what are teh behaviour change taxonomy clusters *

Answer 10

goals and planning

feedback and monitoruing

social support

shaping knowledge

natural consequences

comparison of behaviour

associations

resputation and substitution

comparision of outcomes

reward and threat

regulation

antecedents

identity

scheduled consequences

self belief

covert learning

Question 11

explain goal setting and problem solving in the goals and planning BCT cluster *

Answer 11

goal setting - eg aiming to walk a certain distance a day

problem solving - eg if the problem is financial - brainstorm the nature of the issue and how you colud resolve it

Question 12

which behavuiour change technique is the most effective *

Answer 12

depend on type of behaviour

if for diet and exercise - self reporting has most significant effect - however is time consuming for pt

Question 13

what are the 5 steps in choosing the BCT *

Answer 13

behavioural target specification

behavioural diagnosis

intervention strategy selection

implementation strategy selection

selecotion of specific BCTs

Question 14

describe behavioural target specification *

Answer 14

target behaviour to one aspect eg for pts who have had MI - improve their diet

Question 15

what is behavioural diagnosis *

Answer 15

look at who, what, when, how ofter, where, who with

who - people in cardiac rehab interested in reducing chances of another MI event

what - reduce non-mediteranean food (diet better for cardiac)

when - all meals

where - anywhere eat/source food

how often - all the time

who with - family/friends

Question 16

DESCRIBE INTERVENTION STRATEGY SELECTION *

Answer 16

COM-B

identify the barriers

capabilty - knowledge/mobility to get to the shop

opportunity - physical (finance for oily fish etc), social - family who are supportive

motivation - pros and cons, mental health make it hard to access good food

education and persuation are suggested by literature - eg group talk or website to educate people about diet

depending on resources available - think about the polocy categories that are importabnt

Question 17

dsecribe implementing strategy selection *

Answer 17

focus on the parameters that we have

eg for cardiac rehab - have access to service provision - run a group talk every week eg on a mediteranian diet

finding a way to provide intervention based on the resources that both we and the patient have

Question 18

describe self-monitoring *

Answer 18

a popular behavioural change technique

an individual keeps a record of target behaviours - food and exercise

additional info recorged can help identify barriers eg mood/weather

problem - time consuming ove rthe long term

role in increasing physical activity and healthy eating studied by Michie

Question 19

bariatrics example fo self-monitoring *

Answer 19

emotion driven eating - sub-clinical binge eating disorder

treatment is through cognitive behaviour therapy - behavioural aspect of this is being away of what our behaviours are

self recording - recrod binging/purging (vom/laxitives) and record their emotions at this time

aim is to identify any barriers to a patient’s weight loss

Question 20

what is motivational interviewing *

Answer 20

a person centreed couselling style for addressing the common problem of ambivalence about change

done because knowledge about need to change isnt enough

Question 21

what does the clinicial do in motivational interviewing *

Answer 21

MI spirit - non-judgemental, not educational, flexible, listen for opportunity to enter the conversation with MI techniques

MI-consistant behaviours - recignising when patient identifies that someothing isnt working for them

MI-inconsistant behaviours

using specific techniques - increase client’s readiness to make a behaviour change

Question 22

what are we listening for from our client in MI*

Answer 22

change talk - when the ot recognises the downside to their behaviour and an intention to change

stages of change - readiness to change - where are the patients on the change model - our role is to bring the pts to a place where they are ready to make the change

co-operation, engagement or disclosure - client engagement/involvment - make sure the pt doesnt switch off or become resistant to what we say because we are lecturing them

resistance to change - we need to listen to the signs so we can understand the resistance to change so that we can help patients identify the choices they have

build up client’s self-confidence - positive reinforcement

understand teh discrepancy between making a health change and staying the same

Question 23

describe the importance in understanding the stages of change model *

Answer 23

if dr go in too intensive - trying to force pt - might put them off if they’re not there yet

if pt only at intention to change stage - let the patient know what options and resources are available to hep patients change

Question 24

postive techniques of motivational interviewing *

Answer 24

ask pt what they wanted

used ‘change ruler’- ‘how confident are you that you could make a change’ - then question why they said that number

Question 25

describe implementatoon intentions *

Answer 25

action plans

request a pt to think about critical situations to act and appropriate responses within those situations

eg IF it is friday, THEN i will run

can be created by asking questions like when would be a good time and place for you to exercise, what specific exercises do you enjoy?

aim is to develop paired associations - initially thought out actions like having tablets with breakfast become normal and unconscious

by planning in advance the situation in which an individual will act, cues become accessible

strengthening connection between good situation to act and a suitable action

therefore behaviour is more likely to be enacted

Question 26

positives of using incentives to change health behaviour *

Answer 26

cost-effective

raise awareness

bring individuals into contact with health services, allowing earlier screening and treatmnet of illness

can be cost effective in changing health behaviours - therefore preventing disease and reducing costs associated with disease

generally helpful short term

Question 27

negatives of incentives to change health behaviour *

Answer 27

mixed reviews abput whether they are effective - despite some positive findings

unclear which rewards work best

not maintained when reinforcer is taken away - a problem because need life long chnages

lack of generalisation - only effects behaviour regarding the specific trait that is being rewarded

impractical and expensive

Question 28

is it better to change multiple health behaviours at a time *

Answer 28

may lead to a greater overall chnage but each individual behaviour will be changed less

Question 29

are interventions that comprise of >1 BCT more effective *

Answer 29

yes to a degree - moderately complex interventions combining a small numbe rof techniques might be most useful

ie 2-3 techniques rather than a very complex system

Question 30

Does tailoring educational materials to individual result in larger changes?

Answer 30

yes - small benefit ion effectiveness of behavioural interventions

Question 31

are active interventions more effective than passive interventions *

Answer 31

yes

Question 32

ways we can modify health behavior *

Answer 32

identify any gaps in knowledge and remedy them - without lecturing the person

identify cues and reinforcers - plan rewards

identify and attempt to modify inhelpful beliefs

enhance self efficacy

identify and problem solve barriers to change

identify positive role models

encourage social support

tailor intervention to readiness to change