techniques of behaviour change Flashcards
how can we change the nature of medicine *
“We must reach and be meaningful to people in the lives that they are leading”
summarise the COM-B models *
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
source fof behaviour in the COM-B model *
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
what is the middle section of the behaviopur change wheel *
used to identify the interventions atht would be useful
what is the outer section of the behaviour change wheel for COM-B *
the policies that inform interventions
for example if funding for marketing - promotion for heathly eating could occur as part of campaign
what are behaviour change techniques *
a systematic strategy used in attempt to achange behaviour
what is the difference between a behaviour change technique and intervention *
technique - specific
intervention - broad, encompassing lots of techniques
examples of behaviour change techniques *
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
describe behaviour change taxonomy *
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
what are teh behaviour change taxonomy clusters *
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
explain goal setting and problem solving in the goals and planning BCT cluster *
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
which behavuiour change technique is the most effective *
depend on type of behaviour
if for diet and exercise - self reporting has most significant effect - however is time consuming for pt
what are the 5 steps in choosing the BCT *
behavioural target specification
behavioural diagnosis
intervention strategy selection
implementation strategy selection
selecotion of specific BCTs
describe behavioural target specification *
target behaviour to one aspect eg for pts who have had MI - improve their diet
what is behavioural diagnosis *
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
DESCRIBE INTERVENTION STRATEGY SELECTION *
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
dsecribe implementing strategy selection *
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
describe self-monitoring *
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
bariatrics example fo self-monitoring *
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
what is motivational interviewing *
a person centreed couselling style for addressing the common problem of ambivalence about change
done because knowledge about need to change isnt enough
what does the clinicial do in motivational interviewing *
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
what are we listening for from our client in MI*
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
describe the importance in understanding the stages of change model *
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
postive techniques of motivational interviewing *
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
describe implementatoon intentions *
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
positives of using incentives to change health behaviour *
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
negatives of incentives to change health behaviour *
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
is it better to change multiple health behaviours at a time *
may lead to a greater overall chnage but each individual behaviour will be changed less
are interventions that comprise of >1 BCT more effective *
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
Does tailoring educational materials to individual result in larger changes?
yes - small benefit ion effectiveness of behavioural interventions
are active interventions more effective than passive interventions *
yes
ways we can modify health behavior *
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
