Understanding Health Habits and Behaviour Change

Question 1

What is a health habit?

Answer 1

Actions that are triggered automatically in response to contextual cues that have been associated with their performance

Question 2

Examples of health habits

Answer 2

Washing hands (action) after using the toilet (contextual cue)

Putting on seatbelt (action) after getting into the car (contextual cue)

Tooth brushing (action) after breakfast/before bedtime (contextual cue)

Question 3

7 important health habits

Answer 3

How many hours do you sleep per night?

Do you eat breakfast every day?

Do you snack between meals?

Are you near or within a normal body weight?

Healthy eating

Do you smoke?

If you drink alcohol, is this at a moderate level?

Do you exercise regularly?

Question 4

Outline the habit loop

Answer 4

Cue/trigger: Can be internal or external -a person, place, time, a thing or even an emotion

Routine: Behaviour to reinforce/change

Reward: Makes doing the routine worthwhile

Positive reinforcement

Keep habits going – maintains behaviour

Question 5

3 phases of habit formation

Answer 5

Initiation phase: Define the new behaviour and context it will be practiced are selected

Learning phase: Behaviour is repeated in chosen context to strengthen the context-behaviour association

Stability phase: The habit has formed and its strength has plateaued, habits persists over time with minimal effort

Question 6

How long does it take to form a habit?

Answer 6

Average 66 days

Range 18-254 days

Question 7

What theories supply the idea that parents play an important role in encouraging and modelling good habits?

Answer 7

Social Learning Theory (Bandura, 1977)

Peer modelling – children and vegetable study (Birch, 1980)

Classical conditioning – learning process based on a paired stimulus (e.g. Pavlov’s dogs)

Operant conditioning

Question 8

How is behaviour critical to health?

Answer 8

Non-communicable diseases are the leading cause of death globally e.g. T2DM and CVD

Question 9

Consequences of unhealthy habits on health (health + social consequences)

Answer 9

Health: Increased mortality, increased risk of developing chronic conditions e.g. diabetes, obesity, cancer, hypertension, depression, anxiety

Social consequences: Problems with debt, relationships, employment

Question 10

Examples of unhealthy habits

Answer 10

Too little sleep

Smoking

Alcohol

Caffeine

Drugs

Sedentary behaviour

Social media

Shopping

Gambling

Question 11

What is the COM-B model? (Michie et al, 2011)

Answer 11

Question 12

How is the COM-B model applied?

Answer 12

Question 13

What is the transtheoretical/stages of change model? (Prochaska & Di Clemente, 1982)

Answer 13

Question 14

How is the transtheoretical/stages of change model applied?

Answer 14

Question 15

Behaviour change techniques

Answer 15

Action planning

Goal setting (behaviour/outcome)

Self-monitoring of behaviour

Question 16

Goal setting behaviour change techniques

Answer 16

Set goal specific to behaviour you want to change:

Mode/ Type

Intensity

Duration

Frequency

Make it a SMART goal:

Specific Measurable Attainable Relevant Time-Based

Question 17

Problem solving behaviour change technique

Answer 17

Identify a barrier, then identify a strategy to overcome that barrier

E.g. feel self-conscious at the gym -> exercise at home using YouTube

Question 18

Why is it so difficult to break old habits?

Answer 18

Enjoyable behaviours prompt brain to release dopamine (REWARD)

If you repeat a behaviour and dopamine present – strengthens habit even more

Replacing first-learned habit with a new one does not erase original behaviour

Question 19

Techniques to break old habits with examples

Answer 19

Disrupting old habits e.g. put phone in another room at night, don’t keep certain foods in house

Replace unhealthy habit with a more healthy one e.g. drink water instead of sugary drinks, eat fruit instead of crisps

Increase social support e.g. engage in group activities involving physical activity - buddying/partnering

Seek counselling support e.g. help understand how the habit developed/maintained/quit

Question 20

Principles of motivational interviewing (RULE)

Answer 20

Roll with resistance: Avoid telling patient what to do, persuasion or argument. Instead, reflect and re-frame

Understand motivations: Understand values, needs, abilities, motivations and barriers to change behaviours

Listen with empathy: Seek to understand from patient’s perspective, respect decisions and choices

Empower: Help patient to explore how they can make changes e.g. set goals/techniques to overcome barriers, encourage patient to come up with own solutions

Question 21

Motivational interviewing techniques

Answer 21

OARS

Open questions

Affirmation

Reflection

Summarising

Question 22

Useful models/approaches for helping patients change their behaviour

Answer 22

Models such as COM-B to understand behaviours

Using behaviour change techniques

Motivational interviewing

Question 23

7 steps to change a habit

Answer 23

Identify the habit you wish to change

Examine the possible habit loop that maintains the behaviour

Identify what new habit you want to form

Disrupt old habit and introduce new behaviour

Set realistic goals and identify rewards

Monitor

Long-term goals

Question 24

List advantages of the Transtheoretical Model

Answer 24

Predicts change in some behaviours

Broad and has identified many useful processes involved in behaviour change

Question 25

List disadvantages of the Transtheoretical Model

Answer 25

Stage definitions are arbitrary

Assumes that change is planned (spontaneous change left out)

Doesn’t assess readiness to change

Doesn’t consider negative processes (e.g. wishful thinking, avoidance, blame)

Suggests insight into behaviour

Question 26

What is operant conditioning?

Answer 26

Learning by consequences

Behaviour becomes more or less frequent depending on the stimulus that follows it: e.g. patient in need of social interaction visits GP frequently, if the GP provides the social stimulation

Individual makes association between a particular behavior and consequence

Positive and negative reinforcement can be used to change behavior:

• Reinforcement= increases a desired behavior
• Punishment= decreases an undesirable behavior

Question 27

Outline posiitve reinforcement

Answer 27

Reward is given after a particular behavior occurs, this increases the expression of the behavior in hope that the reward will occur again

Question 28

Outline negative reinforcement

Answer 28

Upon achieving the desired behavior, a negative stimulus is removed

For example: loud noise sounding until a rat pushes the button to make it stop. They then press the button far more often

Question 29

Outline positive punishment

Answer 29

When a behavior is followed by an aversive stimulus, such as pain from a spanking, resulting in a decrease in that behavior (positive because you are adding a stimulus)

Question 30

Outline negative punishment

Answer 30

Occurs when a behavior is followed by the removal of a stimulus, such as taking away a child’s toy following an undesired behavior, resulting in a decrease in that behavior