unit 3 Flashcards
PA is what kind of behavior?
PA is a complex behavior
Theory
Concepts and definitions that present a systematic view of events by specifying relationships among variables in order to explain and predict events.
Theories help answer what types of questions?
Why? What? How?
Construct
Variables from theories
Models
Draw from different theories to help understand a specific problem in a particular setting or context
Social ecological model: levels
Individual factors - you
Social factors - people
Environmental factors - places
Policy factors - laws
Social ecological model: active living domains
Transportation
Occupational
Household
Recreational
Individual level
Students, workers, patients, homeowners, residents, teachers
individual people
Individual factors
Knowledge, attitudes, beliefs, behaviors, motivation, skills (predisposing)
Ages, ability, illness/injury
Self efficacy, readiness to change
Education, sex, race, income
Social environments: Interpersonal and Cultural Level
Friends, classmates, family, co-workers, neighbors
Social environments: Interpersonal and Cultural Level influence PA by:
Social support, peer influence, modeling, group/community norms, cultural background, access to social networks
Physical environment: Natural and created environments
Influence amount / type of PA (+/-)
- parks, trails, rec. (encourages PA)
- worksites, schools, home (discourage PA)
Physical environment: includes
Geography (weather/topography) Availability/access Aesthetics Safety Community design Public transportation
Public policy
- Legislation, regulatory, or policy actions
- Local, state, or federal government
- Informal local policies or rules on schools or worksite s
Public policy examples
- Urban planning policies
- Education policies (require 4 years, PE)
- Healthcare policies
- Workplace policies
The community guide
Provides evidence based strategies to change behavior
The Community Guide tells us…?
- Does it work/how well?
- For whom does it work?
- Under what circumstances?
- Cost effective?
- Barriers?
- Risks?
- Unanticipated outcomes?
What are the 3 different catergories of evidence for the community guide?
- Recommended - evidence supports
- Recommended against - evidence does not support
- Insufficient evidence - not enough evidence to determine
Physical Activity Recommendation Categories
- Campaigns and informational approaches
- Behavioral and social approaches
- Environmental and policy approaches
What is essential for PA participation?
- Identify factors associated with being active (or not active)
- Understand the relationship between PA and those factors
- Identify if this is true for all groups
Correlate
Anything that has a reproducible association
Positive = one variable goes up, the other goes up Negative = one variable goes up, the other goes down
Determinant or mediator
A causal factor
- changes in this factor causes changes in PA behavior
If there is a mediating relationship, think about…
- How strong is the strength of association
- Does exposure to variable precede an increase in PA?
- Is there a does response?
- Is it plausible? (“why” answered?)
Goal
To develop intentions that promote change in mediating factors that will result in increased PA
To change PA, you need to..
- Identify what causes an increase in PA (mediator)
- Understand theories of behavior change
- Understand that unique approaches may be needed for different groups
PA mediators
- process of change
- self-efficacy
- decisional balance
- outcome expectations
- enjoyment
- social support
Informational approaches
Increase knowledge and reinforce our desire to change when we are motivated
Informational approaches may change behavior through several pathways such as
- Increase in knowledge of benefits and risks may be enough to motivate change
- Increase in knowledge about where and how to be active in their communities
- Personal and environmental reasons why one is inactive to help overcome those reasons (increase awareness of a walking event, how to register/participate)
Informational Approaches examples
- Community wide campaigns (effective)
- Stand Alone Mass Media Campaigns (not effective)
- Classroom based health education focused on providing information (not effective)
Community wide campaigns (effective)
Many community sectors; large scale, high intensity, and visibility, broadly targeted strategies; focus on PA related issues (heart disease prevention)
Stand Alone Mass Media Campaigns (not effective)
Can be effective when combined with outreach activities
Classroom based health education focused on providing information (not effective)
Do not typical focus solely on PA; most did not provide time for PA participation; increase knowledge but no behavior
What is an example of a community wide campaign?
- Lets Move
goal = decrease childhood obesity by increasing PA, decreasing sedentary time and promoting good eating - VERB
Behavioral and Social Approaches
- Individual strategies
- Develop skills for behavior change
- Address social support for PA
- Grounded in behavioral theories and models
Individual mediating factors
- Process of change
- Self - efficacy
- Decisional balance
- Outcome expectations
- Enjoyment
- Social Support
Transtheoretical Model: Constructs
- Stages of change
- Processes of change
- Decisional balance
- Self-efficacy
Transtheoretical Model: Stages of change
- Pre-contemplation = not ready
- Contemplation = considering change
- Preparation = ready, making some changes
- Action = active, < 6 months, meeting PA guidelines
- Maintenance = sustaining change, active > 6 months
Transtheoretical Model: Processes of change - cognitive
- increase knowledge
- being aware of risks
- caring about consequences to others
- comprehending benefits
- increase healthy opportunities
Transtheoretical Model: Processes of change - behavioral
- substituting alternatives
- enlisting social support
- rewarding self
- committing self
- reminding self
Decisional balance
Ratio is the perceived benefit to barriers
- consider benefits
- overcome barriers
- for PA, need many benefits, few barriers
- pros (benefits) > cons (barriers
Self efficacy
Confidence in ones ability to perform specific behaviors in specific situations
- influences activities selected
- effort expended
- degree of persistence
Self efficacy is influenced by
- past performance
- vicarious expectations
- verbal persuasion
- physiological cues (anxiety/stress)
How to increase Self efficacy
- Goals
- Self monitoring
- Problem solving behaviors
a. skill developing training
b. time management - “Normalize” feelings/experience
Outcome expectations
What we expect to happen as a result of a behavior
Outcomes that sustain PA
- attainable/realistic outcomes
- health benefits
- increase body image
- psychological benefits
PA outcomes: immidiate
Energy/satisfaction
PA outcomes: long term
fitness, health, weight loss
Why do we enjoy activities?
- social interactions
- self perception of abilities
- social recognition
- mastery/achievement of skills
- movement sensations
How do we modify enjoyment
- select enjoyable activities
- alter the options available to be enjoyable (music, friends, setting)
Types of support
- Informational = info about being active
- Instrumental = something tangible
- Emotional = how is your program going
- Appraisal = feedback and encouragement
Environmental and Policy Approaches
Environmental and policy approaches are designed to provide opportunities, support, and cues to help people be more physically active
Environmental and Policy Approaches involves
- social networks
- physical environment
- organizational norms / policies
- laws
Social environment dimensions
- interpersonal relationships
- social inequalities
- neighborhood and community characteristics
Interpersonal relationships
social support and social networks
Social inequalities
socioeconomic position, income inequality, racial discrimination
neighborhood and community characteristics
social cohesion and social capital, neighborhood factors (home ownership, perception of resources, crime)
Healthy and supportive social environments provide
- inclusion
- acceptance
- social interaction
- emo support
- norms
Successful support comes from individuals
- who are important to you
- whose opinion you trust
- with similar personal attributes
- who share common life experiences
Positive social support influences
- intentions to be active
- cohesiveness in activity groups
- perceptions of norms to be active
- attitude toward activity
- self-efficacy
- adherence to compliance
Enhancing interpersonal support: intervention options
- Social Networks
2. Provide supportive opportunities for people
Is there and interaction between physical environment and people?
yes
cohesive and socially integrated societies tend to have
- better health outcomes
- inverse relationship between social participation and low leisure time PA
Physical Environment Approaches
Public health goal - PA as a part of life
- must have resources like places to go, facilities, equipment
“built environment”
Human modified places that influence opportunities for PA (+/-)
ex. driving centered society (-)
PA Opportunities
- Available = do resources exist
- Accessible = can i get there? how far? convenient?
- Affordable = can i afford?
- Acceptable = do i feel comfortable? safe? welcome?
- Appropriate = suitable for particular purpose, person, occasion?
PA environmental approaches
Access = creating/enhancing access to places for PA
Land use = management, planning, and development of land in defined jurisdictions
Urban Design = form, function and outward appearance of physical environment (landscape design, street deign etc.)
Zoning
legislative land use policy
Community Scale Urban Design
Focus = large geographic areas
Design elements that address:
- proximity of homes to stores, jobs, schools, and recreation
- safety of physical environment
Community Scale Urban Design strategies
- connecting transportation arteries
- tax incentive for developers to build sidewalks and trails
- community wide programs to encourage biking
Street Scale Urban Design
Focus = smaller geographic areas
Design components:
- improves street lighting
- increased safety and street crossing
- use of traffic calming approaches (speed humps, traffic circles)
- enhancing street landscape
Measurement: self reported measures
Self-Report measures of perceptions of environment
- interview, internet, mail survey
- may/may not reflect reality
Measurement: Direct Observation
Audits
- sidewalks, noise, traffic, etc.
- standardized
Measurement: Secondary Analysis Techniques
- geographic info systems
- inputs of various social data (density, traffic, crime, resources, green space)
Walkability - Supportive Features
- Recreational Resources
- parks, trails, open spaces - Land Use
- density of residents and employment
- mixed land use (homes, shops ,etc) - Community Urban Design: Street Connectivity
- crosswalks, frequent intersections, short blocks
- direct routes for pedestrians
Walkability
- Street Scale: neighborhoods
- sidewalks (maintained, continuous, wide)
- street buffers, streetlights, crosswalks, speed bumps, traffic circles - Aesthetics
- cleaned, maintained, shade, benches - Social and Community Support
- people seen exercising
- perceived social support
Road Diet
Reallocation of road space
- typically 4 –> 3 lanes
- space for bike lanes, sidewalks, turn lanes, parking
- reduces speed, fewer lanes to cross
Policy Approaches
Affect changes in physical, economic and social environments; impact local, regional, or national levels
What are the 3 broad classifications of policy approaches
- Laws, rules, and regulations
- they carry legal authority such as…zoning regulations, building distance from streets, sidewalks - Non-legal, but accepted/written standards
- professional standards for developing communities
- worksite expectations - Unwritten social norms
- cultural expectations
Ideally, policy approaches…
- make PA safer/easier
- provide (dis)incentives
- affect large number of people
Policy Sectors
- transportation systems
- urban planning & architecture
- parks and recreation
- health care
- education & schools
- organized sports
- corporation
Promising PA policies
- Quality physical education in schools
- Complete streets policy
- transportation planners & engineers design & operate the entire roadway with all users in mind (bicyclers, pedestrians, public transportations, cars) - Joint Use Policy
- shared use of a space between school & community - Community Trail Policies
- funding for trails - Policies for active transportation to and from school (safe routes)
What does the community guide say about recommended environmental & policy approaches?
- creation of or enhanced access to places for a combined with information outreach activities
- community scale urban design & land use policies
- street scale urban design & land use policies
- point-of-decision prompts to encourage use of stairs
For environmental and policy approaches, what is the insufficient evidence?
Insufficient evidence in transportation & travel policy practices
What is motivational interviewing?
An interviewing technique
- meet clients where they are regarding PA
- enhance motivation
- incorporates empathy & reflective listening with key questions
- OARS
What does OARS stand for?
- open ended questions
- affirmations
- reflections
- summary
Motivational Interviewing Key Elements
- understanding
- client centered
- collaborative
- individualized
- freedom of choice (for client)
- respectful/accepting
Self planning for healthy lifestyles –> process
- Clarify reasons for exercise
- Identify needs - self assessments
- Setting personal goals
- short term (process)
- long term (process or outcome) - Selecting program components
- cardio, RT, flexibility - Writing a plan
- Evaluating process
PA behavior is influenced by:
- individual factors
- social environments
- physical environments
- policies
- to change PA, need to have changes at multiple levels of influence and in multiple sectors
