Week 6 Lectures - Interventions: Part 1 (Models of Behaviour)

Question 1

Prevention

Answer 1

A type of intervention that aims to reduce the likelihood or impact of disease.

Question 2

How does prevention vary by scope

Answer 2

• Universal – e.g., vaccination programmes
• Selective – e.g., HIV/AIDs prevention; Hep C

Question 3

How does prevention vary by timing?

Answer 3

• Primary - prevent disease before it occurs (via immunisation or early intervention)
• Secondary – reduce impact of disease after it occurs (via early detection/screening, slowing disease progression, preventing relapse)

Question 4

Promotion

Answer 4

A type of intervention that aims to improve health and wellness (to bring people up from the neutral midpoint) i.e. think of the illness-wellness continuum : promotion is focused on the upper end of this scale (past the neutral point).

Question 5

Is the distinction between prevention and promotion always absolute ?

Answer 5

Nope, some overlap

Question 6

What are educational interventions

Answer 6

“Knowledge is power” ethos - if people have the information, they will act accordingly.

Question 7

Message framing in educational interventions… messages are more powerful when they are…

Answer 7

Messages are more effective when they:
- come from a credible person
- are simple and clear
- emphasize benefits rather than harms
- connect to person’s important values

Question 8

Ways in which educational interventions fall down…

Answer 8

• Knowledge does not mean action.
• Knowing that something is bad for you (or good for you) does not necessarily mean you will refrain (or engage) in the behavior.
• Educational approaches not necessarily effective
• People are not “rational actors”.

Question 9

People are not rational actors…

Answer 9

e.g. we might know that eating badly is not good for us but we still do it –> it’s so much easier to engage in unhealthy behaviours in today’s obesogenic environment and the idea of educational interventions ignores some of the contextual factors that play into our behavioural choices.

Question 10

Educational interventions summed up

Answer 10

Educational interventions rely on the assumption that if people have the information, they will act accordingly. This assumes that people are “rational actors”, which is not very psychologically sophisticated. That said, some educational interventions can be effective, particularly when messages are framed appropriately

Question 11

Four models discussed in this lecture (list)… Which models are social cognitive models?

Answer 11

-Health belief model
-Theory of Reasoned Action
-Theory of Planned behaviour
-Transtheoretical model

Top three = social cognitive models, the transtheoretical model is a stages of change model

Question 12

Health Belief model–

Answer 12

social cognitive model in which likelihood of undertaking a health behaviour (“action”) is influenced by beliefs about illness (beliefs about risk susceptibility/severity + beliefs about benefits/barriers to change) as well as your health motivation. Also takes into account how both demographic and psychological characteristics collectively influence beliefs.

Question 13

Theory of Reasoned Action (TRA; Ajzen & Fishbein, 1980)

Answer 13

– social cognitive model in which attitudes towards a health behaviour as well as norms influence intentions to act, which influences behaviour.

Question 14

Theory of Planned Behaviour (TPB; Ajzen, 1991)

Answer 14

– refinement of TRA that considers the influence of perceived behavioural control in whether intentions effect behaviour i.e. if you think you have little control over behaviour, may have the best intentions but not act on them.

Question 15

Transtheoretical Model (TTM) (Prochaska & Velicer, 1997)

Answer 15

– or Stages of Change Model (the only one of the four models talked about in this lecture that is not a social cognitive model) . A stage model that recognizes that people move through stages when trying to change behaviour, and that effective behavioural change requires matching the intervention to the stage. Sometimes shown as a cycle, which can include relapse into previous stages or even back to pre-contemplations stage.

Question 16

5 stages to the transtheoretical model…

Answer 16

• Precontemplation
• Contemplation
• Preparation
• Action
• Maintenance

Question 17

Precontemplation =

Answer 17

Does not intend to take action within the next 6 months, might not even be aware that their behaviour could be harmful. At this stage most people underestimate the gains that could be obtained through behavioural change, and over-emphasize the negatives that would come from a change of behaviour.

Question 18

Contemplation=

Answer 18

with the recognition that their behaviour may be harmful, individuals are at a point where they intend to engage in healthy behaviour relatively soon (within the next six months ). They typically have a balanced view of the benefits and difficulties of behavioural change, but despite their realistic perspective they might still display reluctance to engage in change.

Question 19

Preparation=

Answer 19

Individuals are prepared to take action within the next 30 days. They may have come to the realisation that behavioural change will enhance their well-being, and may already have taken small steps in this direction (e.g. given up smoking for the day).

Question 20

Action=

Answer 20

• Having recently changed their attitudes and some behaviours, individuals are encouraged to maintain and move forward with that behaviour change. During this period, individuals might alter their unhealthy behaviours and acquire new healthy habits.

Question 21

Maintenance=

Answer 21

Once individuals have maintained a behavioural change for more than 6 months and intend to continue in this fashion they are said to be in a maintenance stage. Relapse continues to be difficult to avoid and considerable work may be needed to prevent this. However, should this occur, individuals are encouraged to maintain their motivation.

Question 22

In general why are models useful?

Answer 22

These models can be used for creating both mental and psychical health interventions (give theoretical grounding to interventions). It’s important that understand the application of Te Whare Tapa Wha and the Meihana Model if you are working in a New Zealand health context.

Question 23

What are the four psychological strategies discussed by Rothman et al. (2015)?

Answer 23

• “Strategies that Motivate Action” Thinking about other people can motivate action : e.g. changing hospital signs to from “washing hands can help prevent you from getting to sick” to “washing hands can help others from getting sick”
• “Strategies that Aid the Translation of Intentions Into Action” Formulate if-then plans to bridge the intention-behaviour gap.
  If I drink an alcoholic drink I will then also drink a glass of water
• “Strategies to Disrupt Existing Habits” Change environments and contexts to break old habits Introduce policies that make it harder for people to follow unhealthy habits.
• “Strategies to Develop Routines that Create New Habits” Encourage repetition of new habits Piggyback new habits onto old habits.

Question 24

Texting, drinking health intervention study discussed in lecture

Answer 24

Using Thinking about other people can motivate action. Involved a text intervention that was either focused on the self-e.g. “Heavy drinking can cause alcohol poisoning”. Or other focused “Tonight, think about your mates when you drink, you can ruin their nights too.” The texts were sent in orientation week and while for males there was little effect on both drinking in orientation week and throughout the academic year. For females there was a statistically significant decrease in drinking for both of these measures compared to the control group. The study followed up with focus groups and doing that social messages were more effective than the health messages i.e. the participants found the messages more impactful when it referenced their friends. Secondly,
the tone of the messages needs to be tailored to the population. For young adults, messages should adopt a colloquial tone or slang. When this was done we see a significant decrease in drinking for males throughout the academic year.

Question 25

According to the video “The Science of Behavior change”, what three necessary conditions must be met to change behavior?

Answer 25

• Capability – The psychology or physical ability to enact the behaviour
• Motivation – The reflective and automatic mechanisms that activate of inhibit behaviour.
• Opportunity – Physical and social environment that enables the behaviour.

Question 26

Behaviour change wheel

Answer 26

Works around the assumption that you need to come up with a good behavioural diagnosis before trying to come up with solutions/ interventions to health problems –> the behavioural change wheel provides a framework for doing this.

• Middle = green hub (capability, opportunity, motivation) –> which one needs to change for there to be behavioural change –> points to TDF domains
• Yellow = TDF domains —> points to intervention functions
• Red = Intervention functions –> point to policy categories
  -Gray = policy categories

(Just look at the diagram in the slides)

Question 27

Modern benefits and challenges identified in the science of behaviour change video by Susan Michie

Answer 27

• EMA = through use of technologies can constantly measure variables
• Problem with this is so much data –> how do you sort through this.
  Involvement of behavioural science beyond the individual i.e. principles can be applied at a broader level in government policy etc.