WK9 - Promoting Self-Managed PA in PWD Flashcards
What are some evidence-based BCS - disability context?
- goal setting
- self-monitoring
- +ve reinforcement
- self-efficacy (personal mastery, modelling success, persuasion/support)
- time management
- graded tasks (perceived effort)
- barrier identification (pre-participation personal/environment Ax )
- enjoyment/reward
- social support
- attitude of primary care giver
- physician support
- previous successes
- knowledge of benefits
- prompting practice/follow-up
What did McEwan et al, 2016 find between goal setting and PWD?
Signficant effects were found regardless of goal specificity.
Goall setting interventions had min. effect on targeted behaviour… even when goal was vaguely defined (e.g. to be more active)
How did moderators vs mediators affect goal setting?
Moderators:
* ability
* task
* complexity
* commitment
* feedback
* resources
Mediators:
* choice to take action
* stimulate effort
* cue existing strategies
* display persistence
Specific, challenging, performance goal = greater performance
What is the difference between open and SMART goals?
Open:
* non-specific
* exploratory
* self-referenced
e.g. “ see how many steps you can reach today”
SMART
* specific, measureable, attainable, relevant, timely
What is the difference between learning and performance goals?
Learning
* identify strategies used to implement activity
* high focus on process of activity, instead of fiving a set target to achieve
* benefits: reduce pressure/stress related to goals
Performance
1. Does pt have basic skill set of activity aiming to complete?
2. Is activity complexity within scope of improvement?
3. are they intrinsically committed to goal?
4. Does pt have channels to soruce relevant feedback when required?
5. Does pt have resources to complete activity?
What considerations are made for what type of goal might work best initially?
- new to complex task?
- ability, commitment, resources, feedback?
- currently sufficiently active?
- ever been sufficiently/highly active?
- what is most important to pt: experience or outcome?
- found any goal types useful in past?
- do they have preferences?
Why is Tailored Motivation important for PWD?
PWD receive more encouragement/info regarding PA benefits
* media campaigns, info seminars, promotional material etc
* increased exposure to health practitioners through outpatient clinics and ongoing health concerns
Despite this, 79% of all PWD are not compelting required PA levels for health benefits
–> indicates this message is ineffective at increasing PA in PWD
What to consider about motivation as an EP?
- increased no.s of Ct being referred rather than voluntarily attending EP’s (medicare, DVA and workcover)
- individuals have lifelong Hx of being P inactive
- EPs need to implement evidence-based strategies to increase motivation
What is the relationship between motivational interviewing and the stages of change?
Changing Ct demographic results in more individuals presenting in 1st 3 stages of change
1. pre-contemplation
2. comtemplation
3. preparation
MI is effective in transitioning individuals through these stages
Define Motivational Interviewing.
Key concept = ambivalence
Client-centred, directive method for enhancing intrinsic motivation ot change by exploring and resolving ambivalence - Miller 1996
What is intrinsic motivation?
MI focuses on Ct as facilitator of change.
It is not the role of the therapist to ‘inform’ or ‘education’ Ct of benefits of change
Define ambivalence.
Feeling two ways about a behaviour - Pros vs cons
MI demonstrates that unless change is in the person’s inherent interests, it will not happen
What are the 4 principles of MI?
- expressing empathy
- developing discrepancy
- rolling with resistance
- supporting self-efficacy
How to facilitate change through exploring and resolving ambivalence? How does it work?
PA benefits (cons of P inactivity) vs PA cons (benefits of inactivity)
- explore/resolve ambivalence
- change ocurs as result of resolving ambivalence - therapist aids Ct in shifting balance towards change based on the 4 principles.
What does the 1st principle “expressing empathy” mean?
- conveys true acceptance of Ct’s perspetive w/o judging/criticising
- essential to building/maintaining strong therapeutic relationship
- builds non-judgemental and supportive environment
What does the 2nd MI principle “developing discrepancy” mean?
- direct Ct towards exploring/resolving ambivalence
- build motivational discrepancy between Ct’s current behaviour, desired goals and important personal values
- ambivalence
- discrepancy
- action towards change
What does the 3rd MI principle “rolling with resistance” mean?
- therapist elicits the reasons for and against change from Ct
- resistance is feedback for therapist that differing motivational strategies must be used
What does the 4th MI principle “supporting self-efficacy” mean?
- person’s belief in possibility of change is important motivator
- Ct, not pracititioner, responsible for choosing/carrying out change
- practitioners own belief in person’s ability to change becomes self-fulfilling prophecy
Define Behaviour
The action, reaction, or functioning of a person, animal, machine, chemica etc under normal or specified circumstances.
* health behaviours
* PA
* behaviour change
* evidence-based BCS
What are some demographic factors that influence how effective promotion strategies will be?
- gender (males respond differently to females)
- socio-economic status (high respond differently to low)
- age (children vs adolescents vs adults vs eldery)
- ethnicity (aboriginal vs european vs asian)
Define moderators.
Moderators are factors that influence intervention effectiveness (e.g. age, gender…)
A moderator = variable used ot divide people into subgroups for whom a BCS or intervention will work differently.
Disability is a widely accepted moderator of PA promotion strategies. T or F?
T!
- take the stairs?
- park further from shops?
- go for a walk?
What key evidence-based BCS work most effectively for PWD?
- goal setting
- personal mastery
- modelling success
- enjoyment
- social support
- attitude or primary care giver
- physician support
What personal and environmental barriers prevent PA?
- transport
- living arrangement/assistance available
- level of self-care
- Positional change (lying, sitting, standing, floor etc)
- equipment, facilities and natural features of environment
Define stages of change.
- the stage of change that ta person is at is an important moderatory of PA behaviour
- stage of change provides sub-divsions of “active” and “inactive” that help to inform which BCS will be successful
NOTE: all PWD experience all stages of change. However, majority of PWD Ct’s are within stages 1-3
Which stages are considered insufficiently/sufficiently active?
Insufficiently
* stage 1, 2, 3
Sufficient
* stage 4 and 5
Define stage 1 of stages of change.
Pre-comtemplator
* not active, not comtemplating
Define 2nd stage of change.
Comtemplator
* not active but comtemplating
Define 3rd stage of change
Preparation
* active but insufficiently
Define 4th stage of change
Action
* active <6M
Define 5th stage of change
Maintenence
* active >6M
What does stage matching mean?
Stage of change influences what strategies will be successful in increasing PA (it is a moderator)
e.g. education may be successful in moving person from S1-2 but unsuccessful for Stage 3-4.
Interventions must be “stage matched”
Connection with disability - most people at within S1-3
What stage of change am I in?
Q1 = 0
Q2 = 0
Stage 1
What stage of change am I in?
Q1 = 0
Q2 = 1
Stage 2
What stage of change am I in?
Q1 = 1
Q3 = 0
Stage 3
What stage of change am I in?
Q1 = 1
Q3 = 1
Q4 = 0
Stage 4
What stage of change am I in?
Q1 = 1
Q3 = 1
Q4 = 1
Stage 5
