BPS Week 4 Cue Cards

Question-and-answer flashcards covering health behavior definitions, associations with disease, and the COM-B model with the Behavior Change Wheel.

What is the World Health Organization's broad definition of health?

Physical, mental, and social well-being, not merely the absence of disease or infirmity.

How is a health behavior defined in these notes?

An overt behavioral pattern or action related to health maintenance, restoration, or improvement.

What is the difference between a biomedical approach and a biopsychosocial approach?

Biomedical focuses on biological factors alone; biopsychosocial includes biological, psychological, and social/environmental influences on health.

What factors influence whether someone delays seeking health care for a symptom?

Perception of symptoms (intensity, interpretation), fear of serious disease or being dismissed, financial, cultural, age, gender, symptom type/location, embarrassment, and influence of others' emotions/beliefs.

What are 'symptom-driven behaviors' in health care seeking?

Behaviors motivated by the presence or intensity of symptoms, alongside other factors like beliefs and social context.

What are 'behavioral imagines' and 'behavioral pathogens'?

Behavioral imagines: protective/health-promoting behaviors (e.g., exercise, healthy diet). Behavioral pathogens: risky behaviors increasing disease risk (e.g., smoking, sedentariness).

What is the link between pathogenic health behaviors and systemic inflammation?

Pathogenic behaviors contribute to low-grade systemic chronic inflammation, raising risk of metabolic syndrome, cardiovascular disease, cancer, depression, autoimmune and neurodegenerative conditions, sarcopenia, and immunosenescence.

What are the 'big six' modifiable health behaviors mentioned?

Smoking or drug use, sleep, social isolation and chronic stress, diet, weight, and physical inactivity.

Name the key constructs of the Health Belief Model.

Perceived susceptibility, perceived severity, perceived benefits, perceived barriers, and cues to action.

What is the core idea of the Transtheoretical Model of behavior change?

People exist at different stages of readiness to adopt health behaviors; interventions should match the stage of change.

What does Social Cognitive Theory emphasize regarding behavior change?

Interactions between personal factors, behavior, and the environment; learning from experience and observation; environment can facilitate change.

What is the COM-B model a part of, and what are its components?

A core framework stating that behavior requires Capability, Opportunity, and Motivation; Capability includes physical/psychological ability, Motivation includes reflective and automatic processes, and Opportunity includes physical and social environment.

How do capability, motivation, and opportunity relate to behavior in COM-B?

Capability provides the skills and abilities to perform the behavior; Motivation drives decision-making and habits; Opportunity provides the enabling environment.

What is the Behavior Change Wheel and how is COM-B related to it?

The wheel links COM-B to various intervention types and enabling policies; COM-B sits at the heart of the wheel.

What is the difference between a theory and a model?

A theory explains causes and effects; a model is a schematic representation of relationships among components of a theory.

Why are behavior-change theories important in physiotherapy practice?

Most interventions involve changing patient behaviors; the COM-B and related models guide targeting of interventions (education, persuasion, incentives, etc.).

What are common environmental factors that influence health behaviors?

Physical and social environments (e.g., infrastructure like bike tracks, social support, cultural norms).

How does chronic inflammation arise from pathogenic behaviors in the vascular system?

Pathogenic behaviors cause endothelial dysfunction and inflammation, leading to atherosclerosis, hypertension, angina, myocardial infarction, stroke, and related organ damage.

What is the Behavior Change Wheel?

The Behavior Change Wheel is a framework that links the COM-B model to various intervention types and enabling policies, with COM-B at its core.

Why are many health behaviors targeted for change, and what are common motivations and barriers to adopting new health behaviors?

Many health behaviors are targeted for change because they are modifiable and significantly impact health outcomes, contributing to or preventing various diseases and improving overall well-being. Common motivations include:

• Improved physical and mental health.

• Pain reduction and increased energy.

• Desire for better quality of life and longevity.

• Social support and personal goals.

Common barriers include:

• Lack of time, resources, or knowledge.

• Environmental factors (e.g., access to healthy food, safe exercise spaces).

• Social norms, peer pressure, or lack of social support.

• Low motivation, conflicting priorities, or habit.

• Financial constraints or fear of failure.

Define a health behaviour and describe its association with disease risk.

• Health-promoting behaviors (behavioral imagines) such as exercise and a healthy diet can reduce the risk of disease.

• Risky behaviors (behavioral pathogens) like smoking or sedentariness increase disease risk.

• Pathogenic behaviors contribute to low-grade systemic chronic inflammation, leading to increased risk for metabolic syndrome, cardiovascular disease, cancer, depression, autoimmune and neurodegenerative conditions, sarcopenia, and immunosenescence.

• Specifically in the vascular system, pathogenic behaviors can cause endothelial dysfunction and inflammation, which are precursors to conditions like atherosclerosis, hypertension, angina, myocardial infarction, stroke, and other related organ damage.

What is Behavior Change Theory (BCT)?

Behaviour Change Theory (BCT) refers to theoretical frameworks that explain why people adopt or change health behaviours, and how interventions can effectively facilitate these changes. BCTs are crucial in practice (e.g., physiotherapy) for guiding interventions by targeting factors like capability, opportunity, and motivation (as in the COM-B model) and for linking them to intervention types and policies (as in the Behaviour Change Wheel).

What are common Behavior Change Techniques (BCTs) and how can they be applied?

1. Goal Setting: Establishing specific, measurable, achievable, relevant, and time-bound targets for behavior.

   • Application Example: Setting a precise goal to "walk 30 minutes, 5 days a week, for the next 4 weeks."

2. Feedback: Providing information about one's performance or progress towards a goal.

   • Application Example: A fitness tracker giving daily updates on steps taken compared to a daily target.

3. Repetition/Habit Formation: Encouraging the consistent performance of a behavior to make it automatic.

   • Application Example: Consistently performing a morning stretching routine at the same time and place each day.

4. Graded Task: Breaking down a complex or challenging behavior into smaller, progressively easier steps.

   • Application Example: A person wanting to run 5k starts with walking, then alternating walking and jogging, gradually increasing jogging time.

5. Reward and Threat: Using positive reinforcement (rewards) or negative consequences (threats) to influence behavior.

   • Application Example (Reward): Earning points for healthy eating that can be redeemed for a desired item or experience. Application Example (Threat): Highlighting the increased risk of heart disease with persistent smoking.

6. Social Incentive: Leveraging social influence, support, or competition to motivate behavior change.

   • Application Example: Participating in a team-based exercise challenge with group prizes for achieving collective goals.

7. Identity: Framing behavior change as integral to one's self-concept or desired identity.

   • Application Example: Adopting the mindset "I am an active person who prioritizes my health" to sustain exercise habits.

8. Self-Belief (Self-Efficacy): Enhancing an individual's confidence in their ability to successfully perform a behavior.

   • Application Example: A therapist praising small successes and reminding a patient of their capability to manage chronic pain through prescribed exercises.

9. Verbal Persuasion: Using spoken or written arguments and encouragement to convince someone to adopt or change a behavior.

   • Application Example: A doctor explaining the benefits of a new diet plan and verbally reassuring a patient of their ability to follow it.

How are Behavior Change Techniques (BCTs) applied in everyday physiotherapy practice?

1. Goal Setting: Collaborating with patients to define specific, measurable, achievable, relevant, and time-bound (SMART) rehabilitation goals, such as "increase knee flexion to 90circ90circ within 6 weeks" or "walk 100 meters independently in 4 weeks."

2. Feedback: Providing clear, real-time feedback on exercise technique, demonstrating correct movements, using progress charts to show improvements in range of motion, strength, or pain levels, and discussing patient diaries of symptoms.

3. Repetition/Habit Formation: Structuring and scheduling home exercise programs (HEPs) to fit into daily routines, using prompts or reminders, and promoting consistency to build automaticity for beneficial movements.

4. Graded Task: Breaking down complex movements or demanding exercises into smaller, progressively challenging steps (e.g., starting with partial weight-bearing, then full weight-bearing, then adding resistance).

5. Reward and Threat: Employing positive reinforcement through praise for effort and progress (reward), or explaining the potential for re-injury or delayed recovery due to non-adherence (threat).

6. Social Incentive: Encouraging participation in group therapy sessions, recommending support groups, or involving family/caregivers in the rehabilitation process to provide encouragement and accountability.

7. Identity: Helping patients reframe their self-perception from being 'injured' to 'recovering' or 'active,' aligning their rehabilitation efforts with their desired future capabilities and lifestyle.

8. Self-Belief (Self-Efficacy): Building patient confidence by celebrating small achievements, guiding them through manageable challenges, and demonstrating that they possess the capability to perform exercises and manage their condition.

9. Verbal Persuasion: Clearly explaining the rationale behind specific exercises, detailing the benefits of adherence, addressing patient concerns, and offering consistent encouragement and reassurance throughout the recovery journey.