Behavior Change and Health Promotion

What is the Social Ecological Model/Framework?

provides context as to what influences our behavior and motivates us to make lifestyle changes

What are the different spheres on influence on our behavior within the Social Ecological Framework? (7)

1. Individual

2. Interpersonal Factors

3. Institutional/Organizational

4. Community

5. Social Structure

6. Policy

7. Systems

How can we enhance nutrition counseling effectiveness?

through using client-centered approaches

What are some client-centered approaches that can help us enhance nutrition counseling effectiveness? (5)

1. using patient’s priorities and values

2. working collaboratively with client

3. demonstrating you care (empathy)

4. demonstrating professional competence

5. being aware of contextual issues (social determinants of health)

What makes an intervention effective?

if it targets multiple spheres of influence in which helps to bring upon behavior change and motivation to change

What spheres of influence does Public Health usually target? (2)

1. policy

2. systems and environment

larger outer spheres

What spheres of influence does Medical Nutrition Therapy usually target? (2)

1. individual

2. interpersonal spheres

inner circles of spheres

Why do patients tend to struggle with change? (3)

1. reward for good self-management are relatively subtle and mostly long term

2. obstacles can seem to outweigh possible benefits

3. internal obstacles (limited time, lack of comfort, priorities, lack of support system, culture)

Is the lack of knowledge the only thing that patients are struggling with?

no, for the most part its only one barrier

• teaching what is “healthy” may not be enough or even appropriate to what the client needs and we need to consider other things

• although information is necessary it is often times insufficient

What are three characteristics that information regarding nutrition need to be?

1. accurate

2. relevant to knowledge base (info to help manage condition, fill in knowledge gaps, appropriate level of sophistication)

3. relevant to behavior change

What are four things that DO NOT work when it comes to behavior change and motivation?

1. urging more will power

2. threatening bad outcomes

3. the gift of advice (“maybe if you joined a nice gym”)

4. knowledge/information that isn’t actionable

What are four theory driven tools/models that can help to facilitate behavior change?

1. Transtheoretical Model/Stages of Change

2. Health Belief Theory

3. Social Cognitive Theory

4. Mixed Models (combination of the above theories/models)

must tailor approach to audience + have effective communication (no such thing as one size fits all)

Describe the Transtheoretical Model/Stages of Change Model.

• initially used for substances use but was later applied to nutrition

• made by Prochaska, diClemente, Norcross

• looks at behavior change as a process and clients are at different levels of readiness to change

• goal is to help clients progress through the stages to make change

What are the different stages in the transtheoretical model? (5)

1. precontemplation

2. contemplation

3. preparation

4. action

5. maintenance

majority of interventions are designed for people in the action stage, however < 20% of people are actually in the action stage and thus are not ready for such intervention resulting in a mismatch between the target audience and the intervention

How do you apply the transtheoretical model/stages of change model?

have to tailor education to where the client/patient may be

• need to apply processes and strategies specific to a stage for effective interventions

Describe patients in the precontemplation stage of the transtheoretical model.

unaware of problem

• “I am not thinking about…”

Describe patients in the contemplation stage of the transtheoretical model.

thinking about possibility of change in future

• “I am thinking about… in the future, within ~6 months”

Describe patients in the preparation stage of the transtheoretical model.

making a plan to change soon, small steps

• “I am definitely planning to… soon, in the next month or so.”

Describe patients in the action stage of the transtheoretical model.

implementation of specific action plans

• “I am trying now to…”

Describe patients in the maintenance stage of the transtheoretical model.

continuation of desired steps/behaviors

• “I am already…”

What should you do for someone who is in the precontemplation stage?

• increase awareness of need for change

• personalize information

What should you do for someone who is in the contemplation stage?

• motivate

• encourage to recognize potential benefits of change

• decrease barriers

What should you do for someone who is in the preparation stage?

• assist in setting gradual goals

• concrete action plans

What should you do for someone who is in the action stage?

• assist with feedback

• problem solving

• social support

• reinforcement

What should you do for someone who is in the maintenance stage?

• assist in coping

• finding alternatives

• avoiding relapses

Describe the Health Belief Model.

perceived health condition based on factors scares them and thus motivates them

• address a person’s perception of the threat of a health problem

• assumes that a primary motivation for behavior change is fear and that readiness = motivation

What are the different factors perceived by people that influence peoples’ readiness to act within the Health Belief Model? (5)

1. susceptibility to health problem

2. severity of health problem

3. benefits to change

4. barriers to change

5. self efficacy

How can you recognize readiness within the Health Belief Model?

client is able to address

• diet and health link

• wanting to personalize their diet and their health

• how important it is to them

Describe the Social Cognitive Theory.

assumes that behavior changes result from interactions between their network

• learning occurs through personal experience and observation

• peer and community support/belonging facilitates change

• want to involve the individual and relevant others; work to change the behavior through environmental support

According to the Social Cognitive Theory behavior changes result from the interactions of what three sectors?

1. personal factors (cognitions: knowledge, expectations, attitudes)

2. behavior (skills, practice, self-efficacy)

3. environment (family, friends, peers, coworkers, physical environment, social norms, access in community, influence on others)

What is the strength of the Social Cognitive Theory?

it focuses on certain target behaviors and capabilities rather than on knowledge

What factor is at the basis of all of the models?

self-efficacy

What is self efficacy?

a person’s belief in their ability to succeed at a given tasks

• key component inherent in all behavior change models and critical for any sustained behavior change

• goal is to help the patient increase their self efficacy

What are five strategies/approaches for increasing self-efficacy and to ultimately facilitate behavior change?

1. behavior modification

2. monitoring and reinforcement

3. setting small incremental goals

4. behavioral contracting

5. motivational interviewing

How do you implement behavior modification?

modify the environment or other spheres of influence to help make lifestyle change successful

• change the environment

• remove cues for overeating/inactivity

• add cues for healthy eating/exercise

• make the new/goal behavior the easier choice

• enlist support groups or other monitoring and reinforcement techniques

What are three different forms of self-monitoring?

1. tracking food intake

2. tracking body weight

3. tracking blood glucose

What are four characteristics of effective goals?

1. specific (focused on behavior; include plan for what, where, how, when)

2. proximal (short term is best)

3. challenging (moderately so)

4. attainable (realistically)

less food focused and more health focused

What are SMART goals?

goals that are specific, measurable, attainable, relevant, and timely

What is motivational interviewing?

technique that involves exploring and resolving client ambivalence about behavior change

• helps client identify their priorities and motivations about behavior change

• relies on reflective listening techniques to help client shift their decisional balance and move toward change

What are factors to consider when tailoring information to a target audience during nutrition education and MNT? (7)

1. needs

2. knowledge base

3. attitudes and cultural framework

4. motivation level and readiness to change

5. appropriate learning style

6. literacy level

7. incremental steps toward behavioral change

What are some characteristics for Standard Behavioral Treatment (SBT) for lifestyle change?

• in personal (individual or groups) or online self-guided

• usually 3-12 months (6 months on average)

• weekly lessons and homework

• many strategies presented

• given by dietitians, exercise physiologist, psychologists

• variable results, short term usually good but sustainability is the issue

Why can health behavior change lead to continued avoidance of change?

typically health behavior change is often associated with uncomfortable internal experiences, and for those with low tolerance for stress, it can lead to avoidance of change

What is a common Cognitive Behavioral Therapy concept?

recognize and work with cognitions (thoughts) and emotions to help clients navigate difficult environments and promote resilience

• identify thoughts and feelings and help reframe thoughts through cognitive restructuring

What is resilience?

how well a person “bounces back” from set back or disruption

• important skill both in behavior change and for general well-being

• cultivating resilience helps to promote acceptance and behavior change as it emphasizes flexibility rather than rigidity and teaches people to try to find positives in the situation

Why are cognitive Behavioral Therapy Techniques important to consider?

can be used within nutritional counseling when it comes to motivation interviewing techniques, behavior change models, and various other behavior modification approaches

What are examples of applications of counseling for primary prevention?

What are examples of applications of counseling for secondary prevention?

What are examples of applications of counseling for tertiary prevention?