1: Introduction and Changing Behaviour

describe biopsychosocial model influence on health and illness

biological: physical health, genetic vulnerabilities, medications.

psychological: coping skills, perceptions, emotions.

social: family circumstances, socioeconomic status, social support.

explain the biopsychosocial model

illness is caused by different factors at different levels therefore responsibility of health is on the individual and society not just the medical profession. treatment considers physical approach (eg physiotherapy), psychological approach (eg CBT) and social factors (improving social support). incorporates treating the person hollistically.

Describe how biological, psychological and social factors can contribute to health and illness and health related behaviour

biologically the person can have genetic predispositions or may have physical illness. psychologically the person's perceptions and coping skills may result in risky behaviour resulting in illness. socially, the person's family circumstances and socioeconomic status may result in the person not accessing the support they may need.

patient receives psychological assesment preoperatively to screen for significant psychopathology and prepares the patient for post operative lifestyle changes.

what is being applied here?

biopsychosocial method

biopsychosocial model as defining addiction

biological: increase liklihood to develop addiction when a family history of addiction is present. psychologically: people feel rewarded or happy by engaging in addiction whereas the biological impact of engaging in addiction harms the persons physical wellbeing while reward encourages psychological. social: cultural environment around the person eg interpersonal relationships and peer groups where social mindset about the addictive activity is accepted and encouraged

why is it necessary understanding of biopsychosocial model

increased personalised data for analysing patients addiction which allows for clearer path of treatment and allows monitoring implementation and co-ordination of post treatment care creates a more comprehensive treatment plan

describe how and why unhealthy habits are formed

- learning theories

classical conditioning: behaviour becomes a habit through association with other stimuli.

operant conditioning: behaviour is learned through positive or negative reinforcement. unhealthy behaviours continue as they are immediately rewarding.

social learning theory: behaviour learned through observation and modelling and association is strong if observer sees the model being rewarded for these behaviours

describe how to change behaviours

LOC, HBM, transtheoretical model

people with external locus of control may need encouragement from medical professionals and may rely on them to get better. with the health belief model, the likelihood of changing behaviour is determined by percieved threat to patients health. this can be encouraged by fear arosal to persuade people into avoiding associated health-related behaviours. transtheoretical model: people are at different stages of change and intervention should be targetted at these specific stages eg if they are at the pre-contemplation stage intervention may be educating them on the dangers and the effects of their activity.

describe the term and use of 'media campaigns' and mass media campaigns as a practical method of health promotion.

media campaigns is the use of media to interact with a wide range of audiences for health promotion.

describe and evaluate psychological theories of health related behaviours

classical conditioning where behaviour becomes habit due to associated stimuli; operant conditioning where behaviours are learned through positive or negative reinfocement increasing when rewarded and vice versa; social learning theory where behaviour is learned through observation and modelling and is particularly strong if the observer sees the model is rewarded. however they do not take into account of cognitive process, knowledge, beliefs, attitudes, memory and assumes that change in social context will change behaviour.

recognise complexity of changing health behaviour

changing behaviour is not linear but circular at different stages

describe model of stages of behaviour change

precontemplation: patient has no desire to change

contemplation: patient is thinking of changing in the next 6mnths but has not began the process.

preparation: patient is preparing to change within 30 days

action: (

stable lifestyle

complete absence of temptation for previous behaviour

importance of psychology to medicine

link between mental state and physical health as mind and body are inseparable for diagnosis, treatment and healing.

define health

state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity

biomedical approach

an approach to psychological disorders that considers only pathophysiological causes and offers pharmaceutical and medical solutions for symptom alleviation.

compare biomedical vs biopsychosocial approach

biomedical approach to the mind-body relationship is seperate and independent whereas biopsychosocial is in a dynamic system where they influence eachother. biomedical approach to cause of disease is pathogenic only whereas biopsychosocial approach to cause of disease is multiple factors contribute to the disease. biomedical approach is linear whereas biopsychosocial is circular

serial position recall effect and what to do as a physician

information at the start and end and is remembered. so restrict info to what pt can process, repeat and emphasise key information. use simple words and short sentences. be specific

causes of non-adherence

patients beliefs clash with treatment, forgetting advice in GP consultation

medically unexplained symptoms and significance

no organic cause can be identified. multiple psychological processes can generate perceived somatic problems

illness vs disease

illness subjective perception of change in the structure or function of body that gives rise to concern whereas disease is an objectively observable abnormality in bodily structure or function

multiple and interactive factors that influence health

modifiable actions and social aspects addressed by health promotion and non-modifiable

varying definitions of health

not having symptoms of illness, having physical or social reserves. having healthy lifestyles, being physically fit, psychological wellbeing, being able to function.

importance of health definition

implications of who receives treatment and for who can be seen as responsible for our health

models and interventions that explain and oredict behaviour change

health belief model, transtheoretical model, COM-B model, motivational interviewing and MECC

health belief model definition

likelihood of changing behaviour is determined by perceived threat of current situation coupled with evaluation of outcome if they change

cues to action

locus of control. internal perceived symptoms or external influence outside

equation of health benefits model

perceived threat and perceived benefits (minus perceived barriers) -> likelihood of behaviour change

health belief model and smoking cessation

encourage and reinforce cues to action. educate benefits and barriers

losses loom larger than gains

emphasise benefits to patient more than the barriers

fear appeals HBM impact on audience. strong fear appeals and efficacy messages

strong fear appeals and high efficacy messages (those that are supportive of the individual and telling them they are able to quit) produce greatest behaviour change whereas strong fear appeals with low efficacy messages produce the greatest level of defensive responses.

fear appeals- are they efficient

generally ineffective as they don't change a person's beliefs and they will often ignore the information as it is too distressing

transtheoretical model

precontemplation: person not considering changing behaviour

contemplation: consider change in next 6 months

preparation: prepare to change in next 30 days

action: make the change short term under 6mnths

maintenance: maintain change beyond 6mths which leads to a stable lifestyle.

relapse: return to behaviour

importance of relapse as a medical professional

normalise relapse and explore what patient has learned from failure to increase chance of success

cons of health beliefs model

does not address the importance of habit, self-control, associative learning and emotional processing

COM-B model definition

motivation is defined as capability, opportunity, motivation which energise and direct behaviour not just goals and conscious decision making

behaviour change using COM-B model

capability: provision of psychological and physical strategies to engage in behaviour change (eg education)

opportunity: education on available opportunities (nicotine patches, directing to weight management)

motivation: using incentives

two systems of information processing

automatic and reflective

automatic system for processing information

fast, automatic, emotional, impulses, habits, beliefs

reflective system for processing information

slow, effortful, logical, reflective, planning, problem solving

motivational interviewing steps:

1. express empathy

2. develop discrepancy

3. avoid arguments

4. roll along when resistance comes

5. support self-efficiency

express empathy for motivational interviewing

experience the world from clients perspective without judgement or criticism. problems are seen from frame of reference not from stance of doctor

Discrepancy gap in motivational interviewing

not to install motivation in clients but motivation comes within the client so to recognise it. motivation as a function of the discrepancy between the client's present behaviours and values and awareness of this gap can increase motivation to change.

supporting self efficacy

refers to supporting their belief that they can succeed in changing. therapist respond to changes that clients have decided to do and suggests possible ways to proceed but pt remains the final decision maker about change.

allowing resistance in motivational interviewing

explore barriers and reveal persons hopes, desires and fears to change

resistance in treatment definition

active process of pushing against reasons for change

Making every contact count approach

approach to behaviour change that uses the millions of day-to-day interactions that organisations and individuals have with other people to support them in making positive changes to their physical and mental wellbeing

pros of MECC interventions

don't need to be undertaken by a health professional by developing some communication skills and evidence based healthy lifestyle messages. utilises everyday conversations with public to make a difference

how does MECC work

consistent and concise healthy lifestyle information and individuals to engage in conversations about their health at scale across organisations and populations

opportunities for MECC

disease prevention, optimising the management of conditions such as diabetes and heart disease, encouraging self-care, carer support, signposting to local lifestyle services, public health leadership, brief motivational interviews

two reasons pt may not adhere to medical advice

forget the advice, beliefs clash with advice

is illness subjective or objective

subjective

disease is often a ____ explanation for illness

incomplete

what advert would you suggest for gambling and what model

motivational interviewing techniques

why would you not use HBM for gamblers

not HBM as gamblers do so to avoid negative feelings (by inducing fear or increasing risk perceptions, gamblers more likely to gamble to avoid feelings)

Mr Anderson is an 80-year-old man who presents to his GP with severe cold symptoms. He was previously invited to attend his GP for a winter flu jab but did not attend, as he believed he could prevent it through his own personal choices and behaviours. Use the Health Belief model to help you explain his behaviour

what locus of control does Mr Anderson have

internal locus of control

Mr Anderson is an 80-year-old man who presents to his GP with severe cold symptoms. He was previously invited to attend his GP for a winter flu jab but did not attend, as he believed he could prevent it through his own personal choices and behaviours.

Using the Health Belief model, explain why he may not have attended

percieved severity, threat and susceptibility: Mr anderson may not believe the flu is severe; he is not susceptible and therefor it may not be a threat to his health. in regards to cue to action, he may not know anyone who has the flu. he also may perceive more barriers than perceive benefits of having the jab.

Mr Anderson is an 80-year-old man who presents to his GP with severe cold symptoms. He was previously invited to attend his GP for a winter flu jab but did not attend, as he believed he could prevent it through his own personal choices and behaviours. Use the Health Belief model to suggest how you could make it more likely he could attend

information provision to increase his susceptibility, severity, threat perceptions. reduce barriers, increase knowledge of benefits

aims of the program food dudes

applying the science of behaviour change to improve children's health and to prevent childhood obesity. increase fruit and vegetable consumption and physical activity in children through the use of evidence based activities

3 Rs and how they relate to behaviour change theories

role-modelling, repeated tasting, reward

how does the stages of change theory inform the programme food dudes

motivating children to consider eating healthier. educating them on eating healthily, the dudes are trying to move children towards contemplation, preparation, action, maintenance stages

how are learning theories used to inform the food dudes programe.

encouraging repeated tasting is a form of habit building and rewarding children for eating healthily reinforces the likelihood for eating healthily

evaluate WHO definition of health as complete well being

no longer fit for purpose given the rise of chronic disease. emphasis towards ability to adapt and self manage in face of social, physical and emotional changes.