Wk 8/9 secondary prevention

lvls of prevention

• primary → general population

• seocndary → at risk

• tertiary → has diagnosis

major approaches to secondary prevention

• Behavior change (also in primary prevention

• Screening (what health issues may require screening)

• early intervention (what health issues can benefit from early intervention)

Behavior change

• focus on long term positive health behaviors

• What are some long term positive health behaviors?

Transtheoretical Model (Stages of Change)

• Widely used model for changing negative behaviors on a
  continuous basis.

• THE STAGES OF CHANGE MODEL

  • Stage 1: PRECONTEMPLATION

  • Stage 2: CONTEMPLATION

  • Stage 3: PREPARATION

  • Stage 4: ACTION

  • Stage 5: MAINTENANCE

stage 1

• There is no intention to change behavior in the foreseeable future.

• precontemplation

stage 2

• Combines behavioral criteria with a problem. Aware a problem exists.

• Contemplation

stage 3

• Makes a plan for change. Initiates the change process.

• Preparation

stage 4

• Individuals modify their behavior, experiences, or environment to overcome their problems.

• action

stage 5

• Has made behavior change for 6 months. Work to prevent relapse

• maintenance

ASPECTS OF THIS STAGES OF CHANGE APPROACH

• Five stages that people go through in the process of behavioral change

• People go through distinct processes of change

• Stages are associated with cognitive changes

• Stages are associated with levels of self-efficacy

• Interventions should be linked to the stage a person is at

pre-contemplation → contemplation

• Consciousness raising: Increasing information about self and problem; observations, confrontations, interpretations.

• Dramatic relief: Experiencing and expressing feelings about one’s problems and solutions: psychodrama, grieving losses, role playing.

• Environmental reevaluation: Assessing how one’s problem affects the physical environment; empathy training, documentaries.

contemplation → preparation

• Self-reevaluation: Assessing how one feels and thinks about oneself with respect to a problem:

  • values clarification

  • Imagery

  • corrective emotional experience

preparation → action

Self liberation: Choosing and commitment to act or belief in ability to change: decision-making therapy, New Year’s resolutions, commitment enhancing techniques.

action → maintenance

• reinforcement management: Rewarding oneself or being rewarded by others for making changes: contingency contracts, overt and covert reinforcement, self-reward.

• Helping relationships: Being open and trusting about problems with someone who cares: therapeutic alliance, social support, self-help groups.

• Counter conditioning: Substituting alternatives for problem behaviors: relaxation, desensitization, assertion, positive self-statements.

• Stimulus control: Avoiding or countering stimuli that elicit problem behaviors: restructuring one’s environment (e.g., removing alcohol or fattening foods), avoiding high risk cues, fading techniques.

STAGES OF CHANGE PROS/ CONS

• Strengths

  • Useful tool for tailoring interventions for individuals or targeting for groups

  • Theory of behavior change, not just behavior

  • Organizational tool for thinking about types of interventions

• Weaknesses

  • Time periods are arbitrary (e.g., why 6 months?)

  • Stages are not qualitatively different or mutually distinct

  • Stages may not be sequential

  • Apply properly, don’t abandon stage models

EXAMPLES OF HEALTH BEHAVIORS STUDIED...

• Smoking behavior

• Quitting cocaine

• Weight control

• Safer sex

• Condom use

• Physicians’ preventive practices

• Adolescent delinquency
  Sunscreen use

• Radon gas exposure

• High fat diet

• Exercise acquisition
  Mammography screening

EARLY INTERVENTION METHODS

• Most popular methods...

  • Harm Reduction

  • Risk and Protective Factors Model

Harm Reduction Approach (HRM)

• Idea: high-risk individuals have multiple problems and difficult situations → may not be possible to change all of them

• Focus on problem behaviors that pose the greatest public health threat

• In short-term do not address other risky or unhealthy behaviors

• May serve as a building block for changing other behaviors through the buildup of trust and rapport, not being judged

• THERE MUST STILL BE HARM LEFT TO COUNT

HRM pros and cons

• Yay

  • 2 or more conditions

  • Reduce harm

  • Controversial

  • Maybe culturally bound

• Nay

  • One health condition

  • Eliminated harm

  • Behavior change or treatment

  • Universally applied

  • Side effects or complications

condoms for high school students vs. condoms for sex workers

• condoms for high school students is behavior change intervention because risk of STDs, early pregnancies, etc. are reduced. All risk reduced, no harm behavior left.

• Condoms for sex workers reduce STDs, accidental pregnancies, etc. but even w/ the intervention, sex work is still illegal in the U.S. so there is still harm.

RISK AND PROTECTIVE FACTORS MODEL

• Developed by Hawkins, Catalano, et al 1999

  • Sets up overall predictive relationship

  • “epidemiological exposure model”

  • level of exposure to risk/protective factors affects the
    outcome

  • Multiple risk factors mean more than the “sum”

    • Most often used children & adolescents

    • Applied less among adults and elderly population

    • Actual risk & protective factors vary by TOPIC & POPULATION

RISK FACTORS

• Individual: biological & psychological dispositions, attitudes, values, knowledge, skills, problem behaviors

• Peer: norms, activities, attachment

• Family: function, management, bonding, abuse/violence

• School: bonding, climate, policy, performance

• Community: bonding, norms, resources, poverty level, crime, awareness/mobilization

• Society/environmental (sometimes): norms, policy/sanctions

Protective

• Not as well-specified

• Individual: gender, intelligence, temperament

• Social bonding: attachment/ commitment to positive, pro-social individuals and groups

• Healthy beliefs: low valued associate with bad behaviors

• Clear standards for behavior: in families, schools, communities

risk and protective factors model critique

Edberg’s critique:

Still focuses on an output of behavior

Ignores world view in an ecological or meaning context

Difficult to translate into a program/intervention

Does not lend itself to typical research/planning/evaluation designs

screening

• Goal: Early identification

• Mechanism: screening process – usually for those suspected of or at high risk

• Screening followed by....
  ➢ Initiation of early treatment
  ➢ Focus on behavior change
  ➢ Other risk modification

screening US preventitive Service Task Force