1 - Health behaviours

Health behaviour

 Any behaviour people perform with the intention of promoting or maintaining well‐being regardless of the state of their health.

According to the heart and stroke association,

• Over ______ Canadians live with heart disease or stroke

• _____ deaths in Canada cause by heart disease or stroke

 

• _____ Canadians have at least one modifiable risk factor

• 6 million

• 1 in 5

• 9 in 10

Efforts to prevents illness can be of 3 types:

• Behavioural influence (ex. providing info on how to change)

• Environmental measures (ex. public health efforts)

• Preventative medical efforts (ex. going to the dentist)

What are the 3 types of prevention?

1. primary

2. secondary

3. tertiary

Primary prevention

Actions taken to avoid disease or injury BEFORE it happens

• Ex. stop smoking, vaccinations, better diet, wear a seatbelt, genetic counsellors.

Secondary prevention

actions taken to identify and treat illness/injury early, with goal of stopping or reversing the problem.

• Ex. yearly checkups, colonoscopy, mammograms, bone density scans, take medications

Tertiary prevention

Once disease progresses beyond early stages, actions taken to slow or contain damage, or prevent disability.

• Ex. cardiac rehab program (exercise, diet), self-management programs (stress management, diet, exercise), physical therapy

What are the 3 problems in promoting wellness?

1. intrapersonal

2. interpersonal

3. community

Intrapersonal problems in promoting wellness?

• Perceive healthy behaviours as less appealing, inconvenient, with little incentive

• Adopting these behaviours may force changes to long-standing and habitual behaviours (ex. additions)

• Knowledge and skills required to understanding good behaviours, make plans to change, and overcome obstacles.

• Need self-efficacy to carry out change.

• Being sick or taking drugs can affect their moods or energy, affecting cognitive resources and motivation.

 

Interpersonal problems in promoting wellness?

• Conflict between family members behaviours

• Social support and encouragement

 

Community problems in promoting wellness?

• Promotion of healthy behaviours by community organizations or government

• Lack of safe and easy places to exercise

• High number of fast food restaurants

• Health insurance

What are the 3 main factors in health related behaviour?

1. learning (operant conditioning and modelling)

2. social, personality, and emotional factors

3. perception and cognition

Operant conditioning

Consequences of a behaviour can influence (increase or decrease) chances of behaviour

Reinforcement

Consequences of behaviour INCREASE chances of future behaviour

• Positive (adding good)

• Negative (remove bad)

Continuous reinforcement

provides a reward after every correct response, ideal for rapidly teaching new behaviors but prone to quick extinction

Intermittent reinforcement

rewards behaviors only occasionally, creating slower initial learning but much higher resistance to extinction, ensuring long-term maintenance

Extinction

If remove the reinforcers, behaviour will weaken (and eventually “extinguish”)

• Works if new/alternative reinforcers are not introduced

Punishment

Consequences of behaviour DECREASE chances of future behaviour

• Positive (add bad)

• Negative (remove good)

Modelling

learn by observing the behaviour of others.

Better models are often people …

similar to the observer, and of high-status.

Social, personality, and emotional factors tied to health behaviour?

• Many health-related behaviours are affected by social factors

  • Friends and family encouraging, discouraging, modelling behaviours.

 

• The personality trait of conscientiousness is associated with practicing many health behaviours.

high conscientiousness linked to:

Fitness level

Healthy food selection        

Mammogram testing        

Medication taking, as prescribed        

Self-reported health

How does perception and cognition effect health behaviour?

The symptoms people experience can influence their health-related behaviours

 

Cognitive factors play an important role in the health behaviours people perform (ex. accessing their health, making assumptions and predictions).

• Unrealistic optimism

Health belief model

A model of behaviour change; An explanation of people’s health‐related behaviour based on their perception of the threat of illness or injury and the pros and cons of taking action.

the health belief model came about from…

• Developed in the 1950s

• Came about from governments noticing a lack of screening for tuberculosis (offered free screening and people still didn't come)

According to the health belief model, the likelihood of engaging in health behaviour depends on:

1. perceived threat to one’s health

2. Perceived benefits and barriers/costs

Perceived threat to one’s health includes:

• Perceived Seriousness (how serious or severe is the health problem?)

  • Ex. modern medicine is so good, even If I had a heart attack I would bounce right back.

 

• Perceived Susceptibility (how likely are they to experience the health problem)

  • Ex. I have no heart disease in my family

 

• Cues to action (internal or external reminders or alerts about the health problem, e.g., advice from others, sick family member, symptoms, media)

  • Ex. the media focuses on smoking and activity to prevent heart disease.

Perceived benefits and barriers/costs include:

• Ex. fruits and vegetables are so expensive

• Sum = benefits - barriers

The health belief model also proposes what modifying variables?

• demographics, age, sex, gender, positionality

• Self-efficacy

What does the health belief model predict?

Predicts wide range of health behaviours (not always!)

E.g., breast self-exam, fruit/vegetable consumption, dental care, distracted driving

Criticisms of the health belief model?

• Assumes conscious processing (does not account for habits)

• Emphasizes intrapersonal factors (context?)

• Ignores emotional factors (ex. denial, fear)

• Lack of standardized measures

• Assumes direct relationships between beliefs and behaviour (missing link?)

Theory of planned behaviour

An explanation of people’s health‐related behaviour.

Their behaviour depends on their intention, which is based on their attitudes regarding the behaviour and beliefs about the subjective norm and behavioural control.

According to the theory of planned behaviour, the best predictor of engaging in health behaviour is _________

INTENTION (Decision to engage in health behaviour)

According to the theory of planned behaviour, intentions to engage in behaviour are influenced/predicted by:

1. attitude toward behaviour

2. subjective norms

3. perceived behavioural control (self-efficacy)

Attitude toward behaviour includes:

• Beliefs that engaging in behaviour will lead to certain outcomes

  • Ex. sunscreen will help reduce cancer risk and wrinkles

 

• Evaluations of whether the outcomes of behaviour will be rewarding

  • Ex. value not having wrinkles later in life (over that of having a tan)

Subjective norms include:

• Beliefs about others opinions of the behaviour

  • Ex. what do others think?

 

• Motivation to comply with those norms

  • Ex. do I care to align with that thinking?

Perceived behavioural control (self-efficacy) includes:

• Confident that capable of performing behaviour

  • Ex. can I do this?

 

• Behaviour will have desired effect

  • Ex. belief that it will work

Can theory of planned behaviour actually predict behaviour change?

Yes, but intentions only moderately related to actual behaviour (and better for “planned behaviour”).

• Attitudes, norms, control also only moderately related to intention.

Critiques of theories of behaviour change (i.e. TPB and HBM)

• Assume conscious processing (many health-behaviours are habits!)

 

• Better at predicting behaviour in the short-term vs

  • Long-term behaviour change

  • Spontaneous behaviour change

 

• Missing

  • Emotions

  • Social Factors

  • Past behaviours/experiences

  • Behaviour change skills (e.g., problem solving)

 

• Are factors malleable?

  • Attitudes?

  • Social Norms?

What are two major assumptions we make in terms of health behaviour

• People who are not engaging in healthy behaviours just need more information or more convincing

 

• People who engage in health compromising behaviours are motivated to change!

Stages of change model

A theory of intentional behaviour that describes people’s readiness to change with five potential stages: precontemplation, contemplation, preparation, action, and maintenance.

pre-contemplation

(not ready) person has no intention to change (either against, or never thought about it)

practitioner task —> raise doubt and risks

contemplation

(getting ready) person is aware a problem exists and are seriously considering changing to a healthier behaviour within the next several months.

BUT they are not yet ready to make a commitment to take action.

Practitioner task —> weigh pros and cons

preparation

 (ready) person is ready to try to change and plan to pursue a behavioural goal in the next month. May have tried to reach goal recently but never made it.

Practitioner task —> goal setting

action

(ready) Period of 6 months from the start of the person's successful and active efforts to change a behaviour

Practitioner task —> goal setting

Maintenance

(sticking to it) Working to maintain the behaviour change achieved.

Practitioner task —> help identify and use strategies to prevent relapse.

Relapse

(learning) person returns to previous pattern.

• Ex. not going to the gym for a month.

• Relapse is normal in motivational interviewing and is used as a learning opportunity.

 

Lapse is a slight lapse (ex. not going to the gym one day in stead of 2)

Practitioner task —> help renew process

Abstinence-violation effect

A cognitive process whereby a relapse occurs when people feel guilt and reduced self‐efficacy if they experience a lapse in efforts to change their behaviour

What are the two ways to find out the stage of change a client is in?

• They may make spontaneous statements

  • There are also measures to give but often comes about in conversation.

 

• Ask strategic questions (ex. how important is it for you to make a change?)

  • Give a scale.

  • Ex. how important is you to change?

  • Ex. how confident are you that you could make that change?

Motivational interviewing

an empirically-supported directive, client-centered counseling style to elicit behaviour change

• helping clients to explore and resolve ambivalence

• Motivation and reasons for change are elicited from the client (not imposed upon them)

• Incorporates transtheoretical stages of change model

 

Can be Brief!

Two key features of motivational interviewing?

Personalized feedback (“frames”)

• clients receive information on their pattern of the problem behaviour, comparisons with national norms for the behaviour, and risk factors and other consequences of the behaviour.

Decisional balance (REASONS ”FOR” AND “AGAINST” CHANGE) DEVELOP DISCREPANCY BETWEEN HOW THEY ARE NOW AND HOW THEY WANT TO BE.

• clients list their reasons for and against changing their behaviour so that these can be discussed and weighed

F.R.A.M.E.S

• Feedback re: current health + substance use

• Responsibility for change lies with client

• Advice re: harm reduction or treatment (with permission)

• Menu – offer # of options + strategies for change

• Empathy –perspective taking, reflective listening

• Self-efficacy - belief in client’s potential, optimism

How do you develop discrepancy in MI?

Motivation for change when discrepancy between how clients want their lives to be vs. how they currently are

 

• Looking forward – 5 or 10 years with or without substance use

• What are your goals/values in life? How does your substance use fit with these goals?

• Describe “good” and “not so good” things about using.

Behavioural methods focus directly on enhancing people’s performance of the preventive act by managing its …

antecedents and consequences

• Managing antecedents --> ex. using a calendar or reminders

• Managing consequences --> ex. adding reinforcement of good behaviours.