Introduction to behaviour change

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Created by
Beth

Cards (25)

  • Health-related behaviours
    • smoking
    • physical activity
    • diet
    • weight control
    • drug and alcohol use
    • contraceptive use
    • sunscreen use
    • tooth-brushing
    • safety measures
  • Health-related behaviours
    • uptake of vaccination
    • uptake of screening
    • Presenting at services
    • appointment attendance
    • medication adherence
    • self monitoring
    • trigger avoidance
    • general self-care
  • Behaviours are important in preventing and managing many common health conditions
    Biggest risk factors for some conditions e.g. CVD, T2 diabetes
    Key role in management of all e.g. asthma
    Behaviours are important in all aspects of health and healthcare, and at all stages of life
  • Key asthma related behaviours
    • Smoking, vaping?
    • Using inhalers correctly, taking and adjusting medications (technique? adherence?)
    • Self-monitoring (e.g. peak flow/symptoms)
    • Avoiding/managing triggers (e.g. animals, dust, stress)
    • Seeking & presenting at health services when needed
    • Attending appointments (e.g. asthma clinic)
    • General self care (e.g. hand hygiene, sleep etc)
    • Weight control and healthy diet (e.g. fruit & veg)
    • Physical activity
    • Alcohol & drug use
  • When is behaviour important in asthma?
    • primary prevention (early diet including breastfeeding, trigger exposure including smoke, stress, pets?)
    • secondary prevention of asthma attacks (trigger avoidance/control, adjustment of preventive medications, use of reliever inhalers, seeking healthcare)
    • recovery following attacks (adherence to meds attending follow-up appointments)
    • ongoing management (adherence to inhaled steroids, not smoking, trigger avoidance/control, self-monitoring, attending asthma clinic, adequate activity, good diet and weight control)
  • Behaviours are important in asthma, respiratory conditions
    • In primary prevention (e.g. maternal/early diet, exposure to triggers)
    • In secondary prevention of attacks (e.g. trigger avoidance/control, monitoring & adjusting meds, seeking help in time)
    • In recovery following attacks (e.g. taking oral steroids, attending follow up appointments)
    • In ongoing, day-to-day management and control (e.g. adherence to inhaled steroids, not smoking)
  • What influences behaviours?
    • Biological factors - genetics, age, pre-existing illness/damage
    • Environmental factors - availability, access, cost, weather
    • Social factors - culture, class, education, employment, support
    • Psychological factors = more amenable to change - past & concurrent behaviours (habit), personality, emotions, cognitions, NB: knowledge poor predictor
  • Importance of psychology
    • Psychology = scientific study of behaviour
    and mental processes (cognitions, emotions)
    • Aims to describe, understand, predict & modify how people (and animals!) behave, think, feel and interact, based on research evidence
    • Comprises several approaches/sub-disciplines (e.g. biological, behavioural, cognitive, social psychology), all potentially important for understanding and influencing health-related behaviour
    • Differs but overlaps with sociology, psychiatry, public health etc which also important ➔ multi-disciplinary “behavioural science”
  • Impulsive system (behavioural)
    Controlling automatic, habitual behaviour with little conscious awareness
    e.g. driving (helpful), eating (may be problematic)
    May be difficult to change, environment can prompt
  • Reflective system (cognitive)
    Conscious awareness, planning of deliberative action
    e.g. physical activity
    Easier to change, over time can help replace old habits with new
  • Social = relationships with others
    support, pressure, self identity
    Cognitive = internal thought processes
    knowledge, beliefs, attitudes, goals, plans
    Acquired through socialisation, learning
    Assumed to mediate effects of other factors
    May be more open to change
    Beliefs underpin many other cognitions
  • Beliefs
    • Are enduring individual characteristics that shape behaviour
    • Are acquired through socialization, learning
    • Underpin many other cognitions
    • Are modifiable i.e. can be changed
  • Models of motivation/intention
    Health locus of control
    • Internal vs. external locus of control
    Self-determination theory
    • Intrinsic vs. extrinsic motivation
    Health belief model
    • Perceived threat, pros & cons
    Theory of planned behaviour
    • Intention, attitudes, subjective norm, control
  • Beliefs and adherence in asthma
    • Doubts over necessity of inhaled steroids & concerns regarding side-effects (esp. steroid-dependency) related to poorer adherence
    • Illness beliefs consistent with medical viewpoint of asthma being a chronic (vs. episodic), but controllable condition with potentially severe consequences, related to greater adherence to inhaled steroids
    • Illness beliefs influenced adherence directly & via medication beliefs
  • Self-efficacy
    • Motivation and action based on: Outcome expectancy beliefs = beliefs about consequences
    • Perceived self efficacy (SE) = confidence, belief in ability to perform action/behaviour in situation to achieve outcome
    • SE strongly predicts intention & behaviour across wide range of behaviours
    • Important in motivation, action, maintenance of behaviour
  • Models of action/volition
    Social cognitive theory
    • Outcome expectancies, self efficacy
    Implementation intentions
    • Planning when, where, how intention ➔ behaviour
    Control theory / Goal theory
    • Goals, monitoring, feedback, revision of goals
    • Self-regulation = learning from experience
  • Stage models
    • Add temporal component
    Transtheoretical/Stages of Change Model
    • 5 stages plus processes of change
    Precaution Adoption Process Model
    • 6 stages
    Health Action Process Approach
    • 3 stages – motivation, action, maintenance
  • Stage of Change model
    Precontemplation …not thought about doing
    Contemplation …thought about doing, no plans
    Preparation …thought about doing, planning
    Action …currently doing or recently started
    Maintenance …doing for more than 6 months
  • Psychological models/theories developed through research can aid in understanding how beliefs and other cognitions influence health-related behaviours
    There are various models/theories to explain influences on:
    - motivation
    - action
    - ongoing maintenance of behaviours
  • Key social cognitive influences
    • Beliefs about nature of illness/problem
    • Outcome expectancies re: consequences of behaviour
    • Personal relevance / salience of behaviour
    • Attitude +ve/-ve evaluation of beh, based on pros & cons
    • Self-efficacy / perceived control / confidence
    • Social norms re: behaviour & approval of important others
    • Forming goals, plans to implement (specific, realistic, explicit, “contract”)
    • Relapse prevention (if…then coping plans)
    • Support from others
  • Strategies to support change
    Using a person-centred, empathetic approach support people to:
    1. Understand consequences of behaviours, for self and others
    2. Feel positive about benefits of health-enhancing behaviours and changing behaviour (explore importance & confidence)
    3. Identify and reduce real/perceived barriers, including addressing any information deficits, misconceptions, providing skills training
    4. Make a personal commitment to adopt health-enhancing behaviours by setting (+recording) goals reflecting small, easy changes over time
    ➔Increased motivation, self-efficacy
  • Strategies to support change
    • Make action plans to undertake clearly defined behaviours, in certain contexts, over a specified time (e.g. what, where, when)
    • Identify and plan for situations (including social contexts) that might undermine changes, using 'if…then' coping planning to prevent relapse/avoid set-backs
    • Share goals and plans with others and engage social support
    • Self-monitor performance of behaviour/outcomes (e.g. weight)
    • Use information on performance to gain feedback
    • Review and revise goals as necessary
    ➔ Action, self-regulation, maintenance of behaviour change
  • Techniques to promote change
    • Behaviour change techniques (BCTs):
    • Provide a common language to describe content of behaviour change interventions/encounters/efforts
    • Are defined to allow identification (e.g. in reports of studies) and replication in future
    • Have a basis in hypothesised change processes (e.g. theories) so describe what meant to do to promote behaviour change
    • Are being organised into taxonomies grouping related techniques
  • Asthma self-management interventions
    • Approaches revolve around use of written Asthma Action Plans to guide behaviour, which include:
    • Goal setting (e.g. around targets for asthma control)
    • Action/coping planning using If… (e.g. peak flow <X), then… (e.g. increase inhaled steroids, start oral steroids, contact GP, call ambulance) statements
    • Self-monitoring of symptoms, peak flow (using portable meters)
    • Using this feedback to adjust behaviour = self-regulation
    • Behaviours and behaviour change important in prevention, treatment and management of illness (e.g. in asthma)
    • Key psychological factors (underpinned by beliefs), organised into models, predict motivation and actual behaviour change (e.g. smoking, medication adherence)
    • Effective strategies and techniques for supporting behaviour change becoming increasingly clear (e.g. as in asthma self-management interventions)