T2 L19: Behaviour modification for CVD & respiratory health

• What is the IMB model of health behaviour?

  simplest summary of 3 key elements needed for behaviour change

  components may be multifaceted

  
• What is the TTM model?

  (transtheoretical / stages of change)

  
• What are the components of health promotion?

  individual: information / knowledge, beliefs, motivation + persistence (to overcome setbacks), skills, plans

  inter-personal: feedback and rewards, support

  social: environmental context, policy and provision
• What are smacks, shoves and nudges in terms of facilitating healthier choices?

  smacks eliminate choice: legislation, eg smoking bans, drinking age limits, COVID restrictions

  shoves restrict choice: eg sugar tax

  nudges guide and enable healthier choices: make healthy options viable, easier, cheaper
• What are the psychosocial impact and secondary prevention for cardiovascular disease?

  symptoms of depression, anxiety, post-traumatic distress more likely in people diagnosed with CVD

  psychosocial distress is more likely among people who:

  • perceive more serious consequence of CVD
  • have less coherent understanding of their condition
  • have stronger initial emotional response to MI or stroke
• Synthesis of interview-based studies revealed that patients experience a big change to an ‘unfamiliar’ identity: they must find ‘new limits’ as they sought to achieve a ‘new normal’ in a lifestyle that was also ‘worth living’
• Cultivating resilience and adaptive responses to stressful situations is an important part of secondary prevention of CVD
• Effective interventions are linked to better outcomes:

  e.g., group intervention focused on:

  • knowledge skills for coping with serious illness
  • stress management
  • counteracting anxiety and depression
  • relaxation techniques
  • improving social relations and social support

  reduced the likelihood of premature death by 1/3 over a 7-year follow-up
• What is motivational interviewing?

  MI is a 1:1 approach that helps to people:

  • overcome ambivalence about behaviour change
  • enhance commitment to change
  • enhance motivation to change
  • address barriers to change

  Co-operative patient-centred approach based on four key skills OARS:

  1. Open questions - to encourage people to express themselves
  2. Affirmations - to acknowledge what people are doing well
  3. Reflective listening - to help people feel listened to and understood
  4. Summaries - to capture and emphasise key elements of what people tell you
• What are SMART goals?

  Specific, Measurable, Achievable, Relevant, Time-bound
• To be ready to change, what must a person believe that?

  their current behaviour is ‘bad’ for them

  they will be better off if they change

  they have a good chance of succeeding if they try to change
• Lifestyle changes are often not sustained in long-term:

  • 65% change to healthier diet
  • but only around half maintain changes after 1 year
  • = only ~30% sustain a healthier diet
• What to do about 'relapse' in change?

  note that relapse is common

  plan how to manage triggers / temptations - e.g. dual-process model

  boost skills and confidence

  plan alternative responses

  note how negative emotions affect - and are affected by - relapse*

  respond appropriately to relapse:

  framing of relapse

  learning from relapse