6. Promoting Good Behaviour: Factors in Change Flashcards
Health Tips?
- Change is possible (but difficult).
- Doing it on your own isn’t easy.
- Believe in yourself, prepare for lapses - and you might just succeed.
Who is most
often targeted by primary
prevention programs and
campaigns?
Generally speaking there are two populations that are targeted:
- Young people (depending on the behavior ranges from children to adolescents/university students)
- Parents by extension - Vulnerable people (whoever is identified to be at a heightened risk for developing certain health problems)
- People who smoke, children of parents with cancer history
U.S. CDC’s Anti
Smoking Campaign (Spring, 2012)
- Cost $54 million.
- Ran for 12 weeks.
- Aimed to get 500,000
people to try to quit,
50,000 to quit long term.
Initial impact of campaign?
Ads generated 192,000 extra
calls to CDC toll free quit line
and 417,000 new visitors to CDC
website (triple previous traffic).
Anecdotal evidence that ads had
range of responses.
But 2 largest U.S. tobacco companies reported no impact on 2012 earnings.
CDC’s Final Report on Campaign (2013)
Based on survey of 1000s of adult smokers and non smokers before and after?
80% of smokers and 75% of non smokers recalled seeing at least one of the ads during the 3 month campaign.
An estimated 1.6 million smokers attempted to quit smoking based on the national ad campaign.
More than 200,000 Americans quit smoking immediately following the campaign, with 100,000 likely to quit permanently.
What really works?
Durkin et al. (2009) found that the most successful anti smoking ads are…?
emotionally evocative and contain personalized stories
Health agencies and medical professionals, the mass media , news outlets, and the internet play…?
an important role in disseminating health related information.
Methods for Promoting Change - Providing Information?
The way in which health related information is delivered can play an important role in whether or not it is effective (i.e., persuasive and/or results in actual change).
Methods for Promoting Change - Educational Appeals?
Provide general information (vs. tailored content); assume that people will be motivated to improve a health behaviour if they have the correct information.
Educational Appeals - Not always successful; many
factors that must be considered…?
- Colour & vividness of ad.
- Expertise, likeability, and
relatability of messenger. - Avoidance of jargon & stats.
- Length of message.
- Placement of strong arguments.
- Presentation of both sides.
- Clarity of conclusions.
- Avoidance of extremes.
Message Framing?
Refers to whether the information emphasizes the benefits
(gains) or costs (losses) associated with a behaviour or decision.
Gain framed messages focus on?
Gain framed messages focus on experiencing desirable consequences and/or avoiding negative ones.
E.g., “If you exercise, you will
become more fit and less likely to
develop heart disease
Gain framed messages work best for motivating behaviours that serve to prevent or recover from illness or injury (e.g., using condoms, performing physical therapy).
Loss framed messages focus on?
experiencing undesirable consequences and/or avoiding positive ones.
E.g., “If you do not get your blood pressure checked, you could increase your chances of having a heart attack or stroke , and you won’t know that your blood pressure is good.
Loss framed messages seem to work best for behaviours that occur infrequently and serve to detect a health problem early (e.g., drinking and driving, getting a mammogram).
What would you expect to work best for motivating vaccination behaviour, gain or less framing? The COVID 19 vaccine specifically?
Gain frame is best for preventative measures. Also there is more to gain than positive outcomes for yourself, consider your community.
Yet, some studies indicate other results. There is a lot of inconsistencies. It could be that for different demographics benefit more form gain vs. loss framing.
Methods for Promoting Change - Fear Appeals?
Message framing that assumes instilling fear will lead to change.
Fear Appeals effects tend to be transient (they have an initial impact or motivation but it does often not last long enough to see a flood-though). But more persuasive if?
- Emphasize consequences.
- Include personal testimonial.
- Provide specific instructions.
- Boost self efficacy (feel empowered) before urging them to change.
Fear Appeals - Too much fear can also be problematic why?
Might just turn away from the message, stop listening.
Challenge is when you are delivering a message to the entire population everyone has different thresholds.
Methods for Promoting Change - Behavioural and Cognitive Methods
Behavioural methods focus on helping people manage the antecedents (things that led to the behaviour) & consequences of a behaviour.
Cognitive methods focus on changing people’s thought processes.
Behavioural and Cognitive Methods - One popular intervention?
Cognitive behavioural therapy (CBT)
Cognitive Behavioural Therapy (CBT) - Definition?
Evidence based psychotherapeutic intervention that promotes self observation and self monitoring to increase awareness and control of negative thoughts and harmful behaviours.
Cognitive Behavioural Therapy (CBT) - Goal?
Goal:
Regulation of thoughts, attitudes, beliefs, emotions, and behaviours through personal coping strategies.
Self management:
clients can eventually apply these methods themselves.
Cognitive Behavioural Therapy
Applied to Alcohol Abuse?
Identify unhelpful/unrealistic thoughts and beliefs that contribute to the problem behaviour…
“I can’t relax without my alcohol.”
“My friends find me boring when I’m sober.”
Identify triggers (internal/external) that cause you to drink… and removing them!
Negative experiences (or positive like celebrations), specific social situations, locations, etc.
Engage in more realistic and helpful thoughts…
“I know I can’t stop drinking once I start.”
“Lots of people have fun without alcohol.”
“My friends like me for my personality, not my drinking.”
Maintaining health behaviour changes can be difficult… Lapse definition?
An instance of backsliding which does not indicate failure (e.g., a person who quits smoking has a cigarette).
Maintaining health behaviour changes can be difficult… Relapse definition?
Falling back to one’s original pattern of undesirable behaviour; very common when people try to change long term habits (e.g., eating and smoking behaviours).
Maintaining health behaviour changes can be difficult… Abstinence Violation Effect definition?
For some, experiencing a lapse can destroy one’s confidence in remaining abstinent and precipitate a full relapse.
See themselves as a failure can have a full-on relapse.
Methods for Promoting Change - Motivational Interviewing?
A one on one counselling style designed to help individuals explore and resolve their ambivalence in changing a behaviour.
Semi-directive, client-centered therapeutic approach (client is allowed to talk freely for a significant amount of time); originally developed for counselling of alcoholics.
Follows a transtheoretical model of behaviour change in combination with CBT (cognitive behavioural therapy) methods.
Motivational Interviewing tends to be most effective in which stage?
Tend to be most effective in the precontempletion or contemplation stage.
2 Key features of Motivational Interviewing?
Decisional Balance:
Clients list reasons for and against changing behaviour; used for points of discussion.
Personalized Feedback:
Clients receive information on their pattern of problem behaviour, comparisons with norms, and risk factors/consequences of behaviour.
Brief Alcohol Screening and Intervention for College Students
( BASICS): A harm reduction approach.
Designed to help students make better alcohol use decisions based on a clear understanding of the risks associated with problem drinking.
Program is conducted over 2 brief interviews…
(1) Assessing risk of problem behaviours, obtaining commitment to monitor drinking between interviews.
(2) Providing personalized feedback, including comparison to norms, risks, and advice on how to drink safely.
Strategies include: Slowing down, spacing drinks; Different types of drinks; Drink for quality vs. quantity; Enjoy mild effects of alcohol.
One-Year Follow-Up?
Highly effective!
The Skill training group only went to 2 sessions and were compared to two different control groups, in number of days drunk, and number of days of continuers drinking.
Some studies even show a significant effect after a 4 year follow up!
Methods for Promoting Change - Social Engineering?
In addition to changing the individual, we can also change the social environment in order to better support healthy behaviours.
Examples include…
* Nutritional guidelines
* Seatbelt laws, road safety
* School vaccination programs
* Smoking prohibitions
* Taxation of alcohol to increase cost
* Restricting alcohol to adults
* Taxes on sugary drinks
* Eliminating trans fats in foods
* Vaccine mandate / passports
Very often people reject to social engineering with the argument that it infringes on personal freedom.
Social Engineering - Regulation/Prohibition of Drugs?
A traditional approach to preventing substance use/abuse is to regulate, prohibit, and/or criminalize addictive or harmful substances.
- Alcohol
- Tobacco & Marijuana
- Other Illicit Substances
Decriminalization & Harm Reduction?
Evidence indicates that decriminalization does not typically increase the use of drugs.
In contrast to criminalization, a harm reduction approach aims to reduce the negative consequences of substance/drug use; and to treat people who use drugs with respect and dignity.
In order to reduce/remove the effects of social stigma.
In order to better motivate them to be healthy and contributing members of society.
Vancouver’s Downtown East Side (DTES), 1997?
Public health emergency declared
overdose deaths, spike in rates of HIV / Hepatitis C.
Insite Supervised Drug Consumption Site, DTES?
Operated by Vancouver Coastal Health and the Portland Hotel Society under a constitutional exception to the Controlled Drugs and Substances Act; opened in 2003
Extensive research has demonstrated an array of benefits:
- reductions in public injecting and syringe sharing
- increases in the use of detox services and addiction treatment
- significant drop in overdose deaths and new cases of HIV infection.
Today numerous safe conceptions sites around Canada.
Some provinces are experimenting with decriminalisation of illicit substances (possession of small amounts is legal, but not to sell or distribute).
In 2020, BC became the first jurisdiction globally to launch? + results
A large-scale province wide safer supply policy.
Allows individuals with opioid use disorder at high risk of overdose to receive pharmaceutical-grade opioids.
A recent study found that the opioid-related hospitalisation rate uncreased by 3.2 per 100,000 after policy implementation, but reasons are unclear
Addiction defintion?
A condition, produced by repeated consumption of a natural or synthetic psychoactive substance, in which a person becomes physically and psychologically dependent on a
substance.
Physical dependence definition?
Exists when the body has adjusted to a
substance and incorporated it into the “normal” functioning of the body’s tissues.
Always occur to some extent since it effects and alters biological processes, on it’s own it does not constitute as an addiction.
Psychological dependence definition?
A state in which individuals feel compelled to use a substance for the effect it produces, without necessarily being physically dependent on it.
When we refer to addiction, should we describe it as a habit, a disease, or..?
A habit is easier to break, minimising the severity and difficulty of giving up the behaviour.
How much responsibility we place on the individual.
Disease, recognise more factors (social, biological, societal) beyond the individual.
Some criticism of the disease model…
- Gives the false impression that alcoholism is solely a biological disorder.
- Strips the user of personal responsibility, may adopt a victim role.
- Transfer responsibility to doctors (must be diagnosed) and caregivers
- May diminish moral stigma, but imposes a disease stigma.
DSM-5-TR and Addiction
Substance-Related and Addictive Disorders
Alcohol, Caffeine, Cannabis, Phencyclidine (PCP/angel dust), Other Hallucinogens (e.g., salvia), Inhalants, Opioids (e.g., heroin, morphine, OxyContin), Sedatives (e.g., sleeping pills), Hypnotics (e.g., some anti-depressants), Anxiolytics (e.g., Ativan), Stimulants (e.g., meth, cocaine), Tobacco, and other (or unknown) substance.
e.g., ‘Alcohol Use Disorder’
Gambling Disorder (and possibly Internet Gaming Disorder
Very few soles behavioural addictions, otherwise it is a use-disorder associated with a substances.
Caffeine is the only one you can be diagnosed with intoxication or withdrawal, but not recognised as a use-disorder.
What psychoactive substances are being used?
Estimated percentage of Canadians 15 years of age and older in 2013 who consumed alcohol, marijuana, and other illicit drugs in the previous year and/or smoke tobacco.
Alcohol
- By far the most commonly used.
- Usage increased during the pandemic.
- 20% of Canadian’s have problem drinking behaviour.
Tobacco
- About same frequency as marijuana.
Marijuana
- Slight increase
Other illicits
- Not as common
Alcohol Use / Abuse is a Complicated Case of Health Compromising Behaviour. Why?
Socially complicated, we like to drink when we are happy or sad.
Alcohol is very normal in social gatherings.
Short-Term Effects of Alcohol?
- Reduced coordination
- Diminished cognitive ability
- Judgment, decision-making
- Aggression / Emotionality
- Accidents
Long-Term Effects of Alcohol?
- Liver damage
- Cardiovascular disease
- Various types of cancer
- Depression
- Alcohol Use Disorder