Determinants of PA and supporting behaviour change (wk8)

Question 1

What are health inequalities?

Answer 1

Health inequalities measured by differences in health outcomes among different groups of people. In England, life expectancy varies depending on where people live. People living in the most deprived areas have a life expectancy a decade shorter than those living in the least deprived areas. Covid-19 has widened health inequalities in England. Disproportionate effect on those already experiencing health inequalities – living in the most deprived areas and people from ethnic minority backgrounds.

Question 2

Describe the different determinants of health and PA + PA interventions

Answer 2

Behaviour, individual person, lifestyle factors, social and community networks, living and working conditions, general socio-economic, cultural and economic conditions. Different jobs require different states of activity, such as with stairs.
-PA interventions -> Necessary to ensure that more people achieve the health benefits of physical activity.

Question 3

Children, adults and older adults influence/ motivation towards PA behaviour

Answer 3

• Children -> Bone health, cognitive function, CV fitness, muscle fitness, weight status, depression
• Adults -> All-cause mortality, stroke and heart disease, hypertension, type 2 diabetes, 8 cancers, depression, cognitive function, dementia, quality of life, sleep, anxiety/depression, weight status
• Older adults -> Falls, frailty, physical function

Question 4

WHO PA global plan for increasing PA behaviour

Answer 4

• Vision -> More active people for a healthier world
• Mission -> To ensure that all people have access to safe and enabling environments and to diverse opportunities to be physically active in their daily lives, as a means of improving individual and community health and contributing to the social, cultural and economic development of all nations
• Target -> A 15% relative reduction in the global prevalence of physical inactivity in adults and in adolescents by 2030

Question 5

Outline and draw the ‘determinants rainbow’ (ecological model)

Answer 5

-Integration of different behavioural theories and models
-Inter-relationships between individuals and their environment – social and physical environment
-Correlates -> statistical associations – no causality
-Determinants -> longitudinal research – causal associations

Question 6

Describe some determinants of PA in according to different demographics
(learning difficulties, homeless men, black people, gypsy or Irish travellers, LGBTQI+)

Question 7

Identify some determinants of PA according to different demographics
(Canadian Fitness and Lifestyle Research Institute Study)

Answer 7

-Possible reasons for not exercising? -> Barriers. Canadian Fitness and Lifestyle Research Institute – Investigated barriers to physical activity when it conducted the 1995 Physical Activity Monitor. More than 2500 Canadians were asked ‘How important is each of the following in keeping your from maintaining physical activity?’. Those who answered ‘important’ or ‘very important’ to any of the 15 barriers included were considered to be experiencing the barrier. Found: Major barriers – lack of time (69%), lack of energy (59%), lack of motivation (52%). Time, energy, motivation, cost were the top 4 barriers for ages 18-24 and 25-44.

Question 8

Explain the importance of understanding determinants of PA in different groups

Answer 8

-Psychological theories and models help us to understand the process of exercise adoption and adherence -> several major models/theories.
-The determinants rainbow -> PA/exercise adoption (action) and adherence (maintenance). The main psychological determinants include: lack of motivation, feeling uncomfortable, lack of skill and fear of injury (and they are all individual). Psychological determinants are however modifiable.

Question 9

Outline psychological theories and models relevant to promoting PA adoption and maintenance
-Transtheoretical model

Answer 9

-Transtheoretical model -> Understand the stages that people go through with regards to the process of; exercise adoption, maintenance and relapse. Individuals can engage at any stage: design interventions which addresses these barriers or determinants.
-Designing interventions -> No intent to change, couch potatoes, defensive and uninformed, seriously intend to exercise?

Question 10

Outline psychological theories and models relevant to promoting PA adoption and maintenance
-Self-efficacy

Answer 10

-Self-efficacy -> Fallon, Hausenblas and Nigg (2005). Examined whether self-efficacy to overcome barriers could distinguish between the action, maintenance, and termination stages of change for men and women. N= 330 male and 380 female (M age between 24 and 27 years). Barriers-efficacy scale: 12 items. Perceived ability to exercise 5 x per week in the face of barriers (e.g. bad weather, lack of interest/boredom, pain and discomfort, exercising alone). Stages of change questionnaire: 5 items (+1 extra for termination phase) – ‘Do you exercise 3 times a week, for at least 20 minutes each time?’. Level of SE was able to correctly classify 57% of the females according to their reported stage of change.

Question 11

Outline psychological theories and models relevant to promoting PA adoption and maintenance
-Autonomous motivation

Answer 11

-Autonomous motivation -> Zamarripa et al., 2018. Analysed variations in behavioural regulations using the stages of change model. N = 530 participants. Pre-contemplation – external and amotivation predominated. Action and maintenance – intrinsic, integrated and identified.
* Fostering self-efficacy and autonomous motivation towards physical activity and exercise may likely have positive implications for physical activity/exercise behaviour change
* SE theory -> Higher SE for maintenance
* Self-determination theory -> More autonomous motivation for action

Question 12

Describe strategies that can be used to support PA/ exercise adoption and maintenance (6 approaches)

Answer 12

-Need individualised strategies -> 6 broad strategies/ approaches:
1. Behavioural modification
2. Cognitive-behavioural
3. Decision making
4. Social support
5. Reinforcement
6. Intrinsic

Question 13

Behavioural modification approach

Answer 13

Behavioural modification approaches -> The planned, systematic application of learning principles to the modification of behaviour. Examples:
* Behavioural contract -> specifies expectations and responsibilities (goals, dates, consequences)
* Prompts -> Cue that initiates a behaviour (verbal, physical, symbolic)
Kerr et al., (2001). 12-week stair climbing intervention. Banner on stair rises. Maintenance of behaviour can result to banners being removed. Compared sex/age differences -> individualized approaches.

Question 14

Cognitive behavioural approach

Answer 14

Cognitive-behavioural approaches -> Assume internal events (i.e. thinking) have an important role in behaviour change. Examples:
* Goal setting -> Flexible, participant led (set by themselves-> autonomy), intrinsic (personal interest, improving health – rather than intrinsic)
Martin et al., (1984) – Exercise class participants. Participants set their own flexible goals. Attendance = 83% and 47% still exercising 3-months after programme. Instructor set-goals – 67% attendance and 28% exercise maintenance.

Question 15

Decision making approach

Answer 15

Decision making approaches -> Decisional balance – cost vs benefit analysis
+draw the table

Question 16

Social support approach

Answer 16

-> Individuals favourable attitude towards someone else’s involvement in a physical activity or exercise programme.
* Family and friends (significant others) can influence PA/exercise engagement in many ways
1) Verbal reminders/encouragement
2) Model/cue base on own physical activity behaviour
3) Practical assistance (transport, clothing, equipment)

Question 17

Reinforcement approach

Answer 17

Reinforcement approaches ->
* Feedback -> verbal, biofeedback, linked to behaviour (e.g., levels of PA), linked to end goal/outcome (e.g., weight loss)
* Rewards -> E.g., covering the cost of an exercise programme/gym membership? Highest levels of physical activity? E.g., vitality rewards.

Question 18

Intrinsic approach

Answer 18

Intrinsic approaches -> Other strategies can help, but need to inspire physical activity/ exercise maintenance long term -> results in more autonomously motivated.
* Intrinsic motivation -> Due to inherent interest, fun, enjoyment from the activity.
* Focus on the experience itself -> Change the quality of the PA/ exerciser experience
* Focus on the process -> Effort, task mastery (not outcome -> more barriers)

Question 19

Psychological theory v Behaviour change strategy + promoting PA

Answer 19

-Psychological theory v Behaviour change strategy -> Theory helps us find the strategy to target the psychological factor that is proven to influence behaviour. Strategy is not the same as a psychological theory.
-Changing behaviour ->
* Intrinsic motivation is present when an individual performs an activity merely for the pleasure of experiencing it, without expecting a reward or trying to avoid punishment
* One end of the continuum lies amotivation, where an individual does not have any motivation to engage in an activity
* Individuals who are not motivated do not seek social, affective, or material objectives; instead, they experiences negative sensations such as incompetence, apathy, and even depression.
-Promoting PA ->
* Different theories and models can be used to explain the processes underlying the uptake and maintenance of a behaviour
* Extrinsic motivation is found between the extremes of intrinsic motivation and amotivation, and it refers to performing an activity with the aim of obtaining a separable result
* When understanding these processes, we can then target the barriers that people experience to become physically active.

Question 20

Describe health inequalities in ethnic minority communities

Answer 20

-Health inequalities -> People from ethnic minorities are at more risk of having poor health and long-term conditions. Inequality was magnified by the COVID-19 pandemic, with high infection and death rates in UK ethnic minority communities. Messages promoting health, PA and healthy eating were widely developed during the pandemic, but few are suitable or relevant to ethnic minorities. When public health messages are designed properly to reach specific communities, they can support people effectively to change their behaviours.

Question 21

Developing behaviour change programmes in ethnic minority communities

Answer 21

-Developing behaviour change programmes -> First step is to understand the things that matter most to ethnic minorities communities (EMCs) and to ensure programmes are aligned to their values. Understanding of the values useful to inform the development and implementation of relevant programmes. Align priorities and realities of EMCs. Consider the wider determinants of health and health behaviours. Structural, social, economic and environmental factors. Interactions between values beneficial to get a broader overview of drivers of PA and healthy eating behaviour among EMCs.

Question 22

Approaches to developing effective behaviour change communication materials
-Key messages

Answer 22

-Key messages -> Engaging communities throughout the production process is vital to ensure relevant priority topics for messaging. Open mindedness and responsiveness during co-production process. Tokenistic representation of ethnic minority communities in health promotion materials. Government and expert-based materials are more accepted than materials with untraceable sources.