4 - Health Behaviour Change Flashcards
Causes of death now
- disease with a behavioural contribution (e.g. cancer, circulatory disease, respiratory disease) are now the major causes of death.
What is the number one cause of preventable illness and death?
smoking
smoking stats
About half of all persistent cigarette smokers are killed by their habit—a quarter while still in middle age (35-69 years).
Smoking is the number one cause of preventable illness and death.
On average, cigarette smokers die about 10 years younger than non-smokers.
Current prevalence of 19% in UK adults (45% in mid 70s)
-66.4% of men and 57.5% of women in England are overweight
5 modern day killers
- dietary excess
- alcohol consumption
- lack of exercise
- smoking
- unsafe sexual behaviour
Tackling disease = changing behaviour
What is important in terms od tackling disease?
Tackling disease = changing behaviour
Health Behavior
“Any activity undertaken by an individual believing himself to be healthy, for the purpose of preventing disease or detecting it at an asymptomatic stage”
Kasl & Cobb (1966)
The Alameda Stedy
- 6,928 residents of Alameda county, CA, completed a list of 7 health behaviours they practised regularly- not smoking, eating breakfast, not snacking, regular exercise, getting 7-8 hrs sleep, moderate alcohol, moderate weight.
- At 10 year follow-up the mortality rate in individuals who practised all seven behaviours was less than 1/4 of that in individuals who practised three or less.
How can we help people to adopt health behaviours?
- Population level intervention (social media campaigns, television)
- Community level (e.g. cardiac rehabilitation, e.g. working with a culturally diverse group)
- Individual level
Motivational interviewing
- a type of questioning method that…
Smoking Education in Schools Nutbeam et al (1993)
- A programme of education about the effects of smoking was conducted in 39 comprehensive schools in England & Wales; it had a goal to reduce smoking behaviour.
- The programme involved specially trained teachers providing teaching sessions spread over a 3 month period
- Outcomes: a self report questionnaire combined with a saliva test before teaching, immediately afterwards and at 1 year follow-up
-> knowledge is not necessarily enough;
The role of education
- Information does have an important role and is most effective for discrete behaviours (eg getting a child vaccinated)
- Messages tailored to a particular audience are more effective (eg complete abstinence Vs condom use to reduce teenage pregnancy)
- But often people need more than knowledge to change habitual lifestyle behaviours, particularly addictive behaviours (eg social & psychological support, skills to change)
Learning Theory and Health Behaviour
Visual (eg. fast food signs, sweets at checkout)
Auditory (eg. ice cream bell)
Olfactory (eg. smell of baking bread)
Location (eg. the couch or car)
Time (eg. evening)/ Events (eg. end of TV programme ) Emotional (eg. bored, stressed, sad, happy).
Reinforcement Contingencies and health behaviour
Positive reinforcement:
- Dopamine (feel good), filling an empty void/boredom.
- Praise for preparing a high-fat meal for the family.
Negative Reinforcement:
- Avoid painful emotions by comfort eating.
Punishment:
- Preparing a low fat meal is criticised
Limited/delayed positive reinforcement for healthy eating:
- Efforts at dietary change/weight loss go unnoticed by others; Avoiding future health problems is too remote.
Food is often a source of numbing, we use it ti disturb ourselves.
Behaviour modification techniques
Stimulus control techniques:
•Keep ‘danger’ foods out of the house
•Avoid keeping biscuits in the same cupboard as tea & coffee •Eat only at the dining table
•Use small plates
•Do not watch TV at the same time as eating.
Counter conditioning:
•Identify ‘high-risk’ situations/cues (eg stress) and ‘healthier’ responses:
–Eg Can you think of something other than eating that makes you feel better? Maybe something relaxing or exercise?
Examples of contingency management:
Involve significant others to praise healthy eating choices Plan specific rewards for successful weight loss
Vouchers for adherence to healthy eating & weight loss.
Naturally occurring reinforcers:
Improved self-esteem (positive reinforcement).
Reduction in symptoms of breathlessness (negative reinforcement).
Positive reinforcement intervention
- Kegels et al (1978)
Positive reinforcement intervention
Kegels et al (1978)
Children given a talk on dental hygiene and then received one of three types of follow up:
- No further input
- Discussion session
- Reward for compliance with mouthwash programme
Outcome: Compliance with the mouthwash programme assessed over 20 weeks.
