9 - designing behaviour change interventions Flashcards

(33 cards)

1
Q

examples of patient behaviours

A

Screening uptake
Early symptom reporting
Adherence to medical advice
Maintenance of behaviour change

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2
Q

examples of HCP behaviours

A
Persuasive communication and interaction
Appropriate advice and follow up
Continuing professional development
Implementation of evidence-based practice
Adherence to best practice guidelines
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3
Q

why is changing behaviours complex

A

there are a myriad of influences
Eg. social influences, environmental cues, attitudes and
beliefs, past behaviour, habits and routines,
organisational structures (rules and regulations).

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4
Q

Medical Research Council Guidance for developing and

evaluating complex interventions

A

a cycle between 4 aspects:

o Development –> identify evidence base, model procedures
o Feasibility/piloting –> testing procedures, what sample size?
o Evaluation –> assess cost-effectiveness
o Implementation –> monitoring, long-term follow-up?

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5
Q

factors that help you develop a complex but effective intervention

A

Understand the behaviour(s) you are trying to change
Use a framework to help you identify the types of
intervention strategies that are likely to be effective
Take into account the perspectives of the people using the intervention (receiving and delivery)
Target multiple systems to be most effective

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6
Q

examples of frameworks available to guide intervention

development

A
- Intervention Mapping
• Behaviour Change Wheel and COM-B model
• Person-based approach
• CeHRes Roadmap (ehealth)
• 6SQuID
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7
Q

stages in development of an intervention

A

Identify target behaviour(s)
identify what influences the behaviour (is it modifiable?)
Develop a logic model of the problem
think about all the various levels or systems that influence the behaviour
use the intervention mapping approach

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8
Q

what is intervention mapping

A

a 6-step protocol to follow for developing theory-based and evidence-based health promotion programs

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9
Q

6 steps in intervention mapping

A

Needs Assessment –> what is the problem?
logic model of change –> what is the behavioural outcome? (who/what needs to change?)
Program Design –> what are the theory and evidence-based change methods?
Program Production –> draft materials and prototypes
Implementation –> what needs to change to implement the intervention?
Evaluation –> is it effective? does it work through the intended mechanisms?

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10
Q

how do we know what to change when we identify a problem?

A

look at evidence base
carry out qualitative interviews
stakeholder consultations

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11
Q

stakeholder consultation

A

identifies the most important things to change to reach the outcome –> prioritisation

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12
Q

examples of self-care for heart failure

A
  1. engaging in exercise training

2. taking prescribed medicines

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13
Q

in order to implement change we must first understand..

A
  1. why behaviours are as they are

2. what needs to change

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14
Q

what is a logic model

A

step-by-step diagrams which simply summarise:

  • what you are hoping to achieve
  • the processes involved to achieve it

think about what you might need in order to achieve a desired behaviour

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15
Q

3 factors influencing behaviours in COM-B model

A

capability
opportunity
motivation

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16
Q

what is meant by the COM in COM-B model

A

capability –> psychological/physical ability to enact the behaviour

opportunity –> physical/social environment enabling the behaviour

motivation –> reflective or automatic mechanisms that activate or inhibit behaviour

17
Q

explain the COM-B model if the target behaviour was engaging in exercise training for heart failure patients

A

C - start on walking-based program, specific HF activities e.g. hands below head
O - active care-giver involvement, home-based CBE
M - facilitator and care-giver encouragement

18
Q

what is meant by the reflective-impulsive model

A

suggests that social cognition and behaviour are the outcome of two systems of information processing, the reflective system and the impulsive system

19
Q

what is the theory of planned behaviour

A

links beliefs and behaviour

says that attitudes toward behaviour, subjective norms, and perceived behavioural control, shape an individual’s behavioural intentions and behaviours

20
Q

Does changing cognition change health related

motivation and behaviour?

A

yes - if cognitive change is effective, small to medium effect sizes are found for motivation and behaviour

think horizontal bar charts (higher increase in intention for health behaviours than for behaviour)

21
Q

what does the intention-behaviour gap in the theory of planned behaviour mean?

A

the size of effect on intention is not fully translated in effect on behaviour
e.g. intent to stop smoking

22
Q

why does the intention-behaviour gap exist?

A

due to conscious, reflective, deliberative,
reasoned, and slow processes

e.g. as a result of the reflective-impulsive model…

23
Q

behaviours deriving from the reflective system of information processing

A

mindful, conscious awareness and monitoring, top-down

24
Q

behaviours deriving from the impulsive system of information processing

A

bottom up, mindless, default

behaviour is often initiated and sustained with little conscious monitoring.

25
what behaviours results when the reflective and impulsive systems are in conflict
temptation
26
how does conditioning over time develop into addictions and habits
Repeated associations between (1) cue and behaviour (2) behaviour and reward (physiological and emotional) • results in automatic impulsive responses (“conditioning”)
27
why are cues (stimuli) important
prompt automatic responses & behaviour without decisions– so behaviour may conflict with and override what we had intended.
28
how can psychological theories be limited in the regulatory mechanisms they specify?
interventions based on single theories may omit some important regulatory processes or overlook variances between individuals
29
technology to reduce impulsivity
ImpulsePal --> van Beurden (2018) an app that engages reflective system to support dietary change set objective e.g. reduce snacking frequency contextual cues that trigger craving have to be overridden by doing another activity to take mind off craving aims to prevent initiation of impulse devalues reward (snack) - Initiate automatic activation of alternative action - stimulates inhibitory control - Devaluation of control
30
what are change techniques
observable, replicable components of the intervention designed to change causal processes that regulate behaviour.
31
examples of early reliable taxonomy to change frequently used behaviours (taxonomy of change techniques)
``` General information/encouragement Information on consequences Specific goal setting Review goals Provide instruction Prompt practice and self monitoring Provide feedback Contingent rewards Teach to use cues Social support/ change Role model Relapse prevention Stress management Time management ```
32
Behavioural change technique (BCT) taxonomy V1
Michie et al (2013) classification of 124 BCTs from 6 different publications made 6 categories of BCT e.g. goals and planning
33
3 factors to consider when evaluating interventions
outcome evaluation --> does it work? - effectiveness in real world and clinical relevance process evaluation --> how does it work? - mechanisms and techniques - for whom does it work and in what settings economic evalutation - how much does it cost? - is it cost effective?