What is the definition of a health behaviour?
Activities that may help to prevent disease, detect disease and disability at an early stage, promote and enhance health or protect from risk of injury
What are the 2 main categories of health behaviours and examples?
- health promoting/enhancing
e. g. eating fruit, exercising
- avoidance of health harming
e. g. smoking cessation
What are the 2 categories of factors that influence health behaviours?
- internal/personal factors
2. external factors
What are the internal factors that influence health behaviour?
- knowledge about risk associated with the behaviour
- attitudes/beliefs about the behaviour
- circumstances e.g. finances, time, stress
What are the external factors that influence health behaviour?
- social support
- social norms (what other people think of the behaviour)
- laws and regulations
- the environment
- healthcare system
What is the main reason why health behaviours are important?
They can have an effect on reasons for death
Cancer, heart disease and stroke are all influenced by behaviours
What are the 5 major diseases in the UK that cause premature death?
- cancer (42%)
- cardiovascular disease (22%)
- other (21%)
- respiratory disease (9%)
- liver disease (6%)
What are the individual causes of premature death by the main diseases?
- drinking alcohol
- obesity - poor diet and lack of exercise
What are the societal causes of premature death by the main diseases?
- working class
- ethnic minority
- living in the northern UK
- being male
- having a disability or mental health condition
What percentage of cancer cases in the UK are preventable by changes in behaviour?
What are the main cancer risk factors?
- smoking/exposure to another person’s cigarette smoke
- drinking more than 1 unit of alcohol daily
- eating less than 5 portions fruit/veg daily
- eating red/processed meat
- having a BMI over 25
- HIV infection
- increasing age
What are the 4 main lifestyle factors that cost the NHS the most money?
- poor diet
What was the focus of health promotion in the 1850s?
Prevent infectious diseases (e.g. cholera, small pox)
e.g. immunisations, clean water, etc.
what is the focus of health promotion today?
Prevent illness (e.g. heart disease, cancer) and promote good health
What is the difference in interventions today compared to the 1850s?
1850s - interventions impact on health
today - interventions directly impact people’s health related behaviours
What are examples of health interventions today?
Laws, education campaigns, screening
Interventions try to change someone’s behaviour to allow them to live longer, healthier lives
What is the purpose of interventions to change ‘bad’ behaviours?
To persuade people to reduce risk behaviours that increase likelihood of disease
What are the 3 main ‘behavioural pathogens’ and what diseases are they linked to?
(heart disease, cancer)
- sex and contraception
(HIV and other STDs)
(immune system response and cardiovascular disease)
What is the purpose of interventions to encourage ‘good’ behaviours?
To persuade people to increase individual behaviours that benefit health
What are the 4 main behavioural immunogens?
- balanced diet
What is meant by “making every contact count” within the NHS?
The NHS should take every opportunity to prevent poor health and promote healthy living by making the most of health care professionals’ contact with individual patients
What impact has been seen on obese patients advised by a healthcare professional on how to lose weight?
A much larger % of overweight and obese patients attempt to lose weight after having advice given to them by a healthcare professional
What is the traditional approach to public health interventions?
- information on the health risk/health message is given
2. this leads to behaviour change
What is the problem with the traditional approach to public health interventions?
Its effect is dependent on the population being targeted
Many people already know the risks and still choose not to change their lifestyle
Why did the UK Government Change4Life campaign fail?
- it increased awareness but there was no change in attitudes or behaviour
- some people reduced their healthy behaviours as they thought they were doing “too well” already
How do campaigns exploit the threat of danger to cause a behaviour change?
Persuasive messages that arouse fear are used to scare people into changing their behaviour
Is using fear to promote a change in health behaviours effective?
How could it be made more effective?
It is not very effective
It is more effective if there is a message that gives people advice on how to change their behaviour and make them more confident in doing so (self-efficacy)
What is the problem with most campaigns?
They often have unexpected and unwanted consequences
e.g. campaigns against drugs can make them seem more appealing
What are the pros of using information campaigns?
- accessible and easy to understand
- relevance made clear
- memorable, so people recall it
- accurate and appropriate
- large proportion of the population will see them
What are the cons of using information campaigns?
Despite all the pros, none of them are sufficient to change behaviours
What are the 3 main reasons why people keep or change their lifestyle behaviours?
e. g. habit, may be fun, may do it with friends, relaxing, risk perceptions of illness
e. g. external restrictions such as a change in risk perception, illness, change in friends/family
e. g. conscious habits, the environment, rewards/punishments
What is the framework for trials of complex interventions?
It is a theory followed by various stages to test it, and whether the behavioural change intervention actually works
What is the definition of a theory?
A set of concepts, definitions and propositions that explain or predict events or situations by illustrating the relationships between variables
What are the purposes of health behaviour models?
- outline psychological responses relevant to health
- used to predict, explain and change behaviour
- allow us to build on and further behavioural science
- offer explicit hypotheses regarding determinants and processes underlying behaviour
What is the pathway leading from intervention to health?
- psychological constructs
Why do lots of interventions target psychological constructs?
Changing the psychological constructs is what causes the behaviour change
Why are psychological factors of optimal importance in behavioural change?
- they are the proximal determinants of behaviour
- they mediate the influence of interventions
- they are more open to modification than other factors
According to the theory of planned behaviour, what are the 3 constructs that influence behaviour?
- attitude towards the behaviour
- subjective norms (what will other people think of the behaviour)
- perceived behavioural control (how much control do they think they have over the behaviour)
What 2 factors influence attitudes towards behaviour?
- behavioural beliefs
- evaluations of behavioural outcomes
(will changing the behaviour impact them)
What 2 factors influence subjective norms?
- normative beliefs
2. motivation to comply
What 2 factors influence perceived behavioural control?
- control beliefs
2. perceived power
What is the outcome of the theory of planned behaviour?
Any one of the 3 constructs influences the intentions of the behaviour
This leads to a change in behaviour
What are the strengths of the theory of planned behaviour related to the individual?
- it identifies constructs and behaviour to change, not the disease
- it links beliefs to behaviour
- it has been shown to predict behaviour well
- highlights the importance of society (norms)
What are the strengths of the theory of planned behaviour related to interventions?
- it identifies potential targets for health promotion intervention
- it can be used to study the population and identify specific beliefs
What are the weaknesses of the theory of planned behaviour?
- intention-behaviour gap
- it assumes people are rational and deliberative
- it provides targets for behavioural change, but not methods for change
- Perceived behavioural control is both a proxy for actual control and a measure of confidence in one’s own ability
What are the limitations of health behaviour models?
- the causality is rarely tested as most tests focus on correlations among variables
- it assumes people are rational and deliberative but there are impulsive health actions
- the provide only targets for behavioural change, not methods for change
What is meant by taxonomy?
Behaviour change techniques drawn from health behaviour models
How are behaviour change techniques linked to theory of planned behaviour?
- provide information on consequences
- provide information about others’ approval
- prompt intention formation
How are behaviour change techniques linked to Ctrl theory?
- prompt specific goal setting
- prompt review of behavioural goals
- prompt self-monitoring of behaviour
- provide feedback on performance
Which behaviour change techniques are most frequently featured in effective interventions?
combining ‘self-monitoring’ and at least one other technique from Control Theory (self-regulation)
What are habits?
Relatively automatically triggered actions
How are habits formed?
Through repetition in a consistent context
This increases automaticity
What is the aim of habit formation theory?
Helping individuals to ‘learn’ healthy lifestyle behaviours
This helps to maintain the behaviour change over a longer period of time
What are the strengths of habit formation theory?
- it requires less engagement or motivation
- less time-consuming to explain
- easier to implement
- promotes long-term maintenance
What is the underlying factor to human behaviour?
When does behaviour develop and how?
Most human behaviour is learnt, habitual and social
It is developed in childhood via behavioural mechanisms - classical and operant conditioning
What factors play a role in influencing human behaviour?
Personal goals, societal and cognitive factors
Why is motivation to change human behaviour low?
‘bad’ behaviours have immediate rewards
‘unlearning’ bad behaviours is difficult and ‘good’ behaviours have few immediate rewards
What does changing human behaviour require?
What is the definition of health promotion?
The process of enabling people to increase control over, and to improve, their health
How is health promotion achieved?
It moves beyond a focus on individual behaviour, towards a range of social and environmental interventions
What are the 4 types of intervention to change health behaviour?
What are examples of individual interventions to change health behaviour?
Giving advice and empowerments
What are examples of organisational interventions to change health behaviour?
this is the work place/school responsibility for encouraging health
e.g. messages in lifts, smoking support on campus, parking restrictions
What are examples of community interventions to change health behaviours?
Skills and resources set up by communities
e.g. running groups, healthy-eating societies
What are examples of society interventions to change health behaviours?
Laws, taxation and nudges
e.g. sugar tax
What is meant by ‘nudging’ in terms of changing health behaviour?
a technique that alters a person’s decision-making context without removing options or changing the incentives
this promotes choice and behaviour in accordance to their own preferences
What is an example of nudging?
Choosing healthy food over unhealthy food in a supermarket
What are examples of social intervention to change health behaviour for health professionals?
Knowledge, skills, motivation, beliefs, attitudes, risk perception, social norms and self-efficacy
What are examples of organisational interventions to change health behaviour for health professionals?
Anti-bacterial gel in the doorways
What are examples of society interventions to change health behaviours for health professionals?
Having guidelines in place
Protecting patient safety