Flashcards in Health psychology, behaviour change and smoking cessation Deck (51):
1
What are the 3 main categories of health behaviours?
Behaviours related to health:
- Health behaviour
- Illness behaviour
- Sick role behaviour
2
What is health psychology?
Emphasises the role of psychological factors in the cause, progression + consequences of health + illness
EXAM: Aims to (1) promote healthy behaviours + (2) prevent illness
3
What are the aims of health psychology?
Aims to promote healthy behaviours + prevent illness
4
What is health behaviour? Give an example
A behaviour aimed to PREVENT DISEASE (E.g. eating healthy)
5
What is illness behaviour? Give an example
A behaviour aimed to SEEK REMEDY (e.g. go to the doctor)
6
What is sick role behaviour? Give an example
Any activity aimed at getting well (e.g. taking prescribed medications, resting)
7
Give 4 examples of health damaging/impairing behaviours
- alcohol abuse
- substance abuse
- smoking
- risky sexual behaviour
- sun exposure
- driving without a seatbelt
8
Give some examples of health promoting behaviours
- exercise
- eating healthy
- attending health checks
- medication compliance
- vaccinations
9
What proportion of cancers can be prevented by addressing modifiable RFs/lifestyle?
1/3
10
What is the leading cause of death (England + Wales 2013)
Cancer
11
What 2 types of intervention can be done to improve health? Explain them. Give two examples
(EXAM Q)
Population level (health promotion) - via PHE --> process of enabling people to exert control over the determinants of health, thereby improving health. e.g. change 4 life
Individual level (patient centred approach) - care that is responsive to the patient's need. e.g. smoking cessation clinics
12
Give some examples of health promotion campaigns
Change 4 Life + "5 a day"
Stoptober
13
Exam Q: Explain the difference between public health interventions delivered at the population (ecological) and individual levels, using one example for each to illustrate your answer.
Health interventions at population level are aimed at health promotion. It involves enabling people to exert control over the determinants of health, thereby improving health. It is done by public health england. E.g. Change 4 life campaign (or Stoptober)
Individual level interventions is based upon a pt centred approach. it is care responsive to individual needs. E.g., smoking cessation clinics?
14
Give an example of how an primary care intervention can effect individual, community and population levels
Primary care intervention aimed at reducing alcohol consumption
Individual level: reduced domestic violence, reduced alcohol consumption, improved individual health outcomes
local level: reduced local alcohol sales, reduced alcohol related a/e visits
population level: reduced crime, reduced demographic patterns of liver cirrhosis, reduced national alcohol sales
15
Why might knowledge of risk factors (e.g. smoking causing lung cancer) not influence a patients behaviours?
Unrealistic optimism - individuals have inaccurate perceptions of risk and perceptbility (so continue to take health damaging behaviours) --> 4 reasons influencing perceptions of risk:
1. Lack of personal experience with problem
2. belief that preventable by personal action
3. belief that if not happened by now, its not likely to
4. belief that problem is infrequent
other reasons: health beliefs, situational rationality, culture variability, stress, age, socioeconomic factors
16
What influences perceptions of risk?
1. Lack of personal experience with problem
2. belief that preventable by personal action
3. belief that if not happened by now, its not likely to
4. belief that problem is infrequent
17
What can patients perception of risk impact on?
Medication adherence, keeping appointments....
18
How might you promote behaviour change as a dr?
Understanding people's perception of risk
Health information --> informing pt's of their risks + respecting their autonomy
19
What are the NICE guidance on behaviour change?
1. planning interventions
2. assessing social context
3. education + training
4. individual level interventions
5. community level interventions
6. population "
7. evaluating effectiveness
8. assessing cost-effectiveness
in summary:
• Work with your patient’s priorities
• Aim for easy changes over time
• Set and record goals
• Plan explicit coping strategies
• Review progress regularly (this really matters)
• Remember the public health impact of lots of you making small differences to individuals
20
Why is behaviour change important?
Evidence that changing pt's health behaviour can have an impact on some of the largest causes of morbidity + mortality
It is difficult to alter genetic predisposition + socioeconomic circumstances (determinants of health)
21
Why do we need to know about health behaviours?
- some disease can be prevented by modifiable RFs/lifestyle
- economics: saving money
- disease prevention
- complicance to medication / attendance to clinics
22
What factors influence compliance to medication?
- SEs (How to get around this? Education – explaining the complications of the disease)
- Misinformed (e.g. SSRIs are addictive, MMR causes autism) due to headlines
- Cognitive functioning / mental capacity of the patient to help: use of assistive devices (e.g. day
- If patient is asymptomatic (e.g. for primary prevention) – they think they don’t need to take it
- Socioeconomic position – people from disadvantaged backgrounds likely to not take medication (maybe cost of prescription?)
23
give some examples of health promotion interventions?
Screening, vaccination, change4life, 5-a-day
24
Exam Q: how a intervention impacts on an individual level, local level, and population level
Individual: improved individual health outcomes
Local: reduced local rates?, reduced littering (E.g. smoking)
Population level: improved demographic health patterns (E.g. lung cancer)
25
Exam q: what is the best theory to explain why people engage in health impairing behaviours?
Unrealistic optimism: individuals continue to practice health damaging behaviour due to INACCURATE PERCEPTIONS OF RISK and SUSCEPTIBILITY
26
EXAM Q: what is a meta-analysis?
Pooling of the data of the best possible evidence to give a forest plot to see the effect of something
can be done in a systematic review
27
What are the impacts of smoking?
- UK: greatest cause of illness + premature death
- COPD, cancer, heart disease
- ½ of all smokers die from smoking related disease
- biggest cause of inequality in death rates between rich + poor
- Economic:
o Individual cost
o NHS cost
o Loss in productivity from smoking breaks
o Cleaning up cigarette butts
o Fire costs
o …etc
28
Exam Q (will come up): There are 3 main behaviours related to health. Specify the 3 types of health related behaviours and provide an example of each (6 marks)
- Health behaviour: a behaviour aimed to prevent disease (e.g. eating healthily)
- Illness behaviour: a behaviour aimed to seek remedy (e.g. going to the dr)
- Sick role behaviour: an activity aimed at getting well (e.g. taking prescribed medications, resting
29
Exam Q (will come up): Theory of planned behaviour suggests that behaviours are governed by our intentions to carry out target behaviours. Specify the 3 factors that influence our intentions and give an example of each in relation to smoking cessation (6 marks)
- Attitudes: e.g. I don’t think smoking is a good thing
- Subjective norm: e.g. most people who are important to me want me to give up smoking
- Perceived behaviour control: e.g. I believe I have the ability to give up smoking
30
Exam Q (will come up): The transtheoretical model, or stages of change model, specifies 5 sequential stages that an individual will pass through in order for behaviour change to occur. What are these stages?
- Pre-contemplation, contemplation, preparation, action, maintenance
31
Exam Q (will come up): Considering the NICE guidelines on behaviour change – interventions to change health related behaviours should work in partnership with individuals, communities, organizations and populations. Identify 3 typical transition points whereby interventions are likely to be more effective (3 marks)
- Leaving school
- Entering the workforce
- Becoming a parent
- Becoming unemployed
- Retirement + bereavement
32
Give 7 models/theories of behaviour change
1. Health belief model
2. Theory of planned behaviour
3. Stages of behaviour change
4. Social norms theory
5. Motivational interviewing
6. Nudging
7. Financial incentives
33
Exam Q: what are the 4 components to the health belief model
Individuals will change if:
♣ They believe they are SUSCEPTIBLE to the condition
♣ Believe there are SERIOUS CONSEQUENCES if they get the condition
♣ Believe that TAKING ACTION reduces susceptibility
♣ Believe that the benefits of taking action OUTWEIGH the costs (perceived barriers) most important
(perceived susceptibility, perceives severity, perceived barriers)
34
What 2 variables influence the beliefs (in the health belief model)? Give examples
Demographic: age, SES, ethnicity, gender
psychological: personality, peer pressure
35
What are "cues to action" in the health belief model? What are the two types of cues?
o Included in the model – KICK-STARTS THE ACTION TO CHANGE
o Internal cues: e.g. getting out of breath (smoker)
o External cues: e.g. GP advise
36
give some disadvantages of the health belief model?
o Alternative factors may predict health behaviour: e.g. OUTCOME EXPECTANCY (whether the person feels they will be healthier as a result of their behaviour) + SELF-EFFICACY (the person’s belief in their ability to carry out a preventative behaviour)
o Cognitive based model doesn’t consider EMOTIONS on behaviour
o Doesn’t differentiate first time + repeat behaviour
o “cues to action” often missing in research
37
What is outcome expectancy?
Whether the person feels they will be healthier as a result of their behaviour
38
What is self-efficacy
The person’s belief in their ability to carry out a preventative behaviour
39
What is the theory of planned behaviour?
Theory that the best predictor of behaviour is "intention"
40
Exam Q: what influences intention (in theory of planned behaviour)?
- Attitudes: e.g. I don’t think smoking is a good thing
- Subjective norm: e.g. most people who are important to me want me to quit
- Perceived behavioural control: e.g. I believe I have the ability to give up smoking
All 3 lead to the "intention": I intend to give up smoking
The intention leads to behaviour change
41
Exam Q: “scenario about a patient wanting to change + ready but doesn’t” What techniques can we use to bridge the intention-behaviour gap? Give examples
1. Perceived control: e.g.
2. Anticipated regret: e.g.
3. Preparatory actions: e.g. breaking things down into manageable sub-goals/tasks
4. Implementation intentions: e.g. formulating an if-and-then plan
5. Relevance to self: e.g. giving real life relevant advise to patient (E.g. can’t tell morbidly obese pt to go to the gym)
42
Give some disadvantages of the model: theory of planned behaviour?
o Lacks temporal element (+ lack of direction or causality)
o A “rational choice model” – doesn’t account for emotions (E.g. fear) which may disrupt rational decision making
o Doesn’t explain how attitudes, subjective norm and PBC, interact (3 separate factors)
o Habits + routines bypass cognitive deliberation
o Assumes that attitudes, subjective norm + PBC can be measures
o Relies on self-reported behaviour
43
What is the transtheoretical model? Give the 5 stages
Stages of change model
- Sees individuals located at discrete ordered stages examines process of change
- Pre-contemplation contemplation preparation action maintenance
- (relapse)
44
Exam Q: give examples of each stage of the transtheoretical model for smoking cessation? (in exam may be asked to give examples for things other than quitting smoking)
o Pre-contemplation: no intention to give up smoking
o Contemplation: beginning to consider giving up smoking (probably in distant future)
o Preparation: getting ready to quit (near future)
o Action: engaged in giving up smoking now
Maintenance: steady non-smoker (state of change reached)
45
What are some advantages of the transtheoretical model?
o Individual stages tailored interventions for each stage
o Accounts for relapse
o Temporal element
46
What are some disadvantages of the transtheoretical model?
o Not all people move through every stage (E.g. some miss out stages)
o Change might operate on a continuum rather than in discrete stages
o Doesn’t account for habits, values, culture, social, economic factors
47
Describe the social norms theory? Give an example
- Making people aware of what normal is
- Idea is that people have incorrect perceptions of other people’s behaviours (E.g. most people smoke) so the person adjusts their behaviour to the presumed majority
- Social norms theory approach predicts that an intervention which aims to correct these misperceptions by exposing actual norms (making them aware of the real normal) will lead to a behaviour change
- E.g. on trams in Sheffield “did you know there are more non-smokers than smokers in Sheffield”
48
Give a disadvantage of the social norms theory?
o Can’t be used if the norm is the behaviour you want to change (E.g. obesity)
49
What is motivational interviewing and what is the nudge theory?
- Motivational interviewing (counselling approach)
- Nudge theory: altering the environment to elicit behaviour change (E.g. supermarket layouts)
50
what other factors need to be considered in behaviour change?
- Impact of personality traits on behaviour
- Social environment
- Impact of habit/past behaviour
- Assessment of risk perception
- …etc
51