PSY2001 S2 W7 Health Behaviour COMB

Question 1

What is health?

WHO 1948

Answer 1

“A state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”

Question 2

Is the Who 1948 definition actually accurate ?

Answer 2

People with chronic health conditions can still manage to have a good quality of life thanks to advancements in medicine. Health is not a binary state -> health on a spectrum.

WHO definition out of date and not fit for purpose due to: Ageing population & Ability to manage chronic health conditions

Question 3

How was it changed to be better fit to today?

Answer 3

Huber et al. 2011 shifted the emphasis of health towards the ability to adapt and self-manage in the face of social, physical and emotional challenges.

Question 4

Why is WHO definition out fo date?

Answer 4

because of a change in causes of death.
1900s: Pneumonia/flye, Tuberculosis, Diarrhoea
2016: cardiovascular disease, cancer, respiratory disease, accidents

Question 5

What are Health Behaviours?

Conner & Norman, 1996

Answer 5

any activity undertaken for the purpose of preventing or detecting disease or for improving health/well being
BUT health behaviours can have positive and negative health effects (Steptoe, Gardner & Wardle, 2010)

Question 6

What are positive (protective) health behaviours?

Answer 6

can be defined as “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”

Question 7

What are negative (risky) health behaviours?

Answer 7

can be defined as “activities undertaken by people with a frequency of intensity that increases risk of disease or injury”

Question 8

Does behaviour have a effect on health outcome?

Answer 8

Behavioural factors account for around 50% if premature deaths from the 10 leading causes.
Behaviours such as smoking, dietary choice, alcohol consumption, physical activity play an important role in health outcomes.

Question 9

Examples of protective health behaviours?

Answer 9

Exercise
Eating your 5 a day or eating greens
Doing mindfulness
Getting enough sleep
Reducing negative behaviours such as alcohol consumption
Attending medical check ups
Going for screening
Having vaccinations
Practicing safe sex
Adhering to medications that you’ve been prescribed
Wearing sunscreen
Washing your hands
Wearing a seatbelt

Question 10

Examples of risky health behaviours?

Answer 10

Addictive behaviours
Alcohol and drug use
Gambling
Unprotected sex
Unbalanced diet
Lack of physical activity
Drink driving
Not going to the doctors if you notice any changes in your health
Overworking and not having a work life balance
Self-destructing or harming behaviour
Social isolation
Cycling without a helmet
Sedentary lifestyle

Question 11

Which of the following are examples of health behaviours? Cycling in the park, Having the confidence to go to the gym, Wearing a face mask, Losing weight, Intending to walk instead of taking the car, Hugging friends/family

Answer 11

Cycling in the park – exercising has a positive impact
Wearing a face mask – protection from infection
Hugging friends/family – potential to transmit infection

Question 12

How to measure health behaviours with slef-report?

Answer 12

Hard to measure. Typically measured using categorical (do you smoke? yes/no) or continuous (how many cigarettes do you smoke a day) measurements using self-report questionnaires. Limitations: social desirability, subject to recall bias.

Question 13

What are forms of measurements for health behaviours?

Answer 13

Self-report questionnaires
Observation
Proxy Measures

Question 14

What are proxy measures of health behaviours?

Answer 14

Or proxy measres: blood tests counters, pill counters. But proxy measures not always accurate, blood test cna results cna depende on metabolic rate, pill counter rely on pill actually being taken out of a bottel. Step counters: errors in measurement can be falsified.

Question 15

What are observation of health behaviours

Answer 15

Other measures include observation: CCTV cameras to obersev mask wearing in supermarkets

Question 16

What are the seven features of a healthy lifestype?

Answer 16

Non-smoking, moderate alcohol intake, 7-8 hours per night sleep, exercise regularly, maintain a healthy body weight, avoid high calerories snacks, eat breakfast regularly.

Question 17

What were the results of Belloc (1973) on the 7 features of a health lifestyle?

Answer 17

The relationship was so strong that they proposed that people aged over 75 years who carried out all 7 of the behaviours had health that was comparable to those aged 35-44 who did less than 3.

Question 18

What did Belloc investigate?

Answer 18

Baseline postal questionnaire in 1965 followed by regular surveys of death and illness.
7 baseline negative health behaviours predicted mortality: lack of exercise, snacking between meals, smoking, sleep (more than 8 or less than 7), skipping breakfast, regularly drinking more than 5 units of alcohol, under/overweight.

Question 19

What did Khaw et al. investigate?

Answer 19

Analysed data from the EPIC Norfolk longitudinal study of 20,000 men and women. Baseline no known CVD/cancer, aged 45-79. Followed up over 14 years.
Results: Survival was associated with four health behaviours: not smoking, being physically active, drinking moderately, eating 5 or more servings of fruit and veg a day.
The fewer of these behaviours performed the greater the risk of death

Question 20

What points emerged from the definitions of health behaviours?

Answer 20

1- concept of health behaviour is fluid and bheaviorus that are included can change as medica knowledge deveolops.
2-Health Behaviours are not uniformly important but vary in their influence across time and different populations
3-strenght of evidence relating behaviours with health outcomes is variables
4- behaviour’s may be done for non-health purposes

Question 21

What is considered strong evidence?

Answer 21

Case control, prospective, experimental, cross-sectional (but association ≠ causation) But consistent results with different samples and study designs, and a clear biological mechanism – stronger evidence

Question 22

What are important health behaviours in the modern world?

Answer 22

Diet: 2018 only 28% adults eating 5+ servings of fruit/veg a day (NHS, 2020)
Physical activity: More than 80% of adolescents and 27% of adults do not meet WHO’s recommended levels of physical activity (WHO, 2022)
Smoking: Rates declined over the last decade, but ~8 million adults in the UK smoke (ONS, 2021). Highest rates among 25-34 year olds (ONS, 2021).
Sexual behaviour: 47% of sexually active young people do not use a condom when sleeping with someone for the first time (YouGov Poll, 2017)
Alcohol: 25-28% of adult drinkers in UK binge on alcohol on their heaviest drinking day (ONS, 2017). 16-24 year olds-> less likely to drink than any other age group but most likely to binge drink when they do (ONS, 2017)

Question 23

What are the different types of behavior change?

Answer 23

Initiate a new behaviour e.g., wearing face masks.

Stopping an existing behaviour e.g. stopping smoking, stop hugging friends/family.

How a behaviour is performed e.g. changing frequency, intensity, duration of a behaviour (exercising more, eating less)

Question 24

What do we need to consider when changing behaviour?

Answer 24

Our primary motivational concerns in life are the same for umans as they are for most animals - food, water, air, reproduction
Challegning these behaviours that are motivated by these system can be difficult: sexual behaviour, energy seekin gbehaviour, energy conservation behaviour
We need to understand behaviour’s before changing thel - adopting biopsychosocial approach to health

Question 25

What is the biopsychosocial approach of health behaviours?

Answer 25

3 circles overlapping: Biology, psychology, social contex overlap to form health

Question 26

What are some biological determinants of health behaviour?

Answer 26

Twin studies: heritable component to smoking initiation, nicotine addiction as well as body weight and obesity (Plomin et al. 2000) Some Health Behaviours have a physiological response (smoking, drinking, eating, exercising) releasing dopamine, endorphins which can reinforce the behaviour. Ability to carryout many health behaviours is affected by personal health: Disabilities, Symptoms can act as cues to change or stop behaviour (e.g. smoking, adherence to medications etc)

Question 27

What are social determinants of health behaviour?

Answer 27

Health behaviours are strongly affected by peer group influences, family habits and social networks (Baranowski, 1997). Early socialisation (observational learning health habits). Culturally valued or discouraged behaviour (e.g. alcohol consumption in some religions) Peer pressure in adolescence = origin of many risk behaviours. Socioeconomic status - Financial barriers to health behaviours, lack of available resource, lower education Legislative laws

Question 28

What are psychological determinants of health behaviour, specifically cognition ?

Answer 28

Attitudes/beliefs Social cognition models (e.g. Theory of Planned Behaviour (Azjen, 1991) Interventions based on Theory of Planned Behaviour to improve health behaviour

Question 29

What are the two forms of psychological determinants of health behaviours?

Answer 29

Emotion (Ferrer & Mendes, 2018) Cognition (Hermitage and Conner, 200)

Question 30

What are psychological determinants of health behaviour, specifically emotion?

Answer 30

Stress - smoking, drinking, overeating and exercise, Fear – avoidance of healthcare (e.g. dental; delay in response to symptoms, screening etc). Disgust > fear avoidance (blood test, cervical screening).

Question 31

What is the COM-B Model? | Michie et al. 2011

Answer 31

Capability affects both Motivation and Behaviour Oppourtunity affect both Motivation and Behaviour Motivation affect Behaviour behaviour affects and is influenced by Capability, Motivation and Opportunity

Question 32

What is meant by capability in the COM-B model?

Answer 32

The ability to enact behaviour. Made up of physical and psychological capability. 2 types: Psysical capability Psychological capability

Question 33

What is the psychological capability? | COM-B model

Answer 33

Capacity to engage in necessary thoughts processes – knowledge, reasoning E.g. Knowledge of COVID-19 transmission and how to avoid it

Question 34

What is physical capability? | COM-B model

Answer 34

Physical skill/strength to perform the behaviour E.g. ride a bike, lift a 20kg weight

Question 35

What is meant by opportunity in the COM-B model ?

Answer 35

Environment that enables behaviour. Made up of physical and social opportunity. 2 types: Physical opportunity Social opportunity

Question 36

What is Physical opportunity in the COM-B model?

Answer 36

Opportunity afforded by the environment E.g. Close proximity to a gym, availability of cycle lanes

Question 37

What is Social opportunity in the COM-B model?

Answer 37

Opportunity afforded by social/cultural norms. E.g. People around you engaging in a behaviour, reminders to do something, having support from people around you

Question 38

What is meant by motivation in the COM-B model?

Answer 38

Mechanisms that activate or inhibit behaviour. Made up of reflective and automatic motivation. 2 types: Reflective motivation Automatic Motivation

Question 39

What is meant by reflexive motivation? | COM-B model

Answer 39

Evaluations (beliefs about what is good or bad), plans (intentions) E.g. Drinking responsibly is a good thing to do. E.g. Planning to wake up early to go the gym

Question 40

What is meant by automatic motivation? | COM-B model

Answer 40

Emotional reactions, desires (wants and needs), impulses, inhibitions, habits. Anticipated pleasure at the prospect of eating a piece of cake

Question 41

Imagine you want to get hospital staff to disinfect their hands using alcohol gel in high-risk situations. Use the COM-B model to brainstorm what needs to happen for the target behaviour to occur. E.g., Physical capability: have the physical skills to clean hands. | Answers from Michie et al., 2013 (anything along the similar lines would

Answer 41

Physical capability: have the physical skills to clean hands Psychological capability: know the correct technique to clean hands, know how to create if-then rules to prompt hand cleaning Physical opportunity: have alcohol gel available Social opportunity: see senior health professionals clean their hands using alcohol gel Reflective motivation: hold beliefs that using alcohol gel more frequently will reduce infection transmission, believe that consistent hand hygiene will require improved cognitive and self-regulation skills Automatic motivation: have established routines and habits for hand cleaning

Question 42

What are some method to collect data using COM-B model?

Answer 42

Questionnaires, interveiw/focus groups, obersvation

Question 43

How do you use questionnaires while using COM-B?

Answer 43

Specific questions about their capability/opportunity/motivation Reach larger groups of people

Question 44

How do you use interviews/focus groups while using COM-B?

Answer 44

In depth qualitative data. Ask open ended questions about capability/opportunity/motivation, barriers/facilitators of engaging in the desired behaviour Smaller samples

Question 45

How do you use observation while using COM-B?

Answer 45

Self-report data from questionnaires/interviews may be far away from the truth, observations useful tool to see what actual happens.

Question 46

What did Gibson Miller et al. 2020 investigation?

Answer 46

COM-B & behaviour - COVID-19: Explore influences of COM-B components on hygienic practices. 1st wave of a longitudinal survey: Participants self‐reported motivation, capability, and opportunity to enact hygienic practices during the COVID‐19 outbreak. Hygienic practices: Hand washing frequently, Cleaning surfaces, Using tissues, Avoiding touching mouth and face

Question 47

What did Gibson-Miller et al. (2020) find?

Answer 47

All COM-B components influenced behaviour. + Psychological capability, social opportunity and reflective motivation (biggest driver) positively influenced behaviour. - Automatic motivation and physical opportunity negatively influenced behaviour. Interventions should focus on promoting and maintaining: Reflective motivation to act (e.g. planning/goal setting) Social opportunity (social support) Psychological capability (knowledge of COVID-19 transmission)

Question 48

What did Willmot et al. 2021 investigate?

Answer 48

COM-B & Physical activity cross-sectional survey Used validated measures to capture COM (Capability, Opportunity, and Motivation) constructs and physical activity behaviour. Results: The COM-B model explained 31% of variance in physical activity. Capability and opportunity were found to be associated with behaviour through the mediating effect of motivation. Increased capability + opportunity -> increased motivation -> increased physical activity

Question 49

What are the 3 stages of designing behaviour change interventions? | Michie et al. 2011

Answer 49

1) Understanding the behaviour (using the COM-B model) 2) Identify intervention options (intervention functions and policy categories) 3) Identify content and implementation options (behaviour change techniques and the delivery)

Question 50

What is the Behaviour change wheel (BCW) | Michie et al. 2011

Answer 50

synthesis of 19 frameworks of behaviour change interventions to help with this: The Behaviour Change Wheel (BCW) Comprehensive, Coherent, Linked to a model of behaviour (COM-B). Identified 9 intervention functions and 7 policy categories that could enable or support these interventions to occur

Question 51

How does the BCW have intervention functions?

Answer 51

Intervention functions are activities designed to change behaviour. Behavioural diagnosis->aspects of COM-B that need addressing -> intervention functions to change the behaviour Education, Persuasion, incentivisation, coercion, training, modelling, environmental restructuring, restrictions, enablement

Question 52

How does the BCW change behaviour in education?

Answer 52

increasing people's knoweldge

Question 53

How does the BCW change behaviour in persuasion?

Answer 53

using communication to induce positive or negative feelings

Question 54

How does the BCW change behaviour in incentivisation?

Answer 54

creating an expectation of rewarz

Question 55

How does the BCW change behaviour in coercion?

Answer 55

creating an expectation of cost or punishment

Question 56

How does the BCW change behaviour in training?

Answer 56

helping people to develop skills

Question 57

How does the BCW change behaviour in modelling?

Answer 57

providing an example for people to aspire to or emulate

Question 58

How does the BCW change behaviour in environmental restructuring?

Answer 58

changing the physical or social context

Question 59

How does the BCW change behaviour in restrictions?

Answer 59

using rules to reduce opportunity to engage in target behaviour

Question 60

How does the BCW change behaviour in enablement?

Answer 60

giving people means to engage in behaviour or reduce barriers

Question 61

What are some policies categories in the BCW? | Michie et al. 2011

Answer 61

Policies: Decisions made by authorities concerning interventions. Policy categories: Environmental/Social planning Communication & marketing Legislation Service provision Regulation Fiscal measures Guidance

Question 62

What is the environmental/social planning policy category of BCW?

Answer 62

designing and/or controlling the physical or social environment

Question 63

What is the communication and marketing policy category of BCW?

Answer 63

using print, electronic media, broadcasting

Question 64

What is the legislation policy category of BCW?

Answer 64

making or changing law

Question 65

What is the sercive provision policy category of BCW?

Answer 65

delivering a service

Question 66

What is the regulation policy category of BCW?

Answer 66

establishing rules or principles of behaviour or practice

Question 67

What is the fiscal measures policy category of BCW?

Answer 67

using the tax system to reduce or increase cost

Question 68

What is the guidance policy category of BCW?

Answer 68

creating documents that recommend or mandate a certain practice

Question 69

What are Bheaviour change techniques (BCTs)? | Michie et al. 2013

Answer 69

Intervention functions are delivered by behaviour change techniques. “Active ingredients” within the intervention designed to change behaviour: Observable, Replicable & Irreducible components of an intervention. Created a Taxonomy of behaviour change techniques - to help specify interventions and their active ingredients in more detail Can be used alone or in combination

Question 70

What is an example of using BCW (+ COM-B) to develop intervention ? | Munir et al. 2018

Answer 70

dev intervention to reduce sitting time at work Focus groups discussion. Used COM-B, BCW intervention functions and policy categories and BCTs to develop an intervention. ID a number of barriers that were addressed using different intervention functions and BCTs: Physical opportunities Social opportunities Psychological capability Reflective Motivation Automatic Motivation

Question 71

How was psychical opportunity used to dev intervention to reduce sitting time at work? | Munir et al. 2018

Answer 71

Don’t have height adjustable desks Intervention functions: Environmental restructuring, enablement BCTs: Restructuring the physical environment, adding objects (provide height adjustable workstations)

Question 72

How was social opportunity used to dev intervention to reduce sitting time at work? | Munir et al. 2018

Answer 72

social norms made it difficult to stand at a desk and work. Intervention functions: Modelling, Enablement BCTs: Demonstration of behaviour, social support

Question 73

How was psychological capability used to dev intervention to reduce sitting time at work?

Answer 73

Limited knowledge of health risks of prolonged sitting Intervention functions: Education BCTs: Information about health consequences via seminars, instruction booklets

Question 74

How was reflective motivation used to dev intervention to reduce sitting time at work?

Answer 74

beliefs about positive consequences of standing were low Intervention functions: Education, Persuasion BCTs: Information about health consequences via seminars, coaching sessions, feedback on outcomes of behaviour

Question 75

How was automatic motivation used to dev intervention to reduce sitting time at work?

Answer 75

staff need simple automatic reinforcement to change habit Intervention functions: Environmental restructuring, Incentivisation BCTs: Prompts and cues (via the use of an app), self monitoring using a diary of daily sitting and standing time

Question 76

What did Martin-Payo et al. (2021) investigate using the BCW framework?

Answer 76

A pilot behavioral intervention on diet and exercise for individuals with type 2 diabetes mellitus. Assessed the efficacy of an educational intervention based on the BCW framework Two arm pilot study (intervention and usual care group). Intervention: 6-month with guidelines & 4 in-person visits delivered by nurses. Intervention functions: education persuasion incentivization enablement to target psychological/physical capability and automatic/reflective motivation Reuslts: Intervention group significant improvement in diet, exercise, and a decrease in HbA1c levels.

Question 77

Define what we mean by health and health behaviour? | LO

Answer 77

Health is the ability to adapt and self-manage in the face of social, physical and emotional challenges (Huber et al., 2011) Broadly, health behaviour can be defined as “any behaviour that individuals engage in that affect their health” (protective vs risky health behaviours)

Question 78

Demonstrate examples of behaviour in determining health status? | LO

Answer 78

Health behaviours have a significant impact on determining quality of life, risk of illnesses and mortality

Question 79

Discuss how the Behaviour Change Wheel can be used to develop behaviour change interventions | LO

Answer 79

BCW was designed based on COM-B to provide a comprehensive framework of behaviour change interventions to alter behaviour Includes intervention functions (activities that are designed to change behaviour) and policy categories (decisions made by authorities concerning interventions) Taxonomy of behaviour change techniques was compiled to help specify interventions and their active ingredients in more detail Applied to reduce sitting time at work as well as diet and exercise programme in Type 2 diabetes

Question 80

Discuss how the COM-B model can explain behaviour (real world issues) | LO

Answer 80

According to the COM-B model, behaviour occurs as an interaction between three necessary conditions: capability, motivation and opportunity Applied to understand people’s behaviour during COVID-19, physical activity levels etc.

Question 81

Explain some of the determinants of health behaviour | LO

Answer 81

According to the biopsychosocial approach there are biological, social and psychological determinants of health behaviour