behavior change health promotion programs january 31, 2008
TRANSCRIPT
In an effort to prevent disease and improve peoples’ health and well being,
we continually ask them to…
do things they have not done before stop doing things they have done for years, and do more of some things and less of other
things.
“In order to change behavior…it is first necessary to understand why people behave as they do. The more one knows about the variables underlying a person’s decision to perform or not to perform a given behavior, the more likely it is that one can develop successful behavioral intervention programs.”
M. Fishbein et al., 1992
Health Behavior Principles
Determinants may vary by Type of behavior Life course stage Whether intent is to initiate versus maintain behaviors Whether goal is to eliminate versus
encourage behaviors
Principles of Behavioral Change*
Behavioral change is best accomplished by taking advantage of the multiple opportunities for change in the environ- ment.
Interventionists should consider why people change (mediators) and evaluate the ability of their intervention (interven- tion quality) to effect change in the mediators of interest
*from Maintaining Healthy Lifestyles: A Lifetime of Choices, The International Longevity Center, USA, Ltd.
Principles of Behavioral Change (cont.) The goals of healthy behavior change
should reflect a partnership between the participant and the provider and be stated in concrete terms.
The goals of behavior change should be conceptualized as moving targets that are influenced by personal/ interpersonal, life situations, the environment, & policy.
The “dynamic” relationship between the individual and his
environment…
Can introduce barriers to healthy lifestyle choices and making changes in behaviors or
Can play a significant role in fostering individual behavior change by making active/ healthy lifestyle choices more available.
Principles of Behavior Change (cont.)
The adoption and maintenance of healthy behavior requires basic skills that can be taught.
The maintenance of healthy behaviors requires planned follow-up.
A cost-benefit ratio is important to behavior change (and not always $$). Consider other potentials.
Levels of Behavioral Change Interventions
Interventions can be aimed at multiple levels:• personal or interpersonal
level• the organizational or
institutional level• the health care level• the environmental level• the policy or legislative level
Designing and Evaluating Social and Behavioral Interventions
Intervention Intensity, Effects, and Reach
Individually based interventions are more intensive, have stronger effects, but have less coverage.
Population-based interventions are less intensive per person, may have weaker individual effects, but reach more people.
Designing and Evaluating Social and Behavioral Interventions
Time frame for expected effects Most interventions are based on acute model
but conditions are typically more chronicShort term effects typically stronger than long-
term effects Lagged effects may occur where psychosocial
interventions teach skills or provide services that can be used at critical times
Designing and Evaluating Social and Behavioral Interventions
Identifying optimal intervention in terms of type,dosage and frequency
Different intervention approaches target specific mediators and outcomes--menu
Some intervention efforts are too weak to initiate and sustain desired changes
What is the threshold point after which there is diminishing returns
Personal or Interpersonal Level
Successful interventionsinclude use of self-regulatoryskill training Realistic goal settingIdentification of barriers
and activation of problem solving skills
Self monitoring of target health behavior
Relapse prevention
Recipe for an Effective, Tailored Intervention
Ingredients– Awareness– Knowledge– Motivation– Readiness to change– A strong personal commitment or intention to perform the desired
behavior*– The skills needed to establish and maintain the desired change*– Strong self-efficacy specific to the desired behavior– Opportunities to practice skills and new behaviors in a safe environment– Strong social support– A supportive environment free of any constraints to change**According to a consensus report by the National Institute of Mental Health (Fishbein et al. 1992), these
three factors are viewed as necessary and sufficient for producing behavior change.Human Kinetics ©1999
Personal or Interpersonal Level
Skill training accompanied by support and guidance from trained staff member.
Staff training and support delivered effectively through either face to face or mediated (e.g., telephone, mail, internet) communication
channels. Lay-led group support programs for coping with chronic illness also having success
Piecing Together an Intervention Puzzle
Promote increased
awareness and knowledge
Foster supportive
social networksEnhance
motivation
Establish and maintain a supportive
physical environment
Enhance readiness to
change
Teach or enhance the
skills needed to establish and maintain the
desired behaviorEstablish and
enforce supportive
policies
Intervention puzzle: Four pieces to this puzzle are related to
enhancing individual self-efficacy and strengthening one’s intention to change.
Remaining three puzzle pieces represent the environmental side of the equation.
Imagine there are many ways to arrange the interchangeable pieces to this puzzle.
Tailoring an intervention=customizing the plan of action to meet the target population and needs.
A Framework for Achieving Health Promotion Program Effectiveness
Effectiveness = Efficacy + Planning + ImplementationTheory Policy planning Appropriate
targeting(‘evidence’) and financing
framework
Organizational Sufficient coveragestructures and Skilled actionsresources
Workforce and Community community ownership capacity Monitoring andevaluation
*Adapted from Lin V and Fawkes S. ‘Effectiveness of health promotion in changing environment and lifestyles in developing countries of the Western Pacific Region: A review and a proposed framework: Technical paper prepared for WHO Workshop on Capacity Building for Health Promotion. Manila, Philippines, 5-8 November 2002.
Elsevier Limited © 2005
Components of the Stages of Change Model as Applied to Increasing Physical Activity
Stage of ChangePre-ContemplationNot considering increasing physical
activity levels
ContemplationThinks about increasing physical activity
levels
PreparationConsults doctor and visits local
gymnasium
ActionJoins local gym
MaintenanceHas visited gym three times a week for 6
months
Processes of Change
Elicit positive and negative aspects of target behavior(s) and provide simple information (consciousness-raising, dramatic relief)
Motivate and elicit commitment; Enhance self-efficacy; Identify physical activity classes (social liberation)
Identify goals and plan start date and type of physical activity; Use social support (helping relationships); Use stimulus control
Review goals and suggest coping strategies for fatigue, discomfort, lack of motivation etc.; Praise high self-efficacy; Use reinforcement management, counter-conditioning, and stimulus control
Review coping strategies and reassess goals and physical activity type
Elsevier Limited ©2005