Chapter 1Chapter 1

Promoting Healthy Behaviour

Promoting Healthy Behaviour Change

Personal Health?Personal Health?

A Choice?A Choice?

Your Responsibility?Your Responsibility?

Health & Lifestyle - A Life Long Health & Lifestyle - A Life Long Process……. Process…….

What is Health?• Prior to the late

1800’s the opposite of sickness

• if disease didn’t kill you then you were healthy/lucky

• 1900’s • victims of

microorganisms• water, air, human

waste………….

Health and the Math (statistics)• Medical Research - Medical Research -

causes of diseasescauses of diseases• 1900’s - most deaths 1900’s - most deaths

infectious diseases infectious diseases (tuberculosis, (tuberculosis, pneumonia, influenza)pneumonia, influenza)

• Life Expectancy Life Expectancy

Men 58.84 yearsMen 58.84 years

Females 60.60 yearsFemales 60.60 years

With improved sanitation…...• And antibiotics and And antibiotics and

vaccinesvaccines• Life Expectancy Life Expectancy

IncreasedIncreased• Mortality Statistics - Mortality Statistics -

People living longer People living longer (70’s to 80’s)(70’s to 80’s)

• Morbidity Statistics - Morbidity Statistics - people are less illpeople are less ill

• Common Infections &Common Infections & DiseasesDiseases

Faded Away…..

Living Longer….. Different Health Concerns (!) ?

• World Health Organization World Health Organization (WHO)(WHO)

• ““the attainment by all peoples of the attainment by all peoples of the highest possible level of the highest possible level of health”health”

• How - by better professional How - by better professional training, promoting training, promoting cooperation, education, cooperation, education, research…………..research…………..

• ……. A wider view of HEALTH. A wider view of HEALTH

Absence from Disease to Holistic Health!

• People Are People Are multidimensionalmultidimensional

• Health must reflect Health must reflect the whole personthe whole person

• heath is a dynamic, heath is a dynamic, ever-changing ever-changing lifelong processlifelong process

• Successful health Successful health Addresses …………..Addresses …………..

Health and Wellness to its Highest Degree is Achieved Through………...

The Dimensions of HealthMind + Body+ Spirit

Social HealthSocial Health

• interpersonal interpersonal relationshipsrelationships

• daily behavioursdaily behaviours

• interactionsinteractions

• satisfyingsatisfying

• positivepositive

• supportivesupportive

• variety of situationsvariety of situations

HOLISTICHOLISTICHEALTHHEALTH

I Need to Learn and to Grow….

Intellectual HealthIntellectual Health

• learninglearning

• personal develop personal develop

• growth from life experiences growth from life experiences

• Healthy DECISISION Healthy DECISISION MAKINGMAKING

• Age - not an issueAge - not an issue

• Ability - knowing limitsAbility - knowing limits

• Motivation - like to learnMotivation - like to learn

Express Yourself!! for Health and Peace of Mind!

Emotional HealthEmotional Health• expressing emotions expressing emotions

appropriatelyappropriately• emotional expression emotional expression

decrease pressuredecrease pressure• Emotion matches the Emotion matches the

ActionAction• self-esteemself-esteem• self confidenceself confidence• self-efficacyself-efficacy• stress reductionstress reduction

Health Dimensions

Environmental Environmental HealthHealth

• appreciation for appreciation for the environment, the environment, clean, recycle and clean, recycle and respect…….respect…….

• your personal living your personal living environment - safe / environment - safe / quite / comfortablequite / comfortable

Believing in Something….

Spiritual HealthSpiritual Health• believing in somethingbelieving in something• belonging / sense of belonging / sense of

purposepurpose• higher beinghigher being• communitycommunity• feeling - pain, love, sorrow, feeling - pain, love, sorrow,

peace, contentment, and peace, contentment, and wonder…….about life!wonder…….about life!

Physical HealthPhysical HealthPersonal Physical CharacteristicsPersonal Physical Characteristics

body size, shape, sensory acuity, susceptibility body size, shape, sensory acuity, susceptibility to disease/disorders, recuperation form illnessto disease/disorders, recuperation form illness

Overall Health and Overall Health and Physical Well BeingPhysical Well Being

Stress ManagementStress ManagementLife Value AddedLife Value Added

AttitudeAttitudeExerciseExercise

Active LivingActive LivingNutritionNutrition

Feeling Good About Myself...• Honest with theirHonest with their• personal limitations personal limitations • capabilitiescapabilities• attempt to change within attempt to change within

their controltheir control• try to achieve Balance in try to achieve Balance in

mind, body and spirit!mind, body and spirit!• Health is Relative not Health is Relative not

Absolute……e.g. disabled Absolute……e.g. disabled people can be healthypeople can be healthy

Health Throughout The Dimensions of Health

• Looking healthy and being Looking healthy and being healthy…..are they the same?healthy…..are they the same?

• Some Thoughts…………Some Thoughts…………

• Fit-looking (body image!, Media!)Fit-looking (body image!, Media!)• Social BehavioursSocial Behaviours• Emotional IntelligenceEmotional Intelligence• Committed and CaringCommitted and Caring• responsibilityresponsibility• other stuff………..other stuff………..

HEALTH PROMOTIONHelping you stay healthy…. And the message is ?

• Health Promotion Programs:Health Promotion Programs:

• educationaleducational

• organizationalorganizational

• proceduralprocedural

• environmentalenvironmental

• financial Supportfinancial Support

• Provide a consistent message Provide a consistent message for all!for all!

Disease Prevention:Process to Reduce Occurrence and

Severity of Disease

• Goal: Goal: Reduce/eliminate Reduce/eliminate behaviours that behaviours that increase riskincrease risk

• Three levels of Three levels of PreventionPrevention

• Taking actions to Taking actions to prevent sicknessprevent sickness

Health Promotion Helps Positive Change

• Learn more (educational Learn more (educational support) support)

• provide supportive specific provide supportive specific programsprograms

• facilitate behaviour changefacilitate behaviour change• monetary incentives monetary incentives

subsidized programs subsidized programs • (cost savings from not (cost savings from not

smoking)smoking)

PREVENTION….. Is the key to excellent health!!!!

• Best Solution!• Promote healthy

lifestyles before health problem exists

• Cost Effective… less medical intervention

• Start young! • Teach all dimensions

of health• & CONTINUE

THROUGHOUT LIFE

• -

Primary Prevention

• Stop SmokingStop Smoking• physical activityphysical activity• stress managementstress management• nutritionnutrition• educationeducation• practice life skillspractice life skills• psychosocial healthpsychosocial health• CounsellingCounselling

SECONDARYSECONDARY

“……“……...I have a health problem, ...I have a health problem, now what do I do before it gets now what do I do before it gets worse?”worse?”

TERTIARYTERTIARY• AFTER THE AFTER THE

ILLNESS or ILLNESS or HEALTH EVENTHEALTH EVENT

• REHABILITATIONREHABILITATION• Clinical SettingClinical Setting

• HEART ATTACKHEART ATTACK• STROKESTROKE• DIABETESDIABETES• CANCERCANCER

HEALTH TRENDS IN North America!Overwhelming conclusions are

that……...………………..the Leading Cause of..the Leading Cause of

Death in Canada is Related to Death in Canada is Related to behavior/lifestyle choices!!!behavior/lifestyle choices!!!

Thinking about……………...Thinking about……………...

Personal Responsibility forPersonal Responsibility forHealth????Health????Is it promoted?Is it promoted?

Knowledge of Prevention? Are we failing Knowledge of Prevention? Are we failing to provide appropriate education?to provide appropriate education?

Why aren’t Canadians responsible for Why aren’t Canadians responsible for their health?their health?

Gender BiasGender Bias

• Androcentricitya male perspective

• Over -generalizationresearch findings from one

sex is applied to both

• Gender InsensitivityOver looking gender as an important variable

• Double Standardsevaluation, treatment, or measurement applied to both genders equally

• An exampleAn example….1/9 women are ….1/9 women are diagnosed with breast cancer - diagnosed with breast cancer - yet little research!yet little research!

• 1993 - research needs assessed1993 - research needs assessed• 1996 - 6.5 million $$1996 - 6.5 million $$• 1997 - 35 million $$$$$$$1997 - 35 million $$$$$$$• equality of research fund equality of research fund

allocationallocation

The Process of Behaviour Change: The Process of Behaviour Change: From the Individual to an Entire From the Individual to an Entire

PopulationPopulation• Integrative model - to help Integrative model - to help

IndividualsIndividuals• Research leading toward Research leading toward

programs for entire programs for entire populationspopulations

• Behaviour Health ProblemsBehaviour Health Problems• smoking, unhealthy diet, smoking, unhealthy diet,

alcohol abuse, inactivity, alcohol abuse, inactivity, obesity, stress, chronic obesity, stress, chronic hostility, depression……...hostility, depression……...

Making A ChangeAre You Prepared for Behaviour Change??

• Change is a process not a Change is a process not a quick fixquick fix

• positive change should be a positive change should be a lifelong goallifelong goal

• change takes timechange takes time• it needs a planit needs a plan• you may fall back sometimes you may fall back sometimes

and that is alrightand that is alright• because you are HUMANbecause you are HUMAN

What do I Want to Change and Why?

• Why do I do, what I do? …… Why do I do, what I do? …… well let’s see!well let’s see!

• Predisposing FactorsPredisposing Factors• life experienceslife experiences• education/knowledgeeducation/knowledge• culture/ethnic inheritanceculture/ethnic inheritance• current beliefs/valuescurrent beliefs/values• sex, age, race, incomesex, age, race, income• who you are…. Right nowwho you are…. Right now!

Mental Training is Easy!

Enabling Factors• skills / abilitiesskills / abilities• physical capacityphysical capacity• emotional statusemotional status• intellectual capacityintellectual capacity• facilities / resourcesfacilities / resources• Urban vs. Rural lifeUrban vs. Rural life• make decisions more make decisions more

or less difficultor less difficult• + enablers help (fun)+ enablers help (fun)• - enablers inhibit ($$)- enablers inhibit ($$)

Reinforcing Factors• Presence or Absence ofPresence or Absence of• supportsupport• encouragement discouragementencouragement discouragement• Significant Social Contacts!Significant Social Contacts!

• Smoking - friends and family Smoking - friends and family continue and don’t support youcontinue and don’t support you

• Exercise - effort diminished Exercise - effort diminished people who influence youpeople who influence you

On Being Human……. • Occasional• ice-cream / treatsice-cream / treats

• missing an exercise missing an exercise sessionsession

• flare ups of angerflare ups of anger

• other deviations less other deviations less than optimal than optimal behavioursbehaviours

• are human and should are human and should be considered on an be considered on an individual basis…...individual basis…...

Personal Beliefs and Attitudes

• Risky health behavioursRisky health behaviours

• common thinking…. common thinking…. rational/educated people will make rational/educated people will make changes to reduce the riskchanges to reduce the risk

• some people do and many don’tsome people do and many don’t

• Doctors who smokeDoctors who smoke

• health professionals who over work - health professionals who over work - stressed!stressed!

• Knowing is not Doing!Knowing is not Doing!

Do Beliefs and Attitudes Influence Behaviour?

A BeliefA Belief

• an appraisal of the

relationship between

some object, action, or idea

and some

attribute of that object,

action, idea………….

Belief - smoking and whether is it expensive, dirty or causes cancer

An AttitudeAn Attitude

a relatively stable set ofa relatively stable set of• beliefsbeliefs• feelingsfeelings• behaviors towards behaviors towards

something or someonesomething or someone

?…. ?…. Do your beliefs & Do your beliefs & Attitude influence your Attitude influence your health………...health………...

Health Behaviour ModelHealth Behaviour ModelOur Perception is EverythingOur Perception is Everything!!

• Perceived Seriousness of the Perceived Seriousness of the Health ProblemHealth Problem

what is the problem? How serious what is the problem? How serious do I perceive it?do I perceive it?

• Perceived susceptibility to the Perceived susceptibility to the health problemhealth problem

Am I likely to develop this health Am I likely to develop this health problem?problem?

• Cues to ActionCues to Action

reminded or alerted

Your Intention to ChangeYour Intention to Change

Attitudes reflectAttitudes reflect• emotional responses to situationsemotional responses to situations• follow our beliefsfollow our beliefs

Theory of Reasoned ActionTheory of Reasoned Action• behaviour results = intentions to behaviour results = intentions to

perform actionsperform actions• An Intention is a product of our An Intention is a product of our

attitude and what people may attitude and what people may want us to dowant us to do

• Exercise, Smoking, Alcohol ….Exercise, Smoking, Alcohol ….

Significant Others as Change Agents

Influenced by peopleInfluenced by people• approval / disapprovalapproval / disapproval• real or imaginedreal or imagined• friends / loved onesfriends / loved ones• social groups / cultural groupssocial groups / cultural groups• Support for healthy change Support for healthy change • Negative interference reduces Negative interference reduces

chance for changechance for change

Social NetworksFamily and Friends

Your FamilyYour Family• influence who you are!• Many components of• personal development

Social BondsSocial Bonds • School• Work• Positive / Negative

Behaviour Change TechniquesBehaviour Change Techniques• Shaping:Shaping: well defined small steps towards

a goal

• Visualizing:Visualizing: imagined rehearsal - seeing yourself succeed

• Modelling:Modelling: learning behaviours by observing successful people

• Controlling the Situation:Controlling the Situation: Situational Inducement - using situations or occasions to control behaviour

• Positive Reinforcement: Positive Reinforcement: If I do this I will get …….?

Changing Self-TalkChanging Self-Talk The way I think and talk to yourselfThe way I think and talk to yourself (+ -)!(+ -)!

Rational-Emotive TherapyRational-Emotive Therapy• how we feel and what we say!• Irrational statements - events are

different then we want….

Meichenbaum’s Self-Instructional Meichenbaum’s Self-Instructional

MethodsMethods -• Instruction / positive• affirmations…… Stress Management

Blocking/Thought StoppingBlocking/Thought Stopping - consciously stop

thinking negative thoughts……...

Making Behaviour Change

• Self-Assessment:Self-Assessment:• what happens before the event & what

happens after• Antecedents:Antecedents: cue to action / events - physical

events, thoughts, emotions, actions of other people

• Consequences: Consequences: results of the behaviours - whether they are repeated behaviours

• can be physical events, thoughts, emotions, actions of other people

Analyzing the Behaviour You Want to Change

• Frequency • Duration• Seriousness• Basis for problem

behaviour• Antecedents

Decision Making:Choices for ChangeD.E.C.I.D.ED.E.C.I.D.E. one method to consider….one method to consider….

DDecide in advance what the problem is????

EExplore the alternative

CConsider the consequences

IIdentify your values

DDecide and take action

EEvaluate the consequences

Goal Setting…………. Starting Goal Setting…………. Starting Tomorrow I’ll……...Tomorrow I’ll……...

• be realisticbe realistic• be flexiblebe flexible• provide alternativesprovide alternatives• not all or nothing / Black not all or nothing / Black

or whiteor white• behaviour change is a behaviour change is a

process…… can’t just be process…… can’t just be switched off……switched off……

• seek support, help and seek support, help and appropriate information.appropriate information.

Behaviour Health Problems Behaviour Health Problems 60% of All Health Problems60% of All Health Problems

• #1 Health Problem #1 Health Problem 35 years…. smoking35 years…. smoking

• Free Action-Oriented Free Action-Oriented Programs produced Programs produced 1% success rate1% success rate

• Behaviour Change is Behaviour Change is a Process………..a Process………..

Unfolding Over Time…The Stages of Change

• PrecontemplationPrecontemplation• ContemplationContemplation• PreparationPreparation• ActionAction• MaintenanceMaintenance• TerminationTermination

• It Takes Time!It Takes Time!

PrecontemplationPrecontemplation

• NONO Intention to change…….

• No Action in the No Action in the near Future!near Future!

• NoncompliantNoncompliant• resistantresistant• unmotivatedunmotivated

ContemplationContemplation

• Intention to CHANGE - 6 Intention to CHANGE - 6 MonthsMonths

• Aware of Benefits/MeritsAware of Benefits/Merits• Acutely \ Aware of the Acutely \ Aware of the

Disadvantages / Costs of Disadvantages / Costs of ChangeChange

• Giving Up (food, smoking, Giving Up (food, smoking, drinking etc)drinking etc)

• Pros vs. Cons and Pros vs. Cons and AmbivalenceAmbivalence

PreparationPreparation• Intention to take Intention to take

ACTIONACTION• Soon………???Soon………???• Have a PlanHave a Plan• Convinced that Convinced that

Change Benefits Change Benefits Outweighs CostOutweighs Cost

• Ready for Action-Ready for Action-Orientated Orientated TreatmentsTreatments

ACTIONACTION

• Specific overt Specific overt modification modification

• Improved lifestyleImproved lifestyle

• 6 months to set 6 months to set patternpattern

MaintenanceMaintenance

• Preventing RelapsePreventing Relapse

• Continue Effective Continue Effective ActionAction

• Lasts 6 Months to 5 Lasts 6 Months to 5 YearsYears

• Self-Efficacy and Self-Efficacy and TemptationTemptation

TerminationTermination

• Measured by Total Measured by Total Confidence and Confidence and Zero TemptationZero Temptation

• Minority From Minority From Chronic ConditionChronic Condition

• Triggers (causes)Triggers (causes)• EmotionsEmotions• Environment(place/Environment(place/

people)people)

This Stage Paradigm can be A This Stage Paradigm can be A Success Predictor for InterventionSuccess Predictor for Intervention

• Recruitment of people Recruitment of people for behaviour change for behaviour change are in different stagesare in different stages

• >20% are in >20% are in preparation stagepreparation stage

• <40% are in <40% are in Precontemplation Precontemplation StageStage

• <40% are in <40% are in contemplationcontemplation

• What Does this Mean?What Does this Mean?• The best predictor of The best predictor of

premature termination is premature termination is the persons stage of the persons stage of changechange

• Program Success is a Program Success is a measure of the measure of the individual’s entry stage of individual’s entry stage of changechange

Progress = ChangeProgress = Change

• Time-Effective Time-Effective TherapyTherapy

• Drop-out prevention - Drop-out prevention -

Match person to stageMatch person to stage

• Help individuals or Help individuals or populations move populations move through one stage at a through one stage at a timetime

Progress From Stage to StageProgress From Stage to StageResultsResults

• ## of Behaviour of Behaviour ChangeChange

Stages AchievedStages Achieved

• One StageOne Stage• Two StagesTwo Stages• Three StagesThree Stages• ETC, ETC

• Success in six Success in six monthsmonths

• Freedom from Freedom from ProblemProblem

• 66% to 100%66% to 100%• 166% to 200%166% to 200%• 266% to 300%266% to 300%

• Chances get Chances get Better!!!Better!!!