Changing behaviour: Avon FireFit Conference 2006

1. Changing behaviour: Avon FireFit Conference 2006 Dr Melvyn Hillsdon University of Bristol

2. King AC, Circulation. 1995;91:2596-2604

3. Things that behaviour change theories have taught us • Rewards and punishments (response consequences) influence the likelihood that a person will perform a particular behaviour again in a given situation. • Humans can learn by observing others as well as by performing a behaviour personally. • We are most likely to model a behaviour observed by others if we identify with that person. • We are more likely to perform a behaviour if we predict that it will lead to outcomes that we desire or value and the costs of change are not too great. • We are more likely to engage in a particular behaviour if significant others do so (social norm) • We are more likely to perform a behaviour if we are confident we will be successful (self efficacy)

4. The Impact of Physical Fitness Tests on Behaviour at 12 weeks Key to Activity Score 1 - Never 2 - < 1/month 3 - about 1/month 4 - 2 to 3 times/month 5 - 1 or 2 times/week 6 - > 3 times/week Godin et al. 1987

5. Increasing adherence via decisional balance Hoyt & Janis J Personality and Soc Psych 1975; 31

6. Week by week attendance for choice or not of exercise programme Thompson and Wankel J Appl Soc Psych 1980; 10

7. The effect of efficacy training on the frequency of walking MaAuley et al Prev Med 1994; 23

8. Effect of telephone prompts on meeting ACSM physical activity recommendations via walking: Lombard et al: Health Psychology 1995; 14

9. Effect of exercise, frequency, intensity and location on adherence King AC, Circulation. 1995;91:2596-2604

10. Expectations and adherence Neff & King Med Ex Nut Health 1995; 4

11. Life events and exercise adherence Oman & King Health Psych 2000; 19

12. Relapse prevention and reinforcement Marcus & Stanton RQES 1993; 64

13. Readiness/Motivation Importance Confidence

14. Factors that influence readiness to change

15. Does the interaction between practitioner and client influence the likelihood of change? • Motivation to change is elicited from the client, and not imposed from without. • It is the client’s task, not the health professional’s to articulate and resolve the pros and cons of change. • Direct persuasion is not an effective method for resolving ambivalence. • Client resistance predictive of failure to change • Changing negotiating style between confrontational and client centred also changes level of resistance. • The professional’s empathy is associated with more favourable outcomes

16. Summary • At the outset of a programme get clients to systematically go through the anticipated pros and cons of exercise for them. This should preferably be done verbally. • Adopt a client centred interpersonal style during the initial consultation. • Make sure that clients have realistic expectations about the changes they can expect and how long such changes take to achieve. • Have clients actively involved in the decision-making processes that lead to their first programme. This means avoiding the idea of ‘best’ or ‘ideal’ programmes. Introduce a menu approach to programming. • Increase clients’ confidence for exercise by selecting ‘low skill’ exercises and frequently reinforcing successful completion of these exercises. • If possible introduce clients to others who have been successful at changing behaviour.

17. Summary • Maintain regular contact with clients especially during the early weeks. • Have regular meetings with clients to reassess progress towards their goals. Members who don’t think their expectations are being met rapidly reduce their workout frequency.