Behavior Change in Health

1. Behavior Change in Health • Some questions: • What factors predict health behaviors? • e.g., Why do you floss every night? or why not? • How do people change their health behaviors? • Why don’t people change? What are some of the barriers? • Theories, Models, and Practicalities…

2. Behavioral Immunogens and Pathogens • Behavioral Pathogen • A health-compromising behavior or habit • smoking, excessive eating, substance abuse, dangerous driving, risky sexual behavior • Behavioral Immunogen • A health-enhancing behavior or habit • exercising regularly, using sunscreen, healthy eating, practicing safe sex, wearing seatbelts

3. Behavioral Immunogens and Death Rate

4. Preventing Injury and Disease • Primary Prevention(Efforts to prevent disease or injury from occurring – e.g., practicing good nutrition, exercising, avoiding smoking, obtaining regular health screening – these are the behavioral immunogens) • Secondary Prevention(Actions taken to identify and treat an illness or disability early in its occurrence – e.g., monitoring symptoms, taking medication, following treatment regimens) • Tertiary Prevention(Actions taken to contain damage once a disease or disability has progressed beyond its early stages – e.g., radiation therapy, chemotherapy) • less cost-effective and less beneficial than primary or secondary prevention • the most common form of health care in the U.S.

5. What influences Health Behaviors? Fig. 6.1, p.177

6. Barriers to Healthy Behaviors • Individual Barriers • Inertia • Operant conditioning issue – immediate rewards and punishments are much more effective than delayed ones • Finances • Optimistic Bias --The tendency of most people to believe that they are less likely to become ill than others • People who feel vulnerable to specific health problems are more likely to practice preventive health behaviors • Invincibility fable (especially in adolescents) • Within limits, optimism conveys health advantages

7. Family Barriers • Health habits are often acquired from parents and others who model health-compromising behaviors • obese parents are more likely to have obese children • children of problem drinkers are themselves at increased risk of abusing alcohol

8. Health System Barriers • Medicine tends to focus on treatment rather than prevention • A significant percentage of Americans do not have health insurance • Unrealistic or confusing recommendations

9. Community Barriers • Access to _____ (health care, exercise facilities, grocery stores) • Absence of community health promotion (e.g., no incentives to walk) • Some environments promote health-compromising behaviors • e.g., alcohol use and binge drinking in college

10. Models for Health Behavior Change • Given all these barriers, why (and how?) would a person change his or her health behavior? • Theories and Models (give handout “Changing Health Behavior Theories” for homework)

11. Stage Theories • Transtheoretical Model (see Table 6.2) • People pass through 5 stages in altering health behavior • Stage 1: Precontemplation • Stage 2: Contemplation • Stage 3: Preparation • Stage 4: Action • Stage 5: Maintenance • Stage 6: Termination • Examples -- http://www.psychologymatters.org/diclemente.html

12. Stage Theories • Stage theories provide a “recipe” for ideal behavior change, but… • hard to put everyone in a discrete “stage”; probably a more continuous and non-linear process • Enable interventions to be matched to the specific needs of a person who is “stuck” at a particular stage

13. RecoverySelf-Efficacy Coping Self-Efficacy Task Self-Efficacy Action Planning Outcome Expectancies Disengagement Intention Initiative Maintenance Coping Planning Recovery Risk Perception Action Barriers and Resources Health Action Process Approach -- A continuum model http://userpage.fu-berlin.de/~health/hapa.htm

14. The Health Belief Model(Cognitive model) Example from text, p. 183

15. Theory of Planned Behavior (Social cognition model)

16. Support for these theories • People’s self-reported attitudes and intentions predict a variety of health-promoting actions (weight loss, condom use, smoking behavior, health screening) • People are more likely to engage in health-protective behaviors if they feel susceptible to the hazards of not doing so

17. Shortcomings of these theories • People do not always do what they intend (or claim they intend) to do (“the intention-behavior gap”) • Attitudes predict some health-related behaviors, but not others • The predictive power of these theories is greater for some groups (high-SES, for example) than for others • The theories ignore past experience with a specific health-related behavior AND PAST BEHAVIOR IS OFTEN THE BEST PREDICTOR

18. Why Aren’t Health Behavior Theories More Precise? • They say little about how intentions are translated into action • They are unrealistically complex • Health habits are often unstable over time • For the very young, old, and ill, health care decisions are often made by other people

19. Changing Behaviors • How can we influence people to change health behaviors? What needs to be done? What strategies might be effective?

20. Changing Behaviors: Interventions • I. Changing Health Beliefs • II. Social Engineering • III. Cognitive-Behavioral Methods

21. Changing beliefs: Health Education Campaigns • Health Education ideally… • identifies specific health problems in a community • analyzes background factors that predispose, enable, and reinforce lifestyle and environment elements • implements health education program

22. How Effective are Health Education Campaigns? • Mass media appear to be most effective in alerting people to health risks that they otherwise wouldn’t know about, but are less effective in long-term behavior change (unless the message is presented consistently over time, e.g., health risks of smoking) • What about fear-based messages (scare-tactics)? e.g., Framing the message to stress the risk of not performing a health behavior

23. Social Engineering • Changing the environment to change our behaviors • Automatic seat belts and air bags; lowering speed limit • Design change for baby walkers • Elimination of “Joe Camel” ads • Requiring immunizations for school entry • Worksite wellness programs • on-the-job health promotion programs • structuring the environment (on-site gym, banning smoking, etc.)

24. Cognitive-Behavioral Interventions • Methods are usually used in combination (a multimodal approach) • Should be tailored to each person • Too many interventions can overwhelm a person

25. Cognitive-Behavioral Interventions • Three stages: • Self-observation / monitoring • Implementing change • Maintenance / Relapse prevention

26. Self-monitoring • Define target behavior • Record and chart • Continual process with revision

27. Implementing Change (overview) • Conditioning methods • Modeling • Cognitive change strategies • Etc…

28. Conditioning methods • Classical (Pavlovian) Conditioning Interventions • Antabuse • Counterconditioning (cancer nausea) • Operant Conditioning Interventions • Modify consequences of a behavior (e.g., seat belt buzzer) • Shaping • Using rewards (individually or in a group setting, e.g., token economy)

29. Modeling • Observational learning • Preparing a child for an operation • Taking a yoga class • Watching a video on breast self-examination • Going to A.A. • Most successful when it shows the realistic difficulties that people encounter in making changes

30. Stimulus control • Modifying antecedents of a behavior • Poor health habits often tied to events, people, places, or things in the environment (called discriminative stimuli -- DS) • Examples (golden arches, …) • These DS need to be identified and then reduced

31. Contingency Contracting • Creating contract with another regarding consequences of one’s behavior • “Every time I do _____, I instruct my friend to _____”

32. Covert Self-control • Cognitive techniques (e.g., cognitive restructuring) • Train people to recognize and modify internal dialogue • “I’m weak, I can’t control my smoking urges…” • This statement would be targeted for modification

33. Skills Training and Behavioral Assignments • Learn skills to change behavior • progressive muscle relaxation • assertiveness training • stress management • nutrition education • systematic homework assignments

34. Relapse • Why do people relapse? • BioPsychoSocial factors (e.g., with smoking) • Bio: Withdrawal, Genetics, Wt. Gain • Psych: Boredom, stress, anger • Social: Conflicts, lack of social support, social cues (e.g., going to a bar) • Relapse Prevention • Need to control the biopsychosocial factors, especially developing coping techniques for managing high-risk situations • Coping with a “slip” • Integrate behavior change into a generally healthy lifestyle