Download Promoting Healthy Behaviour Change

Chapter 1
Promoting Healthy Behaviour
Promoting Healthy Behaviour
Change
Personal Health?
A Choice?
Your Responsibility?
Health & Lifestyle - A Life Long
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 causes of diseases
• 1900’s - most deaths
infectious diseases
(tuberculosis,
pneumonia, influenza)
• Life Expectancy
Men 58.84 years
Females 60.60 years
With improved sanitation…...
• And antibiotics and
vaccines
• Life Expectancy
Increased
• Mortality Statistics People living longer
(70’s to 80’s)
• Morbidity Statistics people are less ill
• Common Infections
& Diseases
Faded Away…..
Living Longer….. Different
Health Concerns (!) ?
• World Health Organization
(WHO)
• “the attainment by all peoples of
the highest possible level of
health”
• How - by better professional
training, promoting
cooperation, education,
research…………..
• …. A wider view of HEALTH
Absence from Disease to Holistic
Health!
• People Are
multidimensional
• Health must reflect
the whole person
• heath is a dynamic,
ever-changing
lifelong process
• Successful health
Addresses …………..
Health and Wellness to its Highest
Degree is Achieved Through………...
The Dimensions of Health
Mind + Body+ Spirit
Social Health
• interpersonal
relationships
• daily behaviours
• interactions
• satisfying
• positive
• supportive
• variety of situations
HOLISTIC
HEALTH
I Need to Learn and to Grow….
Intellectual Health
• learning
• personal develop
• growth from life
experiences
• Healthy DECISISION
MAKING
• Age - not an issue
• Ability - knowing limits
• Motivation - like to learn
Express Yourself!! for Health and
Peace of Mind!
Emotional Health
• expressing emotions
appropriately
• emotional expression
decrease pressure
• Emotion matches the
Action
• self-esteem
• self confidence
• self-efficacy
• stress reduction
Health Dimensions
Environmental
Health
• appreciation for
the environment,
clean, recycle and
respect…….
• your personal living
environment - safe /
quite / comfortable
Believing in Something….
Spiritual Health
• believing in something
• belonging / sense of
purpose
• higher being
• community
• feeling - pain, love, sorrow,
peace, contentment, and
wonder…….about life!
Physical Health
Personal Physical Characteristics
body size, shape, sensory acuity, susceptibility
to disease/disorders, recuperation form illness
Overall Health and
Physical Well Being
Stress Management
Life Value Added
Attitude
Exercise
Active Living
Nutrition
Feeling Good About Myself...
•
•
•
•
Honest with their
personal limitations
capabilities
attempt to change within
their control
• try to achieve Balance in
mind, body and spirit!
• Health is Relative not
Absolute……e.g. disabled
people can be healthy
Health Throughout The
Dimensions of Health
• Looking healthy and being
healthy…..are they the same?
• Some Thoughts…………
•
•
•
•
•
•
Fit-looking (body image!, Media!)
Social Behaviours
Emotional Intelligence
Committed and Caring
responsibility
other stuff………..
HEALTH PROMOTION
Helping you stay healthy…. And the message is ?
• Health Promotion
Programs:
• educational
• organizational
• procedural
• environmental
• financial Support
• Provide a consistent
message for all!
Disease Prevention:
Process to Reduce Occurrence and
Severity of Disease
• Goal:
Reduce/eliminate
behaviours that
increase risk
• Three levels of
Prevention
• Taking actions to
prevent sickness
Health Promotion Helps Positive
Change
• Learn more (educational
support)
• provide supportive
specific programs
• facilitate behaviour
change
• monetary incentives
subsidized programs
• (cost savings from not
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 Smoking
physical activity
stress management
nutrition
education
practice life skills
psychosocial health
Counselling
SECONDARY
“……...I have a health problem,
now what do I do before it gets
worse?”
TERTIARY
• AFTER THE
ILLNESS or
HEALTH EVENT
• REHABILITATION
• Clinical Setting
•
•
•
•
HEART ATTACK
STROKE
DIABETES
CANCER
HEALTH TRENDS IN North America!
Overwhelming conclusions are
that……...
………..the Leading Cause of
Death in Canada is Related to
behavior/lifestyle choices!!!
Thinking about……………...
Personal Responsibility for
Health????
Is it promoted?
Knowledge of Prevention? Are we
failing to provide appropriate
education?
Why aren’t Canadians responsible for
their health?
Gender Bias
• Androcentricity
a male perspective
• Over -generalization
research findings from one
sex is applied to both
• An example….1/9
• Gender Insensitivity
Over looking gender as
an important variable
• Double Standards
evaluation, treatment, or
measurement applied to
both genders equally
•
•
•
•
women are
diagnosed with breast
cancer - yet little research!
1993 - research needs
assessed
1996 - 6.5 million $$
1997 - 35 million $$$$$$$
equality of research fund
allocation
The Process of Behaviour Change:
From the Individual to an Entire
Population
• Integrative model - to help
Individuals
• Research leading toward
programs for entire
populations
• Behaviour Health Problems
• smoking, unhealthy diet,
alcohol abuse, inactivity,
obesity, stress, chronic
hostility, depression……...
Making A Change
Are You Prepared for Behaviour Change??
• Change is a process not a
quick fix
• positive change should be a
lifelong goal
• change takes time
• it needs a plan
• you may fall back sometimes
and that is alright
• because you are HUMAN
What do I Want to Change and Why?
• Why do I do, what I do? ……
well let’s see!
• Predisposing Factors
•
•
•
•
•
•
life experiences
education/knowledge
culture/ethnic inheritance
current beliefs/values
sex, age, race, income
who you are…. Right now!
Mental
Training is
Easy!
Enabling Factors
•
•
•
•
•
•
•
skills / abilities
physical capacity
emotional status
intellectual capacity
facilities / resources
Urban vs. Rural life
make decisions more
or less difficult
• + enablers help (fun)
• - enablers inhibit ($$)
Reinforcing Factors
• Presence or Absence of
• support
• encouragement
discouragement
• Significant Social Contacts!
• Smoking - friends and family
continue and don’t support
you
• Exercise - effort diminished
people who influence you
On Being Human…….
• Occasional
• ice-cream / treats
• missing an exercise
session
• flare ups of anger
• other deviations less
than optimal
behaviours
• are human and
should be considered
on an individual
basis…...
Personal Beliefs and Attitudes
• Risky health behaviours
• common thinking….
rational/educated people will make
changes to reduce the risk
• some people do and many don’t
• Doctors who smoke
• health professionals who over work stressed!
• Knowing is not Doing!
Do Beliefs and Attitudes
Influence Behaviour?
A 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 Attitude
a relatively stable set of
• beliefs
• feelings
• behaviors towards
something or someone
?…. Do your beliefs &
Attitude influence your
health………...
Health Behaviour Model
Our Perception is Everything!
• Perceived Seriousness of the
Health Problem
what is the problem? How
serious do I perceive it?
• Perceived susceptibility to the
health problem
Am I likely to develop this health
problem?
• Cues to Action
reminded or alerted
Your Intention to Change
Attitudes reflect
• emotional responses to
situations
• follow our beliefs
Theory of Reasoned Action
• behaviour results = intentions
to perform actions
• An Intention is a product of our
attitude and what people may
want us to do
• Exercise, Smoking, Alcohol
Significant Others as Change Agents
Influenced by people
•
•
•
•
•
•
approval / disapproval
real or imagined
friends / loved ones
social groups / cultural groups
Support for healthy change
Negative interference reduces
chance for change
Social Networks
Family and Friends
Your Family
• influence who you are!
• Many components of
• personal development
Social Bonds
• School
• Work
• Positive / Negative
Behaviour Change Techniques
• Shaping: well defined small steps
towards a goal
• Visualizing: imagined rehearsal - seeing
yourself succeed
• Modelling: learning behaviours by
observing successful people
• Controlling the Situation: Situational
Inducement - using situations or occasions
to control behaviour
• Positive Reinforcement: If I do this I
will get …….?
Changing Self-Talk
The way I think and talk to yourself (+ -)!
Rational-Emotive Therapy
• how we feel and what we say!
• Irrational statements - events are
different then we want….
Meichenbaum’s Self-Instructional
Methods • Instruction / positive
• affirmations…… Stress Management
Blocking/Thought Stopping - consciously stop
thinking negative thoughts……...
Making Behaviour Change
• Self-Assessment:
• what happens before the event & what
happens after
• Antecedents: cue to action / events - physical
events, thoughts, emotions, actions of other
people
• 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 Change
D.E.C.I.D.E. one method to
consider….
Decide in advance what the problem
is????
Explore the alternative
Consider the consequences
Identify your values
Decide and take action
Evaluate the consequences
Goal Setting…………. Starting
Tomorrow I’ll……...
•
•
•
•
be realistic
be flexible
provide alternatives
not all or nothing /
Black or white
• behaviour change is a
process…… can’t just
be switched off……
• seek support, help and
appropriate
information.
Behaviour Health Problems
60% of All Health Problems
• #1 Health Problem
35 years…. smoking
• Free Action-Oriented
Programs produced
1% success rate
• Behaviour Change is
a Process………..
Unfolding Over Time…
The Stages of Change
• It Takes Time!
•
•
•
•
•
•
Precontemplation
Contemplation
Preparation
Action
Maintenance
Termination
Precontemplation
• NO Intention to
change…….
• No Action in the
near Future!
• Noncompliant
• resistant
• unmotivated
Contemplation
• Intention to CHANGE - 6
Months
• Aware of Benefits/Merits
• Acutely \ Aware of the
Disadvantages / Costs of
Change
• Giving Up (food, smoking,
drinking etc)
• Pros vs. Cons and
Ambivalence
Preparation
• Intention to take
ACTION
• Soon………???
• Have a Plan
• Convinced that
Change Benefits
Outweighs Cost
• Ready for ActionOrientated
Treatments
ACTION
• Specific overt
modification
• Improved lifestyle
• 6 months to set
pattern
Maintenance
• Preventing Relapse
• Continue Effective
Action
• Lasts 6 Months to 5
Years
• Self-Efficacy and
Temptation
Termination
• Measured by Total
Confidence and
Zero Temptation
• Minority From
Chronic Condition
• Triggers (causes)
• Emotions
• Environment(place/
people)
This Stage Paradigm can be A
Success Predictor for Intervention
• Recruitment of
• What Does this Mean?
people for behaviour
• The best predictor of
change are in
premature termination is
different stages
the persons stage of
• >20% are in
change
preparation stage
• <40% are in
• Program Success is a
Precontemplation
measure of the
Stage
individual’s entry stage
• <40% are in
of change
contemplation
Progress = Change
• Time-Effective
Therapy
• Drop-out prevention Match person to stage
• Help individuals or
populations move
through one stage at a
time
Progress From Stage to Stage
Results
• # of Behaviour
Change
Stages Achieved
•
•
•
•
One Stage
Two Stages
Three Stages
ETC, ETC
• Success in six
months
• Freedom from
Problem
• 66% to 100%
• 166% to 200%
• 266% to 300%
• Chances get
Better!!!