2010 Topic 6

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What is a key purpose of employing theory-based health campaigns?

To create broad, unmeasurable health initiatives

To focus solely on personal factors influencing behavior

To limit the scope of health interventions

To increase the effectiveness of promoting health-protective behavior (correct)

What does the intervention 'mapping' approach emphasize?

Focusing solely on individual behavior without context

Evaluating health campaigns only after implementation

Aligning theoretical determinants of behavior change with relevant methods (correct)

Randomly combining various intervention techniques

Which of the following defines a behaviour change technique or method?

An observable and replicable component designed to alter behaviour (correct)

A description of a health issue without intervention

A theoretical framework for understanding health behaviours

A vague strategy that cannot be replicated

What is an important question to consider when applying behavioral change strategies?

What behaviours need to change, and what mechanisms require activation? Signup and view all the answers

Which of the following has been shown to make the evaluation of health campaigns easier and more costs effective?

The use of theoretically devised approaches Signup and view all the answers

Which statement best describes 'active ingredients' in behavior change interventions?

They can be utilized independently or together with other methods. Signup and view all the answers

What does 'intervention mapping' primarily aim to do?

Match theoretical determinants with behavioral change techniques. Signup and view all the answers

What is a critical benefit of using a theory-based intervention according to the content?

It provides measurable constructs for evaluating outcomes. Signup and view all the answers

Which psychological construct is often linked to behavior change methods to influence intentions?

Self-efficacy beliefs. Signup and view all the answers

Which of the following interventions falls under 'cognitive strategies' for behavior change?

Imagery and mental simulation. Signup and view all the answers

Which of the following best defines behavior change techniques or methods?

Irreducible strategies that actively alter determinants of behavior. Signup and view all the answers

Which strategy is NOT mentioned as a common method used for behavior change?

Online therapy sessions. Signup and view all the answers

What is the primary focus of motivational interviewing?

Encouraging individuals to consider their current behaviors and potential changes. Signup and view all the answers

In the context of health behavior interventions, which of the following is a key determinant addressed in the health action process approach?

Risk perceptions related to health outcomes. Signup and view all the answers

What is a key technique of motivational interviewing that helps in the change process?

Expressing empathy and supporting self-efficacy. Signup and view all the answers

What is the primary goal of motivational interviewing?

To increase an individual's motivation to consider change Signup and view all the answers

How should persuasive communications be structured to effectively change attitudes?

Target underlying beliefs with clear rationale for behaviors Signup and view all the answers

Which element is NOT a key strategy in motivational interviewing?

Offering direct advice Signup and view all the answers

What type of beliefs should interventions based on the Theory of Planned Behaviour target for attitude change?

Salient behavioral beliefs relevant to the individual Signup and view all the answers

What is the concept of cognitive dissonance in the context of behavior change?

A discomfort arising from holding conflicting beliefs simultaneously Signup and view all the answers

What aspect of mass media campaigns is emphasized to improve their effectiveness?

Increasing the number of interventions applied Signup and view all the answers

Which model suggests that personal relevance to an individual increases the likelihood of central processing of messages?

Elaboration Likelihood Model Signup and view all the answers

What is a significant limitation of the Elaboration Likelihood Model as highlighted in various studies?

It assumes that all messages will be understood similarly Signup and view all the answers

What type of behaviors is suggested to have a higher likelihood of success in mass media campaigns?

Episodic or one-off behaviors Signup and view all the answers

Which of the following methods is recommended for tailoring text-based messages to increase motivation in smokers?

Advising on expected challenges during the quitting process Signup and view all the answers

What is considered a weak strategy for changing people's behavior?

Providing knowledge translation through information Signup and view all the answers

Which of the following best describes the role of attitudes in behavior change models?

They are crucial in the majority of behavior change models. Signup and view all the answers

In the context of the Theory of Planned Behavior, which belief is essential for targeting attitude change?

Behavioral beliefs about expected outcomes Signup and view all the answers

What type of messages can enhance self-efficacy in behavior change campaigns?

Messages about the advantages of the target behavior Signup and view all the answers

Which characteristic is a common disadvantage faced by young populations regarding physical activity?

Getting injured during exercise Signup and view all the answers

Which of the following statements about the effectiveness of fear-based mass media campaigns is true?

Their success hinges on balancing fear with perceived efficacy. Signup and view all the answers

What factor does NOT play a role in audience targeting for mass media campaigns?

The geographic location of the campaign Signup and view all the answers

Which of the following best describes the impact of positive health messaging compared to negative health messaging?

Positive framing led to higher intentions to use sunscreen. Signup and view all the answers

In the context of behavior change, what is a significant limitation of single mass media initiatives?

They do not guarantee a change in people's behavior despite high awareness. Signup and view all the answers

What is a crucial element that should be a part of the evaluation process for mass media campaigns?

Assessing whether the campaign has resulted in long-term behavior changes. Signup and view all the answers

What is suggested to be necessary for strong attitude change according to the elaboration likelihood model?

Motivation to process information and alignment with pre-existing beliefs Signup and view all the answers

Which factor is indicated as important for maximizing the effectiveness of peripheral processing in media campaigns?

The credibility and attractiveness of the message source Signup and view all the answers

What limitation of the elaboration likelihood model is highlighted by the study with two differing leaflets about mammography attendance?

Other factors beyond attitude change can influence behavior Signup and view all the answers

Which method is included in the UK's National Institute for Health and Clinical Excellence guidance to motivate smokers to quit?

Encouraging self-efficacy and tailored text messages Signup and view all the answers

What effect did high involvement women show when processing central cues in a health communication advertisement?

Greater intentions to seek mammography, regardless of processing Signup and view all the answers

Study Notes

Why Theory is Important

Theory provides an explanatory system for 'what' and 'how' health behaviours occur.
It helps identify targets for intervention and allows for hypothesis testing.
Theory-based health promotion campaigns are more effective than atheoretical campaigns (Noar, 2006; Webb et al., 2010).
Evaluation of interventions using theoretical approaches is also more efficient and cost-effective (French et al., 2012; Prestwich et al., 2015; Stead et al., 2005).

Basis for Intervention

Intervening on health behaviour involves matching theoretical determinants with specific change methods.
The intervention mapping approach (Kok et al., 1998, 2004, 2016) links psychological variables with behaviour change techniques.

Behaviour Change Techniques/Methods

A behaviour change technique is an observable, replicable, and irreducible component of an intervention (Michie et al., 2013)
These are the 'tools' that directly change behaviour by targeting specific determinants.
They can be used independently or in conjunction with other techniques.

Methods Used to Change Behaviour in Theory-Based Interventions

Common methods include:
- Information provision
- Skill building
- Persuasion techniques
- Planning
- Social encouragement
- Goal setting
- Motivation enhancement
- Self-monitoring

Motivational Interviewing

A non-confrontational approach, particularly effective for individuals reluctant to change (Miller and Rollnick, 2002).
Rooted in self-determination theory, emphasising autonomy and choice.
Goal is to increase motivation to consider change, not dictate how to change.
Addresses ambivalence and creates cognitive dissonance to prompt self-reflection.
Key questions:
- "What are some of the good things about your present behaviour?"
- "What are the not-so-good things about your present behaviour?"
Other elements:
- Expressing empathy
- Avoiding arguments
- Rolling with resistance
- Considering disadvantages of current behaviour
- Highlighting advantages of change
- Evoking intention to change
- Supporting self-efficacy

Information Provision and Communication Persuasion

Providing information to increase knowledge and promote health literacy.
Influences outcome expectancies, personal relevance, attitudes, self-efficacy, and subjective norms.
Example: Fact sheets or health education campaigns.

Attitude Change

Interventions based on the Theory of Planned Behaviour (TPB) should target underlying beliefs (Hagger et al., 2002).
For attitude change, focus on salient behavioural beliefs (Ajzen, 1991).
Elicit these beliefs through open-ended surveys or interviews (Ajzen & Fishbein, 2003).
Persuasive communications should incorporate these beliefs to create a rationale for behaviour change (Ajzen & Manstead, 2007).

Strategies for Behaviour Change

Motivational interviewing interventions
Information provision and communication persuasion
Cognitive strategies
Confidence and self-efficacy interventions
Problem-solving approaches
Goal setting interventions
Planning and implementation intentions
Monitoring interventions
Imagery and mental simulation interventions
Environmental interventions
Public health interventions
Using new technology

Information Provision and Health Literacy

Information provision increases health literacy, leading to better attitudes towards target behaviors and potential behavior change.
Information can provide personal relevance, demonstrating the direct impact of behavior change on personal outcomes.
Information provision alone is not the most effective strategy for behavior change.
The correlation between information and behavior change is weak and primarily influences intentions.

Effective Strategies for Behavior Change

Messages should include self-efficacy elements, providing information on how to perform the desired behavior.
Normative influences can be highly effective, highlighting the prevalence of successful behavior change within a specific group.
The majority of behavior change models emphasize the importance of attitude in influencing behavior.

The Theory of Planned Behavior

Interventions targeting attitudes should focus on underlying beliefs responsible for attitude change.
Behavioral beliefs, including advantages and disadvantages of the target behavior, are crucial to consider.
Interventions should address both the positive and negative beliefs associated with a behavior.

Mass Media Campaigns

Mass media campaigns are a popular approach but effectiveness is questionable for single initiatives.
Coordinated, repeated campaigns are more effective than single interventions.
Evaluation of mass media campaigns is essential but often neglected.

Increasing the Effectiveness of Mass Media Campaigns

Multiple interventions increase the likelihood of success, particularly with one-off or episodic behaviors.
Access to key services and supportive policies facilitate the transition from motivation to change.
Isolating the independent effects of mass media campaigns is challenging, but they can contribute to population health change.

The Elaboration Likelihood Model (ELM)

Suggests two routes to processing information: central and peripheral.
Central processing, characterized by motivation and comprehension, leads to stronger attitude change.
Peripheral processing, lacking motivation or understanding, results in weaker attitude change.
Maximizing the credibility and attractiveness of the message source is crucial.

The Use of Fear in Mass Media Campaigns

A popular approach but often ineffective in driving behavior change.
Protection Motivation Theory emphasizes both threat appraisal and individual efficacy.
Fear-inducing messages are most effective when combined with high baseline efficacy or strong efficacy-enhancing elements.

Information Framing

Positive framing stresses the positive outcomes of action, enhancing information processing, particularly when time is limited.
Negative framing focuses on the negative outcomes of inaction, making the message more memorable.
Evidence regarding the effectiveness of framing is conflicting, with both positive and negative framing showing success in some cases.

Targeting the Audience

Mass media campaigns lack specific focus, making audience targeting more effective.
Targeting can be based on various factors including demographics, behavior, and psychological characteristics.
Engaging the target group in co-creation of messaging can increase relevance and effectiveness.

Mass Media and Behavior Change

Central vs. Peripheral Cues: Central cues focus on information, while peripheral cues rely on factors like source credibility or attractiveness. Central cues are more effective for individuals highly involved with the issue. Peripheral cues are stronger for those with lower involvement.
Effectiveness of Fear Arousing Messages: Campaigns using fear are often ineffective. People tend to tune out. To be successful, fear-based messages should:
- Instill a sense of severity if behavior doesn't change
- Emphasize the individual's ability to control the feared outcome
- Include self-efficacy messages.
Information Framing: Framing messages either positively (stressing benefits of action) or negatively (highlighting negative consequences of inaction). Research shows conflicting results, suggesting further exploration of framing strategies is necessary.
Targeting the Audience: Mass media campaigns are most effective when specifically targeted to a known audience.
- Consider: demographics, socioeconomic status, psychological factors, and motivations.
- Co-creation of messages with the target group is crucial.

Cognitive Strategies for Behavior Change

Cognitive Therapy: This therapy centers around the idea our thoughts regulate our behavior, shaping feelings, motivations, and actions. It aims to:
- Treat beliefs as hypotheses, not facts
- Encourage individuals to examine alternative perspectives
- Develop new behavioral response based on revised thinking.
Identifying Irrational Beliefs (CBT): Irrational beliefs are unrealistic and distorted thoughts leading to distress and unhealthy behaviors.
- They often involve absolutes (e.g., "I must be perfect.")
- Through Socratic dialogues, individuals question the validity of these beliefs.
Confidence and Self-efficacy: Information and cognitive interventions are most effective with individuals who have the skills and confidence to apply them.
- Strategies to enhance self-efficacy:
  - Modeling: Observing relevant tasks performed by others
  - Practice: Graded skills development
  - Verbal persuasion: Encouragement and assurances of capability
  - Self-talk: Positive affirmations (e.g., "just do it")
Vicarious Learning: Learning from observing others perform tasks. Three types:
- Live model: Direct demonstration
- Verbal instructional model: Descriptions or explanations
- Symbolic model: Real or fictional characters in media.

Increasing Confidence and Self-efficacy

"This Girl Can" Campaign: Aimed at increasing self-efficacy among women, addressing barriers to physical activity.
- Featured women of diverse ages and body shapes, promoting a range of activities.
Interventions Focus: Addressing both skills and self-efficacy.
- Examples: Cooking skills intervention, safe sex practices.

Changing Normative Beliefs

Strategies:
- Provide information about others' behavior
- Highlight others' approval of desired behavior
- Encourage social comparison opportunities.

Social support essential for sustained behavior change.

Building Confidence and Self-Efficacy

Confidence and self-efficacy can be built up through various means, including teaching skills and solutions to problems.
Examples include cooking skills interventions and safe sex practices for adolescents.
Interventions can be delivered individually or on a population level.

Normative Beliefs

Normative beliefs can significantly influence people's behavior, especially for adolescents and parents.
Strategies to change normative beliefs include:
- Providing information about others' behavior, making it the norm.
- Highlighting approval from others for performing the behavior.
- Encouraging social comparison to see others successfully perform the behavior.

Behavior contracts can be helpful, outlining goals, rewards, and steps to be taken.
Social support can be provided by health professionals, family, or friends.
It can take various forms, including emotional encouragement and tangible assistance.

Cognitive-Behavioral Therapy (CBT)

CBT is a form of psychotherapy addressing thoughts and behaviors.
It's effective in treating issues like depression, anxiety, trauma, and addictions.
CBT focuses on identifying and challenging irrational beliefs, often automatic thoughts.
It helps modify behaviors that reinforce negative thought patterns.
Core beliefs, deeply held beliefs about oneself and the world, influence how we interpret situations.
CBT aims to change unhelpful core beliefs.

Problem-Solving Approaches

Developed by Egan (2006), this approach focuses on "how" to change, not "whether" to change.
It's problem-oriented and focused on the "here and now", making it suitable for those wanting to change immediately.
It consists of three phases:
- Problem exploration and clarification.
- Goal setting.
- Facilitating action.

Problem-Solving: Example - Smoking Cessation

Smoking involves conditioned responses to cues and a physiological need for nicotine.
Quitting can involve dealing with withdrawal symptoms, coping with cues, and resisting cravings.
Strategies include:
- Coping with cues to smoking.
- Reducing the likelihood of giving in to cravings.
- Managing withdrawal symptoms with nicotine replacement therapy (NRT).

Goal Setting Interventions

Developed by Aiken, this approach focuses on the issues at hand and encourages change.
It involves three phases:
- Problem exploration and clarification.
- Goal setting.
- Facilitating action.

Goal Setting: Example - Smoking Cessation

Individuals need to deal with the loss of mood alteration, withdrawal symptoms, and cravings triggered by cues.
Strategies include:
- Avoidance strategies (e.g., avoiding smokers, not carrying money for cigarettes).
- Coping strategies (e.g., focusing attention away from cravings, reframing withdrawal symptoms as recovery signs).

Goal Setting: SMART Goals

SMART goals are specific, measurable, achievable, relevant, and timely.
Specific: Clear and detailed, addressing "what," "where," "when," and "with whom."
Measurable: Easy to track progress.
Achievable: Set within reach to avoid undermining self-efficacy.
Relevant: Personally meaningful and important for achieving a desired change.
Timely: Having a set timeframe to maintain motivation and encourage action.

Implementing Plans and Intentions

We sometimes fail to translate intentions into action due to:
- Failure to start.
- Becoming derailed from goals.
Implementation intentions (II) involve an "if-then" approach, linking a specific situation with an action.
This creates a mental association that promotes goal initiation and can help resist distractions.

Monitoring Interventions

Effective monitoring interventions involve:
- Setting a suitable goal for monitoring.
- Designing a monitoring strategy.
- Processing the obtained information.

Self-Monitoring

Habits develop through consistent behavior practiced in the same context, triggered by a cue, and reinforced over time.

Habits: Dos and Don'ts

Dos:
- Use trigger events and reminders.
Don'ts:
- Rely on external rewards or motivation.
- Rely on technology.
- Use time-based cues (routine-based are better).
- Provide multiple plans.
- Use negating implementation intentions (e.g., "If I am sad, then I will not eat chocolate").

Applying Self-Monitoring with Individuals

Create a plan: Identify cues that trigger the behavior, develop a strategy, and use environmental prompts.
Monitor progress: Track behaviors and adjust strategies as needed.

Example - Promoting Habits: Physical Activity in the Workplace

Habits play a role in physical activity promotion.
An implementation intention example could be: "If it's 2 p.m., then I'll go for a 10-minute walk."
This mentally links a cue (2 p.m.) to the desired action (walking) and promotes the action when encountered.

If-Then Plans

If-then plans are a simple yet effective strategy to bridge the intention-behavior gap.
They involve anticipating potential obstacles and deciding how to handle them beforehand.
Example: "If I am out with friends and get asked what I want to drink, then I will ask for water." (Goal: Drink eight glasses of water daily)
Repetition and practice help make the plan automatic and effortless.

Environmental Influences on Health Behaviour

Cues to action:
- These can either decrease unhealthy behaviors (e.g., larger warnings on tobacco products) or increase healthy ones (e.g., posters encouraging stair use).
- They can also act as reminders for unhealthy behaviors (e.g., advertisements, movies).
Minimizing the costs of healthy behavior:
- The environment can facilitate or inhibit participation in health-related behaviors.
- Healthy Cities movement (WHO) aims to design cities that promote physical & mental health (e.g., green spaces).
- Examples:
  - Linegar et al. (1991) manipulated physical (cycle paths, exercise equipment) and organizational (release time) environments in a naval base to encourage physical activity.
  - Marketing campaigns promoting walking groups and community exercise classes.
- Environments that inhibit healthy behavior:
  - Poor street lighting, busy roads, high levels of pollution.
Increasing the costs of unhealthy behavior:
- Making unhealthy behavior difficult (e.g., through pricing or availability) acts as a barrier.
- Examples:
  - Increased taxation on tobacco (Hu et al., 1995) found a 25% tax increase resulted in a significant decrease in cigarette sales compared to media influences.
  - Restricting the number of alcohol outlets increases travel time & effort needed to purchase, acting as a deterrent.
- Bans:
  - Smoke-free areas (Heloma & Jaakalo, 2003), resulting in reduced secondhand smoke exposure and lower smoking prevalence in workplaces.
  - Banning smoking in public places (e.g., restaurants and bars in Texas, US) had no reported negative impact on profits or consumption, and may even have positive effects on health.

Habit Formation

Habits are formed when a certain behavior is practiced repeatedly in the same context, in response to a cue, and is reinforced over time.
Event-based cues:
- Using existing habits as triggers for new behaviors (e.g., brushing your teeth as a cue to start flossing).
- More effective but slower to develop.
- Monitoring is needed during this process.
Time-based cues:
- Using reminders like SMS notifications to support behavior repetition.
- May hinder automaticity as people become reliant on the reminder instead of generalizing to other cues.
If-then plans for cues:
- Example: "If I see or smell chocolate, then I will follow my diet goal."
Do's and Don'ts in habit formation:
- Do's:
  - Support trigger events (e.g., use phone ringing as a cue to stand up and pace).
  - Use reminders to support implementation intentions.
- Don'ts:
  - Rely on external rewards as they might not sustain behavior once removed.
  - Focus on external motivation – intrinsic motivation leads to long-term behavior maintenance.
  - Rely on technology, favor event-based cues over time-based ones.
  - Provide multiple plans – start simple and build on existing behaviors.
  - Use negating plans (e.g., "If I am sad, then I will not eat chocolate") as they might reinforce the unwanted association.

Applying If-Then Plans to Individuals

Develop a plan using the if-then strategy or a more detailed action plan approach.
Action Plan:
- Identify cues to action linked to the target behavior (e.g., after lunch, after brushing teeth, before bed).
- Use the environment as prompts or cues (e.g., social distancing markers).
- Restructure the environment to act as prompts (e.g., hat rack on the door, mask hooks).
Example Intervention:
- Habit-forming intervention for sedentary office workers:
  - Identify cues in the environment that could encourage movement.
  - Develop an if-then strategy or an action plan.
  - Monitor progress over time to strengthen habits.

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Test your knowledge on behavior change interventions with this quiz. It covers theory-based health campaigns, intervention mapping, and specific behavior change techniques. Discover the key concepts that drive effective strategies in health promotion.