Behaviour Change PDF

Behaviour Change  Discuss process of behaviour change Examine different theories including Social Cognitive Theory, Stages of Change/ Objectives: Transtheoretical Model, Motivational Interviewing and Self-Management...

Behaviour Change  Discuss process of behaviour change Examine different theories including Social Cognitive Theory, Stages of Change/ Objectives: Transtheoretical Model, Motivational Interviewing and Self-Management Explore the similarities between these theories in promoting behaviour change  Behaviour Change Past: strategy of the health care professional determining goal and expecting people to comply with recommendation Today: patient centred model of health care delivery, the patient is not a passive recipient of treatment but is a partner in determining the course of action  Behaviour Change One goal in Cardiac Rehab is to assist patient(s) in achieving their goal(s); bring about change in behaviour and independence of self-care.  Theories help to explain behaviour Provide a framework that can help us explain why people do what they do Understand the process of behaviour change, strategies Behaviour to recommend and how new Change behaviour can be sustained over time Behaviour change Giving up a negative behaviour Starting a positive behaviour Examples?   Focus on Social Cognitive Theory and Stages of Behaviour Change/ Transtheoretical Model Change  Social Cognitive Theory proposes that human behaviour is the product of the interaction between personal factors, environmental influences and behaviour patterns. Personal/ individual factors ie., emotion, personality, Social cognition Cognitive Behaviour ie., past and current Theory achievements Environment ie., physical, social, cultural Dynamic factors that influence each other over time differently over time  Central to behaviour change is Self-Efficacy Belief in one’s own capabilities to organize and execute the courses of action required to produce desired behaviour Social High self-efficacy together with positive expectations about Cognitive beneficial outcomes should lead Theory to behaviour change Example: high level of confidence in one’s ability to exercise regularly, together with the perception that this would lead to health benefits would increase probability of sustaining exercise. Other examples?  Stages of Change/ TTM describes the steps people Stages of go through when changing Change behaviour (Transtheoret ical Model, recognizes behaviour TTM) change is a process (rather than one-time event)  Ambivalence about change is normal Stages of Change Relapse is normative (Transtheoret (movement back to earlier ical Model, stages) TTM) Self-efficacy is an important principle in the change process Stages of Change/ Transtheoretical Model (TTM): 5 Stages Precontemplation – no intention to change Contemplation – intention to change in the next 6 month Preparation – plans to take action to change within a month Action – carrying out the new behaviour Maintenance – behavioural change for at least 6 months (Relapse) Stages of How to move to next Change stage? (Transtheoreti cal Model, Resolve TTM) ambivalence Decisional balance – movement toward change (or stages) occurs when pros of change begin to outweigh cons Improve self- confidence  To progress through stages, usually requires some external influence. There are 10 processes of change in which people engage to move from stage to stage: Stages of 1. Consciousness-raising - learning Change new information about behaviour to (TTM): Ten heighten awareness (ie., info related to benefits of exercise, smoking cessation). Processes 2. Dramatic relief – initially involve negative emotions (fear/anxiety) from unhealthy behaviour risk, followed by relief of those emotions when change occurs (ie., fear of consequences of health for not exercising/ or not quitting smoking).  3. Self re-evaluation – personal assessment of self-image with or without a particular behaviour (ie., exercise will make me healthier). 4. Environmental re-evaluation – Stages of assessment of how the presence or absence of a particular behaviour Change may affect the immediate social or physical environment (ie., smoking). (TTM): Ten Processes 5. Self-liberation – belief in one’s own capacity to change and commitment to change (ie., achievement of healthy behaviour is possible).  6. Helping relationships – seeking and using social supports to assist in healthy behaviour (ie., someone to talk to about smoking cessation, exercise partner). Stages of 7. Counterconditioning – substitution of healthy behaviour to Change displace unhealthy (ie., substitution (TTM): Ten of drinking pop with carbonated water, doing things with hands as a Processes substitute holding cigarette). 8. Contingency conditioning – increasing rewards for positive behaviour change (ie., reward for not smoking or for exercising).  9. Stimulus control – removal of cues or triggers for unhealthy behaviour (ie., replacing cues for sedentary behaviour with reminders to maintain regular exercise (running Stages of shoes). Smoking cessation? Change 10. Social liberation – appraisal (TTM): Ten that social norms are changing in a Processes direction supportive of the healthy behaviour change (ie., easier to be a non-smoker, awareness of social changes encouraging no smoking or exercise). Stages of Change (TTM): Putting it together Stages of Change (TTM): Putting it together Stages of Change (TTM): Putting it together Stages of Change (TTM): Putting it together Stages of Change (TTM): Putting it together Stages of Change (TTM): Putting it together Stages of Change: Behaviour change → Exercise  Behaviour Change: Tracking new behaviour (Exercise Log); other methods?  Counseling method that involves enhancing a patient’s motivation to change The fundamental spirit of Motivational Interviewing involves Motivation three elements: 1. Collaboration (vs confrontation) al Respect to patient’s perspective or expertise Interviewi 2. Evocation as opposed to education ng: Draw upon patient’s own goals, Fundamen perceptions and values (cannot be imposed by CR staff; tal Spirit education presumes patient lacks knowledge) 3. Respect of patient’s autonomy Affirm patient’s right and capacity for self-direction vs authority (telling patient what they must do)  1. Express Empathy (vs sympathy) Patient-centered approach involves reflective listening and empathy (involves Motivationa understanding, acceptance and l reflection of patient’s perspective). Interviewin Listen to discussion and use reflection: g: 4  “So, what you are saying is you want better BP/chol/BS levels but you enjoy General your food.” Principles  “Have I understood? What you are saying is that you know you should exercise but you don’t want to.”  Ask permission to ask questions or give advise; “Do you mind if I ask you…” or “If you don’t mind, I’d like to share some ways…”  2. Develop Discrepancy Change is motivated by discrepancies between Motivationa present behavior and patient’s goal l Ie., CR staff point out the Interviewin discrepancies in what a g: General patient is saying: “You are saying that you want to Principles lose weight but also that you are not willing to change certain habits”… allows patient to present the arguments for change.  3. Roll with Resistance CR staff acknowledges and accepts the reasons for resistance and turns the Motivation problematic issue or question back to the patient for al resolution Interviewin It’s counterproductive to argue g: General with patient; confrontation should be avoided Principles Use reflective listening “This has been hard for you and it feels like (behaviour) is too much to take on right now.”  4. Support Self-Efficacy Supporting self-efficacy helps patient build confidence in making a change. ie., seeking potential solutions from patient rather than providing the Motivation solutions, patient has a sense of empowerment al Interviewin CR staff supports patient’s g: general perception that they are capable of change (ie., examples of past principles successes) “You said in the past you managed to quit smoking by calling your friend when you had a craving… sounds like having that social support really helped. Maybe you can lean on your social supports again to help you…”  Self-efficacy is a central factor in the effective self-management of chronic disease (ie., CVD) How do we enhance self-efficacy? Create opportunities to enable patients to develop mastery of tasks or behaviours Provide patients with effective modeling or vicarious experience Self- of tasks (learning through Manageme observation ie., witnessing of task modeling) Providing effective verbal nt: Skills persuasion through educational efforts Providing patient skills to understand, manage and be able to interpret one’s own physiological and emotional states (ie. symptom management, BS levels)  Problem-solving  Patient should learn how to manage disease related problems and how to generate practical solutions Self- Decision-making  assist patient in acquiring Manageme health-related info to nt: Skills enable effective problem solving related to their condition Resource utilization Finding and utilizing multiple sources (ie., community based)  Partnership formation Learn to form productive partnerships with health care providers ie., reporting symptoms Action planning Self- Making action plan (goal Manageme setting); SMART goals nt: Skills Self-tailoring  Patient should be encouraged to self tailor activities such as exercise or dietary change based upon previous learned skills.  Goal of CR: empower patient to take control of their health and enable self-management of their health/ health behaviour Behaviour change guided by Guiding patient’s goal(s) As part of intake behaviour assessment (ie., patient change … questionnaire), patient is in CR asked about their goals setting Examples: “weight loss, regain strength, improve stamina, learn how to exercise/ improve diet to keep my heart strong, be able to walk up stairs feeling less short breath”  Adherence to CR is positively affected by: Strength of endorsement from referring physician Patient’s beliefs about their illness with regards to: Behaviour perceptions of illness Change: controllability Adherence to perceptions regarding CR potential for positive outcomes perception about their contribution of their personal health behaviours to their heart condition perceived self-efficacy Practice Question: 1. Match the comments with the stage of change they are in: a. “I wonder if exercise will really help lower my triglycerides.” b. “I met up with my friend and we exercised together.” c. “It has been 6 months and I am still smoke-free!” d. “I quit smoking for 10 years, I had one cigarette and now I am right back to smoking.” e. “I have no symptoms form my high blood pressure, so I am not worried about it.” f. “I joined weight watchers last week to assist in my goal to reduce my weight and body fat.” References American College of Sports Medicine. (2018). ACSM’s guidelines for exercise testing and prescription (10th ed.). Lippincott Williams & Wilkins. Belton, A., & Simpson, N. (2010). The How to of Patient Education (2nd ed.). Canadian guidelines for cardiac rehabilitation and cardiovascular disease prevention: Translating knowledge into action (3rd ed. ). (2009). Canadian Association of Cardiac Rehabilitation. Forsyth, L., & Marcus, B. (2009). Motivating People to be Physically Active (2nd ed.). Human Kinetics Publishers.