Theories of Health & Behaviour Change PDF

Theories of Health & Behaviour Change Physical Activity (Definition) 1 (Caspersen, Powell & Christenson, 1985) Movement of the body produced by skeletal muscles Results in energy expenditure Has a positive correlation with physical fitness Typically focus on ‘physical activity for health’ traditio...

Theories of Health & Behaviour Change Physical Activity (Definition) 1 (Caspersen, Powell & Christenson, 1985) Movement of the body produced by skeletal muscles Results in energy expenditure Has a positive correlation with physical fitness Typically focus on ‘physical activity for health’ traditionally promote MVPA (mod-vig PA) Recent interest in light intensity PA (LIPA) Exercise (Definition) 2 (Caspersen et al., 1985) body movement produced by the skeletal muscles results in energy expenditure very positively correlated with physical fitness planned, structured and repetitive bodily movement objective to maintain or improve physical fitness Sport (Definition) 3 (Rejeski & Brawley, 1988) governed by rules ivolves gross motor movement involves physical prowess, strategy and chance traditionally competitive or points-based Health (Definitions) “ a complete state of physical, mental and social well-being, and not merely the absence of disease or infirmity” - (WHO, 1946) “a dynamic state of well-being characterized by a physical and mental potential, which satisfies the demands of life commensurate with age, culture, and personal responsibility” - (Bircher, 2005) “health does not just mean the physical well-being of the individual but refers to the social, emotional, spiritual and cultural well-being of the whole community” - (NHMRC, 1996) 4 What are the outcomes & impact of sedentary behaviour? 5 A growing body of evidence indicates that time spent sitting is consistently associated with premature mortality, T2DM, and risk factors for CVD, irrespective of time spent being active Among adults, sedentary behaviour is related to premature death from all causes and from cvd, higher risk of T2DM and certain cancers, higher overall energy intake, and being overweight or obese (Gontved & Hu 2011, Kolle & Ekelund 2013, Lynch 2010, Pearson & Biddle 2011) Children and young people who spend prolonged periods of time in sedentary behaviour have poorer physical, mental, social and academic profiles (Hinkley et al., 2012, Okely et al. 2013) Higher levels of sedentary behaviour among children and younger people are associated with: Greater risk of obesity and CVD risk factors greater risk of depressive symptoms higher overall energy intake and consumption of energy-dense food and drinks, and lower intake of fruit and veg lower academic performance, delayed cognitive development and poor school performance reduced psychosocial wellbeing and self-worth poor pro-social behaviour poor sleep patterns Why use Theories? 6 behaviour theories are our attempt to explain why human behaviours and therefore give us insights into how we can help people make those changes. these theories cite environmental, personal, and behavioural characteristics as the major factors in behavioural determination = reflection of the compiled evidence of behaviour research theory is the only foothold we have in development of behaviour physical activity interventions since theories are (or should be) a generalised and careful interpreted systematic summary of empirical evidence Foundations of Behaviour Change Theories: 7 Theories are underpinned by some common building blocks. Most explore environmental, personal, and behavioural characteristics How each theory relates these factors, however, can vary dramatically Social Cognitive Theory Social Cognitive Theory… continued 8 Behaviour is learnt and modified via an interaction of personal, behavioural and environmental influences What are the Elements of Social Cognitive Theory? 9 Symbolising Capability: Understand and anticipate likely consequences of action. Self-regulation: Ability to regulate our behaviour based on our goals, behaviours and feelings. Outcome Expectancies: Reflect on and understand the consequences of our behaviours. Efficacy Expectancies: Reflect on and undertand our own capabilities. What is Self-Regulation? 10 Ability to pursue goal-directed behaviour; Engage in goal-promoting opportunities Reject opportunities that do not enhance goal attainment Assumption of rationale, reflective behaviour. Efficacy + Outcome Expectations 11 Self-efficacy: “ People’s judgements of their capabilities to organise and execute courses of action required to attain designated types of performances > It is concerned not with the skills one has but with judgements of what one can do with whatever skills one possesses.” Self-Efficacy and Behaviour: 12 Self-efficacy is a strong predictor and enabler of behaviour. Many programs use various intervention techniques to build self-efficacy among the participants. Increasing Self-Efficacy: 13 Performance Attainment (Mastery) Successful past experience Building skills gradually to ensure success Praise and focus on successful elements of performance Realistic expectations Imitation and Modelling (Vicarious) Observing success and failure in others’ performances Vicarious experience for learning Allows social comparison Provides a reference point for performance Similar performers can promote behavioural attempts Verbal and Social Persuasion Sources(s) of persuasion need to be perceived as trustworthy Weak form of self-efficacy intervention Motivation: The Four Qualities 14 1. Direction and choice: Making the choice to be active 2. Persistence: Ability to sustain focus and behaviour in spite of easier or simpler options 3. Continuing motivation: Ability to engage in motivated behaviour until task is complete, or on an on-going basis 4. Intensity: The amount and intensity of motivation SCT applied to Physical Inactivity: 15 A school-based obesity-prevention program for adolescent girls theory mapped to the SCT The Theory of Planned Behaviour (TPB) What is the Theory of Planned Behaviour? TPB is a psychological theory that links beliefs to behaviours The theory maintains that three core components, namely, attitude, subjective norms, and perceived behaviour control, togethe shape an individual’s behavioural intentions. Ajzen, I. (1985). From intentions to actions: A theory of planned behavior. In J. Kuhl and J. Beckmann (eds.), Actions Control: From cognition to behavior (pp. 11-39), Springer-Verlag, New York. Ajzen, I. (1988). Attitudes, Personality and Behaviour. Open University Press, Milton Keynes. 16 The Theory of Reasoned Action and Planned Behaviour: 17 Breakdown of Components of TRA & TPB: 18 Attitudes: an individual’s beliefs about the attributes and outcomes of doing the behaviour (or changing it), weighted by their evaluations of these attributes or outcomes. Subjective Norms: an individual’s beliefs regarding important others’ approval or disapproval of tobacco use (normative beliefs), weight by their motivation to comply with these important others’ wishes. Perceived Behavioural Control: an individual’s perceived control over the behaviour use in the presence or absence of facilitators and barriers to change. What are Attitudes? 19 Widely accepted to influence behaviour Extensively researched in social psychology ‘A psychological tendency that is expressed by evaluating a particular entity with some degree of favour or disfavour’. Eagly & Chain, 1993, p.1. What are the 3 Components of Attitudes? 20 1. Cognitive Beliefs regarding PA experience Beliefs regarding PA outcomes 1. Affective Likes and dislikes for PA Regret / satisfaction for attending / missing PA 1. Behavioural Intentions to do PA Avoid / seek PA opportunities What are Subjective Norms? 21 = the result of social and environmental surroundings and a person’s perceived control over the behaviour. People close to me do (or do not) fo this Family / friend support Physical environment support (safety, access) What is Perceived Behavioural Control? 22 On a conceptual basis, perceived behavioral control is similar to self-efficacy both constructs refer to the person's belief that the behavior in question is under his or her control but, operationally, perceived behavioral control is often assessed by the ease or difficulty of the behavior (e.g., ‘I find it difficult to exercise three times a week’), while self-efficacy is operationalized by the individual's confidence in being able to carry out the behavior in the face of extenuating circumstances (e.g., ‘I am confident that I can exercise three times a week even when I am away on vacation’ Mapping of TPB to Nurse motivation to promote PA intervention 23 The research aimed to create more understanding ogf how an education program can influence health professionals to recommend Generation Games to and increase exercise behaviour in T2DM patients. TPB applied in questionairres to determine exercise behaviour: 24 This study aimed to determine the factors associated with exercise behaviour based on the TPB among the sarcopenic elderly people in Cheras, Kuala Lumpur Self-Determination Theory What is Self-Determination Theory? 25 a motivational theory considers the predictors of long-term behaviour and psychological well-being involves Four ‘mini’ theories 1. Cognitive Evaluation Theory (Deci, 1975) 2. Organismic Integration Theory (Deci & Ryan, 1985) 3. Causality Orientations Theory (Deci & Ryan, 1985) 4. Basic Psychological Needs Theory (Ryan & Deci, 2000) According to SDT, what are Humans’ 3 basic needs? 26 1. Competence - need to be effective in dealing with environment 2. Autonomy - need to control the course of their lives 3. Relatedness - need to have a close, affectionate relationships with others Self-Determination Theory: 27 Basic Psychological Need Satisfaction leads to well-being Thwarting of the needs leads to psychological distress, amotivation and disengagement Nutriments to growth, integrity and well-being Need satisfaction leads to intrinsic motivation Individuals differ in terms of ‘ease’ of need satisfaction Basic Needs: Autonomy 28 A need to have a sense of control over one’s actions, thoughts and behaviours A need to be in ‘the driver’s seat’ when it comes to decision making Autonomy can still be perceived when acting under instructions if the rationale for the instruction is clear and the individual have some element of choice Autonmoy Support: Provide the opportunity for choices / reduce controllingness Provide meaningful rationale Acknowledge the performer’s feelings Use autonomy supportive language Basic Needs: Competence 29 A need to behave and perform effectively and to successfully interact within the environment. Similar to Perceived Behavioural Control (TPB), self-efficacy (SCT) and capability (BCW) Competence is a perception and satisfaction can be enhanced by providing high quality feedback, building capacity and providing safe learning opportunities. Basic Needs: Relatedness 30 A need to feel a sense of belonging and association with others. Similar to social norms (TPB) Not necessarily just about friendships or direct relationships, can be based on feeling welcome and familiar in an environment. What are ways to satisfy Basic Needs? 31 feedback goal setting ongoing communication education Opportunities for decision Self-monitoring group exercise Leadership introductions technology / apps facilitating social support Technique training Involvement in program preparation Self-Determination Theory: 32 Organismic Integration Theory: 33 Maintains the idea of Intrinsic and Extrinsic Motivation Advocates for the QUALITY of motivation rather than the quantity, Categorises motivation based on level of internalisation and autonomy What is Intrinsic Motivation? 34 Doing an activity for its own sake, rather than to receive or obtain the outcomes or rewards of the activity. Fun Enjoyment Interesting Challenging Intrinsically motivating activities are linked to high levels of autonomy and feelings of self-control What is Extrinsic Motivation? 35 Doing an activity in order to receive or obtain outcomes that are associated with performance. rewards avoiding punishment receive benefits Avoid adverse consequences of inactivity following instructions Avoiding guilt, shame, embarrassment Extrinsic motication was traditionally perceived as a poor form of motivation How does the Self-Determination Theory relate to Extrinsic Motivation? SDT differentiates extrinsic motivation based on the level of internalization an individual feels regarding the outcomes. Highly valued and meaningful outcomes / rewards leads to a very satisfying and highly internalized/autonomous motivation; If an individual exercises in order to become healthy, which is a goal that is personally meaningful to them, thenm although the exercise may not be intrinsically motivating, it may be still perceived as very internalized motivation. 36 What is Integrated Regulation? 37 Engaging in a behaviour in order to achieve important personal goals or to align actions with a sense of self. What is Identified Regulation? 38 Engaging in a behaviour out of choice in order to achieve important goals. What is Introjected Regulation? 39 Engaging in a behaviour due to reasons of pride, guilt, embarrassment avoidance, shame or other personal reasons that relate to gaining the approval of others What is External Regulation? 40 Engaging in a behaviour because of instructions from others, coercion, feeling forced, the receipt of external rewards or avoidance of punishment What is Autonomous Motivation? 41 Engaging in an activity because it is personally fulfilling as of the activity itself is rewarding (intrinsic) or the outcomes are personally meaningful (integrated/identified reg). What is Controlled Motivation? 42 Engaging in an activity to preserve one’s ego (introjected) or to please others (external) Motivation, Needs and Behaviour: 43 Autonomous motivation is strongly associated with need satisfaction, long-term behavioural engagement and well-being. Controlled motivation is strongly associated with need thwarting, no behavioural engagement or short-term engagement and poor well-being. Application of Self-Determination Theory: 44 This paper outlines the development of a need-supportive, person-centred physical activity program for frontline aged-care workers. The Transtheoretical Model (TTM) What are Stages of Change? 45 Description of how individuals progress from complete disengagement with a behaviour through to maintenance (or cessation) of a behaviour. What is TTM? 46 = When and how individuals progress through the stages of change A model suggesting that health behavior change involves progressing through six stages of behavior change In exercise physiology, what are we trying to identify by using the TTM when working with a client? 47 We are trying to identify a clients readiness to change. What are the TTM Stages? 48 Cyclical Stages of Change: 49 What are the TTM Stages? 50 Pre-contemplation Contemplation Preparation Action Maintenance What characterises the Pre-contemplation Stage? 51 Currently inactive, no intention to be active. What characterises the Contemplation Stage? 52 Currently inactive, considering or planning on starting in the near future. What characterises the Preparation Stage? 53 Sporadic activity, planning and trialling ways of increasing activity levels. What characterises the Action Stage? 54 Currently active, only recently regular activity. What characterises the Maintenance Stage? 55 Currently physically active, have been so for some time (6 months +) What are the two limitations of the TTM? 56 1. The transtheoretical model ignores the social context in which change occurs 2. Lines between stages can be arbitrary, no set criteria to determine a persons stage of change More TTM Stage Characteristics: 57 What are the Processes of Change? 58 Cognitive (Thinking) Increasing knowledge Being aware of risks Caring about consequences to others Increasing healthy alternatives Understanding the benefits Behavioural (Doing) Substituting alternatives Enlisting social support Rewarding yourself Committing yourself Remininding yourself TTM: Stage Matches Interventions 59 Interventions to increase PA can be tailored according to the Stage of Change that the individual is currently in. Acknowledgement of self-efficacy levels Acknowledgement of barriers and ability to overcome Acknowledgement of changing attitudes Direct and support processes of change (Pre, Cont, Prep) Facilitate processed of change (Prep, Action) Review processes of change (Maint) Stage Matched IV’s vs. Standard IV's 60 Integrate Behaviour Change Model Integrate Behaviour Change Model for PA: 61 What are some important features of the Integrated Model? 62 Attitudes Motivation Perceived Ability Overcoming barriers Ability within our environment Intentions Integrate Behaviour Change Model cont... 63 Consider the Autonomic: Response to stimuli isn’t always based on conscious thought processes Element of automatic/impulsiveness Self-control is required to overcome Habitual activity Low cognitive load Low self control Question… 64 Answer… Nudge Theory What is the nudge theory? 65 Based upon the idea that by shaping the environment aka choice architecture can influence likelihood one option is chosen over another Think Nudging someone where you want them to go Dual Process Theory 66 Two distinct cognitive processes that influence decision-making. What are automatic processes? 67 Unconscious thinking; relies on heuristics and emotions; prone to bias and error Associations in memory Patterned responses Innate needs/ desires Reflective Processes 68 Slow, deliberate, and conscious thinking; involves logical reasoning and critical analysis. Less bias Conscious decisions, Attitudes, Motivations Based on knowledge and values What is Automaticity 69 Typical features of automatic process Unintentional Outside of awareness Uncontrollable and efficient What are some difficulties in changing automatic processes? 70 1. Strong neural pathways resist change. 2. Deep-rooted habits impede adjustment. 3. Limited cognitive resources hinder reprogramming. Incongruent Reflective & Automatic 71 Easier to drive behaviour if Automatic and Reflective responses are similar How Can We Use Automatic Processes to Increase Physical Activity? 72 1. Create habitual cues (alarms) for exercise reminders. 2. Integrate physical activity into daily routines (exercise snacks or active transport). 3. Offer immediate rewards for engaging in active behaviors. What are some arguments to support the use of nudging in public health? 73 1. Encourages healthier choices without limiting freedom. 2. Capitalises on human biases to promote positive behaviors. 3. Cost-effective approach for improving population health outcomes. What are some arguments against the use of nudging strategies? 74 1. Raises ethical concerns about manipulation and autonomy. 2. Potential for unintended consequences or biases 3. Relies on assumptions about individual preferences and behaviors. What does MINDSPACE stand for? 75 MINDSPACE is a powerful mnemonic that highlights the contextual influences that shape our behavior, going beyond cognitive factors. Linked To Nudge Theory MINDSPACE - Messenger 76 Influence of the source on decision-making. Are they: Credibility, Trustworthy Likeable MINDSPACE - Incentives 77 The presence of rewards or punishments can drive behavior, guiding us towards certain choices and actions based on potential gains or losses. MINDSPACE - Norms 78 Social norms play a pivotal role, shaping our behavior based on what we perceive as socially acceptable or expected within our communities or groups. MINDSPACE - Defaults 79 People tend to opt for the default option when faced with choices, making default settings a potent force in influencing behavior and decision-making. MINDSPACE - Salience 80 Prominence affecting what we notice and act on. MINDSPACE - Priming 81 Subtle cues or stimuli can "prime" our minds, affecting our subsequent choices and behavior without our conscious awareness MINDSPACE - Affect 82 Emotional states and experiences influence decision-making, prompting us to make choices based on our feelings in the moment MINDSPACE - Commitments 83 Publicly made commitments, either written or verbal, can influence behavior by aligning actions with personal values or group expectations. MINDSPACE - Ego Our self-image and desire to maintain a positive self-identity can influence behavior and decisionmaking to preserve a sense of pride or reputation. 84