Lecture 1: Theories and Models Used to Design and Implement an Intervention - PDF

Lecture 1: Theories and models used to design and implement an intervention Sarah Blunden PDt MSc (c) CDE August 30 2024 NUTR 511 Nutrition and Behaviour  Agenda 1 2 3 4 Introduction Course Outline Primary Goals Theorie...

Lecture 1: Theories and models used to design and implement an intervention Sarah Blunden PDt MSc (c) CDE August 30 2024 NUTR 511 Nutrition and Behaviour  Agenda 1 2 3 4 Introduction Course Outline Primary Goals Theories and Questions models used to design implement an intervention. 2 2023  Introductions 3 2023  Course Outline 4 2023  Evaluations 5 2023  Part 3: After your 5-day diary: Propose a new policy, change, global/individual intervention that could address the role of the food environment and its components (marketing, packaging, influencers, etc..) in the diet of individuals in Canada. - Answer: o What is the name of the policy? o What would be the policy? What are the main components? o Why do you think it would work? o How would you measure its effectiveness? Due date: Oct 3th 11:59 P.M. Format: Digital (Word or PDF). Any font, size 12. Single spacing, regular margins. MAX length: 2 pages for Part 1, 1 page for each daily entrance (total of 5). 1 page for policy proposal. Citations needed (any format). Grading: 15% iii) Group presentation: A set of case studies will be uploaded to MyCourses. Your group (3 students) will select one to present in class during the assigned class times (Oct 25 – Nov 29). The case study consists of a real-life scenario of a relevant topic discussed in class. For the presentation, you will have to present: A description of the case, a theoretical introduction (a summary of your case report with references), why the group chose it, how it can be referenced to class material and discussions, how you would address the topic, barriers, how it is relevant to the “real world”. All members of the group must participate in the oral presentation. Format: PowerPoint presentation Grading: Complete content on the slides, relating to course material (10%). Oral presentation skills (5%). 6 2023  Evaluations 7 Presentation title 20XX 8 Presentation title 20XX 9 Presentation title 20XX 10 Presentation title 20XX 11 Presentation title 20XX  Topics : top choice and what is missing? 12 2023  1. Define the different models and theories 2. Understand how to implement the different models and theories Objectives 3. Discuss their purpose and benefits 4. Discuss their limitations 5. Questions 13 2023  Why? Theories and theoretical models consist of principles, constructs, and variables, which offer systematic explanations of the human behavior change process. Behavior change theories and models provide a research-based rationale for designing and tailoring nutrition interventions to achieve the desired effect. A theoretical framework for curriculum and treatment protocols, it guides determination of: (1) what information patients/clients need at different points in the behavior change process, (2) what tools and strategies may be best applied to facilitate behavior change, and (3) outcome measures to assess effectiveness in interventions or components of interventions. https://www-ncpro-org.proxy3.library.mcgill.ca/pubs/2020-encpt-en/codeC-1  The Theories and models The following theories and models have proven valuable in providing a theoretical framework for evidence-based individual and interpersonal level nutrition interventions. Other theories may be useful for community level interventions (eg, Community Organization, Diffusion of Innovations, Communication Theory). Nutrition counseling based on cognitive behavioral theory approach Nutrition counseling based on health belief model Nutrition counseling based on social learning theory approach Nutrition counseling based on transtheoretical model and stages of change approach 15 2023  Typically Used with the Following 16 2023 17 2023  Other considerations? environment, physical activity 18 2023  Nutrition Counseling Based on Cognitive Behavioral Theory Approach Description CBT is based on the assumption that all behavior is learned and is directly related to internal factors (eg, thoughts and thinking patterns) and external factors (eg, environmental stimulus and reinforcement) that are related to the problem behaviors. Application involves use of both cognitive and behavioral change strategies to effect behavior change. Implication for Counseling Interventions CBT, derived from an educational model, is based on the assumption that most emotional and behavioral reactions are learned and can be unlearned. The goal of CBT is to facilitate client identification of cognitions and behaviors that lead to less-than-optimal eating or exercise habits and replace these with more rational thoughts and actions. 19 2023 The process is: Goal directed Process oriented Facilitated through a variety of problem-solving tools Behavioral and cognitive techniques to modify eating and exercise habits are taught for continuous application by the client. Practitioners implement Cognitive Behavioral Theory by partnering with clients to study their current environment to: Identify determinants or antecedents to behavior that contribute to less-than-optimal eating/exercise Identify resultant behavior (eg, overeating, vomiting) Analyze consequences of this behavior (cognitions, positive and negative reinforcers and punishments, eg, decreased anxiety, feeling over full, losing or gaining weight) Make specific goals to modify the environment/cognitions to reduce target behaviors 20 2023  Cognitive and behavioral strategies used to promote change in diet and physical activity may include: Goal setting Self monitoring Problem solving Social support Stress management Stimulus control Cognitive restructuring Relapse prevention Rewards and contingency management https://www.youtube.com/watch?v=Jz55Uk9EH6U 21 2023  The Health Belief Model (HBM) is a psychological model that focuses on an individual’s attitudes and beliefs to attempt to explain and predict health behaviors. The HBM is based on the assumption that an individual will be motivated to take health-related action if that person (1) feels that a negative health condition (eg, diabetes) can be avoided or managed, (2) has a positive expectation that by taking a recommended action, he or she will avoid negative health consequences (eg, good blood glucose control will preserve eyesight), and (3) believes he or she can successfully perform a recommended health action (eg, I can use carbohydrate counting and manage my diet. I can engage in regular physical activity). 22 https://www-ncpro-org.proxy3.library.mcgill.ca/pubs/2020-encpt-en/codeC-1-HBM 2023  Health Belief Model 23 https://www-ncpro-org.proxy3.library.mcgill.ca/pubs/2020-encpt-en/codeC-1-HBM 2023 24 https://www-ncpro-org.proxy3.library.mcgill.ca/pubs/2020-encpt-en/codeC-1-HBM 2023 25 https://www.youtube.com/watch?v=Knedre8Ul60 2023 Presentation title  Nutrition Counseling Based on Social Learning Theory Approach Description Social Learning Theory, also known as Social Cognitive Theory, provides a framework for understanding, predicting, and changing behavior. The theory identifies a dynamic, reciprocal relationship between environment, the person, and behavior. The person can be both an agent for change and a responder to change. It emphasizes the importance of observing and modeling behaviors, attitudes and emotional reactions of others. Determinants of behavior include goals, outcome expectations, and self-efficacy. Reinforcements increase or decrease the likelihood that the behavior will be repeated. Implication for Counseling Interventions Social Learning Theory is rich in concepts applicable to nutrition counseling. The following table provides definitions and application guidance for the key concepts of the theory. https://www-ncpro-org.proxy3.library.mcgill.ca/pubs/2020-encpt-en/codeC-1-SLT 27 2023  https://www-ncpro-org.proxy3.library.mcgill.ca/pubs/2020-encpt-en/codeC-1-SLT 28 2023  https://www.youtube.com/watch?v=UZLx_l5my48 https://www-ncpro-org.proxy3.library.mcgill.ca/pubs/2020-encpt-en/codeC-1-SLT 29 2023 Presentation title Stages and Processes of Health Behavior Change CHAPTER 5  Transtheoretical Model/Stages of Change ▪ Purpose is to guide timing and content of interventions for better health ▪ Meets client at level of behavior change they are ready to address Figure 5-1 Clients progress through stages of change.  Stages of Change (1 of 5) Change viewed as unfolding process over time https://www.youtube.com/watch? v=VVyhhMzWkiU Presentation title  Stages of Change (2 of 5) Precontemplation Client unaware, uninformed, or unconcerned about problem Must assess client’s views on making a change and address reasons for not wanting to change Contemplation Client aware problem exists and intends to do better eventually  Stages of Change (3 of 5) Preparation Client determined to make a change and intends to take initial action soon (30 days) Counselor may inquire about: Becoming more physically active Making nutritional choices that support heart health Keeping records of food intakes  Stages of Change (4 of 5) Action Client takes action to implement plan and overcome problem Counselor develops relationship with client Maintenance Client integrates new health behaviors into lifestyle over several months or years  Stages of Change (5 of 5) Termination Changes have been maintained for years Recycling (relapse) Most people proceed through stages in a spiral, rather than linear fashion Lapses and relapses common problems  Processes of Change (1 of 5) 10 processes of change to progress through SOC when there are shifts in behaviors, thoughts, and intentions Cognitive and behavioral activities with specific tasks and goals to be accomplished  Processes of Change (2 of 5) Consciousness raising Increases awareness of risks and consequences Dramatic relief or catharsis Increases emotional awareness about unhealthy behavior Self-reevaluation Reassessments of self-image with or without unhealthy eating  Processes of Change (3 of 5) Environmental reevaluation Assessment of how problem affects client’s social environment Self-liberation Belief that one can change and commitment to act on that belief Social liberation Increases social alternatives and opportunities  Processes of Change (4 of 5) Counterconditioning Changing behavior in response to activities Stimulus control Replaces unhealthy environmental cues with healthy ones Reinforcement management Positive reinforcement and rewards for healthy behaviors  Processes of Change (5 of 5) Helping relationships Provide caring, openness, acceptance, and support for healthy food choices and behavior change  Matching Processes to Stages of Change (1 of 2) Precontemplation stage Consciousness raising and self-reevaluation Contemplation stage Consciousness raising, self-reevaluation, and environmental reevaluation Preparation stage Stimulus control, reinforcement control, and self-liberation  Matching Processes to Stages of Change (2 of 2) Action and maintenance stages Stimulus control Counter conditioning Reinforcement management Self-monitoring Recipe modification Learning coping responses Developing a social support system  Decisional Balance Uses motivational interviewing to move patient forward Process of weight pros and cons to address behavior change Most often used in precontemplation or contemplation Changes in pros need to occur more frequently than changes in cons Decisional Balance Example  Self-Efficacy One’s belief that they can: Control their own actions or events that influence their lives Cope with temptations in high-risk situations without relapsing Affects motivation and coping https://www.youtube.com/watch?v=SGezYkj5EEo Presentation title https://courses.lumenlearning.com/suny-buffalo-environmentalhealth https://www.frontiersin.org/files/Articles/482389/fpubh-08-00131 /part/chapter-3/ HTML/image_m/fpubh-08-00131-g001.jpg 50 2023 https://www.youtube.com/watch?v=5NNw0GSUR-c Presentation title  Theories and Models Health Belief Cognitive Social Model Behavior Learning Theory Theory Ecological Transtheoret- Model ical Model/Stage s of Change Questions? 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