UK Society for Behavioural Medicine
9th Annual Scientific Meeting
“Behavioural Medicine: From Laboratory to Policy”
University of Oxford Examination Schools
Monday 9 and Tuesday 10 December 2013
NPRI
UK Society for Behavioural Medicine
9th Annual Scientific Meeting
“Behavioural Medicine: From Laboratory to Policy”
Parallel Session A
Behaviour Change
11.05-12.20
Chaired by Jean Adams
NPRI
UK Society for Behavioural Medicine
9th Annual Scientific Meeting
“Behavioural Medicine: From Laboratory to Policy”
Testing the Process Model for
Behaviour Change in a
Weight Loss Intervention
Fiona Gillison
NPRI
Processes of behaviour change and weight
loss in a theory-based weight loss
intervention programme (Waste the Waist)
Fiona Gillison
Afroditi Stathi, Prasuna Reddy, Rachel
Perry, Gordon Taylor, Paul Bennett,
James Dunbar & Colin Greaves.
Waste the Waist
• 9 sessions held over a 9 month period
• Two key messages
• Small changes can make a big difference
• Aim for a lifestyle that is healthy and enjoyable
• Initially based on HAPA model (motivational phase,
volitional phase)
• Ask – Tell – Discuss
• Patient centred counselling techniques
Changing behaviour
Get Motivated
Take Action
Trial and Error
Process Model for Lifestyle Behavior Change
Action
Motivation
Maintenance
understand
the process
enhance
motivation
engage
social support
make
plans
try it out
/monitor
progress
review
progress
deal with
setbacks
Overarching philosophy: empowerment / empathy-building
Initial results
- 108 high CVD risk participants recruited through health
checks and GP lists (M age = 65, BMI = 33, 33%
women)
- 55 received intervention, across 6 groups
- Main outcomes:
Intervention
group
Control
group
Effect size
Weight loss 4 months (kg)
3.33 (3.48)
.99 (3.57)
.66
Weight loss 12 months (kg)
4.25 (5.49)
2.04 (6.87)
.35
Change in fat and fibre intake
Effect sizes:
fat: d=.21
fibre: d=.70
6
4
2
grams
0
4 months
-2
-4
-6
-8
12 months
Intervention group
4 months
12 months
Control group
Fat intake
Fibre intake
Change in MVPA
Effect size:
d=.11
5
4
Minutes per day
3
2
1
0
4 months
12 months
Intervention group
-1
4 months
12 months
Control group
Testing the model: Q2
Diet related variables
Intervention
d = .81***
d = .29
d = .97***
d = .39
Understand the
BC process
Enhance
importance
Enhance
confidence
Engage social
support
Testing the model: Q2
Physical activity related variables
Intervention
d = .81***
d = .67*
d = .42**
d = .89***
Understand the
BC process
Enhance
importance
Enhance
confidence
Engage social
support
Testing the model: Q3
Q3: Did changes in process variables lead to increased
participation in action planning, coping planning and
self-monitoring?
Process variables for diet (4 months)
Change
Correlations at 4
months
Action planning
Coping
planning
Self-monitoring
Understanding
importance
Selfefficacy
Social
support
Testing the model: Q3
Q3: Did changes in process variables lead to increased
participation in action planning, coping planning and
self-monitoring?
Process variables for diet (4 months)
Change
Correlations at 4
months
Action planning
Coping
planning
Self-monitoring
Understanding
importance
Selfefficacy
Social
support
Q4: Did self-regulatory activities impact
behavioural variables?
Short term:
• Diet self-monitoring mediated self-efficacy - weight loss
• Diet self-monitoring mediated understanding – fat intake
Long term:
• Diet coping planning associated with weight loss
• Diet self-monitoring associated with fat intake
• PA action and coping planning associated with MVPA
In summary…
- Largely supported for diet but not PA
- Self-efficacy and self-monitoring strongest
effects
- Limited evidence coping planning may be more
important long-term
Where does that leave us now?
Lack of effect for PA
1) Model not applicable, or not sufficiently comprehensive
for physical activity
• What other process factors may be important?
2) Are bigger changes in mediating variables needed to
promote physical activity?
• Failed to change some constructs (AP, CP) that were predictive
of outcomes
Where does this leave us now?
Some inconsistent results for diet
•
Fat & fibre intake predicted by different factors
•
•
Which other dietary behaviours may be influenced, and by
what? (e.g., portion size)
No effect on importance and social support
•
Introduction of different strategies may be needed
Thank you for listening!
http://www.bergerandwyse.com/food-cartoons/wide-foods/
UK Society for Behavioural Medicine
9th Annual Scientific Meeting
“Behavioural Medicine: From Laboratory to Policy”
NPRI