CHANGING BEHAVIOUR
Dr Tabassum Alvi
Assistant Professor Psychiatry/Behavioural Sciences
Majmaah university
OBJECTIVES
At the end of the session the student should be able to:
a. Explain why changing patient behavior is important
b. Describe the ‘changing behavior cycle’
c. Identify the stages in the changing behavior cycle and plan
interventions in patient care
Explain why changing patient
behavior is important
THE DIMENSIONS OF HEALTH AND THE WELLNESS
CONTINUUM
Figure 1.1
KEY DETERMINANTS OF HEALTH
Figure 1.2
• Population-level interventions may affect
individuals
• Community- and family-level interventions may
affect whole populations.
•
Human behaviour is defined as:
‘The product of individual or collective human actions, seen within
and influenced by their social and economic context’
• These actions produce observable social, cultural and economic
patterns which limit – or enable – what individuals can do.
HEALTH PROMOTION
Health promotion includes;
•
Education
•
Organization
•
Policy
•
finance
•
Environmental supports to reduce risk factors
•
Promote healthy lifestyles
Assist individuals in their pursuit of specific behavior changes;
• Identify healthy people who are engaged in risk behaviors
• Motivate people to change their actions
• Provide support that increases chance of success
HEALTH PROMOTION
Educational support: provides info. about risk behaviors and
consequences, helps facilitate learning
Organizational support: provide programs and services that
encourage participation and set up systems of social support
Environmental supports: provide rules that govern behaviors and
support behavior change
Financial support: provide monetary incentives to motivate change
toward healthy behaviors
• Health promotion increases likelihood of long term success on the road
to health and wellness
DISEASE PREVENTION:
• Primary prevention – Reduce risk and avoid health
problems before they start
• Secondary prevention – Interventions that take action to
stop risk behaviors before an actual illness
• Tertiary prevention – Treatment/rehabilitation after an
illness
BEHAVIOUR CHANGE
…1
List the important changes in the pictures ???
BEHAVIOUR
CHANGE…2
Today its me,
because of u...
Tomorrow its u,
because of me...
Fully burnt Cigarette ASH
Smokers Lung
Quit smoking... Tar the roads... NOT your LUNGS!
Describe the ‘changing behavior cycle’
5A’s-Assess, Advise, Agree,
Assist, Arrange
Diagram adapted from: Glasgow, R. E & Nutting, P. A. (2004). Diabetes. In Handbook of
Primary Care Psychology. Ed., Hass, L. J. (pp. 299-311)
Assess
Risk Factors, Behaviors, Symptoms,
Attitudes, Preferences
Advise
Specify plans for
follow-up
(visits, phone calls,
mail reminders)
Specific, personalized,
options for tx, how sx
can be decreased,
functioning, quality of
life/health improved
Personal Action Plan
1. List goals in behavioral terms
2. List strategies to change health behaviors
3. Specify follow-up plan
4. Share plan with practice team
Assist
Agree
Provide information, teach
skills, problem solve
barriers to reach goals
Collaboratively select goals
based on patient interest and
motivation to change
14
Arrange
Identify the stages in the changing
behavior cycle and plan interventions in
patient care
HOW TO CHANGE BEHAVIOUR
???
FIVE STAGES OF BEHAVIOUR CHANGE
Stage 5
Maintenance
Stage 1
Precontemplation
Stage 4
Action
Stage 2
Contemplation
Stage 3
Preparation
PRECONTEMPLATION.
• People do not intend to take action in the foreseeable future,
usually measured as the next six months.
• Being uninformed or under informed about the consequences of
one’s behavior may cause a person to be in the Precontemplation
stage.
• Multiple unsuccessful attempts at change can lead to demoralization
about the ability to change.
•
Both the uninformed and under informed tend to avoid reading,
talking, or thinking about their high-risk behaviors.
• They are often characterized in other theories as resistant,
unmotivated, or unready for help.
CONTEMPLATION.
People intend to change in the next six months.
They are more aware of the pros of changing, but
are also acutely aware of the cons.
This weighting between the costs and benefits of
changing can produce profound ambivalence that
can cause people to remain in this stage for long
periods of time.
Individuals in the Contemplation stage are not
ready for traditional action-oriented programs that
expect participants to act immediately.
PREPARATION
People intend to take action in the immediate future,
usually measured as the next month.
Typically, they have already taken some significant
action in the past year.
These individuals have a plan of action, such as
joining a health education class, consulting a
counselor, talking to their physician, buying a self-help
book, or relying on a self-change approach.
These are the people who should be recruited for
action-oriented programs.
ACTION
People have made specific overt modifications in their
lifestyles within the past six months.
Overall process of behavior change often has been
equated with action. But in the TTM, Action is only one
of six stages.
Typically, not all modifications of behavior count as
Action in this Model.
For example, reduction in the number of cigarettes or
switching to low-tar and low-nicotine cigarettes were
formerly considered acceptable actions.
Now the consensus is clear—only total abstinence
counts.
MAINTENANCE.
People have made specific overt modifications
in their lifestyles and are working to prevent
relapse;
they do not apply change processes as
frequently as do people in Action.
People are less tempted to relapse and grow
increasingly more confident that they can
continue their changes.
Maintenance lasts from six months to about
five years.
TERMINATION.
• Individuals are not tempted; they have 100% self-efficacy.
• Whether depressed, anxious, bored, lonely, angry, or stressed,
individuals in this stage are sure they will not return to unhealthy habits
as a way of coping.
• It is as if their new behavior has become an automatic habit.
Examples:
• Adults who have developed automatic seatbelt use or who
automatically
• Take antihypertensive medication regularly
Two components of decisional balance, the pros and the cons, have
become critical constructs in the Transtheoretical Model.
STAGES OF BEHAVIOUR
CHANGE… DIABETES
Stage 1
Precontemplation
Stage 2
Contemplation
I don’t have
disease …..
I am no
more
Happy… I
am
worried… I
am having
Diabetes
Why should
I change ????
Stage 3
Preparation
I am ready to
change
Stage 4
Action
I am doing…
Stage 5
Maintenance
I will
continue to
do….
• I want to LIVE... • Learn regarding • Dietary changes • Positive reenforcement,
I will save myself healthy practices • Physical activity
• Filter facts from • Regular
Negative re• Prevention is
Myths
enforcement
better then cure
medicines
• Doctor calling
and awarding
• Opinion leader
BEHAVIOR CHANGE
PROCESS
STAGES OF CHANGE
CONTINUUM
Unaware
Aware
Concerned
Knowledgeable
Motivated to
change
Trial behaviour
change
Sustained
behaviour
change
CHANNELS
Mass media
Community
networks and
traditional media
Interpersonal/group
communication
Enabling factors
•Effective
communication
•Enabling
environment
•User friendly
services and
accessible
commodities
MYTHS AND FACTS ABOUT
BEHAVIOUR CHANGE
MYTHS
Crisis is a powerful impetus for
change
Change is motivated by fear
We can't change because our
brains become "hardwired" early
in life
Behaviour change methods
don’t yield adequate results
Change in behaviour is not sustained
FACTS
People go into denial of the bad things that
might happen to them
To achieve sustainable results, it takes
time.
Regular reinforcements are needed
Majority of patients don't sustain changes
in the unhealthy lifestyles that worsen their
disease
Change for better is always difficult to
make
We can continue learning complex new
things throughout our lives
Behaviour addressed should be the
“felt need” of the people targeted
Community involvement is important
for success of any change process
ASSIGNMENT
Write a learning agreement showing how the theories of
changing behavior can be used to improve patient care