Behavior Change Self-Study:
Self monitoring and Goal Setting
Michael T. Smith, Ph.D.
JHU CENTER for BEHAVIOR
msmith62@jhmi.edu
5510 Nathan Shock Dr., STE 100
Baltimore, MD 21224
410-550-7000 Phone
Aims
1) Brief review of take home messages from first lecture on
principle of behavior change
2) Reinforce the Utility of Health Belief for the BMW Rotation
3) Introduce the Experiential learning component of the
rotation
•
Goal setting / Self Monitoring with FitBit tracker
•
Physical activity or Sleep Duration
•
Social Learning Dimension
•
Activity Group Discussions (creating a community
focused on facilitating behavior change)
•
Incentives plan for posting
Take Home Messages
1) Myth: Behavior change is hard
2) Start with targets where patient is ready , confident & able
3) Make it personal (appeal to the beast)
4) Set small realistic SMART goals (75% confident)
5) Use Prompts, triggers, & clear environmental path /barriers
6) Use social learning principles

Make public a personal commitment

Modeling

Norms
7) Self monitoring: must be easy and informative
General Principles of Behavior
Change: Health Belief Model
Seriousness of the risk / disease
Odds it will happen to me ?
Ability to change ?
Reminders / Triggers
Self Efficacy
is King
To help patients make a health behavior change: 1) Teach patients how serious their related medical
condition is and how behavior influences it. Convince patients that a bad disease outcomes are likely to
happen / are happening to them personally. Bolster their perceived ability (confidence) to make the
behavior changes. Teach them to use prompts in their environment to remind them to change.
Experiential Learning Component:
Objectives
Overall Objectives:
1) Increase empathy for the challenges of asking patients to change
2) Gain in insight into use of goal setting, self-monitoring, social
determinants, and incentives as behavior change tools
1) Increase self-efficacy for helping patients make sustainable
changes
1)
Create a supportive culture of healthy behavior change
 We serve as models for ourselves and our patients
2) Establish enduring resources for the JHMI community for
patients and healthcare professionals
3) Improve your own health / wellbeing and have fun
Experiential Learning Module:
Overview
Two Components Managed Online Via Fitbit Website:
1) Rotation-related Small Groups
• Goal Setting / Self-Monitoring
• Opt to view and discuss each others progress towards personal goals on
line (sharing is optional)
• Aggregrate the data by cohort for comparison by other cohorts
2) General Discussion Groups (not personal goals)
Physical Activity
Eating Behavior / Obesity
Substance Abuse / Alcohol
Smoking / Tobacco
Sleep
General Health Behavior Change
Ground Rules: small group & general
discussion groups
• Posting personal goals / sharing progress / data is optional
• Only open to Hopkins residents and CBH faculty / staff
• Absolutely No PHI
• Be Kind & Respectful of yourself, peers and patients
• No profanity
• No question is stupid
• Push yourself a little
Rotation-Related Small Groups
Self-Monitoring
•If you can not measure it, you can not improve it. - Lord Kelvin
•Establishing a baseline to measure progress is critical
•Must be quick and easy: objective data is especially helpful
•Immediate real-time digestible feedback on behavior
•
Can act as a prompt / reminder
•
Easier to make small course corrections than deal with large setbacks
Strategies and tools : Preparation
Goal Setting:
Poorly crafted goal: “I want to lose weight.”
Smart goal
Specific:
Measurable:
Action - Oriented
Reasonable:
Time Delineated
Long-term Goal
“I want to lose 1 pound / week for 3 months by:”
Short-term Goals / Steps
1) Decrease alcohol to 2 servings / week
2) Cut meal portion sizes by about 20% and limit red meat to 2X week
3) Limiting snacks to 100 calories of fruits & veggies between meals
4) Walking 10,000 steps, 4 days a week
Physical Activity Goal
Setting a Long-term (3 – 6 month) PA Goal: where to start
DHHS Guidelines Adults (18-64 years olds):
•150 minutes / week of moderate-vigorous aerobic physical activity
• 30 Minute brisk walk, 5 days a week or more.
• Accumulate in intervals at least 10 minutes at a time
• shorter intervals do not have the same health benefits.
•Strengthening activities, like push-ups, sit-ups and lifting weights,
• at least two days a week.
Physical Activity Goal:
Setting a Long-term PA Goal: a place to start
Pedometer Programs Are Effective (several meta-analyses)
•
Richardson et al. Annals of Family Medicine, 6(1), 69-77 & Bravata et al., JAMA, 298(19), 2296-304
10,000 Steps-a-day as a long-term target – Why?
•Individuals meeting 10,000 steps / day; likely to meet DHHS PA guidelines
•
(LeMasurier et al., Res Q Exerc Sport , 74, 389-94)
•Lowers blood pressure in mild essential hypertension
•
•
Iwane et. al., Hypertension Research, 23, 573-580
Produces weight loss over 36 weeks in sedentary overweight / obese
adults
•
Schneider et al., American Journal of Health Promotion, 21, 85-89 (2006)
Normative Data, Steps / Day:
Bohannon, Physical Therapy, 87(12), 1642-1650 (2007)
Special Population
Targets to Consider (Engel
& Lidner, Diabetes Education,
32(1), 2006)
Healthy older adults:
6000-8500 step / day
Older Adults with
disabilities and chronic
illnesses:
3500-5500 steps / day
•
Canadian Amish Steps/Day: Males (aged 34 = 18,425/day & Females Aged 32 = 14,196/day
Physical Activity Goals: Approaches
a) Percentage increase from baseline: e.g., 25%
b) Graded approach
If baseline:
< 8000 step / day: increase by 10% every 2 weeks until 10K and hold
8000 - 10,000 / day: increase by 5% every 2 weeks until >10,000
If > 10,000 / day: Consider specific goals for exercise, e.g. 30 min/day of
moderate to vigorous activity to include jogging 4 days/week for 30 mins.
C) Increase by a constant from baseline: + 2000 steps
- increasing 400 steps a week
Sleep Duration
Goal
If Sleep has no purpose, then
it would be the biggest
mistake evolution has ever
made...
Allan Rechtschaffen
38% of Adults
Report Insufficient
sleep (CDC)
Kripke et al. 2001, Arch Gen Psych
Self-Reported Total Sleep Time
Sleep Duration Increases Diabetes
Risk
•
Experimental sleep restriction to 4 hrs/night for 6
days causes insulin resistance (Spiegel et al. (Lancet, 1999)
•
Sleep duration impacts prevalence of diabetes
Adjusted for age, sex, race, waist girth, caffeine,
alcohol, smoking, and apnea-hypopnea index
Gottlieb et al. (2005)
Arch Intern Med
J of Sleep
Research
2, 1-12 (2003)
Sleep Extension Goal Setting:
Strategies/Approach
Normal adult sleep ranges between 7- 8.5 hours / night
•
This may be insufficient for some.
•
•
Historically before advent of electric light, average sleep time was 8.5+/night
Considerable individual variability in sleep need
• Make small weekly increments (5 or 15 minutes)
• Consider Chronotype (lark or owl)
•
Generally easier to get up later than to go bed earlier
• Intrinsic clock is 24 hour +20 mins
• Getting up later is going with the grain
• unless phase advanced and / or older adult
• Stopping rule for sleep window extension
•
Average weekly Sleep Efficiency (total sleep time / Time in BED * 100) drops
below 85-90%
Sleep Extension Goal Setting:
CAVEATS
1) Appropriate for insufficient sleep syndrome:
•
Normal sleep that is curtailed due to choice, habits or environmental
circumstances
2) Do not select this goal if you likely have a sleep disorder.
• Insomnia - trouble initiating or maintaining sleep with daytime
consequences:
•
•
•
•
•
•
•
Despite adequate sleep opportunity
Sleep Extension will make Insomnia worse
Sleep apnea
Circadian Rhythm Disorders
Periodic limb movement disorder
Restless legs syndrome
Narcolepsy/hypersomnia
General Discussion Groups
• 6 Content Areas: Moderated by CBH “champions”






Physical Activity
Eating Behavior / Obesity
Substance Abuse / Alcohol
Smoking / Tobacco
Sleep
General Health Behavior Change
•
Open to all residents and CBH Faculty as soon as they they signup
for their fitbit account.
•
During Rotation must post at least 1 new question or comment a
week in different categories that arise related to patient care
• General questions (no PHI)
• Seeking resources
• Issues / Concerns
CBH General Discussion Groups
• Discussion threads intended to be an educational resource only
• Not to be construed as psychological or medical advice/consultation
• Champions will log in at least once / week
• Gems and teaching points that are particularly useful will be edited
into enduring materials to compliment the existing materials on the
CBH website.
• Champions and CBH faculty will be encouraged to share their fitbit
data with the general community
• Norms
• Role model
Incentivizing Discussion Behaviors
•Monthly $100 Prizes (must be health-related items)
• E.g. Exercise clothes, fruit, session with a personal trainer, etc
•To be eligible for a monthly prize (winner determined by lottery)
• Must make at least one substantive post during the month
• Earn up to one new entry in the monthly drawing per week
•
Post can’t simply be a brief reply of encouragement (though this is encouraged)
•
Must be a new thread / topic / query / issue / resource / thoughtful comment
•Grand Prize at end of the program = $1,000 value of a Health-related item
or service
•
•
•
year long membership at Maryland Athletic Club
A bike
Treadmill, etc.
To be eligible for grand prize – must have at least 1 substantive post every
month for 8 months
Earn up to one new entry in grand prize drawing for every month in which
all weeks had a least one post
From: Financial Incentive–Based Approaches for Weight Loss: A Randomized Trial
JAMA. 2008;300(22):2631-2637. doi:10.1001/jama.2008.804
Effect of incentives may attenuate over time
Best where short-term behaviors can have a major impact
•
•
Incentivizing perinatal care, Physical Rehab, etc
Extrinsic motivation might compromise intrinsic motivation in some personality
types
Date of download: 1/16/2014
Copyright © 2014 American Medical
Association. All rights reserved.