Individual-Level Interventions

EPHE 348

Interventions

Defn: promoting activities that change psychosocial, biological, or behavioural outcomes

– Efficacy trials – Effectiveness trials

So….what works?

Average individual-level intervention effect is a small effect size (Dishman & Buckworth, 1996; Hillsdon et al., 2005; Kahn et al, 2002)

This lowers with clinical, obese, and disabled populations

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Healthy Obese CHD D.P. P.D.

Figure 17.2

Types of interventions

Behaviour modification (small effect)

Cognitive modification (trivial)

Health education (trivial)

Prescription (trivial)

Curriculum (small)

Implemetation

Marcus et al. 2007 show relatively little difference across medium (face to face, internet, booklet, group, etc.)

Face to face and internet have current appeal

What Generally Makes A Good Exercise Counselor?

Most important instrument during prescription is yourself as a person

Bring the human qualities and the exercise experiences that have influenced yourself to the session

Being merely a technical expert will result in a sterile experience for the client

General Exercise Counseling Roles

Provide a climate for change

Arrive at an prescription/intervention that is best for the client while meeting the requirements of the prescription

Help clients recognize their own strengths and weaknesses, and discover how to overcome their barriers

When Should You Counsel?

Counsel when the issues are linked to exercise or you have knowledge in the area of concern

Do not counsel when the area is out of your expertise (e.g., depression). Instead refer to a specialist

Decision-Making Paradigm

FitnessAssessment

Development ofExercise Program

Implement FitnessProgram

Formal Counseling

Exploration

Identify PsychosocialFactors

Assess & DevelopStrategy or Refer

Informal Counseling

Exploration

Identify PsychosocialFactors

Assess & DevelopStrategy or Refer

Counseling Strategies

Three components of Communication– Attending

awareness of nonverbal behaviorawareness of client’s nonverbal behavior

– Listeningunderstanding feeling and content of verbal

messagesidentifying incongruities

– Empathic Respondingshowing Empathyunderstanding core message

Attending:Nonverbal Behavior of the Counselor

Examples

– squaring turning one’s body to fully focus attention. Failure to do so can reflect disinterest and lack of respect.

– energy level –Absence of energy is frequently interpreted as a lack of interest or preoccupation. Presence of energy will directly affect the clients openness to you and also affects “approachability”.

Nonverbal Behavior of the Counselor Cont...

– Posture – folded arms crossed legs, foot shaking. Can be signs of disinterest in the client or topic.

– Eye contact – most common and powerful technique. In our society, steady eye contact reflects interest.

– Others to watch are: facial expressions, gestures, voice volumes, mannerisms

Keep behavior congruent with the message!

Attending: Nonverbal Behavior of Clients

Often more significant than verbal communication

Conveys 65% of the meaning in a message (Gazda, 1984).Powerful because it is not as censored.

Look for incongruities (e.g., smiling with a nervous gesture)

Listening Active listeners can accurately identify

congruities and inconsistencies in verbal and nonverbal behavior

5WH strategy “who” “what”, “when”, “where”, “why”, and “how”

Empathic Responding

Empathy – ability to understand the experience of another person from that person’s frame of reference

May be the most important factor for bringing about change (Rogers, 1957)

May need to paraphrase or perception check to make this work

Key to Exercise Counseling

Be aware of these strategies

Develop your own style

Exercise Get into groups of three

Assign roles: 1) client, 2) counselor, 3 observer

Client talks about what she/he has done over the past weekend and what she/he felt about it

Observer marks the use of counseling strategies by the counselor using the check list

Do for 5 minutes then switch roles….

Setting in Interventions

Home superior to Community-based (small effect size difference) – Rhodes et al., in press

School (small)

Worksite (small)

Health Care (small to trivial)

Multi-site may be most effective (McKay et al., in press)

Social Context

Group (ranges) Individual (small) Family (trivial)

Supervised (small) Unsupervised (ranges)

Interventions by Theory Rhodes & Pfaeffli , in press

Theory # of Studies % Symmetry

% Positive Symmetry

Formal Mediator Analysis

TTM 9 78% 22% 4 (mixed 2-2)

SCT 3 100% 67% 1 (mixed by constructs)

TPB 3 100% 33% None conducted

PMT 2 100% 50% None conducted

SDT 2 100% 50% None conducted

Results: Construct Evidence

Construct # of Studies % Symmetry

% Positive Symmetry

Formal Mediator Analysis

Self-Efficacy 22 73% 23% 5 (1 support; 4 null)

Outcome Expectations

16 69% 19% 4 (all null)

Self-Regulatory Processes

18 83% 33% 4 (mixed 2-2)

Social Constructs

9 78% 22% 2 (mixed 1 – 1)

Self-Regulatory Strategies: What Works?

1) Planning- moving from vague intentions to concrete plans..

When, where, how, and what

2) Problem solving – identifying obstacles and creating alternative solutions

Goal Setting (Locke & Latham, 1981)

Technique that effectively increases performance in many domains

Goal – “attaining a specific standard of proficiency on a task, usually within a specified time limit”

90% of studies have found this technique effective

How Does Goal Setting Work?

Directs attention to the task (allows for a map)

Prolongs effort over time (reviewing & revising goals)

Motivates the person to develop relevant strategies to attain the goals (breakdown of requirements)

The Findings in Goal Setting Research

Specific goals are more effective than general goals

Short term goals help attain long-term goals

Goal setting is most effective when feedback is provided

Goals need to be accepted by the client to be effective

How to Goal Set 1) Specify the task to be done

2) Determine how progress will be measured

3) Specify the standard to be reached

4) Specify the time period in which to reach the goal

5) Prioritize goals

6) Modify goals from time to time when necessary

SMART

Specific Measurable/Meaningful Attainable Realistic Time-Frame

Exercise Enjoyment and Strategies to Enhance EnjoymentInstruction: 1.In the COLUMN A, list the factors related to PROXIMITY of where you plan to exercise,2.In the COLUMN B, list the AESTHETIC factors of the environment where you plan to exercise,3.In the COLUMN C, list the ways to enhance your engagement in exercise, including factors that increase your INTEREST in exercise, opportunities for SOCIAL interaction, and other aspects that provide VARIETY to your exercise routine (i.e. listening to music)

COLUMN APROXIMITY

COLUMN BAESTHETICS

COLUMN CINTEREST

Example: Where will I exercise? Is the location where I plan to exercise close to my home?

Example: Is the location a pleasant environment for performing exercise?

Example: How can I…-make exercise more interesting/stimulating?-involve friends and family or others in exercise?-incorporate variety, and other aspects such as music to enhance my engagement in exercise?

Location #1: Factor #1: Interest:

Location #2: Factor #2: Social:

Location #3: Factor #3: Variety:

Patient Signature:______________________

therapist Signature:__________________

Date:_____________________________

Date:________________________

Tangible Incentives

E.G., awards, time off, money etc. Most people respond to this if the tangible

incentive is sought by the individual Caution: extrinsic factors should not

replace intrinsic interest itself Best strategy is to initiate with these and

slowly drop them out of the program Also must watch the “satiation factor”. A

strategy is to use variable incentives