understanding behaviour change michelle constable health psychologist intraining
TRANSCRIPT
Understanding behaviour change
Michelle Constable
Health Psychologist inTraining
Content
• What is health psychology?• Lets start a conversation!• Models of behaviour change• Communication• Motivational Interviewing• How to communicate your message• Things to consider when planning a project
Health Psychology?
• Promotion and Maintenance of Health
• Prevention and Treatment of Illness
• Cause and diagnostic relationship of Health and Illness
• Health care system and health policy
What areas do Health Psychologists research?
• Stress• Dr/patient communication • Risk behaviours – smoking/alcohol• Health protective behaviours• Health cognitions/beliefs• Long term conditions – coping/resilience
Lets start a conversation!
• What does current practice look like?• What tools/apps do you recommend?• What methods/theories do you use?• How do you communicate your
message?• What challenges do you face?
Models of Behaviour change
Determinants of health
Stages of change
Procheska and DiClemente (1982)
The COM-B Model
Michie S, M van Stralen, West R (2011) The Behaviour Change Wheel: A new method for characterising and designing behaviour change interventions. Implementation Science, 6, 42.
The Behaviour Change Wheel
Self efficacy/Health beliefs
• Self efficacy important factor in behaviour change (Ashford et al. 2010)
• Shown to predict physical activity in adults• Positive experience – increases self efficacy –
can increase physical activity (Parschau et al. 2013)
• Participation greater for those with a belief that physical activity is beneficial for their disease. (Ehrlich-Jones et al. 2011 )
Things to consider in the planning phase
1. Base interventions on a proper assessment of the target group, where they are located and the behaviour that is to be changed:
2. Work with other organisations and the community itself to decide on and develop initiatives
3. Build on the skills and knowledge that already exists in the community, for example, by encouraging networks of people who can support each other
4. Take account of – and resolve – problems that prevent people changing their behaviour (for example, the costs involved in taking part in exercise programmes or buying fresh fruit and vegetables, or lack of knowledge about how to make changes)
5. Base all interventions on evidence of what works
6. Train staff to help people change their behaviour
7. Evaluate all interventions.
Communication
Brief intervention
A
3 step
30 second
systems based
approach
Make Every Contact Count (MECC)
• Offering brief advice on healthy lifestyles opportunistically, smoking, weight, physical activity
• Giving information about importance of behaviour change
• Simple advice and signposting• Aims to reduce health inequalities• Encourages patient to take responsibility for own health• http://learning.nhslocal.nhs.uk/feature-list/making-every-
contact-count• http://www.alcohollearningcentre.org.uk/eLearning/IBA/
MOTIVATIONAL INTERVIEWING
What is MI?
MI is a collaborative, goal-orientated style of communication which pays particular attention
to the language of change. It’s aim is to strengthen personal motivation and commitment
to a specific goal (like increasing physical activity) by exploring the person’s own reasons
for change.
FEATURES OF MI
• MI’s style is conversational and accepting
• It’s a shared decision making conversation
• It’s collaborative and solution focussed
• EQUALITY- They are the expert in their own behaviour but you have the skills and knowledge to help them!
THE TASK OF MI CONVERSATIONS• Identify when behaviour is inconsistent
with the client’s goals or ambitions. • Focus where there is a discrepancy
between their values i.e. I don’t want to smoke and their current behaviour i.e. smoking.
• It’s very hard to be resistant to someone who is trying hard to understand you.
• With MI we don’t necessarily wait for the client to be ready for change, MI is good for people who are in two minds.
THE PRINCIPLES OF MI
RESIST THE RIGHTING REFLEX
UNDERSTAND/ EXPLORE CLIENTS’ MOTIVATIONS
LISTEN WITH EMPATHY
EMPOWER THE CLIENT, ENCOURAGE OPTIMISM
SUPPORT SELF EFFICACY
MOTIVATIONAL INTERVIEWING - How Do We Do This?
Eliciting Change is like climbing a mountain where our client is the climber and we are the guide.
• A guide can’t take you up the mountain, he/she can’t make those steps for the client.
• The guide can only suggest when to rest, what to eat, what to wear, what has helped others climb.
• Most importantly, the practitioner holds the confidence they will ultimately succeed
Instead of…Could you?Have you thought of…?TRY• How might you best go about that?• What would that be like for you?• What are your thoughts?• What strengths do you have?• Looking forward 1-2 years, how would you like your life
to be?• Where should the focus of our conversation be today, to
make it as helpful as possible for you?
Clear messages?
• Importance of clear information• Stoke-on-Trent study• Readability assessment• Identify jargon• Patient/public involvement group• Lower then anticipated reading age
Estacio EV & Protheroe J; Assessing the readability of sexual healthinformation leaflets in GP practices in Stoke-on-Trent: A multi stage study.
Next steps?
• Consider psychological factors when setting up a project/intervention
• Review the evidence to see what works• Think about the skill mix within your team• Work with partners• Communication is key to success• Contact the Public Health Service • Health Psychology in Public Health Network
Thank you!
Note: Please see next slide for follow up information since the meeting
Update since meetingReferences for papers included in this presentation are given below:
What is the best way to change self-efficacy to promote lifestyle and recreational physical activity? A systematic review with meta-analysis (attached)
Stefanie Ashford, Jemma Edmunds and David P. French
British Journal of Health Psychology, Volume 15, Issue 2, pages 265–288, May 2010
Positive experience, self-efficacy, and action control predict physical activity changes: A moderated mediation analysis
Linda Parachu, Lena Fleig, Melina Koring, Daniela, Lange, Nina Knoll, Ralf Schwarzer and Sonia Lippke
British Journal of Health Psychology, Volume 18, pages 395- 406
Relationship between beliefs, motivation, and worries about physical activity and physical activity participation in persons with Rheumatoid Arthritis
Linda Ehrlich Jones, Jungwha Lee, Pamela Semanik, Cheryl Cox, Dorothy Dunlop and Rowland Chang
Arthritis Care & Research, Volume 63, no. 12, pages 1700 – 1705, December 2011
Update since meetingHealth Psychology in Public Health Network
We are a new and developing network that has been created to share best practice and experience
between the two disciplines. We welcome all practitioners with an interest in how behavioural
science can be embedded in and improve public health and have members from a wide range of
disciplines. So far we have over 140 members and have run three network events. This would be a
fantastic forum for your Herts PA & Sport Stakeholder Alliance members to be involved with.
A news letter and registration form can be downloaded with the minutes.
Contact Michelle Constable if you would like more information.
Please could all completed registration forms be returned to: [email protected]
