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126 Cards in this Set

  • Front
  • Back
what are some examples of health professionals
-physicians
-nurses
-physiotherapists
-respiratory therapists
-occupational therapists
-dentists
-kinesiologists
-dieticians
-many others
who gets advice about health
-public health campaigns
=everyone who notices
Face to face
-people who ask
-more personal
what influences help seeking
on 33% of people with symptoms seek advice from hcp
-problems with people who need care not consulting and people who dont neeed care are consulting
why dont patients seek help
to busy
denying they need help
bad past experience
how can symptoms of being sick be displayed
-persistent
-perceived to be serious
-perveived to be amenable to treatment
-interfere with other valued activities
-that reduce attractivenss
-causal understanding of symptoms
what are some social influences that affect patients from getting help
-advice from others
-ease of access to services
-having opportunity (time away from work, etc.)
-consultation not interfering with other activities (having time)
what influences adherence in patients
symptoms
-persistent
-perceived as serious
-perceived as curable
-interfere with other goals or activities
Treatments
-perceived to be effective
-dont interfere with other goals or activities
-not complex of difficult to adhere to
-short term
what has the lowest adherence rates
-chronic disorders
-no immediate discomfort or risk is evident
-life-style changes are required
-prevention instead of symptom palliation or cure is desired outcome
-if chronically ill dont see immediate results or benefits
how serious does the problem have to be for people to adhere to
glaucoma patients were told they would go blind if they didnt put drops in their eyes 3 times per day
only 42% adhered to produce the desired outcome
-when they became blind in one eye it improved to 58%
adherence to blood pressure
adherence to blood pressure medications is onyl 30%
why is it hard to adhere to blood pressure medication
-3 pills per day hard to maintain
-hypertension is asymptomatic
-forget
-away from home
-side effects
what is linked to high blood pressure
stroke, heart disease, aterial disease, kidney disease, cognitive decline, dementia
what can we do to help with this adherence
-education program
-memory gadgets
-changing meds and regimes
-behavioural strategies
-encourage physicians to be more firm
-encourage patients to self monitor so they are aware of control levels
-encourage patients to ask physicians why control is poor
-encourage physicians to update practices
-include patients in decision making and monitoring of treatemnt effectiveness
what is compliance
-extent to which patients are obedient and follow the instructions, proscriptions, and prescriptions of HCP's
-the extent to which the patients behaviour coincides with the HCP's medical or health advice (passive role of the patient)
what is adherence
used to imply a more active, voluntary collobarative involvement of the patient in a mutually acceptable course of behaviour to produce a desired preventative of therapeutic result
what are factors that influence adherence
-characteristics of the target behaviour (treatment)
-characteristics of the target
-characteristics of the person giving advice
-normative influences-subjective norms (social pressure) and Decriptive norms (what do people like me do)
characteristics of target treatment
-beleive in its efficacy
-complexity
-convenience
-side effects
-is it long term
-does it require lifestyle change
characteristics of target person
-do they live alone
-SEs
-how do they interpret symptoms
-personality (conscientiousness(increases adherence) pessimism (decreases adherence))
-stress levels
-job other life responsibilities
characteristics of source of advice
are they an expert? (do you feel like the physician knows what there talking about?
-is source knowledgeable (expert knowledge and personal knowledge)
normative influences
-SES
-prevalence of target behaviour in normative group
-attitudes toward target behaviour
-social pressures on relevant behaviour (example pressure to smoke or not to smoke)
targets of behaviour change what do we expect
- at population level 10% is good
why do we mean by 10% change in behaviour change of target
-10% of the people achieve the behaviour
-or 10% change their behaviour
ex.10 percent reduce caloric intake
-10 percent increase physical activity
what is an apprpriate outcome measure
-is it health
-is it bllod sugar, or or weight change
-based on the outcome the times to meet the outcome would vary
intervention techniques
ex. perveived severity to promote protection or detection behaviours
-just self-efficacy to promotr behavioural uptake
combining techniques
combinations work best
different techniques work differently with different behaviours
linking behaviour to outcome is most effective strategy
-be careful when your doing an intervention to not do to much
what can a health care professional
-provide info on risk
-link target behaviour to desired outcome
-explain how to do the behaviour
-lkeep prescriptions simple
-use persuasion to advise target person that they need to do it, that they can do it, and that it wont interfere with other valued tasks
-work with the person to examine solutions to barriers
how can we promote behaviour change
motivation is a prerequisite to action
what is motivation?
goal directed thoughts and behaviours
what influences motivation?
beliefs
-knowledge
-availibility of facilities and services
-availability of social support
what are motivational variables
attitudes, self efficacy, normative influences
self-determination theory
a theory of motivation that is concerned with the beneficial effects fo intrinsic motivation and the harmful effects of external motivation
extrinsic motivation
ex. that shirt looks good on you
external motivation
ex. money
what are different level in the social ecological method
individual (ksas), interpersonal (family, friends, social networks), organisational (organisations, social institutions), community (relationships among organizations), public policy (national, state, local laws)
what are the key components of information motivation behavioural skills model
1-information provision
2-motivation
3- behavioural skills
what comprises behavioural skills?
-self regulatory skills (being able to control ones actions)
-motor skills(ex. use of exercise machines) ex.cognitive skills and self-efficacy) (ability to control body movement)
social skills- communication and interaction with people
-social skills- to manage behaviour and seek others support for changw
what does intervention mapping describe?
a protocol for the development of theory- and evidence based health promotion programmes
what does intervention mapping protocol describe
it provides guidelines and tools for the selection of theoretical foundations and undepinnings of health promotion programmes
what is evidence based practice
when evidence based health promotion programmes are based on empirical data and theory
where do we get evidence
journals, review articles, and meta analysis
look for correlates of the health behaviour ie. benefit of condom usage, sexual experience
what are some barriers to EBP
time to access, critique and apply data
-lack of confidence and knowledge how to develop EBP
-break down the barriers using an approach such as the intervention mapping
how are health promotion programs guided
by social and behavioural science theories of health behaviour and behaviour change
what are the 5 steps for intervention mapping towards developing theory-based and evidence based programs
1-specification of the general program goal into proximal programme objectives that explain who and what will change as a result of the intervention
2-the selection of theoretical methods and practical strategies
3-actual design of the program, organizing the strategies into a deliverable program taking into account target groups and settings, and producing and pretesting the materials.
4- program planners develop a plan for the systematic implementation of the programs
5- anticipating process and effect evaluation
list what the first step is to intervention mapping and then describe it?
it is the specification of the general program goal into proximal programme objectives that explain who and what will change as a result of the intervention
-also determine performance objectives (self-efficacy, outcome expectations)
-as well as determine target group
what do proximal program objectives specify?
what need to learn
what needs to change
ie. buy and carry condoms
in step 1 of intervention mapping you need to determine...
-target (teachers and students)
-determinant
-performance objective (hand signals)
what is a determinant
A factor that decisively affects the nature or outcome of something.
list what step 2 in IM is and describe it
step 2 is the selection of theoretical methods and practical strategies
-is a technique derived from theory and research to realize a proximal program objective, a strategy is the practical application of that method
ie. theoretical based performance and peer role modeling in a video, change attitude about condom usage
what is an example of step 2 in intervention mapping?
the uofa students to bike safely to and from the uofa.
-the selection of theoretical methods and practical strategies
list step 3 in IM and describe the step.
-actual design of the programme, organizing the strategies into a deliverable program taking into account target groups and settings, and producing and pretesting the materials.
ex. get uofa students to and from the uofa?
-design the program, taking into account target groups and settings, and producing and pretesting the materials.
list step 4 in IM and describe it.
program planners develop a plan for the systematic implementation of the program
-develop a linkage system between programs and users (practitioner and client)
List step 5 in IM and describe it.
anticipating process and effect evaluation
-the list of proximal programme objectives guides the evaluation of programme effects
what steps is the psychological theory most important to in IM
in between step 1 and 2
-theory provides methods for the accomplishment of program objectives
what are the 4 program strategies?
1- modelling
2- active learning
3- risk scenario strategy
4- anticipated regret
whats involved with modelling?
target id's with the model
-model demos feasible sub skills
-model receives enforcement
-target perceives a coping, not a mastery model
what is involved in active learning?
video scenes presenting high-risk situations were stopped after the situation had developed, and the students were able to eloborate on what they would do or advise the role-actor, first individual and then in a group.
-group discusses the development of the scene
describe step 3 risk-scenario strategy?
-determinant is risk perception
-risk info and risk feedback, message framing, self evaluation and fear arousal
-the info includes a plausible scenario with a cuase and an outcome, instead of just an outcome
anticipated regret
methods of attitude change
-use imagery
-ex. 1)condom usage had adv not related to health
2) strong perception of health related benefits
3) adv of safe sex outweighs
4) plan to cope with condom usage
what is the purpose of the elaboration likelihood model
to describe how people choose to manage information they encounter
what are the 2 routes of persuasion
1- central route (systematic) processing
-involves greater cognitive elaboration
-scrutinizes the logic of message
-meaning of message is critical to persuasion
2-peripheral route of persuasion (dont understand and dont care)
-involved little systematic processing]
-the means by which message receivers evaluate persuasive messages when they are unmotivated and unable to elaborate on its logical merits
what is the continuum in the elaboration likelihood model?
one end a virtual 100 percent probability of expending considerable cognitive effort to evaluate the central merits of a persuasive message
what are the 3 purposes variable can serve in a persuasive context?
1- take on the role of persuasive arguments that are evaluated via the central route
2- can serve a positive or negative peripheral cue that allows message receivers to reach conclusions
3- function as motivators affecting the amount and direction of issue relevant elaboration
what happens when changes result from central route processing?
changes will be more persisten
-better predictors of behaviour
-more resistant to counter persuasion that attitude changes that result from being exposed to peripheral cues
when is central route processing more likely to occur?
-increased motivation
-increased ability to engage in effortful elaboration
when is peripheral route processing more likely to occur?
lack of motivation
-poor ability to engage in effortful elaboration
ex. its to late to stop, cant get worse.
central route to persuasion
-people have time
-people have knowledge
-decision made on basis of
-strength of arguments
-fairness of arguments
Peripheral route to persuasion
in ELM
-people dont have time
-people dont have capability (no knowledge or poor message content)
-message does not have sufficient arguments
-message does not have sufficient arguements
-decision based on
-expertise
-large number of arguments
-consensus
what are some other considerations in ELM
-relevance to person
-relationship of person to messenger
-expert?
-why?
-perceived expert
-person who has had the experience
-preexisting attitude (stronger preexisitng attitude result in stronger reactance to strong messages) (neutral pre existing attitudes- more likely to consider 2 sides of an argument.
which form of processing (central of peripheral) is associated with more stable attitude change?
central because you have more time and people understand it.
-in terms in health promotion we need to give patients time to process and to understand what message is trying to be portrayed as well as educating them so they understand.
ELM- how do we change the behaviour of those lacking motivation?
-peripheral route to persuasion
-people dont have time
-people dont have the capability (no knowledge or poor message content)
-message does not have sufficient arguments
-decision made on the bases of (expertise, consensus, larger number or arguments)
what is self efficacy?
-belief that one has the ability and resources to succeed in achieving a goal despite environmental barriers
-situation specific self confidence
-confidence for performing the behaviours required to produce a particular outcome
what are the sources of self efficacy?
-mastery experiences
-vicarious experiences (see someone you can relate with do soemthing)
-verbal persuasion (communication or feedback)
-perception of physiological and affective states ex. being moody, anxious, or nervous
how do health behaviour influence health?
Generating direct biological changes (e.g., smoking causes irreversible lung damage)
Changing exposure to health risks (e.g., using condoms, getting vaccinated)
Ensuring early detection of disease (e.g., screening, Pap tests)
what are things that influence health behaviours?
-SES
-Gender
Age
Cognitions
◦Because SES, gender, age, are not amenable to change
◦So do we accept that certain groups just have poor health behaviours?
what are factors associated with health behaviour
Accessibility of health care services
Attitudes to health care (beliefs about quality and benefits of treatment)
Perceptions of disease threat
Knowledge about disease
Social network characteristics
Demographic factors
why do people engage in any behaviour?
Theories and models have been developed to examine this
Basically
◦They have to think engaging in the behaviour is a „good‟ thing
◦They have to think that they are capable of doing the behaviour
◦They have to think that their social influences will also think it is a good thing
◦In the case of „health‟ –they have to believe there is a health threat or a health gain
◦They have to have access to any required facilities or support
◦They have to be capable of self-regulation
what are the components of TPB
Attitude = belief about outcomes x evaluation of outcomes
Subjective norms = normative beliefs x motivation to comply
Perceived behavioural control = perceived likelihood of occurrence x perceived facilitating/inhibiting power
What influences motivation?
Beliefs
Attitudes, control beliefs, normative beliefs
Knowledge
Underpins beliefs
If you don’t know about something – you can’t do it
Availability of facilities and services
Availability of social support
•Behaviour change interventions
–Employ theory to specific and relevant change mechanisms
–Intervention techniques prompt change in psychological systems
Behaviour change techniques
1.Provide information about behaviour-health link (IMB)
–General info regarding risk, health outcome or mortality risk in relation to the behaviour
–LINK
2.Provide information on consequences (TRA, TPB, SCT, IMB, HBM)
–Info about costs and benefits of action/inaction, focus on what will happen if a person does not perform behaviour
3.Provide information about personal susceptibility (HBM, PMT)
–Info about negative consequence
–LINK
4.Provide information about others approval (TRA, TPB, IMB)
–Info about what others think about the persons behaviour (approve/disapprove)
–LINK
5.Prompt intention formation (TRA, TPB, SCT, IMB)
–Encourage the person to decide to ct or set a general goal
–LINK
6.Prompt barrier identification (SCT)
–Identify behaviours and plan ways of over coming them
7.Set graded tasks (SCT)
–Set easy tasks and increase difficulty until larger target behaviour is performed
–LINK
8.Provide instructions (SCT)
–Tell person how to perform the behaviour
–LINK
9.Model or demonstrate the behaviour (SCT)
–An expert shows how to correctly do the behaviour
–LINK
10.Prompt specific goal setting
–Detailed planning (i.e. FITT, when, where, how or with whom)
–LINK
11.Prompt self-monitoring
–Person is asked to keep a record of specified behaviours (diary)
–LINK
12. Teach to use prompts/cues (OC, operant conditioning)
–Teach person to identify environmental cues to remind them of specific behaviour
–LINK
13. Planned social support/social change (social support theories)
–Prompt consideration of how others can change their behaviour
Evidence of effectiveness of these techniques
•Intention formation
–Medium-large changes in intentions = small-medium changes in behaviour
•Information provision and persuasive communication
–Small-medium
•Risk awareness studies
–Condom usage = not effective
•Rehearsal skills/ goal-setting/ action planning/ self-monitoring
–Small to medium effects on behaviour
•Incentives/ social support/ pressure
–Strongest effects on behaviour
Design and evaluate behaviour change interventions
•Structure of interventions
–CONSORT guidelines (consolidated standards for the reporting of clinical trials)
–KOK et al., 2004 article
•Intervention planning
–Intervention mapping (Bartholomew et al., 2006; Kok et al, 2004)
•Availability of accurate detailed descriptions of the intervention
•Evaluation between people that received and did not receive the intervention
•Randomzation
•Multi-level modelling (stats technique)
•Attrition rates
•Use valid and reliable measures
what are the 4 types of health behaviours
1- health harming
2- health enhacing
3- health protecting
4- sick rolel
definition of health behaviours
in the activity undertaking for the purpose of preventing or detecting disease for improving health or well being
things that influence health behavious
age
gender
SES
ethnicity
Cognition
how do health behaviours influence health?
generationg direct biological change
changing exposure to health risks (ex. condoms)
ensuring early detection of disease (screenin
factors associated with health behaviours
-acessibility of health care services
-social network characteristics
-knowledge about disease
-perceptions of disease threat
-attitudes to health care
-demographic factors
why do people engage in any behaviour
-engaging in behaviour is a good thing
-they have to think they are capable
-social influences with also think it is a good thing
-have to believe there is a heath threat or gain
-have to have access to any rewuired facilities or support
-have to be capable of self regulation
what is lower SES linked with
-higher smoking
-higher snacking
-higher body weights
-less health care
-less self-care
how do we change the perceptions of normal
-normativeinfluences
-belief systems
-information
-modeling (show someone how to do it)
-in behavioural medicine they tqalk about social marketing and puvblic health promotion
Theory of Planned Behaviour (TPB)
external variables (demographic variables, and personality traits) attitude+subjective norm+perceived behavioural control=behavioural intention=behaviour
what are the key components Social cognitive theory
behaviour, environment and cognition
what are the key social cognition models
health belief model
-protection motivation theory
-theory of planned behaviour
-social cognitive theory
what is motivation
it is goal directed thoughts and behaviours
what influences motivation
beliefs
knowledge
availability of facilities
availability of social supports
what is the definition of personality traits
Personality traits are broad dimensions of individual differences between people that relate to the way in which we engage with our social worlds. They underpin the consistency with which we think, act and feel across different situations and over time
WHAT ARE HEALTH enhancing behaviours?
-exercise
-healthy eating
what are health protective behaviours
health screening
-prophylactic use (ex. condoms)
-vaccination
what are health harming behaviours
smoking
excessive alcohol cosumption
risk taking
substance abuse
what are the 4 health behaviours
health enhancing
sick role
health harming
health protective behaviours
what is the health behavior definition
any activity undertaken for the purpose of preventing or detecting disease or for the improvement of health and well being
what do people engage in any behaviour
they have to think engaging in the behaviour is a good thing
-are capable to doign the behaviour
-think that social influences also think it is a good thing
-in case of health they have to believe there is a health threat or gain
-the have access to the facilities
-they are capable of self regulation
all theories on health include looking at these factors
-interests/beliefs
-willingness to spend money
-nature of the behaviour in question
what is low SES linked to?
-higher smoking
-less snacking
-less self care
-less health care
-higher body weights
What is included in the theory on planned behaviour (TPB)
Attitude, subjective norms, and perceived behavioural control these all lead to behavioural intention which leads to behaviour
perceived behavioural control can lead straight to behaviour
what are the key components of social cognitive theory
behaviour-environment-cognition
what is self efficacy?
-situation specific confidence
-confidence that we are able to perform the behaviouirs
what is outcome expectations
-social outcomes of rthe behaviour
-self reliant outcomes of the behaviour
what are social structural factors
impediment or opportiunities in life\
\
what are the 4 key social cognition theories?
1-health belief model
2-protection motivation theory
3-theory of planned behaviour
4-social cognitive behaviour
what is included in the health belief model?(HBM)
-included threats (perceived susceptibilty and perceived severity)
-Health Motivation
-Response Effectiveness (cost vs benefit)
as well as cues to action can help you towards the behaviour
whats important in the protection motivation theory?
involves 2 appraisals
1-threat appraisals
2-coping appraisals
-linked to fear appeal (trying to scare someone into doing something)
-threat appraisals (perceived severity, perceived vulneralbility, extrinsic rewards, intrinsic rewards)
-coping appraisals (response cost, response efficacy, self efficacy) ====protective motivation====behaviour
external variable are sources of information
what is self determination theory?
a formal theory that defines intrinsic and exrinsic motication cognitive, and social development and in individual differences.
-conditions supporting the individuals relatedness, competence, autonomy.
what is argues to foster the most volitional and high quality forms of motivation and engagement for activities?
competence
autonomy
relatedness
what is the social ecological model and what are the compomnents that make it up?
individual, interpersonal, organizational, community, public policy.
it includes inidividual and social determinants of behaviour and recognizes different levels of intervention
what is the information-motivation-behavioural skills model?
key components
-information provision
-motivation
-behavioural skills (self-regulation, motor skills, social skills)
what is the purpose of the elaboration likelihood model?
to describe how people choose to manage information they encounter
what are the routes of persuasion in ELM
1-central route processing
-involves greater cognitive elaboration
-scrutinizes the logic of message
-meaning of the message is critical to persuasion
2-peripheral route processing
-involves little systematic processing
the means by which message receivcers evaluate persuasive messages when they are unmotivated and or unable to elaborate on its logical merits
when are peripheral cues most and least important in engaging in effortful elaboration
most important when there is a decrease in motivation and ability to engage in effortful elaboration
variables when trying to persuade someone can serve 3 purposes
1- take on the role of persuasive arguments that are evaluated via the central route
2- can serve a positive or negative peripheral cue that allow message receivers to reach conclusions
3- function as motivators affecting the amount and direction of issue relevant elaboration
when is central route processing more likely to occur?
increased motivation
able to participate in effortful elaboration
knowledge of topic
when is peripheral route more likely to occur
when there is lack of motivation and inability to engage in effortful elaboration
what components need to present for central route to persuasion
people have time
people have knowledge
decision is made on strength and fairness of arguments.
what components would need to present to end up doign peripheral route to persuasion
people dont have time
people dont have capabilityi
message does nto have suffiecient arguemtns
decision made on the basis of:
-expertise
-large numbers of arguments
-consensus
what other considerations are considered in ELM
-relevance to person
-relationship of person to messenger

prexisting attitude
what is the definition of self efficacy
beliefe that one has the ability and resources to succeed in achievcing a goal despite environtmental barriers