Health Education and Promotion Department

Umm Al-Qura UniversityFaculty of Public Health and Health Informatics

By: Dr. Ahmed Abdullah

Behavior change to prevent chronic diseases through

population

Chronic diseases

Burden of The Chronic Diseases

Risk Factors

Prevention

Coaching and Motivational Interviewing

Contents of the Lecture

Chronic diseases• They are medical conditions mainly of non

infectious etiology, and they are lifelong conditions (continuous for a long period of life more than one year).

• They are the illness and impairments that limits daily activities and functioning.

• They are generally progressive.

Examples of The Common Chronic Diseases

Addison's disease اديسون مرضAsthma الربو

Bipolar Mood Disorder الثنائي المزاج اضطراب

القطب

Bronchiectasis الهوائية القصبات توسع

Cardiac failure القلب فشل

Cardiomyopathy القلب عضلة اعتالل

Chronic kidney disease المزمن الكلى مرض

Chronic obstructive pulmonary disease الرئوي االنسداد مرض

المزمن

Chronic renal disease المزمن الكلوي المرض

Coronary artery disease التاجي الشريان مرض

Examples of The Common Chronic Diseases

Crohn's disease كرون مرض

Diabetes insipidus الكاذب السكري مرض

Diabetes mellitus (type 1 and type 2) نوع ) السكري (2ونوع 1داء

Dysrhythmia (irregular heartbeat) انتظام ) عدم النظم خلل) القلب ضربات

Epilepsy الصرع

Glaucoma ) الزرقاء ) المياه الزرق

Haemophilia الدم سيولة

Hyperlipidaemia (high cholesterol) الشحوم نسبة ارتفاع) المرتفع) الكوليسترول

Hypertension (high blood pressure) الدم ضغط ارتفاع

Examples of The Common Chronic Diseases

Hypothyroidism غير ) الدرقية الغدة خمولنشطه(

Hyperthyroidism الدرقية الغدة نشاط فرط

Multiple sclerosis المتعدد التصلب

Parkinson's disease الرعاش الشلل مرض

Pulmonary disorder رئوي اضطراب

Rheumatoid arthritis الروماتويدي المفاصل التهاب

Schizophrenia الشخصية في انفصام

Systemic lupus erythematosus (SLE) الجهازية ) الحمامية (SLEالذئبة

Ulcerative colitis التقرحي القولون التهاب

Chronic Diseases

Genetic

ExposureBehavior

The development of chronic diseases is a combination of 3 factors:

Burden of The Chronic Diseases• Now, the chronic diseases are the major

cause of disability and death globally.• Chronic illnesses have a serious impact on

individuals and on society in general. They affect the quality of life of individuals and can be a financial burden on those who are affected.

Burden of the chronic diseases• In USA, as of 2012, about half of all adults—117

million people—had one or more chronic health conditions. One of four adults had two or more chronic health conditions.

• Seven of the top 10 causes of death in 2010 were chronic diseases. Two of these chronic diseases—heart disease and cancer—together accounted for nearly 48% of all deaths.

Burden of the chronic diseases• Arthritis is the most common cause of

disability, 53 million adults with a doctor diagnosis of arthritis.

• Diabetes is the leading cause of kidney failure, lower-limb amputations other than those caused by injury, and new cases of blindness among adults.

Chronic Diseases Prevalence in Saudi Arabia

• Elevated BMI (11.64%)• Dietary risks (9.68%)• Elevated FPG (9.53%)• Elevated blood pressure (7.83%)• Physical inactivity (5.33%)• Smoking (3.02%)

Major Causes of Death in KSA• Cerebrovascular disease (13.20%)• Ischemic heart disease (6.23%)• Road traffic injury (11.75%)• Chronic kidney diseases (3.99%)• Diabetes mellitus (3.70%)• Hypertensive heart disease (2.37%)

Risk Factors• A number of risk factors related to an

individual's lifestyle can contribute to the development of chronic diseases (e.g. cardiovascular diseases, chronic respiratory conditions and diabetes).

Modifiable Risk Factors

Unhealthy Diet

Physical Inactivity

Smoking

Healthy Lifestyle Practices• Adopting healthy lifestyle practices can

prevent or control the onset of chronic diseases. Healthy lifestyle practices can be obtained by changing the behavior:

• A healthy diet• Regular physical activity• Avoiding tobacco use

Health Risk Behaviors

• Health risk behaviors are unhealthy behaviors you can change.

• Four of these health risk behaviors:• Lack of exercise or physical activity.• Poor nutrition.• Tobacco use.• Drinking too much alcohol and other

drugs.

Prevention• Prevention is effective in reducing the

effect of chronic conditions and early detection results in less severe outcomes.

• Clinical preventive services include:• Screening for the existence of the disease.• Counseling.• immunizations against infectious agents.

Primary Prevention• Primary prevention seeks to prevent the

onset of specific diseases via risk reduction: by altering behaviors or exposures that can lead to disease.

• Examples include smoking cessation and vaccination.

Secondary Prevention• It includes procedures that detect and

treat pre-clinical pathological changes and thereby control disease progression.

• Screening procedures (such as colonoscopy to detect early stage of colon cancer) are often the first step, leading to early interventions that are more cost effective than intervening once symptoms appear.

Tertiary Prevention• Once a disease has developed and has

been treated in its acute clinical phase, tertiary prevention seeks to reduce the impact caused by the disease on the patient’s function and quality of life. Examples include cardiac rehabilitation following a myocardial infarction, assisting a cardiac patient to lose weight.

Positive Health Outcomes• Positive health outcomes for chronic illness

require:• Effective treatments• Adherence to the treatments.

Coaching In Health Behavior Change

• Coaching in health behavior change is defined as:

• A method of patient education that guides and prompts a patient to be an active participant in behavior change.

Coaching In Health Behavior Change

• For example: coaching for patients with coronary disease includes:

1. Assessment of the patient’s knowledge and practice of lifestyle.

2. Drug treatments.3. Education of the patient about how to take the

treatment.4. Encouragement for the patient to reach the

target goals.

Coaching In Health Behavior Change

• Coaching used the theoretical frameworks of the Transtheoretical Model of Change. (Five stages of change).

Motivational Interviewing• Motivational interviewing is a technique

used in some self-management programs to identify a client’s readiness to change and how barriers can be overcome.

• The professional-client relationship during motivational interviewing is a partnership rather than an expert-recipient relationship and the counseling style is a quiet and eliciting one.

The Principles of Motivational Interviewing

Express Empathy

Develop Discrepancy

Avoid Argumentation

Roll with Resistance

Support Self-efficacy

Characteristics of Motivational Interviewing

1. Client centered2. Non-judgmental3. Expressing empathy4. Building trust5. Being collaborative6. Reflective listening

Characteristics of Motivational Interviewing

7. Increasing discrepancy8. Exploring ambivalence9. Reducing resistance10. Increasing readiness11. Eliciting change talk 12. Increasing self-efficacy

Examples of Prevention Interventions

Disease Intervention level

Primary Secondary Tertiary

Colorectal Cancer

Individual

Counselling on healthy lifestyles: dietary counselling for people at risk of colorectal cancer, etc.

Hemoccult stool testing to detect colorectal cancer early

Follow-up exams to identify recurrence or metastatic disease: physical examination, liver enzyme tests, chest x-rays, etc.

Examples of Prevention Interventions

Disease Intervention level

Primary Secondary Tertiary

Colorectal Cancer

Population Publicity campaigns alerting the public to the benefits of lifestyle changes in preventing colorectal cancers; promotion of high fibre diets; subsidies to help people access exercise programmes; anti-smoking campaigns

Organized colonoscopy screening programs

Implementation of health services organizational models that improve access to high-quality care

Examples of Prevention Interventions

Disease Intervention level

Primary Secondary Tertiary

Metabol

ic Syndrome

Individual Nutrition and exercise counselling

Screening for diabetes

Referral to cardiac rehabilitation clinics

Examples of Prevention Interventions

Disease Intervention level

Primary Secondary Tertiary

Metabol

ic Syndrome

Built environment favorable for active transport (walking, bicycling rather than using a car)

Community level weight loss and exercise programs to control metabolic syndrome

Implementation of multidisciplinary clinics

Built environment favorable for active transport (walking, bicycling rather than using a car)

Questions? Comments?