6. Health-behavior change techniques

Łukasz Kaczmarek, IP UAM, 2010-2011

Provide information about behavior-health

link

General information that a behviour may be linked to poor

health outcomes.

Provide information onconsequences

Information about the benefits and costs of action or inaction, focusing on what will happen if the person

does or does not perform the behavior

STOP SMOKING: Medical advice - methods

Types of intervention: Minimal

advice with 20 minut consultation+ optional leaflet) < 20 minut

Complete + 1 follow up visit

IntensiveAdvice with longer consultation + leaflet + further resources (demonstrations, self-help manuals) + follow up

STOP SMOKING: Medical advice - effectsOdds ratio: Minimal intervention vs no advice:1.69 : 1

Among people at risk: 1.82

Among people without risk:1.20

STOP SMOKING: Intervention by nursesVerbal instruction to stop

smoking (regardless of giving information about risk)

Low intensity: advice + leaflet

High intensity: contact > 10 minutes + further materials (manuals) + follow ups.

Effective smoking cessation 1.43

Most effective for patients with CHD 2.14

No effect for patients with other somatic ilness

Provide information Provide information about others’ approvalabout others’ approval

Information about what others Information about what others think about the person’s behavior think about the person’s behavior and whether others will approve orand whether others will approve or

disapprove of any proposed disapprove of any proposed behavior changebehavior change

Prompt intention Prompt intention formationformation

Encouraging the person to decide Encouraging the person to decide to act or set a general goal, for to act or set a general goal, for example, to make a behavioral example, to make a behavioral

resolutionresolution such as “I will take more such as “I will take more exercise next week‘exercise next week‘

Michie, S., Abraham, Ch. (2008)

Prompt barrier identification

Identify barriers to performing the behavior and plan ways of

overcoming them

PICK UP A BEHAVIOUR YOU WOULD LIKE TO CHANGE.

WHAT WOULD BE THE BAD SIDES (COSTS) AND GOOD SIDES (BENEFITS) OF THE CHANGE? COSTS: ………………………………………………………………………………………

BENEFITS: .……………………………………………………………………………………

WHAT MIGHT BE THE BARRIERS IN MAKING YOUR CHANGE?

A. _____________B. __________C. _______________

PLAN HOW YOU MIGHT OVERCOME THE BARRIERS: A.………………………………………………………… B.………………………………………………………… C.…………………………………………………………

A brief discussion

Provide general Provide general encouragement encouragement

Praising or rewarding the person Praising or rewarding the person for effort for effort or performance or performance (not the (not the

results)results)

Set graded tasks

Set easy tasks, and increase Set easy tasks, and increase difficulty until target behavior is difficulty until target behavior is

performedperformed

„Flow„ (optimal challange) and starting new behaviours

„Flow„ (optimal challange) and starting new behaviours

Provide instructionProvide instruction

Telling the person how to Telling the person how to perform a behavior and/or perform a behavior and/or

preparatory behaviorspreparatory behaviors

Model or demonstrate Model or demonstrate the behaviorthe behavior

An expert shows the person An expert shows the person how to correctly perform a how to correctly perform a

behavior, for example, in class behavior, for example, in class or on videoor on video

Marzipan penguinwww.marthastewart.com

[…] Break off a piece of blue marzipan, and roll into a 1/2-

inch ball for the head; pinch to form a beak. Use black

marzipan to make eyes; attach to head. Shape white

marzipan ball into a body (about 1 by 1 1/4 inches). Use orange marzipan to make 1/2-

inch-long feet. Roll out remaining blue marzipan to

1/4 inch thick. Cut out shape for wings (pictured below) […]

Consequently and corectly using condoms

Buy condoms

Locate condom displays in drug store

Chose condoms that are product tested

Carry condoms or have condoms easily available

Carry condoms in

wallet or purse for no longer

than a month

Carry or store

condoms in place far from hot places

Negotiate the use of a condom with a partner

State shared goals

such as pregnancy

or AIDS prevention

State clearly that

using a condom is necessary

for you

Listen partner’s concerns

Propose solutions to

partners worries that reference

mutual goals and personal expectations

Correctly use condoms

Use water-solube

lubricants

Use a new condom for

each intercourse

Follows instructions

on packeage

for use

Follows instructions

on packeage

for disposal

Maintain use over time

Provide Provide conditionalconditional rewardsrewards

Praise, encouragement, or material Praise, encouragement, or material rewards that are explicitly linked to rewards that are explicitly linked to

the the achievement achievement of specifiedof specified behaviorsbehaviors

Teach to use Teach to use promptsprompts or cues or cues

Teach the person to identify Teach the person to identify environmental cues that can be environmental cues that can be

used used to remind them to remind them to perform a to perform a behavior,behavior, including times of day or including times of day or

elements of contexts.elements of contexts.

Agree on contractAgree on contract

Agreement (e.g., signing) of a Agreement (e.g., signing) of a contract specifying behavior to be contract specifying behavior to be

performed so that there is a performed so that there is a writtenwritten record of the person’s record of the person’s

resolution witnessed by anotherresolution witnessed by another

Prompt self-talk

Encourage use of self-instruction and self-

encouragement (aloud or silently) to support action

y – output (present behaviour)r – target (zachowanie prozdrowotne)e – difference – between Y and r (present behaviour vs target behaviour)C – regulator (regulatory cognitive processes)u – input (% healthy food, time spent jogging)P – subject (person)

Controll

Prompt review of behavioral

goals

Review and/or reconsideration of

previously set goals or intentions

Prompt specificgoal setting

Detailed planning of what the person will do, including a

definition of the behavior specifying

frequency, intensity, or duration and

specification of at least one context,

that is, where, when, how, or with

whom

Provide feedback

on performance

Providing data about recorded

behavior or evaluating

performance in relation to a set

standard or others’ performance, i.e.,

the person received feedback on their

behavior.

Prompt self-monitoring of

behavior

The person is asked to keep a record of

specified behavior(s) (e.g., in a diary)

?

Plan social support Plan social support or social changeor social change

Prompting consideration of how Prompting consideration of how others could change their others could change their

behavior to offer the person behavior to offer the person helphelp

Prompt identification as a role model

Indicating how the person may Indicating how the person may be an example to others and be an example to others and influence their behavior or influence their behavior or

provide anprovide an opportunity for the opportunity for the person to set a good exampleperson to set a good example

STOP SMOKING: self-help

Individual attempts without the help of health care experts:

Written materials,Audio & video

recordings,Telephone hotlines,Computer programs.

No effect on abstinence.

R. Schwarzer, 2006

R. Schwarzer, 2006

Provide opportunities for social comparison.

Facilitate observation of nonexpert others’ performance for example, in a group class or using video or

case study