This is the Chapter 6 of the book Introduction to Health Psychology (Val Morrison_ Paul Bennett) 4th Edition. Which is content for the exam of the component Health Psychology of Module 5 (Health Psychology & Applied Technology) of the University of Twente, in the Netherlands. 

Ch. 6: Behind changing behaviour

Development interventions:

General Health Interventions: change behaviour entire population

• PRECEDE-PROCEED model: identifies a range of psychosocial variables that could be the target of any intervention
  • Predisposing factors: knowledge/attitudes/personal preferences/existing skills and self-efficacy in relation desired behaviour
  • Enabling factors: environment facilitate behaviour changes (availability and accessibility of resources)
  • Reinforcing factors: factors reward desired behaviour change (ex: social support/economic rewards/social norms)
• Phases of implementaton:

1. Social diagnosis: planners impression health problems affect community
2. Epidemiological/behavioural/environmental diagnosis: identification and assessment health issues, and related behavioural and environmental influences
3. Educational and ecological diagnosis: determine how behaviour phase 2 can be changed --> identity predispositions and reinforcing factors
4. Administrative and policy diagnosis: program consistency with policy organization
5. Implementation of program: implementation intervention. 3 elements evaluation:
   • Process: program do as intended?
   • Impact: impact on outcome
   • Outcome: long-term effects on health

Risk behaviour changed?

• How do we increase motivation, change beliefs and attitudes, encourage people to work towards desired goals, and so on?
  • Stages of change (Prochaska and di Clemente): stage model --> pre-contemplation/contemplation/preparation/change/maintenance or relapse --> reasonably accurate predicting behaviour. Move back and forth along change continuum.

Motivational change:

• Provision of Information:
  • Novel information: does not contradict previous understandings of issues, is highly relevant to the individual, and is relatively easy to act on
  • Involve social, psychological and situational factors --> men and women found negotiation of the use of condoms, as well as their actual use, complex and embarrassing
  • Influence motivation:
    
    • negative consequences of health-damaging behaviour
    • Information about the ease of behavioural change
    • NICE guidelines for behaviour change: when quitting smoking
      
      • Outcome expectancies: Smoking causes people to die on average eight years earlier than the average
      • Personal relevance: If you were to stop smoking, you could add six years to your life, and be fitter
      • Attitude: Life is good and worth living
      • Self-efficacy: managed to quit before.
      • Descriptive norms: 30 per cent of people of your age have successfully given up smoking.
      • Subjective norm: Your wife and kids will appreciate
      • Personal/moral norms: Smoking is anti-social and you do not want your kids to start smoking
• Elaboration Likelihood Model (ELM): only individuals already interested beforehand info, will pay attention and act accordingly.
  
  • Peripheral processing: not motivated, not involved, incongruent beliefs --> maximize credibility/attractiveness message through use indirect cues/info
  • Motivated to receive argument when:
    • Congruent pre-existing beliefs
    • Personally relevant
    • Intellectual capacity to understand message
• Use of fear: key strategy to motivate change --> considered fear engendering advertisements to be more effective than humour
  
  • protection motivation theory: individuals will respond to information in either an adaptive or maladaptive manner depending on their appraisal of both threat and their own ability to minimise that threat
    
    • most likely to behave in an adaptive manner in response to a fear arousing health message if they have evidence that engaging in certain behaviours will reduce any threat and they believe they are capable of engaging in them
  • Witte’s (1992) extended parallel process model: individuals who are threatened will take one of two courses of action
    
    • Danger control: reducing the threat, usually by actively focusing on solutions. Needs to consider that an effective response is available (response efficacy) and that they are capable of engaging
    • in this response (self-efficacy)
    • Fear control: reduce the perception of the risk, by avoiding thinking about the threat
  • Most persuasive message:
    • Arouse fear
    • Severity if no change is made
    • Emphasise ability individual to prevent feared outcome (self-efficacy)

Information framing:

• Positive: stressing positive outcomes associated with action
• Negative: emphasising negative outcomes associated with failure to act
• --> no consistent  benefit from either approach

Motivational interviewing:

• Motivation to consider change, not show how to change. Aim: get interviewee state of cognitive dissonance: state of discomfort resulting from holding two sets of opposing beliefs --> resolved by rejecting one set of thoughts. Most effective form of persuasion in one-to-one
• Alternative strategies for changing behaviour:
  • Consider disadvantages of status quo
  • Consider benefits of change
  • Intention change: How important is this to you? How much do you want to do this?
  • Optimism about change

Problem-solving approaches:

• Focus how behaviour can change and not why behaviour should change -->Problem-oriented counselling approach: proper analysis problem, mobilise the individual’s own resources both to identify problems accurately and to arrive at strategies of solution --> consists 3 phases:

1. Problem exploration/clarification
2. Goal setting
3. Facilitating action

• --> Done by direct/descriptive questions and by empathic feedback.

Quit smoking:

1. Conditioned response to cues environment
2. Physiological need for nicotine
   
   • Nicotine acts on the acetylcholine (neurotransmitter is released at the ends of nerve fibres in the parasympathetic nervous system and is involved in the transmission of nerve impulses in the body) system, which mediates levels of attention and muscle activity throughout the body.

• When quitting:
  • withdraw symptoms: worst first 2 days, after 2 weeks disappear
  • loss of a powerful means of altering mood and level of attention
  • urge to smoke triggered by environmental cues
• Nicotine Replacement Therapy (NRT):  use nicotine gum/patches to get rid of behaviour --> combined with problem-oriented interventions --> best approach
• Strategies:
  
  • Avoidant strategies: Sit with non-smoking friends at coffee breaks
  • Coping strategies: Remember your reasons for stopping smoking – carry them on flashcards.
  • Make it difficult to smoke
  • Cognitive re-labelling: these horrible symptoms are signs of
  • recovery.

Plans and Intentions:

• Fail to translate goal intentions into goal attainment:
  • Failing to start: not remember to start, they do not seize the opportunity to act
  • Becoming ‘derailed’ from goal striving: derailed by enticing stimuli
• Implementation intentions: if-then approach. Planning change, action is specified in terms of when, where and how. Examples:
  
  • Failing to get started: If it is 8 am on Friday, I will ride my bike to work.
  • Missing opportunities: As soon as I hear from the doctor, I will book my health check-up.
  • Initial reluctance:  If it is Saturday 10 am, I will prepare five healthy meals to eat during the week.
  • Unwanted attention: If I start to think about to distractors  snacking, I will focus on alternative things to do.
  • Stopping old habits: If I see the stairs, I will tell myself how good I will feel if I walk up the stairs – and do it.

Modelling:

• Problem-focused implementation-intention: develop strategies of change and determine when such changes can be enacted.
  • Change difficult --> lacks the skills or confidence in their ability to make them.
• Bandura’s Social Learning Theory: develop behavioural change by showing good example (vicarious learning)
  
  • Live model: actual individual demonstrating behaviour
  • A verbal instructional model: descriptions behaviour
  • Symbolic model: real or fictional characters displaying behaviour
  • Coping model: does not leave the observer feeling de-skilled or incapable of gaining the skills

Cognitive interventions:

• Thoughts influence behaviour --> make aware cognitions are hypothetical, and that alternative thoughts/outcomes are possible
• Socratic dialogue: structured conversation. Intention to ask someone why is using something and summarize it --> reason for use is not seldom
• Downward arrow technique Beck et al. (1993): designed to question the very core of an individual’s beliefs
• Homework tasks: directly challenge any inappropriate cognitive beliefs. Example: believes that they cannot go to a party without drinking --> homework task of trying to remain sober at a party

Changing environment:

• Health belief Model --> environment encourages healthy behaviour should:
  • Cues to engage healthy behaviour/remove cues unhealthy behaviour
  • Minimize cost/barriers associated healthy behaviour
  • Maximize costs health-damaging behaviour
• --> Environmental strategies central to PRECEDE model: framework for the development of public health programmes
• Healthy Cities movement: design city environments in ways that promote the mental and physical health of their inhabitants. Involve citizen and community groups.

Spreading word:

• To spread new behaviour, Rogers divided population into:
  • Innovators: high status. Test new ideas
  • Early adopters: wider sphere of influence. Opinion leaders
  • Early majority: adopts ideas reasonably early, but no power to influence
  • Late majority: adopt innovation only after adopted by early majority. Careful group
  • Laggards: adopt change last, or not at all