Applying Transtheoretical Model of Change to Anti-Depression Campaigns

Transcription

1 Applying Transtheoretical Model of Change to Anti-Depression Campaigns Tatiana Levit Magdalena Cismaru University of Regina, Canada

2 Outline Depression and anti-depression campaigns Research questions, need for theory Appropriateness of TTM Methodology 5 campaigns studied How the campaigns align with TTM Recommendations 2

3 Depression Common mental disorder is among the leading causes of disability and premature death in the world today (NIH Medline Plus, 2012 ; WHO World Health Organization, Mental Health, 2012) Connected to reduction of quality of life, impairments, work disability, reduced productivity, financial difficulties, as well as suicide (Katon, 2009; NIH Medline Plus, 2012 ; WHO World Health Organization, Mental Health, 2012) Worldwide depression affects more than 120 million people of all genders, ages, and backgrounds (NIH Medline Plus, 2012) Treatable and preventable in most instances But often not recognized as a disease (WHO, 2012) Societal barriers: stigma and self-stigma (Jorm et al., 2003) Men find it especially difficult to acknowledge (Rochlen et al., 2005) 3

4 Campaigns Against Depression Social marketing campaigns are developed by government and NFP organizations Main messages: it is an illness, help is available, don t judge Anti-depression campaigns discussed in the academic literature (Nemec, 2005; Rochlen et al., 2006; Reavley and Jorm, 2011) The British Defeat Depression Campaign Beyond Blue, Australia s national depression initiative Real Men. Real Depression Findings Somewhat successful in changing public views, improving depression awareness and reducing stigma Need theoretical basis (Kelly, Jorm & Wright, 2007; Noar, 2006) 4

5 Research Questions Examine social marketing campaigns aimed at preventing depression to determine: How can we design more persuasive campaigns, effective in promoting behavioural change? Are the existing campaigns based on any theoretical model? If not, which model/s would be most appropriate? 5

6 Transtheoretical Model Precontemplation people are most likely unaware that their behaviour is problematic; have not intention to take action Contemplation people are beginning to recognize that their behaviour is problematic and start to look at the pros and cons of their actions Preparation people are intending to take action in the immediate future, and may begin taking small steps towards change Action people have made specific overt modifications in their life style, and positive change has occurred Maintenance people are working to prevent relapse (the return from action or maintenance to an earlier stage) Termination individuals have zero temptation and 100% selfefficacy... they are sure they will not return to their old unhealthy habit as a way of coping (Prochaska and Velicer 1997). 6

7 Transtheoretical Model (Norcross, Krebs, & Prochaska, 2011; Prochaska, DiClemente, & Norcross, 1992; Prochaska, Norcross, & DiClemente, 1994) 7

8 Methodology Snowball search methodology Keywords: depression, mental health, anti-depression, antistigma, mood disorders, mental disorders, depression campaigns, depression initiatives, depression and Transtheoretical Model, depression and meta-analysis Mental health related government websites US National Institute of Mental Health UK National Institute for Health and Clinical Excellence Mood Disorders Society of Canada etc. Social Sciences Citation Index, Jstor, PsycInfo, ABI/INFORM Google and academic literature search 8

9 Anti-depression initiatives Inclusion / exclusion criteria Included Excluded Target: adults (men, women, or both) Level: national and international Complexity: mass-media components, such as television, radio, magazine ads, posters, brochures, postcards etc. Target: youth or children Level: local (city, state) Complexity: websites that simply provided links to other websites or campaigns 9

10 Results of Search 5 major national campaigns from 5 English-speaking countries Evaluations Objectives Education, information, understanding Overcoming resistance Empowering individuals to feel confident, to talk, to seek help Assisting individuals in their recovery Suicide prevention 10

11 Campaigns Studied: Objectives BeyondBlue (AUS) What Better Feels Like (Canada) Time to Change (UK) Real Men. Real Depression. (USA) National Depression Initiative (NZ) Beyondblue s work is aimed at achieving an Australian community that understands depression and anxiety, empowering all Australians, at any life-stage, to seek help. MDSC embarked on a project to assist individuals suffering from depression in their recovery. MDSC believes that consumers, families and caregivers are entitled to clear, accurate information about mood disorders and other mental illnesses. Informing yourself about your own or a loved one s illness is an essential step in the journey to recovery. Time to Change is England's biggest program to challenge mental health stigma and discrimination. The goal is to to empower people with mental health problems to feel confident talking about the issue without facing discrimination, and the three quarters of the population who know someone with a mental health problem to talk about it too. The National Institute of Mental Health (NIMH) focused on educating men and those close to them about the symptoms of and treatments for depression. The goal is to overcome resistance to mental health services by sending a message that it takes courage to ask for help, it is not unmanly or weak to admit to needing help and that by looking at your feelings one can become a better man. (NDI) is a national project which is part of the Government s commitment to addressing suicide prevention, as well as improving the mental health and wellbeing of all New Zealanders. The goal is to reduce the impact of depression on the lives of New Zealanders.

12 Campaigns Studied: Primary Target All Adults Men Additional BeyondBlue (AUS) Y Aboriginal, Multicultural, GLBTI, Women /perinatal, Men, Older, Youth, Workplace (materials and programs) What Better Feels Like (Canada) Y Workplace. Classroom or workplace ( Elephant in the Room posters) Time to Change (UK) Y Two sides: those who suffer and helping others (family, friends, coworkers, students) Real Men. Real Depression. (USA) Y Latino (PSAs for television, radio, and print, fact sheets and brochures) National Depression Initiative (NZ) Y High risk groups, affected but reluctant to seek help, whānau, family, health sector

13 Campaigns Studied: Components Mass media components TV, radio, magazine, posters, websites, postcards, washroom door panels, beer mats, billboards, bus stop advertising Helplines Talking points Training, educational kits, action packs Events and sponsorship Internet media, discussion and support groups, forums, online self-help program

14 TTM Stages Campaign Transtheoretical Model: Stages of Change PC C Pr A M BeyondBlue (Australia) H H H H H What Better Feels Like / Defeat Depression (Mood Disorders Society of Canada) M M H H H Time to Change (Mind, UK) H H H H M Real Men. Real Depression. (NIMH, USA) National Depression Initiative (Ministry of Health, New Zealand) H H H H L H H H H H H-High M-Medium L-Low

15 Precontemplation Target: people are most likely unaware that their behaviour is problematic; have not intention to take action Testimonials inform about signs of disease Fight stigma: It takes courage to ask for help Real Men. Real Depression. (NIMH) 15

16 Precontemplation Use a celebrity (Sir John Kirwan, rugby coach) Include self-assessment tools National Depression Initiative (NZ) Over the last two weeks I have felt down or hopeless Not at all For several days Nearly every day 16

17 Contemplation Target: people are beginning to recognize that their behaviour is problematic and start to look at the pros and cons of their actions Where to get more information and help Encourage to seek support from others Time to change. Time to talk. (UK) 17

18 Preparation Target: people are intending to take action in the immediate future, and may begin taking small steps towards change Give options Encourage to take small steps BeyondBlue (Australia) 18

19 Action and Maintenance Target: Action people have made specific overt modifications in their life style Maintenance people are working to prevent relapse Encourage to fully commit to recovery Remind about rewards Help plan for setbacks What Better Feels Like (MDSC) 19

20 Recommendations for using TTM of Change based on meta-analysis of 39 studies (Norcross, Krebs, & Prochaska, 2011) Assess the client s stage of change Only about 20% of people are in the action stage (Velicer et al., 1995) Do not impose action on precontemplators Set realistic goals by moving one stage at a time Tailor the processes to the stages Avoid mismatching stages and processes, practice integratively Consciousness-raising at the earlier stages Behaviouristic methods in later stages Anticipate recycling Most people will recycle several times before achieving longterm maintenance 20

21 Our Recommendations: What campaigns should do at each stage Stage campaigns should target Precontemplation Inform about definition of depression (signs and symptoms). Help recognize and admit the problem. Inform about increased risks (costs)of doing nothing and vast benefits of change. Take the stigma away and fight the defenses. Provide testimonials and evaluation tools. Contemplation Encourage to seek professional and social support. Inform about ways to receive immediate help and where to find more information. Discuss what can help. Encourage to try small actions to see how they help. Preparation Encourage to reconsider the importance of benefits versus risks. Provide with more helpful techniques. Encourage to create an action plan. Remind of the importance of positive self evaluation (Cismaru et al., 2008) Action Encourage to notice the benefits of change and use of self-encouragement Maintenance Remind of temporary slips, effective coping with setbacks and recycling. Continue to stress the importance of positive self-image and confidence. 21

22 Defeat Depression with TTM theory Thank you! 22

23 References Cismaru, M., Lavack, A. M., Hadjistavropoulos, H. D., & Dorsch, K. (2008). Understanding health behavior: An integrated model for social marketers. Social Marketing Quaterly, 14, Jorm, F., K. M. Griffiths, H. Christensen, A. E. Korten, R. A. Parslow and B. Rodgers (2003), Providing information about the effectiveness of treatment options to depressed people in the community: a randomized controlled trial of effects on mental health literacy, help-seeking and symptoms, Psychological Medicine, 33 : pp Katon, Wayne J. (2009). The impact of depression on workplace functioning and disability costs. American Journal of Managed Care, Dec;15(11 Suppl):S Kelly, Claire M, Anthony F Jorm and Annemarie Wright (2007). Improving mental health literacy as a strategy to facilitate early intervention for mental disorders, Medical Journal of Australia, 187 (7): 26 NIH Medline Plus Nemec, Kathryn (2005). Phoenix Research Public Health Depression Initiative: A Review of Depression Campaign Lessons for New Zealand. Noar S. (2006). A 10-year retrospective of research in health mass media campaigns: where do we go from here? Journal of Health Communication 2006; 11: ] Norcross, J.C., Krebs, P.M., & Prochaska, J.O. (2011), Stages of change. Journal of Clinical Psychology 2011 Feb;67(2): Prochaska,, J. O., DiClemente, C. C., & Norcross, J. C. (1992). In search of how people change. American Psychologist, 47, Prochaska, J. O., Norcross, J. C., & DiClemente, C. C. (1994). Changing for good. A revolutionary sixstage program for overcoming bad habits and moving your life positively forward. New York, NY: Harper Collins. 23

24 References Reavley Nicola J.; Jorm Anthony F. (2012) Public recognition of mental disorders and beliefs about treatment: changes in Australia over 16 years, British Journal of Psychiatry, Volume: 200 Issue: 5 Pages: Rochlen, Aaron B.;Whilde, Margaret R.;Hoyer, Wayne D. (2005). The Real Men. Real Depression Campaign: Overview, Theoretical Implications, and Research Considerations. Psychology of Men & Masculinity, Vol 6(3), Rochlen, Aaron B.;McKelley, Ryan A.;Pituch, Keenan A. (2006). A preliminary examination of the "Real Men. Real Depression" campaign. Psychology of Men & Masculinity, Vol 7(1), Roadways to Healthy Living: A Guide for Depression Prevention (2009), written by Pro- Change Behavior Systems, Inc., in collaboration with Recardo F. Munoz, Ph.D., West Kingston, Rhode Island. Mastering Change: A Coach s Guide To Using The Transtheoretical Model (2006), written by Pro-Change Behavior Systems, Inc., West Kingston, Rhode Island. Velicer, W.F., Fava, J.L., Prochaska, J.O., Abrams, D.B., Emmons, K.M., & Pierce, J.P. (1995). Distribution of smokers by stage in three representative samples. Preventive Medicine, 24(4), WHO World Health Organization, Mental Health 24