CHANGING HEALTH BEHAVIOUR

Transcription

1 CHANGING HEALTH BEHAVIOUR Dr Sam Caton ScHARR

2 Learning objectives 1. Identify different types of heath behaviour 2. Identify the importance of understanding health behaviours 3. Define unrealistic optimism as it relates to health behaviour 4. Identify factors to consider in promoting behaviour change

3 What are health behaviours? Behaviours related to health There are 3 main categories: Health Behaviour Illness Behaviour Sick role Behaviour

4 What are health behaviours? Health Behaviour: a behaviour aimed to prevent disease (e.g. eating healthily) Illness Behaviour: a behaviour aimed to seek remedy (e.g. going to the doctor) Sick role Behaviour: any activity aimed at getting well (e.g. taking prescribed medications; resting)

5 Health Behaviours Health Damaging/Impairing e.g. smoking, alcohol & substance abuse, risky sexual behaviour, sun exposure, driving without a seatbelt Health Promoting e.g. Taking exercise, healthy eating, attending health checks, medication compliance, vaccinations

6 Why do you need to know about health behaviours?

7 Economics: Estimates suggest overall alcohol-related harm costs the NHS in England 3.5bn/ year (Public Health England ) Estimates of the direct and indirect costs to the NHS of treating overweight and obesity range between 2.6bn and 15.8bn/ year (National audit office 2001, Butland et al. 2007)

8 Disease prevention

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10 Sufficient sleep duration contributes to lower cardiovascular disease risk in addition to four traditional lifestyle factors: the MORGEN study Prospective cohort study including 8128 men and 9759 women aged years, free of CVD at baseline Follow-up for 10 14y Sufficient sleep and adherence to all four traditional healthy lifestyle factors was associated with lower CVD risk. Hoevenaar-Blom et al. 2013, Eur J Prev Cardiol

11 Leading causes of death - England & Wales,

12 Combined impact of lifestyle factors on mortality Relative risk of mortality over 24 yrs in relation to five lifestyle factors Smoking Being overweight Taking little physical activity Excess alcohol Poor diet Each lifestyle factor independently and significantly predicted mortality. Van Dam R et al., Combined impact of lifestyle factors on mortality: prospective cohort study in US women. BMJ 2008; 337 doi: /bmj.a1440 (Published 16 September 2008)

13 Why is this important? Important from both an individual and population perspective Overwhelming evidence that changing people s health behaviour can have an impact on some of the largest causes of mortality and morbidity Interventions to change behaviour may offer a relatively simple solution to reducing disease A genetic predisposition to disease is difficult to alter Socio-economic circumstances associated with disease are difficult to change Interventions to treat/manage disease are often very expensive, with significant side effects By comparison, people s behaviour as individuals and collectively may be easier to change. NICE Guidelines: Behaviour change at population, community and individual level. NICE 2007

14 Health behaviour & Medicine Health impairing behaviours & mortality are related Morbidity also an issue - Diabetes, CHD, mental health issues Quality of life, working days lost to sickness What is the solution?...

15 Health behaviour & Medicine Intervention - Population level Health promotion The process of enabling people to exert control over the determinants of health, thereby improving health (Health Promotion Agency) Intervention Individual level Patient centred approach Care responsive to individual needs

16 Health Promotion Health promotion campaigns Everyone enjoys a drink, no one enjoys a drunk. Change 4 Life Campaign Stoptober, Movember Promoting screening and immunisations Cervical smear screening MMR vaccine

17 Effects of intervention are rarely restricted to one level E.g. a brief primary care intervention aimed at reducing alcohol consumption among individuals could have an impact: Individual's behaviour (level of alcohol consumption, individual health outcomes, or incidence of domestic violence) Local community (local alcohol sales, alcohol-related crime or accident and emergency [A&E] events) Population level (for example, national alcohol sales and consumption, national statistics on alcohol-related crime and A&E events, or demographic patterns of liver cirrhosis)

18 Why do we engage in damaging health behaviours? Or to put it another way why take risks with your health? news.bbc.co.uk/1/hi/health/ stm

19 Unrealistic Optimism Individuals continue to practice health damaging behaviour due to inaccurate perceptions of risk and susceptibility Perceptions of risk influenced by: 1. Lack of personal experience with problem 2. Belief that preventable by personal action (Weinstein, 1983) 3. Belief that if not happened by now, its not likely to 4. Belief that problem infrequent

20 Other reasons Health beliefs Situational rationality Culture variability Socioeconomic factors Stress Age Etc

21 As health professionals, should we: 1. Focus on the social determinants of health and not try to change individuals behaviour? 2. Respect individuals autonomy and simply inform them of their risks? 3. Intervene in people s lives by trying to persuade them to change their behaviour whether they want to or not?

22 If we want to help people change their health behaviour we need An overview of the theories and models of behaviour change An understanding of what works in practice

23 Some models and theories of behaviour change 1. Health belief model (HBM) 2. Theory of Planned Behaviour 3. Stages of change (transtheoretical) model 4. Motivational interviewing (MI) 5. Social marketing 6. Nudging (choice architecture) 7. Financial incentives 8. Social norms theory

24 Health Belief Model (Becker 1974) Individuals will change if they: Believe they are susceptible to the condition in question (e.g. heart disease) Believe that it has serious consequences Believe that taking action reduces susceptibility Believe that the benefits of taking action outweigh the costs

25 Theory of planned behaviour (Ajzen, 1988) Proposes the best predictor of behaviour is intention e.g. I intend to give up smoking Intention determined by: A persons attitude to the behaviour The perceived social pressure to undertake the behaviour, or subjective norms A persons appraisal of their ability to perform the behaviour, or their perceived behavioural control Ajzen, I (1988) The theory of planned behaviour, Organisational Behaviour and Human Decision Processes, 50:

26 Theory of planned behaviour Attitudes Subjective norm Perceived behavioural control Intentions Behaviour

27 Theory of planned behaviour Attitude I do not think smoking is a good thing Subjective Norm most people who are important to me want me to give up smoking Perceived Behavioural Control I believe I have the ability to give up smoking Behavioural Intention I intend to give up smoking

28 Stage Models of health behaviour Stage theories see individuals located at discrete ordered stages, rather than on a continuum. Each stage denotes a greater inclination to change outcome, typically behaviour, than the previous one. Transtheoretical model, or Stages of change model (Prochaska & DiClemente, 1984) Proposes 5 stages of change: precontemplation, contemplation, preparation, action, maintenance Not ready yet Thinking about it Getting ready Doing it Sticking with it

29 Transtheoretical model Progress Precontemplation (Not ready yet) Contemplation (Thinking about it) Preparation (Getting ready) 30 days Action (Doing it) 3 6months Maintenance (Sticking with it) > 6 months Relapse

30 Transtheoretical Model Precontemplation no intention of giving up smoking Contemplation beginning to consider giving up, probably at some ill-defined time in the future Preparation getting ready to quit in the near future Action engaged in giving up smoking now Maintenance steady non-smoker, i.e. state of change reached

31 Other factors to consider Over recent years - growing interest in the development of interventions to change health behaviour. However mixed patterns of results reported. Single unifying theory yet to be developed Other factors to consider: Impact of personality traits on health behaviour Assessment of risk perception Impact of past behaviour/habit Automatic influences on health behaviour Predictors of maintenance of health behaviours Social norms

32 So what can you do?

33 Being a doctor helps! Public s trust in sources of health information (max score 4) GP 3.51 Radio documentary 2.43 TV documentary 2.39 Magazine article 1.8 TV advert 1.72 Newspaper advert 1.69 Friend/neighbour 1.68 (692 adults, Budd & McCron in Tones and Tilford 2001)

34 NICE guidance on behaviour change 1. Planning interventions 2. Assessing the social context 3. Education and training 4. Individual-level interventions 5. Community-level interventions 6. Population-level interventions 7. Evaluating effectiveness 8. Assessing cost-effectiveness

35 Individual-level interventions Health professionals should help people to: Understand the short, medium and longer-term consequences of their health-related behaviours, for themselves and others Feel positive about the benefits of health-enhancing behaviours and changing their behaviour Plan their changes in terms of easy steps over time Recognise how their social contexts and relationships may affect their behaviour

36 In summary, as doctors helping individuals to change their health behaviours... (NICE 2007) Work with your patient s priorities Aim for easy changes over time Set and record goals Plan explicit coping strategies Review progress regularly (this really matters) Remember the public health impact of lots of you making small differences to individuals

37 To conclude... Addressing health behaviour is an important aspect of medical care Attending to modifiable risk factors can improve health Interventions at a population / local level affect individuals and vice versa Numerous theories and models of behaviour change exist, however, a single unifying theory needs to be developed

38 Recommended reading Ogden J. (2007) Health Psychology: A Textbook, 4 th Ed. Open University Press. Berkshire, UK. Marks, D.F., Murray, M., Evans, B., Willig, C., Woodall, C. & Sykes, C.M. (2005). Health psychology: Theory, research and practice (2 nd Edition). London: SAGE. NICE Behaviour change at population, community and individual level. NICE, London. PH006 Quick Reference guide available as pdf. f