University:
Boston University
Course:
SAR HP 151 | Introduction to Health Professions
Academic year:

2022
Views:

495

Pages:

22
Author:

granitt3c2r

Outline • Why is it so difficult to change behavior? • The importance of theory • Motivational Interviewing as a vehicle to delivery theory based interventions • Applications My Research: Develop and Test Health Behavior Interventions Health Behaviors • Smoking Cessation & Second Hand Smoke Reduction • Medication Adherence (Cystic Fibrosis, Asthma) • Sleep Apnea • Pediatric Oral Health Underserved Populations: • Medically ill • Physical Disabilities • Low income & Inner city • Hispanic, African-American, Native American Across the Lifespan: • Children, Teens, Adults, Older adults Internal forces against change “My child is big-boned. She’s not overweight.” “I would rather eat what I want and smoke and die early than to have to go through all of these changes.” “I want to take my medicine but I keep forgetting.” “I’ve tried so many times to diet and failed. What’s the point?” “I drink a bit, but not more than my friends and I have a good job.” External Forces Stage of Change and HTN Meds Wiley et al 28.8 31.1 Not thinking about taking meds Ambivalent Taking steps Action 6.8 Maintenance 19.8 11.9 Targets for Adherence  Treatment entry  Treatment adherence Treatment engagement  Treatment response  Maintenance of treatment adherence/response Outline • Why is it so difficult to change behavior? • The importance of theory • Motivational Interviewing as a vehicle to delivery theory based interventions • Applications Importance of Theory  Theory guides the search for why people do/do not change behavior.  Set of concepts that explain or predict events by illustrating relationships between variables.  Helps identify targets for intervention.  Provides coherence to health behavior interventions.  Guides development of program strategies to reach target audiences and have maximum impact.  Must be applicable to a broad variety of situations. • IOM, WHO, Surgeon General • Recent reports emphasizing examination of social and behavioral determinants of health and disease. Theory and Treatment Effects • Preserves the internal validity • More efficient and effective delivery • Helps ensure that the intervention is delivered as intended • Increases a providers’ ability to work flexibly with different patients.  Interventions based on theory have greater treatment effects (Ellis et al 2007).  Enhances replicability and exportability. Challenges for Using Theory • Initiation and maintenance of behaviors. • Complex constellation of behaviors • Individual, social, and economic determinants of behavior. • Theory must map onto intervention components that can be delivered in the real world: clinical and community settings. • Array of psychological theories, many with overlapping constructs. Types of Theories • Explanatory Theories (Why) • Health Belief Model • Theory of Planned Behavior • Social Cognitive Theory • Behavioral Activation theory • Change Theories (Process) • Stage of Change • Precaution Adoption Process Model • Ecological Theories (Multiple levels of influence) • Diffusion of Innovations Theory • Community Organization and Other Participatory Models • Conceptual Frameworks (models for merging theory+practice) • Chronic Care Model • Precede-Proceed Process of Theory Testing 1. Identify theoretical model(s): review of literature, expert consultation, how well a particular theory fits a particular issue. • Ensure that it takes into account multiple factors that influence behaviors. 2. Outline theory, components, and constructs and map onto operationalization of the intervention. • Closely specify which aspects of the intervention relate to specific dimensions of the models. • Use Protocol Review Group (independent experts) 3. Pilot test intervention, use feedback from participants and providers to refine intervention to more closely fit theoretical model. 4. Assess change in outcome and change in theoretical constructs as a function of the intervention, using mediational analyses. Monitor Theory During Implementation • Interventions that articulate a theory without monitoring fidelity to the theoretical components lead to weak effects (Zakarian et al 2008). • Assess adherence to theory during delivery of intervention. • Theoretical fidelity • Independent raters rate theoretical components/guess theory • Ensure that control group is not getting theoretical components. • Avoid dilution of theories (measuring some constructs, not others). • Avoid mixing theories (CBT+ feedback is not CBT; its applied behavioral analysis). Potential Mediators of Tx Effect: Causal Steps Approach Treatment Mediator(s) Outcome Significant association between: 1. Tx and outcome 2. Tx and mediator 3. Mediator and Outcome Precaution 4. Reduced association between tx and outcome when mediator Effectiveness in the model (Mackinnon et al 2002; Baron & Kenny, 1986) Moderated-Mediation Models Intention Planning (Weidemann et al. 2009) Outcome Outline • Why is it so difficult to change behavior? • The importance of theory • Motivational Interviewing as a vehicle to delivery theory based interventions • Applications B. Borrelli, Ph.D Troubleshoot Barriers to Adherence Elicit Motivation To Improve Health Elicit Motivation to Take Medication Help Patient Develop a routine For medicationTaking Determine if Medications Taken Regularly Disruptions to medicationtaking by forgetting, side effects. Adopted from Rosen, Ryan, & Rigsby (2002). Behavior change, 19(4), 183-190 Long Term Adherence Adherence Relapse Thinking about changing Contented Not thinking about change Thinking about changing Taking Action Preparing to change Taking Action Preparing to change 1. Prochaska JO, et al.. Am Psychol 1992; 47:1102–1114. ® Problems with Standard Practice Unwelcome advice elicits resistance Knowledge weakly correlated with behavior change Controlling and directive approaches are appropriate for acute care, not behavior change. Mismatch between counseling approach and patient’s level of motivation Motivational Interviewing (MI) • Patient Centered • Explore patient’s reasons for and against change. • Technique to raise change issues without patient resistance. • Collaborative, not prescriptive. • Designed to enhance intrinsic motivation • Conduct consultation in manner that the patient feels responsible for the decision to change (enhances sustainability of change).Miller & Rollnick, 1991, 2002 Borrelli, Riekert, Weinstein & Cardella, 2007 Borrelli, Tooley, Scott-Sheldon, 2015 Communication Styles Fix-it Role  Focused on problem & solution  Parental relationship  I am the expert  Assumes pt. motivated  Advise, warn, persuade  Goals are prescribed  Argumentation and correction of pt’s perspective Motivational  Focused on pt’s concerns and perspectives  Equal partnership  Match intervention to pt level of motivation  Emphasize personal choice  Ambivalence: normal part of the change process.  Resistance: influenced by counselor behavior.

Develop and Test Health Behavior Interventions

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