CHANGING

BEHAVIOUR
FOR A HEALTHY
LIFESTYLE
H LT H 1 0 0 1
WEEK 10
WEEK 10
• No tutorials Week 10.
• You submit your oral presentation in Week 11 during your tutorial
timeslot (e.g. Tuesday 12.30pm)
• There is an Assessment 3 folder on Blackboard (Under the Assessment
tab) – please submit your PPT presentation (with the notes) during
your tutorial time
CRITIQUE OF JOURNAL
ARTICLE - HEALTH HOT TOPIC
• PLEASE SEE course outline
• Check rubric
• Check Week 7 folder under tutorials for PPT with recording
• We will submit by Week 11 during tutorial.
• **PLEASE SUBMIT TO THE ASSIGNMENT LINK UNDER
ASSESSMENT TAB ON BLACKBOARD**. This will be submitted
during your tutorial time (e.g. Tues 12.30pm OR Thursday 8.30am
etc…..).
RESEARCH PAPERS

• Will be at least 2 weeks

• (approx 200 papers)
WEEK 11, 12 AND GOING
FORWARD
• No more tutorials for the rest of Semester
• Week 11 – brief lecture and general feedback for research papers
• Week 12 – was meant to be a guest speaker/s series but with current
issues it wont happen
• Week 13 – Short course review lecture and information on online final
exam – will be conducted through Blackboard – **REVIEW
QUESTIONS**
LAST BIT OF HOUSEKEEPING

• Please check emails

• Communication /Professionalism
IMPROVING YOUR HEALTH

• Lets go back - What influences a person’s health?

 He
re
di Gender me/
o
ty Inc us
t
sta
Personal
health Social
practices support
Cultural
and ethnic Education
background
HEALTH

Development Employment
/ work
conditions

Access to en So
health/quality of vi cia
ro
health care nm l
s en
kill Physical t
s
i ng environment
p
Co
11
HEALTH PROMOTION
“is the process of enabling people to increase
control over and to improve their health”
(Ottawa Charter)

Greene & Richards define health promotion

as:
The combination of educational and
environmental supports for action and
conditions of living conducive for health.
GOALS of Health
promotion….
- to maintain health conducive
behaviours
- to adopt health conducive
behaviours
- to change health compromising
behaviours
- maintain behaviour change
 Spectrum of Philosophies
to Public Health – what is your
philosophy??
Individualistic - Structural
individual Collectivist -
responsibility – everyone is
education is the responsible –
cure all related to whole of
community
Both ends of the spectrum approach -
necessary for comprehensive, environmental
effective health promotion – adaptations
change & improvement
 How?
Health promotion …..A spectrum of
approaches
Individualistic Structural collectivist
Health Promotion approach
(IHP) (SCHP)
Health education focus – Participation of community +
knowledge, health risks, legislation + bureaucratic
persuade/motivate interventions e.g., public health
lifestyle change policy, legislation to control
ban/behaviours, curriculum
Victim blaming??
Personal responsibility??
 How?
What does this mean for PA?

Individualistic Structural collectivist

Health Promotion approach
(IHP) (SCHP)
Health education Physical activity govt groups

Physical education Policy: Minimum amount of PE

in schools
Campaigns
Urban planners and town design
Social Marketing
Find 30
CHANGING
HEALTH
BEHAVIOUR
FACTORS IN BECOMING PHYSICALLY ACTIVE (NEWELL)

co
t
in

ns
tra

tra
ns

in
co

t
constraint

Lifelong Physical Activity

 FACTORS IN BECOMING PHYSICALLY ACTIVE (NEWELL)

Individual = Person
“Stage of Change”
motivation, confidence, maturation,
current PA level

co
t
in

ns
tra

tra
ns

in
co

t
Task = Environment =
What Promotions – events,
type PA: recreation
constraint opportunities,
choice &
Facilities,
skills Social Support
Lifelong Physical Activity
IS CHANGE POSSIBLE?

• Since one goal of health promotion is to change

behaviour, an understanding of the behaviour
change process is essential
• Human behaviour, and especially health
behaviour, is complex and not always readily
understandable (Egger, Spark & Donovan,
2005).
WHAT MOTIVATES HEALTH BEHAVIOUR

• Behaviours are triggered by stimuli however

• Individual responses differ!!
• Healthy behaviours might be adopted –Reasons
for doing so may differ and Motivation for health
behaviour is dynamic

e.g. Puffing when climbing stairs – seek higher

fitness levels
or may not relate it to your health…….

Look for the lift!

HEALTH BEHAVIOURS
 Health behaviours impact significantly on health
 These are influenced by an interaction of factors:
 Social Determinants of Health
 Concept of Risk
 Knowledge
 Beliefs and attitudes
 Values
 Social norms
 Experiences
 The media
 Not as easy as personal responsibility
 HEALTH KNOWLEDGE AND BEHAVIOUR

• Knowledge alone is not sufficient – it does not always

motivate logically appropriate behaviour.
• Why?
• Information clutter – selectively focus on information that
supports their existing beliefs and behaviour.
• Incoming information is interpreted in terms of personal
experiences, backgrounds, beliefs, values and attitudes.
• Information must be personally relevant
• Other beliefs might inhibit change
• The influence of the media
 MODELS FOR BEHAVIOUR CHANGE
THE COGNITIVE DISSONANCE MODEL; THE HEALTH BELIEF MODEL; THE SOCIAL LEARNING THEORY MODEL; THE
THEORY OF REASON ACTION; THE THEORY OF TRYING; PROTECTION MOTIVATION THEORY

 Can be classified as attitude models

 Knowledge Attitude Behaviour
 An attitude towards an object, person or behaviour is
based on a set of beliefs about that object, person or
behaviour.
 Eg: a person might believe that jogging:
 Must be strenuous to be effective;
 Improves overall health; and
 Increases alertness, but
 Is liable to cause knee injuries.
FOR EXAMPLE

• Person A: values improvement in health and increased

alertness; but
• Considers the consequence of injuries to be
detrimental
• If positive beliefs out weigh negative beliefs, the
attitude will be positive and vice versa (equal
weighting)
• Person B: has a knee injury and may place far greater
weighting on this attribute than the others
MODELS FOR BEHAVIOUR CHANGE

• The Health Belief Model

• The Social Learning and Social Cognitive
Theory model
• The Theory of Reasoned Action
• Stages of Change Model
• The Health Belief Model identifies two
factors that influence health protective
behaviour:
– the feeling of being personally threatened by disease,
– the belief that the benefits of adopting the protective
health behaviour will outweigh the perceived costs of
it.
• Social Cognitive Theory suggests that self-efficacy—the
belief that one has the skills and abilities necessary to
perform the behaviour —and motivation are necessary for
behaviour change.
• In other words, a person has to believe she/ he can perform
the behaviour in various circumstances and, she / he has an
incentive (positive or negative) to do it 
 SELF EFFICACY AT WORK

 I am confident I can maintain this sitting position

 I believe that chasing that cat would not be a good career move
 ROLE OF SELF EFFICACY
SOCIAL COGNITIVE
THEORY
SELF EFFICACY

Focal determinant – beliefs influence goals and aspirations

Past Social factors

Crucial to can boost –
experiences
motivation social
/success can
influence persuasion

High S.E. – more apt to Vicarious exp. Verbal

initiate, exert effort and and physiological encouragement,
persist in activities arousal peer role models
SELF EFFICACY
• For exercise adoption and adherence – findings have indicated that
interventions (including health and exercise) must also focus on the
development of S.E. to improve sense of control, self management
skills and perseverant effort (Bandura)
DIFFERENT FOR DIFFERENT
INDIVIDUALS
Cardiac patient, post surgery, using self efficacy to help him embrace
starting to exercise
• 1. Look at past history of sport/exercise – any past success? In
nutrition, exercise, any examples.
• 2. Set goals, appropriate feedback, examining how he went at small
tasks (simple to progressive tasks)
• 3. Vicarious experience – any videos/examples of other cardiac
patients – can we model?
• 4. Social persuasion – encouragement and support from yourself,
family, partner etc.
• 5. Physiological arousal – controlling nerves and anxiety –
mindfulness and meditation to help with these.
• The Theory of Reasoned Action explains behaviour as a
result of the person’s intention to perform that behaviour.
• That intention is influenced by
– the person’s own attitude towards the
behaviour, or
– the belief that people important to the person
think she/ he should or should not perform the
behaviour. Of course, the person’s own ideas
are influenced by the society she or he lives in.
 MAJOR BEHAVIOUR CHANGE THEORIES

• The Stages of Change model views behaviour change as

a sequenced learning process in five main stages (pre-
contemplation, contemplation, preparation, action,
maintenance).
• The model holds that to get people to change their
behaviour, it is necessary to determine at which stage they
are and then to develop interventions that move them to the
stages 
 STAGES OF CHANGE MODEL
• Prochaska & DiClemente (1980s)
• Originally developed in smoking cessation
programs
– People don’t just change habitual (chronic)
behaviours all at once
– Considers an individual’s readiness for change
• Transtheoretical model – blend of cognitive and
behavioural theory
FIVE STAGES OF CHANGE…

1. Precontemplation
2. Contemplation
3. Preparation
4. Action
5. Maintenance & Termination
1. PRECONTEMPLATION
(34%)
• Question? …. Not intending to change within the next 6
months
• Do not intend to change behaviour
• As a group: the pros of continuing their risky behaviour
more attractive than the cons of risky behaviour
2. CONTEMPLATION (35%)
• Question?…..Seriously intend to change in next 6
months
• On average individuals stay in this stage for ~2 yrs
• intending to change but putting it off
• Chronic contemplators pros = cons
CONTEMPLATION
• Ambivalence may lead you to weigh and re-weigh the benefits and costs: "If I
stop smoking, I'll lose that hacking cough, but I know I'll gain weight," or "I
know smoking could give me lung cancer, but it helps me relax; if I quit, the
stress could kill me, too!“
• Health educators have several ways of helping people move on to the next
stage.
• One strategy is to make a list of the pros and cons, then examine the barriers
(the cons) and think about how to overcome them.
• For example, many women find it difficult to get regular exercise because it's
inconvenient or they have too little time. If finding a 30-minute block of time
to exercise is a barrier, how about two 15-minute sessions? Could someone
else cook dinner so you can take a walk after work? If you feel too self-
conscious to take an exercise class, what about using an exercise
video/app/online program at home?
3. PREPARATION (15%)
• Question? ….Change in the near future – w/in the next
month
• Typically have a plan and have taken action in the last year
(e.g., decrease #cigarettes, began walking the dog)
• Risk behaviour pros < cons
• Not a stable stage – progress over the next 6 months
PREPARATION
• At this stage, it's important to anticipate obstacles.
• If you're preparing to cut down on alcohol, for example, be aware of
situations that provoke unhealthy drinking, and plan ways around
them.
• If work stress triggers end-of-day drinking, plan to take a walk when
you get home. If preparing dinner makes you want a drink, plan to
have an alternative ready (soda water with lemon or lime) instead of
wine.
4. ACTION (12%)

• Questions? …. Overt behaviour change over the

last months
• New behaviour must be the target, low risk
behaviour (e.g., 30 mins of moderate activity on
most days)
• Busiest, least stable stage, high risk of relapse
• Definition of this phase varies b/w researchers
5. MAINTENANCE AND TERMINATION (4%)

• Questions? …6 months or more at criterion

behaviour
• +5 yrs in maintenance
TERMINATION

 No temptation to engage in the old behaviour

 100% self-efficacy in all previously tempting
situations
 With Alcohol & Smoking – 15 -17% terminate their
problem
 For the Physically inactive – adopting new behaviour
which requires “maintenance” – Do they remain at risk
of relapse and must continue to work to maintain
regular exercise?
“WHO IS AT WHAT STAGE?” (PROCHASKA &
DICLEMENTE)

4%
PREcontemplation
12%
34% Contemplation

15%
Preparation

Action

35% Maintenance and

Termination
IN ESSENCE

• We go from "not thinking about it" to "weighing the

pros and cons" to "making little changes and figuring
out how to deal with the real hard parts" to "doing it!" to
"making it part of our lives.
• Many people "fall off the wagon" and go through all the
stages several times before the change really lasts.
 SOME CRITICISMS OF BEHAVIOUR CHANGE MODELS…

1. Exaggerate the ease with which behaviour can be changed

2. Overly simplistic connection is made between knowledge,
attitudes and behaviour
3. Evidence of long term success lacking
4. Broad brush approach - Culturally appropriate health
messages? Take into account ethnicity, gender, class factors?
5. Implicit message of “victim blaming”
6. A lot of models focus on the change of behaviour – but not
the maintenance

Richmond (p161- 173)

(Etter & Perneger 1999; Bunton et al. 2000; Whitelaw et al. 2000; Sutton
2001; Etter & Sutton 2002; Littell & Girvin 2002)
SOME CRITICISMS OF BEHAVIOUR CHANGE MODELS…WHERE TO
NOW?
• Models needed that encompasses decision‐making processes and
motivational processes that are not necessarily accessible to conscious
awareness.
• Needs to take account of the fact that the behaviours concerned reflect
the moment‐to‐moment balance of motives.
• At a given time an individual may ‘want’ to do one thing (e.g. smoke a
cigarette) but feel they ‘ought’ to do something else (e.g. not smoke it)
—but these feelings and beliefs are not present most of the time—they
arise under specific circumstances.
• A model of change needs to describe what these circumstances are and
how an individual's desires and values are shaped and changed. The
model needs to consider the difference between desire and value
attaching to a specific behaviour (smoking a cigarette) vs. a label
(being a smoker).
• Lasting behaviour change relies on the balance of motivational forces
regarding the specific behaviour consistently favouring the alternative
whenever the opportunity to engage in it arises. (West, 2005)
Relationship
  between attitudes and behaviour

situation

attitudes intention to behave behaviour

I believe I am not going to
In this situation
I would …

Influences Influences
Who and what has influenced my Who and what would
thoughts and feelings? influence my behaviour?
MASLOW’S HIERARCHY OF
NEEDS
RELEVANCE TO HEALTH PROMOTION - HELPS TO CLARIFY WHY
NOT EVERYONE RESPONDS TO THE CONCEPT OF RISK,
KNOWLEDGE AND ATTITUDES
Take Norm, unemployed, a working class man in a rural town,
slumped in front of the television with a beer in one hand
and a cigarette in the other, totally depressed by his last visit
to the employment service.

• Now consider those public health messages that see Norm

and his friends as a captive audience, beaming at those
messages about the need for physical activity and the
dangers of drinking and smoking.

• The problems these men are encountering may be so

overwhelming as to render them unable to respond to these
media campaigns.

• Health needs in this case might be compromised for the sake

of satisfaction of lower-order needs
WHY ELSE DO WE CHOOSE NOT TO CHANGE
OUR BEHAVIOUR?
 PERFORMING A RECOMMENDED BEHAVIOUR

• Formed an intention or made a commitment

• No physical or structural constraints
• Have skills, resources, and opportunity necessary
• Perceive themselves as capable
• The benefits outweigh the costs
• Social pressure is greater to perform than not to
• Behaviour is consistent with self image
• Behaviour is consistent with social roles
 Health
Interventions

Policy Education
Interventions Interventions

Enabling Environment Enabling Beliefs and

(Financial, Social Behaviours
Physical)

Desired Change?
REVIEW QUESTIONS
 1. Describe the Stages of Change
Model – each stage and % of people in that stage
and what are 4 key criticisms of the model?
 2. Describe Maslow's Hierarchy of Needs and
how it relates to behaviour
 3. Explain the key constructs of Self efficacy and
the implications for exercise adoption and
adherence