Prediction, Prevention & Change

Introduction Changing or preventing risky or unhealthy behaviour has become a major concern of health professionals and Governments. One way to approach change or prevention is to consider factors that contribute to a person’s intention to change an unhealthy behaviour. Any model must consider how intention might be transformed into an actual behaviour.

Theory of Reasoned Action (TRA) A cognitive theory first proposed by Azjen and Fishbein (1975) Assumption: A person’s decision to perform a particular behaviour (such as stopping smoking) can be predicted by their intentions (problems?!). Intentions are based on ...   1. Behavioural (aka Individual) Attitude  This is our personal attitude towards the target behaviour.  It is the sum of all our knowledge, attitudes, prejudices etc. that we think of when we consider the behaviour.   2. Subjective norms Considers how we view the ideas of other people about the target behaviour.  A product of social influences.  

Theory of Planned Behaviour (TPB) - This takes the previous theory (TRA) and adds ‘Perceived Behavioural Control’ (Azjen, 1985) [aka. ‘Self efficacy’] - This means adding the extent to which you believe the change in behaviour is possible.  - The theory believes that this perception of behavioural control acts on either the intention or directly on the behaviour itself. This has two effects: - The more control we believe we have over our behaviour, the stronger our intention to perform the behaviour. - The person with the higher perceived level of control will try harder and longer to succeed.  

Theory of Planned Behaviour Behavioural Attitude Subjective Norm Intention Behaviour Perceived Behavioural Control

Perceived behavioural control Godin et al (2006) examined the extent TPB could explain smoking intentions and behaviours. Data was collected using questionnaires and trained interviewers. P’s surveyed at start of study and 6 months later. Researchers found the 3 elements helped to explain intentions, whereas only perceived behavioural control was the most important predictor of ultimate human behaviour, as predicted by the model. Researchers concluded that prevention programmes should help smokers to focus on the will-power required to give up smoking and also alert smokers to the effort that is required to modify smoking behaviour.

Self Efficacy Self Efficacy - a person's belief in their own competence TPB proposes that intentions to change behaviour will be stronger in people who have an increased sense of control. Such self efficacy has been shown to be important in many aspects of addiction prevention such as relapse prevention programmes. Eg. Majer et al (2004) investigated the role of cognitive factors, including self efficacy on abstinence. They found that encouraging an addict’s belief in their ability to abstain was related to optimism and a positive outcome. Concluded that enhancing self efficacy should form a primary goal of treatment plans.

Factors in Intervention

Success of treatment often depends upon a number of factors related to the individual including: Motivation to change Support from family/friends. Pressure to receive treatment from outside force: Criminal justice system (CJS), employers etc.

Public Health Interventions & Legislations These are mostly pre-emptive, targeting the population as a whole. Can either be ‘educational’ or ‘restrictive’ Useful in (partly) shaping ‘Individual Attitudes’ (IA) and ‘Subjective norms’ (SN) Broadly, they can be in the form of: Doctor’s advice Workplace interventions Government initiatives

Doctor’s advice Russell et al (1979) carried out a study in five doctors’ surgeries over a four week period.  Patients were being encouraged to give up smoking and were placed in one of four treatment groups: Treatment offered Success A follow up session four weeks later 0.3% Questionnaire about their smoking habit and follow up 1.6% Doctor’s advice to stop, questionnaire and follow up 3.3% Doctor’s advice, leaflet with advice on quitting, questionnaire and follow up 5.1%

Doctor’s advice II Fiore (2008) Meta-analysis: physician advice to quit smoking (even if brief) led to a quit rate of 10.2%, as opposed to a quit rate of 7.9% for ‘no advice’ For actual physician counselling sessions, duration and number of sessions correlated with the effectiveness of smoking cessation. Higher intensity (more than 10 minutes) = 22.1% quit rate No contact = 11% quit rate More than 8 sessions = 24.7% 0–1 sessions = 12.4%

Government initiatives This can be in the form of: Banning or restricting advertisement Increasing cost through taxation Control on sales Harm Minimisation Reducing harmful components Promoting responsible usage

Workplace interventions Either be government-led (e.g. the smoking ban), or smaller, localised initiatives adopted by the workplace (restrictions before the ban, discouraging lunchtime drinking, etc) This can foster a better environment for those trying to quite and influence IA & SN. HOWEVER, it might increase smoking at home to compensate for their lack of nicotine UK ban was introduced in July 2007.  Between April & December 2007 an estimated 250,000 people quit.  Most were in the nine months prior to the ban being introduced.  Australian study of attitudes immediately & 6 months after a smoking ban in 44 government buildings found the ban only resulted in 2% quitting completely. 

Using the Internet to Promote Health Behaviour Change The internet is being increasingly used to promote health behaviour change. Webb et al (2010) analysed 85 studies of such interventions and concluded that those based on a theoretical model, especially TPB, tended to have greater success. This suggests the TPB can have an important role in the development of internet prevention programmes.