Health knowledge, attitudes and behaviour R.Fielding

Learning objectives At the end of this lecture, you should be able to –give a balanced account of the role of knowledge in behaviour change –define “attitudes” and explain how they relate to both knowledge and behaviour

Continued –define “self-efficacy” and explain why it is important in behaviour change –give examples of barriers to behaviour change and examples of ways to overcome these.

Why is this topic important? CHD, HT, CVD and Cancers are commonest causes of death in HK and many other countries. Most can’t be cured, but a majority of cases could be prevented. Most of these diseases arise from people’s lifestyle (i.e. their behaviour), e.g. no exercise, diet, smoking.

Why is health knowledge important? To prevent disease people must change their hazardous behaviour. Why do people behave in ways hazardous to their health? Because most people don’t think of their health until it is threatened or they lose it, preferring instead to pursue their goals.

So why is knowledge important? Ignorance of health hazardous behaviour. Knowledge is a first step to changing behaviour. But knowledge alone insufficient to change behaviour.

Is knowledge alone sufficient? Not usually, although it helps. Knowing something can affect your health and perceiving a health threat are not the same. Once a threat is recognised, people may be more motivated to change their behaviour, except....

Except what??? Unless the threat is imminent (with severe consequences), most people will ignore or forget it. Conversely, where a threat is perceived significant changes in behaviour may occur. e.g. belief that tap water in HK is unsafe to drink.

...and... e.g. UK, BSE in beef --> drop in beef consumption. Though beef is now safe, consumption remains low. e.g. most people who smoke know health risks, but continue to smoke (Li et al, 1996).

Why is attitude relevant? Attitudes are evaluative social judgements -orientations that locate objects of thought on dimensions of judgement Mixtures of components –cognitive: beliefs –emotional: feelings –behavioural: predispositions to act

Do attitudes predict behaviour ? Usually not very well. Giving information which changes attitudes doesn’t always change behaviour. Why? –attitudes are generalisms, behaviours are more specific; –attitudes are only predispositions to act.

Changing attitudes To effectively change attitudes you need: –credibility (expertise/ trustworthy) –likeability (physical attractiveness) –persuasive arguments –to consider listener’s original position.

To effectively change behaviour, you need... Recognition that behaviour change is needed / desirable Motivation to make change Belief that change can occur and be maintained (perceived self-efficacy) Triggers/cues to initiate change Perceived benefits of that change.

What is perceived self-efficacy? Modelling w. guided mastery --> new skills, but these not applied if no use. Acquiring vs. using skills effectively under different circumstances. “Success requires not only skills, but also a strong self-belief in one’s capabilities to master problems.” (Bandura, 1986)

PSE affects every stage of change process : –whether or not people consider changing –how hard they try if they choose to do so –their resiliance following setbacks –how well they maintain the gains achieved (Bandura, 1986, p.162).

...and Modelling?... Seeing effective practices in use is v. persuasive. –greater demonstrable benefits, greater likelyhood example will persuade. –exhortations to change are by themselves mostly useless. Confucian society relies on example for changing behaviour.

Knowledge Attitude Behaviour This is not how it works.

So..is health behaviour change hard to achieve...? Yes. –Treatment non-adherence ranges from 30-60% –Prophylactic treatment adherence only 30-35% –Protective health behaviour %

Yet, people indulge in all kinds of health related activities - clearly it isn’t an aversion to these so much as an unwillingness or inability to adopt specific regimens prescibed by health professionals.

Is it really that bad? Yes. Health behaviour change approaches usually ineffective. Few achieve more than the preoportions of people who successfully keep their New Year’s Resolutions. But if health workers adopted better methods, they would be more effective.

…Are health professionals better? Literature indicates HCPs do not follow clinical procedures they know should be implemented: –Physician performance ranges between 48-72% of professional standard (Peterson etal, 1980)

–Nurses deviate from infection control rules (Raven & Harley, 1982) –Dentists fail to adequately shield patients during x-rays (Green & Neistat, 1983), –20% error rate in care procedures in old people’s homes (Kayne & Cheung, 1973). etc...

Do HCPs modify their behaviour? Self-imposed protocols designed to improve care for UTI in primary care clinics were adhered to between100%-38% of the time. (Sullivan et al, 1980)

Cont. US Residents in internal medicine given update reading materials on 13 common preventive care actions: adherence to recommendations <10% of time. (Cohen, 1985).

Why are things so poor among HCPs? The same factors that influence the public probably influence HCPs. These include: –beliefs & attitudes of people about their actions –the complexity of the procedures advocated –the perceived costs (ie effort) versus benefits

Cont. –low perceived self-efficacy –faulty memory –inadequate skills and resources –previous failures.

Implications “ There is enough evidence of professional non-compliance for it to seem likely that even if clinicians were aware of these techniques, they would not necessarily use them.” Ley, (1986).

Implications cont. If clinicians will not change their behaviour, are we being realistic in expecting patients to do so just because we exhaut them to? No, we need to change our behaviour if we expect patients to change theirs.

The End. Attitudes 2: Interactions with patients. Addiction and behaviour. Who are you? Individuals and groups.