 The value of theory  Moving beyond the Stages of Change  Tips for theory-guided intervention

Biological/ Demographic Age Gender BMI Education Employment Ethnicity Injury history Psychological/ Cognitive Attitudes Intentions Perceived Control Mood Self esteem Motivation Knowledge Enjoyment Social Social Support Family Physician influence Peers Group cohesion Class size Environmental Access to facilities Climate Cost of programs Neighbourhood safety Physical environment (sidewalks) Behavioural History of physical activity Dietary habits Type A behaviour Coping skills

 What is theory?  Explains why a behaviour or phenomenon occurs  Why use it?  Effective methods for accomplishing behaviour change  Identify key factors + processes to target for change  Measurable constructs  allow for assessment of change ▪ Basis for detecting success/failure of an intervention

 Key Premises  The environment in which one lives can restrict the range of behaviours that are possible  Multiple levels influence our behaviour (ex. physical environment, community, society, government)  Synergistic relationship between the environment and the individual INDIVIDUALENVIRONMENT Vs.

Macrosystem Exosystem Mesosystem Microsystem Individual Society Ex. mass media, social norms Systems influencing Microsystems Public health units, school boards Interaction of Microsystems Ex. how parents coordinate with schools to create PA programs People/places that support PA Ex. family, peers, school

Macrosystem Exosystem Mesosystem Microsystem Individual Society Ex. mass media, social norms Systems influencing Microsystems Public health units, school boards Interaction of Microsystems Ex. how parents coordinate with schools to create PA programs People/places that support PA Ex. family, peers, school

Macrosystem Exosystem Mesosystem Microsystem Individual Society Ex. mass media, social norms Systems influencing Microsystems Public health units, school boards Interaction of Microsystems Ex. how parents coordinate with schools to create PA programs People/places that support PA Ex. family, peers, school

Macrosystem Exosystem Mesosystem Microsystem Individual Society Ex. mass media, social norms Systems influencing Microsystems Public health units, school boards Interaction of Microsystems Ex. how parents coordinate with schools to create PA programs People/places that support PA Ex. family, peers, school

Macrosystem Exosystem Mesosystem Microsystem Individual Society Ex. mass media, social norms Systems influencing Microsystems Public health units, school boards Interaction of Microsystems Ex. how parents coordinate with schools to create PA programs People/places that support PA Ex. family, peers, school

Macrosystem Exosystem Mesosystem Microsystem Individual Society Ex. mass media, social norms Systems influencing Microsystems Public health units, school boards Interaction of Microsystems Ex. how parents coordinate with schools to create PA programs People/places that support PA Ex. family, peers, school

Behaviour Change Theories MOTIVATION ACTION

Precontemplation Contemplation Preparation Action Maintenance Progression towards behaviour change

 Predicting movement ▪ Moving backwards? ▪ Skipping stages  Arbitrary durations  6 months  Complexity of the behaviour  Can be in different stages for various PA behaviours  Stage-targeted interventions  may not produce longer-term behaviour change

 Tips for theory-guided interventions  Self-monitoring  Gain-framed messages  Goal setting  Planning

 2 Phases  1) Motivation Phase – getting ready to be active  2) Action Phase – engaging and maintaining PA

Self Efficacy Risk Perceptions Outcome Expectancies GoalsPlanning Recovery Maintenance Initiative MOTIVATION PHASEACTION PHASE

 Self Efficacy  “I am confident that I can start exercising 3x a week in the next month, and maintain this routine all year”  Outcome Expectancies  “ If I exercise more frequently, I will have less time to do other daily tasks” (negative)  ``If I exercise more frequently, I will lose some extra weight`` (positive)  Risk Perceptions  “ There is a history of heart disease in my family. If I continue to be inactive, I will further increase my risk.  Goals  “I plan to being active 2x a week for the next 12 weeks in order to reduce my risk of heart disease.” Self Efficacy Risk Perceptions Outcome Expectancies Goals MOTIVATION PHASE

 Self Efficacy  “I am confident that I can start exercising 3x a week in the next month, and maintain this routine all year”  Outcome Expectancies  “ If I exercise more frequently, I will have less time to do other daily tasks” (negative)  ``If I exercise more frequently, I will lose some extra weight`` (positive)  Risk Perceptions  “ There is a history of heart disease in my family. If I continue to be inactive, I will further increase my risk.  Goals  “I plan to being active 2x a week for the next 12 weeks in order to reduce my risk of heart disease.” Self Efficacy Risk Perceptions Outcome Expectancies Goals MOTIVATION PHASE

 Self Efficacy  “I am confident that I can start exercising 3x a week in the next month, and maintain this routine all year”  Outcome Expectancies  “ If I exercise more frequently, I will have less time to do other daily tasks” (negative)  ``If I exercise more frequently, I will lose some extra weight`` (positive)  Risk Perceptions  “ There is a history of heart disease in my family. If I continue to be inactive, I will further increase my risk.  Goals  “I plan to being active 2x a week for the next 12 weeks in order to reduce my risk of heart disease.” Self Efficacy Risk Perceptions Outcome Expectancies Goals MOTIVATION PHASE

How do we get people into the action phase? How do we get them to maintain this behaviour? Planning Recovery Maintenance Initiative ACTION PHASE

Self Efficacy Risk Perceptions Outcome Expectancies GoalsPlanning Recovery Maintenance Initiative MOTIVATION PHASEACTION PHASE

Self Efficacy Risk Perceptions Outcome Expectancies GoalsPlanning Recovery Maintenance Initiative MOTIVATION PHASEACTION PHASE

Self Efficacy Risk Perceptions Outcome Expectancies GoalsPlanning Recovery Maintenance Initiative MOTIVATION PHASEACTION PHASE

Any effort by a human being to alter its own response Making sure actions are in line with the goals/intentions

 Examined the role of self-monitoring in effective weight control  56 participants – weight loss program  Participants provided with self-monitoring booklet  record all food consumption and calories eaten throughout the week  Members stratified in terms of frequency of self- monitoring  Measured weight change

Self Monitoring and Weight Change Weight Change

Self Efficacy Risk Perceptions Outcome Expectancies GoalsPlanning Recovery Maintenance Initiative MOTIVATION PHASEACTION PHASE

Gain-framed

Loss-framed

Gain-framed

** Week 2Week 9 Physical activity (METS min/wk) Gain Loss Mixed **  *p<.05

Self Efficacy Risk Perceptions Outcome Expectancies GoalsPlanning Recovery Maintenance Initiative MOTIVATION PHASEACTION PHASE

S SPECIFIC Ex. I will go for a 30 min jog 3x a week either outside or at the gym. M MEASURABLE Ex. Measure = time = 30 minutes x 3 times a week A ADJUSTABLE Ex. If I don’t have 30 min to fit into my day I will go got a 15 min run, 6x a wee k R REALISTIC Ex. I usually have an 1hour lunch break so a 30min duration is doable T TIMELY Ex. I will continue to do these 30 min runs for the next 3 months

All participants (older adults 65yrs+) fill out a lifestyle assessment questionnaire Intervention Group Control Group 15 min face- to-face counseling/feedback regarding activity + nutrition goal setting, monitoring, adjusting goals, sub goals Counselors help participants create reasonable + obtainable goal Standard care No feedback or counseling regarding goals Measure Activity and Diet

Health Behaviour Measures at 12 Week Follow-up * Statistically significant

Self Efficacy Risk Perceptions Outcome Expectancies GoalsPlanning Recovery Maintenance Initiative MOTIVATION PHASEACTION PHASE

WHEN will I be active WHERE will I be active HOW will I be active

 75 sedentary women (mean age = 48yrs)  Randomly Assigned: 1) Action Plans 2) No Action Plans  Measure PA at 8 week follow-up Control Group (no action plans) Experimental Group (action plans) Given calendars Asked to list possible activities they could do to become active Given calendars Asked to plan out and record WHEN, WHERE, and WHAT type of PA they planned to do in the next 8 weeks All participants asked to record on calendars any PA they performed for 8 weeks

PERCEIVED BEHAVIOURAL CONTROL SELF EFFICACY

Number of Weeks Participants Engaged PA 2days/week # Weeks

Do a workout at home. No transportation to the gym. Plan time to drive to the gym. Poor weather for running outside Reschedule workout for the following day. Missed a workout due to unexpected commitment. ANTICIPATING POTENTIAL BARRIERS CREATING PLAN TO OVERCOME BARRIERS

 211 Patients with CHD  Randomly assigned to one of 3 conditions  Measured PA levels at ▪ baseline ▪ 2 months following discharge Standard Care (Control) Action PlanningCombined Planning No action or coping plans 3 action plans + 3 coping plans

Minutes of Strenuous Physical Activity Per week

 Tips for theory-guided interventions  Self-monitoring  Gain-framed messages  Goal setting  Planning

 Tips for theory-guided interventions  Promote enjoyment

DeterminationMotivation TYPES OF MOTIVATION AmotivationExtrinsicIntrinsic No motivation or complete lack of interest Motivation that comes from external sources (4 types) Doing something for your own interest or enjoyment

Amotivation Intrinsic Motivation Low Self-DeterminationHigh Self-Determination Extrinsic Motivation

Amotivation Intrinsic Motivation Low Self-DeterminationHigh Self-Determination Extrinsic Motivation External Regulation External Regulation Engage in Behaviour for reward or punishment

Amotivation Intrinsic Motivation Low Self-DeterminationHigh Self-Determination Extrinsic Motivation External Regulation External Regulation Introjected Regulation Behaviour Imposed by self- imposed pressure

Amotivation Intrinsic Motivation Low Self-DeterminationHigh Self-Determination Extrinsic Motivation External Regulation External Regulation Introjected Regulation Identified Regulation Engage in behaviour to achieve an outcome

Amotivation Intrinsic Motivation Low Self-DeterminationHigh Self-Determination Extrinsic Motivation External Regulation External Regulation Introjected Regulation Integrated Regulation Identified Regulation Engage in behaviour to confirm sense of self

Amotivation Intrinsic Motivation Low Self-DeterminationHigh Self-Determination Extrinsic Motivation External Regulation External Regulation Introjected Regulation Integrated Regulation Identified Regulation AutonomyCompetence Relatedness

 Psychological Needs:  Autonomy (self-determination)  Competence (experience mastery)  Relatedness (social interaction) PERCEIVED BEHAVIOURAL CONTROL SELF-EFFICACY

Testing a self-determination theory intervention for motivating tobacco cessation: supporting autonomy and competence in a clinical trial. N = 1006 Adult Smokers Intensive Intervention Condition Intensive Intervention Condition Community Care Condition Community Care Condition Public health booklet List of cessation programs Encouragement to enroll and speak with MD Same community care condition PLUS: Meet with counselor 4x over 6months Opportunity to speak with MD (visits acknowledged patients’ perspectives, supported their initiatives, offered choice about treatment, provided relevant info, minimized pressure and control)

 Tips for theory-guided interventions  Promote enjoyment

 The value of theory  Moving beyond the Stages of Change  Tips for theory-guided intervention