Chapter 2 Strategies for Promoting Physical Activity & ‘Stages of Change Model’ VCE Physical Education - Unit 3 Text Sources 1.Nelson Physical Education VCE Units 3&4: 4 th Edition – Malpeli, Horton, Davey and Telford Live It Up 2: 2 nd Edition – Smyth, Brown, Judge, McCallum and Pritchard 2006.

Mediators of Behavioural Change Strategies for Promoting Physical Activity & ‘Stages of Change Model’

Mediators for behavioural change A mediator is the mechanism through which the intervention (strategy) is believed to influence physical activity behaviour. Self-efficacy can be improved if a person is taught strategies to remind themselves to be more active. The improvement in these mediators combined might lead to a greater chance of behavioural change occurring. VCE Physical Education - Unit 3

Physical Activity Promotion Strategies for Promoting Physical Activity & ‘Stages of Change Model’

Promotion of Physical Activity Population based promotion Policy Environmental Mass media Population approaches are designed to reach large segments of society or specific population groups. Population based information is often collected by VicHealth, National Heart Foundation and various universities. Information collected is used to establish government priorities and initiatives. Individual based promotion Theoretical models of change Print and web-based media Counselling and screening These strategies are often based on theoretical models of individual behaviour change VCE Physical Education - Unit 3

Population-based Promotion Policy Strategies See table 2.6 Legislation – Formal, documented policies. Organisational policies – Bring about changes in behaviour within a particular organisation. eg. SunSmart in sporting clubs and schools. eg. ‘Smoke Free’ venues such as workplaces and sporting clubs. Case Study 2.2 p.53 and 2.3 p.54 Structured Questions 2.4 p.54 VCE Physical Education - Unit 3

Population-Based Promotion Environmental Strategies 1.Tailoring – Changing physical environments to suit community needs. Eg. Walking track along Wimmera river promotes walking. 2.Removing impediments to activity – Take away reasons for people not to participate in PA eg. Design walking tracks away from major highways/roads. 3. Introducing new resources and facilities – eg. New sports grounds, age specific playgrounds. 4. Support from other programs – eg. Reducing crime in an area will make people feel more safe to go for a walk. 5. Opening Hours – Opening sporting venues before and after business hours. VCE Physical Education - Unit 3

Print and Web-based Media Print media can promote PA in; Booklets Brochures & handouts It is available from; Recreational centres Regional Sports Assemblies Health care centres School and workplaces Mail outs Doesn’t require internet access. Web bases media promotes PA through; Interactive websites Works through the stages of change Great short term value – not long term Examples VCE Physical Education - Unit 3

Print and web-based media Print media can promote PA in; Booklets Brochures & handouts It is available from; Recreational centres Regional Sports Assemblies Health care centres School and workplaces Mail outs Doesn’t require internet access. VCE Physical Education - Unit 3 Web bases media promotes PA through; Interactive websites Works through the stages of change Great short term value – not long term Depending on their stage of change, tailored materials can be matched to a person’s place within the Stages of Change Model.

Mass Media & Participation Mass media can influence participation by; Providing information on its health and non-health benefits Encouraging public participation Providing information regarding access to community based programs Motivating individuals to take action VCE Physical Education - Unit 3

Mass Media Campaigns VCE Physical Education - Unit 3 Go for Your Life (VIC) Find 30 (WA) 10,000 Steps (QLD) Smartplay (SA) Get Moving (National)

VCE Physical Education - Unit 3

Go for Your Life VCE Physical Education - Unit 3 Go For Your Life - physical activity quizzes

VCE Physical Education - Unit 3

Find Thirty VCE Physical Education - Unit 3

Find Thirty VCE Physical Education - Unit 3

Theoretical Social Models Many professionals are trying to change people’s physical activity levels. The focus of their promotion is biological, cognitive and behavioural factors the influence physical activity participation. Physical activity theories cover; determinants of physical activity, relationships between factors and the conditions required to get people involved in physical activity. Social Models; Provide a framework of health behaviour that can enhance our understanding of participation in physical activity. Can direct the development of strategies used to increase physical activity levels. The major theoretical models related to physical activity; 1. Social cognitive theory Social cognitive theory 2. Ecological framework Ecological framework 3. Behaviour-choice model Behaviour-choice model VCE Physical Education - Unit 3

1. Socio cognitive (socio learning theory) demographics behaviourenvironment VCE Physical Education - Unit 3 Behavioural capability – a persons P.A. skills Observational learning – learn about P.A. by looking. Expectations – as in what results to expect from P.A. Self-Efficacy – feeling of confidence to be P.A. in adverse conditions. Self control Reinforcements - +ve or –ve events that promote P.A. Note: this theory is usually used under an environmental constraint. Eg, we could study a 5 labourers from a remote country town, we then would have trouble comparing data attained to a inner city business worker

2. The ecological framework –Looks to explain the cause of inactivity by looking at six sets of factors that are effectively solutions to the problem of physical inactivity Individuals Socio Environment Physical Environment VCE Physical Education - Unit 3 1.Interpersonal Factors – Knowledge, skills attitudes etc. 2.Interpersonal Processes – social situations eg family or friends. 3.Institutional Factors – eg school, football/netball club etc. 4.Community Factors – interaction between organisations. Eg the after school basketball at YHS 5.Public Policy – local, state, national rules/laws. Eg, no chewing gum – murder. 6.Environmental Factors – weather, facilities etc

3. The Behaviour-choice model –Includes three reasons why people choose to behave in certain ways. 1.Reinforcement Value – the positive or negative consequences of an even, that result in a choice. Eg, Jim smokes because his grandfather smoked a pack a day and lived til he was Preference – choose one behaviour over another. Eg, play hockey instead of football. 3.Environmental barriers – lack of bike paths results bike being used less often. VCE Physical Education - Unit 3

Psychological Theories These theories are used to guide individual approaches. These models are used by practitioners and policy makers to justify, shape and focus health promotion strategies. Theories; Health-belief model Pender’s health promotion model Pender’s health promotion model Theory of reasoned action Theory of reasoned action Stages of Change (Also called the ‘transtheoretical model’) VCE Physical Education - Unit 3

Health Models The Health-belief Model Promotes healthy behaviour change by addressing the patients health beliefs via; 1.Perceived susceptibility and severity of illnesses. 2.Perceived benefits 3.Information access to prompt action 4. Self-efficiency Pender’s Health Promotion Model Developed to describe and explain health enhancing behaviours via; 1. How people value their health 2. Self-efficiency 3. Perceived health status and benefits 4. Barriers to change 5. Interpersonal factors 6. Family members 7. Relationships with health professionals VCE Physical Education - Unit 3

Models - Behaviour Theory of reasoned action/theory of planned behaviour People intend to participate in physical activity when; 1.Benefits of physical activity is weighed up against long term health 2.Motivated by significant others such as family and peers. VCE Physical Education - Unit 3

Stages of Change Model VCE Physical Education - Unit 3 Stage 1. Precontemplation Not considering behavioural change No intention of being more active within the next 6 months. Not aware their lack of activity is a problem. Most difficult group Only start to think about change due to constant pressure or after a significant health event eg. heart attack. Stage 1

Stages of Change Model VCE Physical Education - Unit 3 Stage 2. Contemplation Acknowledge that they need to become more active. Weighing up the pros and cons of being more active. Intention of becoming more active within the next 6 months. Some individuals remain in this stage for long periods. Stage 2

Stages of Change Model VCE Physical Education - Unit 3 Stage 3. Preparation Seriously considering becoming more active May exercise once or twice a week or several times a month. May be doing physical activity but are not meeting the physical activity guidelines. Stage 3

Stages of Change Model VCE Physical Education - Unit 3 Stage 4. Action Requires the largest effort, time and energy. Attempting to follow National Physical Activity Guidelines. Relapse is common, however if an individual maintains the active stage for six months they move into the maintenance stage. Stage 4

Stages of Change Model VCE Physical Education - Unit 3 Relapse Potential of relapse at any stage between precontemplation and termination. Individuals who have reached maintenance stage are more likely to only relapse to Stage 3. Individuals who have never reached Stage 5 can relapse to Stage 1. Relapse is not failure and occurs most commonly between Stages 2 and 4.

VCE Physical Education - Unit 3

Strategies for promoting PA VCE Physical Education - Unit 3

Readiness to change – (motivational readiness) VCE Physical Education - Unit 3 Are you accumulating at least 30 minutes of moderate-intensity physical activity on most (five+) days of the week? NoYes Are you accumulating at least 30 minutes of moderate-intensity physical activity at least one day per week? Have you been doing this on a regular basis for the last six months? Do you intend to increase your physical activity? If you’re doing physical activity irregularly, you’re in the preparation stage. If you’re not even thinking about it, you are in the precontemplation stage. If you're giving it a thought now and then but not doing it, you are in the contemplation stage. If you have been doing this consistently but for fewer than six months, you are in the action stage. If you’re maintained the new habit for six months of more you are in the maintenance stage. No Yes

Counselling options Telephone counselling and automated telephone-delivered advice Programmed to call people automatically including during convenient times. Collect data for PA research. Counselling for people living in isolated or remote areas Social support for older adults if not familiar with using web- based technologies. VCE Physical Education - Unit 3 Health-professional counselling Advice from GPs is often highly regarded. GPs sometimes prescribe PA instead of a prescription for medication.

Counselling strategies VCE Physical Education - Unit 3 1.Assessing motivational readiness One of the first steps is to assess a persons motivational readiness to become more active. Once their stage is determined, an individual ’ s motivation readiness can be matched with processes to change their behaviour.

Counselling strategies VCE Physical Education - Unit 3 2.Matching processes of change with motivational readiness Stages of change = when people change behaviour Processes of change = how people change their PA behaviour Processes of change can be grouped into two different categories: cognitive processes & behavioural processes. Table 2.2 pg 44. Individuals in early stages (Stages 1 or 2) focus on cognitive strategies eg increasing awareness and knowledge of the benefits of physical activity. Later Stages (Stages 3,4 and 5) might include behavioural strategies such as developing a reminder system an encouraging the use of rewards. Data Analysis p. 47

Counselling strategies VCE Physical Education - Unit 3 3.Identifying opportunities to be active Before you can identify opportunities to be more active you have to be aware of how often you move. (See Table 2.5, a sample daily personal activity record.) Modern technology has minimised the need to move and people today sit longer hours than previous generations.

Counselling strategies VCE Physical Education - Unit 3 4.Contracting You could draw up a simple contract that states your activity goals and have a witness sign it with you. Set a date to reassess whether or not you have met your behavioural goal. Reward yourself if goals are achieved. Punishments can be used but should be determined by you. Punishments should not be in the form of physical activity; eg. no television for a week.

Counselling strategies VCE Physical Education - Unit 3 5.Enlisting social support Not having an exercise partner is often a barrier to physical activity. Many studies report that having someone to exercise with greatly increases your chances of being sufficiently active. Support may come from family members, partners, friends, work colleagues or other community members.

Counselling strategies VCE Physical Education - Unit 3 6.Reminder systems Reminding yourself to be active is especially important when you are in the ‘ contemplation ’ to ‘ action ’ phases of the Stages of Change Model. The following are some example reminder systems: Leave yourself a note on the refrigerator, computer or mirror. Use a diary. Poster on office wall or desk. Get friends to send or text message to remind you Set reminders using your computer or mobile phone.

Counselling strategies VCE Physical Education - Unit 3 7.Gradual programming Similar to ‘ progressive overload ’ - gradual increase in workload, frequency or intensity. A slow, step-by-step approach desirable for inactive people For a beginner, being exhausted at the end of an activity greatly reduces likelihood of continuing to be active.

Counselling strategies VCE Physical Education - Unit 3 8.Tailoring Prescribing a physical activity plan to meet the individual needs of each person. Laboratory 2.2 p.48 Individual factors to consider include : social support, access to facilities, work hours, cultural factors, family structure, fitness levels and climate.

Cognitive Strategies Increasing Knowledge –Encourage individual to read and think about P.A. Being Aware of risks –Provide the individual with the message that being inactive is very unhealthy. Caring about the consequences to others –Encourage the person to recognise how their inactivity affects their family, friends and co-workers. Comprehending benefits –Assist the individual to understand the personal benefits of being physically active. Increasing healthy opportunities. –Help the individual increase their awareness of opportunities to be physically active VCE Physical Education - Unit 3

REVISION QUESTIONS 1.List five examples of professionals or occupations that are likely to use counselling as a strategy to promote individuals to be more active. 2.Name three methods of delivering physical activity advice and describe one of these 3.Outline six strategies used in physical activity counselling and summarise two of these strategies. 4.What are the processes of change? 5.Provide two examples of cognitive and two behavioural strategies that people can employ to become more active. VCE Physical Education - Unit 3

Behavioural Strategies Substituting alternatives –Encourage the individual to participate in physical activity when they are tired, stressed, or unlikely to want to be physically active. Enlisting social support –Encourage the individual to find a family member, friend, or co-worker who is willing and able to provide support for being active. Rewarding yourself –Encourage the individual to praise themselves and reward themselves for being physically active Committing yourself –Encourage the individual to make promises, plans and commitments to be active. Reminding yourself –Teach the individual how to set up reminders to be active, such as keeping comfortable shoes in the car/office, ready for use at any time VCE Physical Education - Unit 3

REVISION QUESTIONS 1.List three examples of population approaches to physical activity promotion 2.Explain the difference between the terms ‘natural’ and ‘constructed’ environment 3.Define the term ‘policy’ and explain why policy development is an extremely important component in the promotion of physical activity at the population level 4.List three key roles of mass media in the promotion of physical activity 5.Explain three strategies necessary to the design of intervention programs targeting special populations or ‘at risk’ populations VCE Physical Education - Unit 3

Specific ‘At Risk’ Groups Groups at risk of being inactive include; Low socio-economic backgrounds Race and ethic minorities Disabled people Intervention programs include; 1. Community involvement – Local planning to target specific groups 2. Needs assessment – Community surveys, interviews etc of focus group. One program doesn’t fit all. 3. Understanding the target group – Need to make the program with an understanding of key values, cultural beliefs and methods of overcoming barriers to PA. VCE Physical Education - Unit 3 p.61

CONCEPTS CHECKLIST + P61 1.Individual level physical activity promotion strategies 2.Population level physical activity promotional strategies 3.Stages of change model (SOC) 4.The importance of self-efficacy and its association with SOC 5.Settings based approaches to physical activity promotion 6.Critique of strategies used in school, workplace and community settings VCE Physical Education - Unit 3

Web Links – Chapter 2 Australian Sports Commission: Find 30 promotion (Government of WA Department of Health): Walking School Bus promotion (UK): Ministry of Health (New Zealand) toolkits: The 10,000 Steps Rockhampton project: Travelsmart Australia: World Health Organisation: Heart Foundation Australia: VicHealth (The Victorian Health Promotion Foundation): Be Active promotion (Government of South Australia): Go For Your Life: Physical Activity Resources for Health Professionals – Introduction (Centre for disease control and prevention – USA): Health Promotion (Public Health Agency of Canada): Strategic Inter-Governmental Forum on Physical Activity and Health (SIGPAH): Healthy youth (Centre for disease control and prevention (USA): America On The Move promotion: Papers from the International Journal of Behavioural Nutrition and Physical Activity: Department of health and aging (Australian government): Building a healthy, active Australia (Australian government): National Public Health Partnership: Be Active promotion (Government of South Australia): Sport and Recreation Australia: The 10,000 Steps Rockhampton project: Find 30 promotion (Government of Western Australia Department of Health): Go For Your Life: America On The Move promotion: Be Active promotion (Government of South Australia): Building a healthy, active Australia (Australian government): Go for green, active living and environment program (Canada):