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

4. 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

5.  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

6.  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.

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. Behaviour Change Theories MOTIVATION ACTION

14. Precontemplation Contemplation Preparation Action Maintenance Progression towards behaviour change

15.  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

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

18.  2 Phases  1) Motivation Phase – getting ready to be active  2) Action Phase – engaging and maintaining PA

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

20.  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

21.  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

22.  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

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

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

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

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

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

28.  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

29. Self Monitoring and Weight Change Weight Change

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

31. Gain-framed

32. Loss-framed

34. Gain-framed

36. ** 0 200 400 600 800 1000 Week 2Week 9 Physical activity (METS min/wk) Gain Loss Mixed **  *p<.05

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

38. 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

39. 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

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

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

42. WHEN will I be active WHERE will I be active HOW will I be active

43.  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

44. PERCEIVED BEHAVIOURAL CONTROL SELF EFFICACY

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

46. 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

47.  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

48. Minutes of Strenuous Physical Activity Per week

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

50.  Tips for theory-guided interventions  Promote enjoyment

51. 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

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

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

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

55. 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

56. 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

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

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

59. 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)

62.  Tips for theory-guided interventions  Promote enjoyment

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