Theme 3: Learning Outcomes

1. Theme 3: Learning Outcomes Promoting health with individuals Participants will be able to: discuss the main theories that contribute to an understanding of the influences on individual health-related behaviour critically evaluate the concept of empowerment as applied to personal health and identify limiting factors Improving Health: Developing Effective Practice

2. Self-empowerment • Self empowerment is a state in which an individual possesses a relatively high degree of actual power – that is genuine potential for making choices. • Tones and Tilford (2001) Improving Health: Developing Effective Practice

3. Self-esteem • How good you feel about yourself; your opinion of yourself. • Ewles and Simnett (2003) Improving Health: Developing Effective Practice

4. Self-efficacy • Whether people believe they can change • If a person feels confident in their abilities to perform a desired behaviour for a specific setting, then they are more likely to engage in that activity. • Bandura (1977) Improving Health: Developing Effective Practice

5. Behavioural Modelshttp://www.civilservice.gov.uk/wp-content/uploads/2011/09/Behaviour_change_reference_report_tcm6-9697.pdf

6. The Stages of Change model • Adapted from Prochaska • and Di Clemente (1982) Improving Health: Developing Effective Practice

7. Precontemplation • • No evidence of intention to change behaviour in the foreseeable future • • Lack of awareness of any problem relating to self • • Ability to see solution to problem in relation to others • • Hallmark: resistance to recognising or modifying lifestyle • • May believe self unable to change Improving Health: Developing Effective Practice

8. Contemplation • • Awareness of problem relating to self • • Thinking of changing • • Not yet committed to action • • Weighing up costs and benefits of change and seeking information to assist decision • • This stage can last for minutes, months or years • • Ambivalent • • Change is still not worth it Improving Health: Developing Effective Practice

9. Preparation • • Perceived benefits of change appear to outweigh costs • • Belief that change is possible and worthwhile for self • • May require extra knowledge, skills and support to change • • Often associated with small behaviour change, e.g. smoking less Improving Health: Developing Effective Practice

10. Action • • Modification of behaviour, experiences and/or environment. • • Requires positive decisions to act differently. • • Sometimes a need to make temporary changes in other aspects of lifestyle to support change, e.g. avoiding pub for new non-smokers. • • Features of success: • • clear goal • • realistic plan • • appropriate support • • rewards. Improving Health: Developing Effective Practice

11. Maintenance • • Continuation of change • • Working to prevent relapse and consolidate changes made • • Time needed to ‘break habit’ and establish ‘safer’ lifestyle • • Can involve struggle to maintain new behaviour • • Requires ongoing support Improving Health: Developing Effective Practice

12. Relapse • • A normal part of the change process • • Happens in high-risk situations • • Planning ahead can help prevent it Improving Health: Developing Effective Practice

13. For discussion: Are you aware of it already? Have you used it? Can you relate the model to the list of factors you identified as influencing behaviour change in the previous activity? What are the most important implications of the model? What type of situations might it usefully be applied to? Can you identify any limitations of the model? Improving Health: Developing Effective Practice

14. Stages of Change: summary • Describes process of change that requires practitioners to: • • identify distinct stages to work through with clients • • accept ‘relapse’ as an integral part of the process of change • • design individualised interventions to support change • • acknowledge practitioner effectiveness in moving clients through stages. Improving Health: Developing Effective Practice

15. Stages of Change: limitations • Takes little account of the social context in • which person is attempting change. • Allows for a prescriptive application of • interventions to stages. • It isn’t easy to categorise people into stages. • People don’t move through the stages in order Improving Health: Developing Effective Practice

16. Health Belief modelhttp://www.civilservice.gov.uk/wp-content/uploads/2011/09/Behaviour_change_reference_report_tcm6-9697.pdf

17. Health Belief model • Assumes behaviour change depends on: • • having an incentive to change • • seeing threat associated with current behaviour • • feeling that change would be beneficial • • ability to carry out the change • Originally proposed by Rosenstock (1966), modified by Becker (1974) Improving Health: Developing Effective Practice

18. Health Belief model limitations • • Takes little account of the influence of family, friends and peer groups • • Presupposes ‘ideal’ rather than real behaviour • …as such it is limited in accounting for • as much of the variant in an individual’s • health behaviour. • Nutbeam and Harris (1999) Improving Health: Developing Effective Practice

19. Theory of Reasoned Actionhttp://www.civilservice.gov.uk/wp-content/uploads/2011/09/Behaviour_change_reference_report_tcm6-9697.pdf

20. Theory of Reasoned Action • Assumes behaviour change depends on: • • what people think the consequences will be of a change in their behaviour • • how important the outcome of changed behaviour is to them • • what ‘significant others’ in their lives think, and how much attention they pay to these other people • • how strong the motivation is to conform. • Presupposes that behaviour can be predicted by people’s intentions. • Ajzen and Fishbeing (1980) Improving Health: Developing Effective Practice

21. Theory of reasoned action limitations • • In practice, not all intentions lead to action • • Depends on the stability of an individual’s belief Improving Health: Developing Effective Practice

22. Summary of points from key theories • • Importance of knowledge and beliefs • • The importance of self-efficacy • • The importance of social influences • • The importance of recognising different stages of change • • The importance of shaping or changing socioeconomic and environmental conditions as well as addressing personal skills Improving Health: Developing Effective Practice

23. Key concepts • • Readiness to change • • Ambivalence • • Autonomy • • Resistance Improving Health: Developing Effective Practice

24. Where the power lies… • Who has the power in this situation? • Where does it come from? • How can the balance of power be made to be more equal? Improving Health: Developing Effective Practice

25. Empowerment • Empowerment...the process whereby individuals take increasing control of their own lives while at the same time behaving in ways that enable others to take more charge of theirs. • Dalziel (1999) • The mechanisms by which people, organisations and communities gain mastery over their lives. • Rappaport (1984) Improving Health: Developing Effective Practice

26. Empowerment Improving Health: Developing Effective Practice