Behavior Change: The Soul of Health Promotion

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Behavior ChangeThe Soul of Health Promotion
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Individual Behavior

• Awareness/education
• Motivation
• Tools, strategies
• Policy and environment
• Social Determinants of Health

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Individual
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Individual
Family
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Individual
Family
Worksite
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Individual
Family
Worksite
Community
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5-a-day 1 million
Food Marketing 25 Billion
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Nation/ world
Individual
Family
Worksite
Community
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Percent of adults who are overweight or obese by
country
US 74
Russia 50
Percent
India 16
WHO, 2007
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Good Nutrition

• Healthy, appealing cafeteria options
• Healthy foods at meetings
• Healthy snacks
• Potlucks and celebrations
• Arrangements with restaurants
• Deliver healthy foods
• Catering trucks
• Farmers markets
• Healthy vending machines
• Tax deduction for healthy meals
• Healthy business location

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Physical Activity

• Physical activity facilities
• Active commuting
• Facility design
• Nutrition standards in workplaces
• Employer liability for physical activity
  promotion
• Insurance premium breaks

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How to Change Behaviors
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• What was the last major life change you
  implemented? (i.e. job, health, family)
• Why did you do it?
• What did you have to overcome?
• What did you have to learn?
• What motivated you?
• Whos help did you have to enlist?
• When did it become permanent?
• Did you change your environment?

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Social Marketing

• Focus The application of commercial marketing
  technologies to increase the practice of healthy
  behaviors in order to improve individual and
  collective well-being.

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Social Cognitive Theory/Social Learning Theory

• Focus Behavior is explained by dynamic
  interaction among personal factors, environmental
  influences, and behavior.

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Stages of Change/Transtheoretical Model

• Focus Readiness to change or attempt to change a
  health behavior varies among individuals and
  within an individual over time. Relapse is a
  common occurrence and part of the normal process
  of change.

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• From
• Contemplation

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To Action
To Action
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Theory of Reasoned Action/Theory of Planned
Behavior

• Focus People are rational beings whose intention
  to perform a behavior strongly relates to its
  actual performance through beliefs, attitudes,
  subjective norms, and perceived behavioral
  control.

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Health Belief Model

• Focus Peoples' perceptions of the threat of a
  health problem and appraisal of behavior
  recommended to prevent or manage problem.

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Does Anyone Use These Models?
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What Really TriggersHealth Behavior Change?

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You would think . . .

• that having had a heart attack would be enough to
  persuade a man to quit smoking, change his diet,
  exercise more, and take his medication

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You would think . . .

• that hangovers, damaged relationships, an auto
  crash, and memory blackouts would be enough to
  convince a woman to stop drinking

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You would think . . .

• that very real threats of blindness, amputations,
  and even early death would be enough to motivate
  diabetics to lose weight, exercise and eat better

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You would think . . .

• that time spent in prison would dissuade people
  from re-offending

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Why is behavior change so hard?

• Fix me up Doc mentality
• Too much pressure to be unhealthy
• Lack of education
• Lack sufficient motivation
• Dont know how
• Barriers are too great to overcome
• I-dont-care-itis

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• Behavior Change Simplified

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• Educate
• Motivate
• Build skills
• Change the environment

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Behavior Change even more Simplified

• Why and What
• How
• Things that help me do this

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Educate (Why and What)

• Create individual awareness
• Create community and organizational awareness and
  support
• Create buzz

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• Flyers
• Posters
• Email notifications
• Television/video programs
• Books

• Payroll stuffers
• Internet sites
• Magazines
• Lunch and learns
• Special speakers
• Newsletters

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Motivate

• Before/after stories in newsletters
• Incentives
• Extrinsic and intrinsic
• Triggers
• Emotional
• Social
• Physical/health

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Build Skills (How do I do this?)

• How to overcome barriers
• How to strategies
• Goal setting, contracts
• Healthy substitutions
• Making healthy choices
• How to make healthy foods
• Finding inexpensive healthy foods

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Change the Environment

• Physical Environment
• Policy
• Culture

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Supportive Environments

• Physical environments
• Healthy food in cafeteria
• Freedom from media and advertising that peddle
  risky behaviors
• Farmers market
• Free from overly demanding work
• Opportunities to be physically active
• Walking paths
• Bike paths
• Recess and PE at schools

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• Smoke free air to breath at home
• Safe place to exercise
• Convenient access to healthy, inexpensive foods

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• Policies
• Medical coverage for preventive services
• Absenteeism policy that supports being healthy
• No smoking policies
• Flex time
• Time to be healthy
• Free from overly demanding work

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• Culture
• Health role models (champions)
• Peer support
• Supportive friends
• Church, community support
• Worksite health promotion programs