Changing Behaviours to Increase Healthy Physical Activity

1. Changing Behaviours to Increase Healthy Physical Activity Physical Activity Resource Centre Funded by the Government of Ontario

2. Key Session Points

3. Purpose of the Session To help you identify practical ways to apply principles of best practice, behaviour change theory and research to the planning and implementation of physical activity initiatives in your community.

4. “The only person that likes change is a wet baby.” - source unknown

5. “Successful self-changing individuals follow a powerful and, perhaps most important, controllable & predictable course.” James Prochaska

7. Understanding the change process • What are the barriers that get in the way of being physically active on a regular basis? • What are the things that make this behaviour easier?

8. Theoretical Background

9. Stages of Change Model (SCM) July 2005

10. SCM • Developed by Prochaska, DiClemente, Norcross • Consists of 6 stages and 10 processes • The idea behind the SCM is that behaviour change does not happen in one step • People tend to progress through different stages on their way to successful change • Each person progresses through the stages at his/her own rate

11. Precontemplation • Have no intention of changing behaviour in the foreseeable future • May not see the behaviour as a problem for them • resistant, unaware, unwilling • “It isn’t that I can’t see the solution; I can’t see the problem.”

12. Reasons for Precontemplation • Reluctance – inertia or lack of information prevents the person from being fully aware • Rebellion – active resistance or hostility to the problem or desired behaviour may exist • Resignation – a belief in the inability to change (efficacy); a lack of energy for & investment in change • Rationalization – determines there is no problem, the odds of risk are in their favour, or problem is someone else’s

13. Contemplation • Usually something happens that prompts change • Aware that a problem exists & seriously considers action but has not yet made a commitment to action • Ambivalent, aware, open, need convincing • Lacks confidence & commitment • Open to information but waiting for that “one thing” to move them • The end of this phase – anticipation, activity, anxiety, excitement • “I want to stop feeling so stuck.”

14. Decision Point • An event, not a stage • Concluded that the negatives of the behaviour outweigh the positives • Chooses to change behaviour

15. Decisional Balance

16. Preparation • Accepts responsibility to change • Evaluates & selects techniques for behaviour • Develops a plan – getting organized • Intent upon taking action soon & often reports some steps taken • Combination of behavioural intentions & actions • Usually take serious action within a month • Some ambivalence remains • Relatively transitory stage • Anticipation, willingness

17. Action • Aware the problem exists & actively modifies their behaviour, experiences & environment • Commitment is clear • Great deal of effort is expended • Have made a plan & begun to implement • Ambivalence is still an issue • Gains new insights & develops new skills • Learns to overcome the tendencies for unwanted behaviour • Usually lasts 1-6 months • Change is more visible to others

18. Maintenance • Has made a sustained change • Masters the ability to sustain the change with minimal effort • Remains alert to high-risk situations • New pattern of behaviour has replaced the old & is firmly established • Self-controlled • Threat of relapse becomes less intense • Relapse likely after an initial slip

19. Relapse • Event not a stage • May occur at any time • Personal distress or social pressures are allowed to interrupt the behaviour change process • Temporary loss of progress which resumes at an earlier stage • Experience is educational to help prevent further lapses • Most successful self-changers go through the stages 3-4 times; most return to Contemplation

20. Stages of Change & Time

21. Allegory of ChangebyPortia Nelson • I walkdown the street. There is a deep hole in the sidewalk. I fall in. I am lost.......I am helpless. It isn't my fault. It takes forever to find a way out. • I walk down the same street. There is a deep hole in the sidewalk. I pretend I don't see it. I fall in again. I can't believe I am in the same place, but it isn't my fault. It still takes a long time to get out. • I walk down the same street. There is a deep hole in the sidewalk. I see it is there. I still fall in..........it's a habit. My eyes are open. I know where I am. It is my fault. I get out immediately. • I walk down the same street. There is a deep hole in the sidewalk. I walk around it. • I walk down another street.

22. Limitations of the Theory • Individually based • Ideally complemented with a broader approach to changing the environment • Not generally population-based • Resource intensive

23. So how do you know what stage? Nomogram • I am not currently … & am not thinking of doing so in the coming month. • I am not currently … but I have thought about … • I am not currently … but I plan to do so within the next month. • I am currently … but have only been doing so for the past 6 months or less. • I am currently … and have been doing so for 7 months or more.

24. Strategies for each Stage- Precontemplation • Increase awareness of need to change (risk, benefits) • Give personalized information (e.g. benefits) • Encourage thinking about change • Offer to help is they do decide to change • Recommend a solution

25. Strategies for each Stage- Contemplation • Motivate & increase confidence • Emphasize benefits of change & identify barriers • Explore concerns & fears • Help resolve ambivalence

26. Strategies for each Stage- Preparation • Help individualize a plan for change • Set realistic goals • Provide options & logical information • Provide & have person seek social support • Develop necessary skills to take action • Motivation is key

28. Strategies for each Stage- Action • Reaffirm commitment & follow-up • Teach behavioural skills • Provide educational materials • Stress benefits • Reduce barriers through problem-solving • Access social support • Celebrate successes & use rewards • Continue follow-up

29. Strategies for each Stage- Maintenance • Plan for potential difficulties • Develop & utilize a support network • Reminder of benefits • Reassure about ability to sustain new behaviour (efficacy)

30. Strategies for Preventing Relapse • Identify coping strategy for the short-term • Analyze what went wrong; use lapse as a learning opportunity • Plan next attempt at change & identify what will be different next time • Persevere

32. Processes of Change The different types of strategies used to influence people in moving from one stage to another. Two types: Experiential – changes in the ways people think & feel Behavioural – changes in the way people act

35. Experiential Processes of Change Consciousness Raising • Involves providing information regarding the nature & risk of unsafe behaviours; gets people thinking about the issue Dramatic Relief • Fosters the identification, experiencing, & expression of emotions related to the risk the safer alternatives

36. Experiential Processes of Change (2) Social Liberation • An awareness of circumstances in the environment that provides additional behavioural alternatives (e.g. I see fewer people doing …) Self Re-evaluation • A re-appraisal of personally relevant consequences associated with the changes

37. Experiential Processes of Change (3) Environmental Re-evaluation • An awareness of the impact that one’s behaviour has on others

38. Behavioural Processes of Change Counterconditioning • Refers to replacing the behaviour with a substitute Stimulus Control • Concerns removing cues or avoiding situations which trigger the behaviour

39. Behavioural Processes of Change (2) Reinforcement Management • How people reward themselves (or are rewarded by others) (consider the original motivators) Helping Relationships • Trusting others and accepting their support or seeking professional assistance

40. Social- nature of personal relationships; expectations of class, position, age, gender; access to knowledge, information.Cultural - the behaviors and attitudes considered acceptable in given contexts - eg. relating to sex, gender, drugs, leisure, participationEthical and Spiritual - influence of personal and shared values and discussion about moral systems from which those are derived - can include rituals, religion and rights of passage Legal- laws determining what people can do and activities to encourage observance of those lawsPolitical- systems of governance in which change will have to take place - can, for example, limit access to information and involvement in social actionResource - affect what is required to make things happen - covers human, financial and material resources; community knowledge and skills; and items for exchange 6Features of the Enabling Environment(The Communication Initiative)

41. Tools Authors: James O. Prochaska, John C. Norcross, Carlos C. Diclemente Format: Paperback, 1st ed., 304pp. ISBN: 038072572X Publisher: Morrow,William & Co Pub. Date: August  1995

42. Tools Transtheoretical Model / Stages of Change Overview (University of South Florida) http://hsc.usf.edu/~kmbrown/Stages_of_Change_Overview.htm The Stages of Change http://www.skysite.org/primer/stagesofchange.html

43. Stages of Change related to Marketing Strategies Developed by Andreasen (1995):

44. Motivation • McLelland & Atkinson • Identified three types of people: • Affiliation • Achievement • Power / Prestige

45. Affiliator • Goal is to be with others & enjoy mutual friendships • Seeks out relationships • Likes to work with other people • Sensitive to feelings, needs of others • Supports others in achieving goals • Talks about feelings

46. Achiever • Experiences success in a situation which requires excellent or improved performance. • Concerned with results, personal best • Sets goals, takes risks to get there • Innovative, restless • Likes to be challenged • Likes to work alone

47. Prestige/Power Person • Wants to have an impact or an influence on others. • Tries to shape opinions • Wants to change things • Exercises power to benefit others • Concern for position, respect, reputation • May be charismatic • Can be verbally aggressive, forceful

49. Motivational Ideas (Health Canada) • Recommend setting personal goals to work toward • Use questionnaires to assess personal readiness to change • Emphasize incremental changes • Encourage use of logs to monitor progress • Use physical activity and fitness appraisals to determine each individual's level of preparedness • Create messages about physical activity that target personal values such as helping the environment and raising self-esteem

50. Motivational Ideas (2) • Encourage people to make a commitment; they will be more likely to carry out the behaviour • Find a spokesperson to whom your audience can relate, preferably someone within the community who was successful in changing his/her behaviour • Engage respected role models as effective motivational speakers • Motivate people through friendly competition with the use of rewards, recognition and prizes for participation