Factors for Successful Behaviour Change Interventions

Factors for Successful Behaviour Change InterventionsCritically assess the let out elements that contri just nary(prenominal)e to successful behaviour change hinderances.The carry for changeE rattlingone wants a recollective and estimable bearing although some young sight subscribe to that they do non wish to be emeritus. This is because of the negative connotations of old age. It is too a flippant opt-out of taking responsibility. The rationale behind a healthy style of living is unassailable. So why is it rugged to get raft to change their ways? For many flock, simply getting them to change at all is a major obstacle. As Niccolo Machiavelli observed to a greater extent than ergocalciferol years ago,1 It must be considered that at that place is nothing more difficult to carry out, nor more doubtful of success, nor more dangerous to handle, than to initiate a new order of things.It is not only innate mule-like conservatism that hampers change. in that respect be too positive attri besideses to the status quo. The tobacco industry has long contracted to portray sens as cool, sophisticated and arousey. To the rational person, disbursement vast amounts of money to ruin your health and smell like an old ashtray rumpnot be cool, sophisticated or ease up any trace of sex appeal. Over many decades Hollywood has connived to portray gage in a positive well-to-do and this does put one over at least(prenominal) a imperceptible effect.2Simply giving pile information closely the bumps of obstinate lifestyles and the benefits of changing their ways is not tolerable. The relationship mingled with sens and lung crab louse has been reality knowledge since the report of the Royal College of Physicians on seduce and wellness in 1963 although the association was first suggested in 19503 and the association with an opposite(prenominal) diseases in 1956.4 at that place has to be a sustained cuddle with a solid suppositious background. p uts for changeThe two theories that atomic number 18 roughly commonly employed in health promotion are the Transtheoretical Model (TTM) and the wellness stamp Model (HBM). Both are most commonly employed to produce changes in health promotion nevertheless the TTM model can be utilise to produces changes in other fields including industry. Both these models focus on the decisiveness making process of the individual. Other models include the Theory of Reasoned achieve (TRA) and the Theory of Planned Behaviour (TPB). All four have been check overed by transferome.5Transtheoretical ModelThe Transtheoretical Model was devised in the 1980s. It sees fin stages of treat.Stage 1 is the pre-contemplative stage. It is delimit as having no role to change in the next six months. To use pot as an example, the person whitethorn not give notice the current level of risk. They whitethorn be aware that there is adverse publicity about tobacco. Perhaps some people around them are gi ving up but they have not taken it severely enough to think of doing so themselves. both desire to change is belt up at a subconscious level.Stage 2 is the contemplative level. It is defined as intention to change in the next six months although it may take longer. The people knotty are aware of the benefits of changing but they are also acutely aware of the challenges. They must decide the match between costs and benefits.Stage 3 is the preparation phase. There is intention to take action in the near future and preparation is in hand. The people confused have al put in taken some probatory steps to prepare for the change. Action is planned for the next month or so. With regard to locoweed, they may have discussed it with other people. They may have seek out frequent groups and discussed prescription of nicotine replacement therapy (NRT) or bupropion. They may have plant a date to quit.Stage 4 is action. The people involved have modified their thinking and behaviour. In th is case, they have actually stop green goddess.Stage 5 is maintenance and focuses on sustaining the success. It is outstanding to ascertain that the people involved do not relapse into the old behaviours and are sure-footed of maintaining the new ones. They may focus on money saved, feeling fitter and enjoying food more. It is also necessary to address negative aspects such(prenominal) as possible incubus bring in.Health Belief ModelThe Health Belief Model is quite popular amongst healthcare overlords. It was developed in the fifties in the USA to examine why there was a moo uptake of a screening programme for tuberculosis.There are five stepsThe first is perceived susceptibility. It relates to an individuals feeling of how possible he is to suffer from a condition. It may run in the family or affect a friend. Many people calculate to regard themselves as immune to certain illnesses. We all know the tobacco user who refuses to give up because he knows someone who smoked al l of his life without any bald problem.Perceived seriousness is the next step. This is similar to susceptibility. Does the patient see lung cancer as curable? Does he see other dope link diseases as manageable?The third step is perceived benefits and barriers. Patients weigh up the benefits against the costs of taking action. This means implication rather than financial costs. maintenance of being excluded from his group of sens friends may be a barrier. white plague of cervical smears may be impaired by potential embarrassment.self-importance susceptibility is step four. It is sometimes called health motivation. It describes how a person sees the efficacy to change behaviour. If a person thinks that he is unable to stop smoking this is a barrier.The fifth stage is inspires to action. This is the trigger that initiates change. It may be an intervention from a health professional, an illness or a life vitrine such as a new baby. Becoming pregnant can be a strong cue for wom en.Curtailing smokingSmoking termination is a in particular relevant area to analyse. Smoking is the greatest evitable contributor to ill health and premature death. E actuallyone knows of the dangers although perhaps they hold to undervalue them. Even young people still take up the habit. A Cochrane review found limited support for the effectiveness of multi-component interventions in the fellowship to help prevent the uptake of smoking in young people.6 Smoking tends to be most prevalent in deprived communities. A clear public health guidance called Identifying and supporting people most at risk of dying prematurely focused mainly on smoking uttermost and the provision of statins as being cost effective and clinically effective.7 Both NICE8 and CKS9 have extensively reviewed the order and made recommendations with regard to smoking result. There are also plenty of Cochrane reviews.10 NICE regards those of lower amicable class and pregnant women as a priority. Before the dangers of smoking were in public known there was no difference in smoking habits between social classes. Now there is a distinct gra neglectnt11 and it is said that smoking accounts for a significant amount of the decreased health and increased death rate through the social classes.12 This is known as health inequalities.Key elements in changing behaviorThe first element of change has to be to plant in the individuals mind that there is a strike for change. With regard to smoking this may come in many ways. general health messages much pr all(prenominal) the wisdom of quitting. Health issues are embossed whenever tax is increased and the price of cigarettes rises. This does reduce consumption.13 Possibly milestones in life such as a 40th or 50th natal day may spur consideration of ones health. Pregnancy is often a strong incentive to quit and both partners should do so to allow the baby a smoke free home. A Cochrane review was unimpressed at the evidence that getting both of a pair to quit together increased the success rate.14 However, lack of evidence of efficacy and evidence of lack of efficacy are not the same and it does seem a good idea. The matter may arise during a interview with a health professional. This may be when reviewing a directly relevant disease such as diabetes, coronary heart disease, hypertension, asthma or COPD or it may simply be brought up as it comes to light on the health promotion template. It has been shown that if GPs simply raise the issue during a consultation this can have an effect.15 NICE suggests that people who are not ready to quit should be asked to consider it and to seek help in the future.Some people fail to understand the concept of risk. They need it explained in terms that they can understand. There is no certainty that a smoker impart die of a disease related to his habit nor that a non-smoker exit have a long and healthy life. It is useful to have some simple figures. About 1 in 5 non-smokers die bef ore 65 years old compared with 2 in 5 smokers. Half of all smokers die of a smoking related disease. If you do the National Lottery in the hope of winning the jackpot the find oneself of doing so is 1 in 14 million. For young people who cannot recollect being as old as 30, a different approach is needed. Smoking accelerates the aging process in arteries, in the lungs, in castanets and in the skin. For those who fear old age, they are bringing it on. Money, fitness and feeling fresh are also positive attributes.Nicotine is highly addictive.16 There are other components to the urge. There is the ritual of lighting up and something to do with the hands as well as the image. All these must be address to help the individual to cope. Many people find it helpful to set a date to quit. This allows for some counseling before the event and for such matters as NRT or bupropion to be discussed.17 The forum in which this is done may well be a smoking cessation clinic within aboriginal care . It is usually nurse led. There may be one-to-one counselling but groups may also be helpful.18 The members give each other mutual support and tips for how to cope.Having brought the person to the point of quitting it is important to give support through the potentially difficult time ahead. In the early days motivation is high. This must be sustained. Congratulate the person on the achievement. contrive him feel good about himself. Reinforce the positive aspects of quitting. Some people collect the money that they would have spent on tobacco each day and put it towards their holiday.NRT can give a slow plow background level of nicotine in the blood to help ameliorate withdrawal. It is very important that the individual does not smoke. Inhalation of nicotine gives a rapid zoom along and this surge contributes greatly to the addictive mechanism. Some people test that their patients have been abstinent by using a hundred monoxide meter.19 Carbon monoxide is bow in tobacco smoke and it binds to haemoglobin with 210 times the affinity of oxygen. Therefore, carbon monoxide is released slowly for a while after smoking.At what stage has a person successfully quit? Is it after a week, a month or 6 months?There is a joke that goes, Giving up smoking is motiveless. Ive done it many times. This emphasises the great problem of recidivism. It is a problem with smoking, alcohol and medicate abuse. Those who counsel drug addicts and alcoholics continue for a long time after abstention to ascertain that it continues. Alcoholics Anonymous pull up stakes invite people to their meetings even years after they last had a drink. They know how precarious the position is. throng who stopped smoking may restart 6 months, a year or even a couple of years after they quit. It is often said that ex-smokers are the most intolerant of the smell of tobacco smoke and this is good. People may choose to start again in times of stress or crisis. A typical scenario is when out drinking . Smokers often try to undermine those who have successfully quit. Perhaps they emphasise their own inadequacy. Go on. Just have one. It will do you good are the sort of thing that alleged friends say. In the words of Alcoholics Anonymous, whizz is too many and 100 is not enough. One night out drinking can lead to complete reversion. This is little potential to happen now that smoking in pubs and bars is ineligible but it is still a risk and should be discussed in counselling. Forewarned is forearmed. check on learning in health promotionIt is easy enough to read and learn the theories of health promotion but putting them into exert is another matter. There will always be surprises and there will always be areas to learn. No isolated incident comes to mind but there are a number of issues that have emerged with accumulated run across.Any reasonable person will look at the health issues involved and will conclude that the healthy way of life is the logical option. This applies p articularly to not smoking. However, not everyone is reasonable and this includes highly educated people. Matters that are not much emphasised in health promotion advice and the literature are friction match twitch and denial.It used to be said that the prevalence of smoking was higher amongst nurses at the completion of their training than at the start although the true incidence of smoking amongst nurses is uncertain.20 There is no doubt that peer pressure within a school of nursing is high. Stress is also disposed(p) as a reason for smoking.21 However, stress is a subjective experience and it may be used as an excuse to conform to peer pressure.Practice what you preach is a common proverb. An obese healthcare professional who advises clog loss or one who advises cessation of smoking whilst be known to indulge personally, lacks credibility. However, the sinner is also less probable to attempt health promotion.22 Nurses who smoke are less likely to believe the obligate argume nts about the dangers of smoking.23 This is unlikely to represent an objective scepticism about the evidence but simply denial.If all this applies to nurses, it is unsurprising to find that it is at least as true when dealing with patients. People have to be ready to change. The mere noting of the fact that a patient smokes and the raising of eyebrows is another cue for it to sink in. There is no point in trying to pressurize the person who is not yet ready but leave an invitation to perish when the time is right.What makes a person believe? It is not the level of evidence. People will find all sorts of excuses to doubt the overwhelming evidence about smoking or to pretend that it does not apply to them. On the other hand it seems much easier to convince people that the MMR vaccine causes autism when there is not a shred of evidence to support the allegation.24 The convenience of a thought is important.We must lead by example. The sinner as a preacher is unconvincing although the reformed sinner may be more credible. It is important not to appear as sanctimonious with a holier than thou attitude. We need to show empathy with those we try to help. This applies not just to the physical addiction to nicotine but to the demands of peer pressure. The latter is especially important for young people.It is very easy for the non-smoker to see only negative images of smoking. Ask the patient to make a list of all the good things about smoking and all the good-for-nothing things about it. A similar technique is used when counselling drug abusers. There must be something positive about taking drugs or no one would do it. Similarly, there are positive aspects to smoking. This shows that there is empathy towards the positive aspects. It also allows the patient to see the balance and to believe that he is making his own decision. He is not being coerced or bullied.It is also important to be realistic about the negative attributes of smoking cessation. silver dollar give s credibility. It is often not so much the nicotine addiction that is a problem. This wanes with time. It is the gain in weight.25 Weight gain is much more visible than slander to lungs or arteries. Many teenage girls say that they smoke to aid weight control. In fact, starting to smoke as a teenager in all likelihood does not help at all whilst the later in life that smoking is stopped the more marked weight gain is likely to be. Exercise rather than smoking is much healthier and much more effective. Nicotine has a nauseating effect and so when it is withdrawn there is likely to be increased appetite. Food now tastes better and some people suck sweets to occupy their mouth. It is important to discuss the matter. Weight gain is heavy(p) for health but unless the gain is enormous the benefit of smoking cessation will greatly outweigh the dangers of weight gain. If the patient decides to start smoking again the result will be a fat smoker. The weight will not melt away.Health promo tion is a very personal matter. It requires a relationship on a one-to-one basis. It requires trust and respect. The health promoter must be seen as an honest divisor rather than an evangelist. This requires empathy and it requires respect of the patient too. It is an important and difficult decision and he needs help and support.11 Niccolo Machiavelli. The Prince. 1532. Translator W. K. Marriott http//www.sonshi.com/machiavelli.html2 Tickle JJ, Sargent JD, Dalton MA, Beach ML, Heatherton TF. favorite movie stars, their tobacco use in contemporary movies, and its association with puerile smoking. Tob Control. 2001 Mar10(1)16-22. http//www.ncbi.nlm.nih.gov/pubmed/112263553 Doll R, Hill AB. Smoking and carcinoma of the lung preliminary report. Br Med J. 1950 family 302(4682)739-48.4 Doll R, Hill AB. Lung cancer and other causes of death in relation to smoking a second report on the deathrate of British doctors. Br Med J. 1956 Nov 102(5001)1071-81.5 Behaviour change Taylor et al m odels review. NICE 2006. http//www.nice.org.uk/nicemedia/pdf/Behaviour_Change-Taylor_et_al-models_review_tables_appendices.pdf6 Sowden A, Stead L. Community interventions for preventing smoking in young people. Cochrane Database of overbearing Reviews 2002, pick out 3. Art. No. CD001291. http//www.cochrane.org/reviews/en/ab001291.html7 NICE. PH15 Identifying and supporting people most at risk of dying prematurely guidance. phratrytember 2008. http//www.nice.org.uk/nicemedia/pdf/PH015Guidance.pdf8 NICE. Smoking cessation. March 2006 http//www.nice.org.uk/guidance/index.jsp?action=byIDo=113759 CKS Library. Smoking cessation. 2007. http//www.cks.library.nhs.uk/smoking_cessation10 Cochrane Collaboration. http//www.cochrane.org/reviews/index.htm11 Jefferis BJ, Power C, Graham H, Manor O. Changing social gradients in cigarette smoking and cessation over two decades of adult accomplish in a British birth cohort. J Public Health (Oxf). 2004 Mar26(1)13-8. http//www.ncbi.nlm.nih.gov/pubme d/1504456712 Jha P, Peto R, Zatonski W, Boreham J, Jarvis MJ, Lopez AD. Social inequalities in male mortality, and in male mortality from smoking indirect estimation from national death rates in England and Wales, Poland, and North America. Lancet. 2006 Jul 29368(9533)367-70.http//www.ncbi.nlm.nih.gov/pubmed/1122635513 Leverett M, Ashe M, Gerard S, Jenson J, Woollery T. Tobacco use the impact of prices. J rectitude Med Ethics. 2002 Fall30(3 Suppl)88-95. http//www.ncbi.nlm.nih.gov/pubmed/1250850914 Park E-W, Schultz JK, Tudiver F, Campbell T, Becker L. Enhancing partner support to improve smoking cessation. Cochrane Database of Systematic Reviews 2004, event 3. Art. No. CD002928. DOI 10.1002/14651858.CD002928.pub2. http//www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD002928/frame.html15 Smoking cessation guidelines for health professionals an update. Health Education Authority. West R, McNeill A, Raw M. Thorax. 2000 Dec55(12)987-99.http//www.pubmedcentral.nih.gov/artic lerender.fcgi?tool=pubmedpubmedid=1108388316 Russell MA. The nicotine addiction immobilise a 40-year sentence for four cigarettes. Br J Addict. 1990 Feb85(2)293-300. Review. http//www.ncbi.nlm.nih.gov/pubmed/218051217 Guidance on the use of nicotine replacement therapy (NRT) and bupropion for smokingcessation. NICE technology appraisal no. 39 (2002). www.nice.org.uk/TA03918 Stead LF, Lancaster T. Group behaviour therapy programmes for smoking cessation. Cochrane Database of Systematic Reviews 2005, Issue 2. Art. No. CD001007. http//www.cochrane.org/reviews/en/ab001007.html19 Middleton ET, Morice AH. Breath carbon monoxide as an indication of smoking habit. Chest. 2000 Mar117(3)758-63. http//www.ncbi.nlm.nih.gov/pubmed/1071300320 The incidence of smoking amongst nurses a review of the literature. Rowe K, Clark JM. J Adv Nurs. 2000 whitethorn31(5)1046-53. Review. http//www.ncbi.nlm.nih.gov/pubmed/1084023721 Rowe K, Macleod Clark J. Why nurses smoke a review of the literature. Int J N urs Stud. 2000 Apr37(2)173-81 http//www.ncbi.nlm.nih.gov/pubmed/1068495922 McKenna H, Slater P, McCance T, drag a bunt B, Spiers A, McElwee G. Qualified nurses smoking prevalence their reasons for smoking and desire to quit. J Adv Nurs..2001 Sep35(5)769-75. http//www.ncbi.nlm.nih.gov/pubmed/1152997923 The effect of training on knowledge and opinion about smoking amongst nurses and student teachers. Elkind AK. J Adv Nurs. 1988 Jan13(1)57-69. http//www.ncbi.nlm.nih.gov/pubmed/337288624 Bandolier Extra. MMR vaccination and autism. http//www.jr2.ox.ac.uk/bandolier/Extraforbando/MMRextra.pdf25 Filozof C, Fernndez Pinilla MC, Fernndez-Cruz A. Smoking cessation and weight gain. Obes Rev. 2004 May5(2)95-103. http//www.ncbi.nlm.nih.gov/pubmed/15086863