Changing behaviour: Avon FireFit Conference 2006

Dr Melvyn Hillsdon

University of Bristol

King AC, Circulation. 1995;91:2596-2604

Things that behaviour change theories have taught us

• Rewards and punishments (response consequences) influence the likelihood that a person will perform a particular behaviour again in a given situation.

• Humans can learn by observing others as well as by performing a behaviour personally.

• We are most likely to model a behaviour observed by others if we identify with that person.

• We are more likely to perform a behaviour if we predict that it will lead to outcomes that we desire or value and the costs of change are not too great.

• We are more likely to engage in a particular behaviour if significant others do so (social norm)

• We are more likely to perform a behaviour if we are confident we will be successful (self efficacy)

The Impact of Physical Fitness Tests on Behaviour at 12 weeks

4.8

4.24.4

4.2

1

1.52

2.5

3

3.54

4.5

5

PF HA PF-HA C

Group Assignment

Act

ivity

Sco

re 1

-6

Key to Activity Score

1 - Never

2 - < 1/month

3 - about 1/month

4 - 2 to 3 times/month

5 - 1 or 2 times/week

6 - > 3 times/week

Godin et al. 1987

Increasing adherence via decisional balance

Balance sheet

Relevant Irrelevant Control

Mean number of exercise classes (7 weeks)

11.6 5.8 5.6

Hoyt & Janis J Personality and Soc Psych 1975; 31

Week by week attendance for choice or not of exercise programme

0

0.5

1

1.5

2

2.5

1 2 3 4 5 6

Choice

No Choice

Thompson and Wankel J Appl Soc Psych 1980; 10

The effect of efficacy training on the frequency of walking

0

50

100

150

200

250

300

350

Min

ute

s o

f w

alki

ng

/mo

nth

M1 M2 M3 M4 M5

Month of programme

Intervention

Control

MaAuley et al Prev Med 1994; 23

Effect of telephone prompts on meeting ACSM physical activity recommendations via walking:

Lombard et al: Health Psychology 1995; 14

King AC, Circulation. 1995;91:2596-2604

Effect of exercise, frequency, intensity and location on adherence

Expectations and adherence

0

10

20

30

40

50

60

70

80

90

100

1 2 3 4 5 6 7 8 9 10 11 12

OR

PR

DO

SP

Neff & King Med Ex Nut Health 1995; 4

Life events and exercise adherence

Oman & King Health Psych 2000; 19

Relapse prevention and reinforcement

RP Reinforcement Control

% attendance

18 weeks

51 49 44

Marcus & Stanton RQES 1993; 64

Confidence

Impo

rtan

ceReadiness/Motivation

Factors that influence readiness to change

Importance - Why Confidence - How, what?

Readiness - When

Is it worthwhile? Can I? When?

Why should I? How will I do it? Should I do it now?

How will I benefit? How will I cope with x,y,z?

What about other priorities?

What will change Will I succeed if..?

At what cost? What change?

Do I really want to?

Will it make a difference?

W

Does the interaction between practitioner and client influence the

likelihood of change?• Motivation to change is elicited from the client, and not

imposed from without.• It is the client’s task, not the health professional’s to

articulate and resolve the pros and cons of change.• Direct persuasion is not an effective method for resolving

ambivalence.• Client resistance predictive of failure to change• Changing negotiating style between confrontational and

client centred also changes level of resistance.• The professional’s empathy is associated with more

favourable outcomes

Summary• At the outset of a programme get clients to systematically go through the

anticipated pros and cons of exercise for them. This should preferably be done verbally.

• Adopt a client centred interpersonal style during the initial consultation.• Make sure that clients have realistic expectations about the changes

they can expect and how long such changes take to achieve.• Have clients actively involved in the decision-making processes that

lead to their first programme. This means avoiding the idea of ‘best’ or ‘ideal’ programmes. Introduce a menu approach to programming.

• Increase clients’ confidence for exercise by selecting ‘low skill’ exercises and frequently reinforcing successful completion of these exercises.

• If possible introduce clients to others who have been successful at changing behaviour.

Summary

• Maintain regular contact with clients especially during the early weeks.

• Have regular meetings with clients to reassess progress towards their goals. Members who don’t think their expectations are being met rapidly reduce their workout frequency.