Health Behaviors Enhancing Vs Compromising

Definitions Disease vs. Illness Disease is a diagnosable biological dysfunction or infection. Illness is an individuals unique experience of pain and suffering.

Etiology 1 : CAUSE, ORIGIN ; specifically : all of the causes of a disease or abnormal condition

Why do people get sick? Biomedical Model: Exposure to infectious agents or pathogens Immune response either sufficient or insufficient

Biopsychosocial Model of Disease

Preventing Disease: Primary Prevention) Efforts to prevent disease or injury from occurring e.g., practicing good nutrition, exercising, avoiding smoking, obtaining regular health screening Secondary Prevention) Actions taken to identify and treat an illness or disability early in its occurrence e.g., monitoring symptoms, taking medication, following treatment regimens( Tertiary Prevention) Actions taken to contain damage once a disease or disability has progressed beyond its early stages e.g., radiation therapy, chemotherapy

A health-enhancing behavior or habit exercising regularly, healthy eating, practicing safe sex, wearing seatbelts Healthy Exercise 1. 3 hours per week (across 3 5 sessions) 2. Warm-up a. Stretching and flexibility exercise b. Strength and endurance exercise 3. Aerobics a. Rhythmic exercise of large muscle groups b. Raise heart rate to moderately high level

Health-Compromising Behaviours A health-compromising behavior or habit smoking, excessive eating, substance abuse, dangerous driving, risky sexual behavior

Barriers to Healthy Behaviors 1) Individual Barriers inactivity Operant conditioning issue immediate rewards and punishments are much more effective than delayed ones Finances Optimistic Bias -- The tendency of most people to believe that they are less likely to become ill than others People who feel vulnerable to specific health problems are more likely to practice preventive health behaviors 2) Family Barriers Health habits are often acquired from parents and others who model health-compromising behaviors obese parents are more likely to have obese children children of problem drinkers are themselves at increased risk of abusing alcohol 3) Health System Barriers Medicine tends to focus on treatment rather than prevention

A significant percentage of Sudanese do not have health insurance Unrealistic or confusing recommendations 4) Community Barriers Access to health care, exercise facilities, Absence of community health promotion (e.g., no incentives to walk) Some environments promote health-compromising behaviors e.g. drinking alcohol

Given all these barriers, why (and how?) would a person change his or her health behavior?

Changing Behaviors How can we influence people to change health behaviors? What needs to be done? What strategies might be effective?

Changing Health Behaviors: Intervention I. Changing Health Beliefs II. Social Engineering III. Cognitive-Behavioral Methods I. Changing beliefs :Health Education Campaigns Health Education ideally identifies specific health problems in a community analyzes background factors that predispose, enable, and reinforce lifestyle and environment elements implements health education program How Effective are Health Education Campaigns? Mass media appear to be most effective in alerting people to health risks that they otherwise wouldnt know about, but are less effective in long-term behavior change (unless the message is presented consistently over time, e.g ,.health risks of smoking What about fear-based messages (scare-tactics)? e.g., Framing the message to stress the risk of not performing a health behavior II. Social Engineering Changing the environment to change our behaviors a. b. c. d. Automatic seat belts and air bags; lowering speed limit Design change for baby walkers Requiring immunizations for school entry Worksite wellness programs i. on-the-job health promotion programs

III. Cognitive-Behavioral Interventions

i. Methods are usually used in combination (a multimodal approach ii. Should be tailored to each person iii. Too many interventions can overwhelm a person Health Belief Model understanding why people encage in a healthy behavior or Not? Susceptibility Severity Costs/Benefits Cues/Motivation Barriers Susceptibility: How likely one thinks a bad outcome (e.g., get sick or a disease) is if behavior persists (doesnt change). Severity: The consequence is perceived to be severe as opposed to mild. Benefits of Behavior: The alternative behavior will reduce the likelihood of the negative consequence (e.g., disease). & Benefits are perceived to outweigh costs. Motivational cues: Cues (internal or external) that help convert intentions into behavior e.g: Ahmed is likely to continue smoking because: He agrees with the tobacco industry--smoking doesnt cause lung cancer (susceptibility). He believes that dying from lung cancer is not any worse than any other way of dying (severity). Ahmed feels that smoking relaxes him (cost/benefits). His friends offer him cigarettes (barrier to quitting) e.g: James is not likely to continue smoking because He thinks that He might get lung cancer if he continues to smoke (susceptibility). He believes that dying from lung cancer is terrible (severity). James does not find smoking to be very pleasurable (cost/benefits). His friends are supportive of her quitting (absence of barrier)

Medication Non-Compliance: As A health psychologist why should you worry about compliance? Why Is Prescription Medication Compliance Important?

Drugs dont work if people dont take them. C. Everett Koop, MD What Is Noncompliance? Noncompliance or non-adherence refers to people who do not take their medications appropriately. How Big A Problem Is Medication Noncompliance? Up to 60% of all medication prescribed is taken incorrectly, or not at all. Noncompliance includes: Not filling a prescription, Over medication, Taking wrong medication, Taking right medication at wrong time, Taking wrong amount, Forgetting to take medication, Deliberately under dosing, or not taking medication. Overall Rates of Noncompliance: 90% of elderly patients make some medication errors. 35% of the elderly make potentially serious errors. Older adults average 2.3 serious medication errors per patient per month. 50% of all long term medications are abandoned in the first year.

Overall Rates Of Noncompliance: More than half of chronic care patients prescribed drugs either stop taking their medications at some point, or they dont take them as directed. Even patients who understand and agree with treatment are only 75% compliant. Where Is The Problem The Biggest? Chronic Diseases Patients: Diabetes Congestive Heart Failure (CHF) End Stage Renal Disease (ESRD) Chronic Obstructive Pulmonary Disease (COPD) Asthma Coronary Artery Disease (CAD) Depression HIV/AIDS Depression Prevalent, Costly Chronic Condition: Affects approximately 20 million people. Costing $43.7 billion a year in medication, benefits and lost work days. One of the biggest problems is patient compliance with medication usage. Patient based information technology could help reduce medication noncompliance. Assessing Medication Compliance Is Difficult To Do:

Physicians are unable to predict patients noncompliance at rates better than chance. Patients self-reporting is usually overestimated by a significant amount. Noncompliance measures are highly reactive (white coat effect) and are, therefore, often inaccurate. What Can NEXDOSE Do? Nexdose is an IT based aid in monitoring medication compliance. Help patients take medications right. Provide a platform for managing medication compliance. Help achieve cost benefit from improved compliance. Class assignment Chose a chronic illness Using HBM predict the health behavior of your patient? Be specific Assume that medical compliance is a problem with your patient How can you increase compliance? Tip use the three pillars Changing Health Beliefs II. Social Engineering III. Cognitive-Behavioral