Health Promotion

How can a health practitioner facilitate behaviour change in an individual with a health-risk behaviour?

Health practitioners play an essential role in facilitating behaviour change in individuals that display health risk behaviours. Health practitioners are exposed to the aftermath of risky health behaviours everyday. Leading a lifestyle full of health risk behaviours is the most common cause of death and disease within most countries. For example, smoking is a significant modifiable behaviour within Australia that is known to directly cause many forms of Cancer, cardiovascular disease and the degeneration of the body. Health practitioners should promote good health behaviours such as the cessation of smoking through enabling individuals to increase their control over their health (Sinclair, J. Wk 7, LA, Slide 3).

In order to facilitate behavioural change in an individual with a health risk behaviour such as smoking, health practitioners need to consider the individuals’ current health status, including their physical, mental, and social wellbeing (Walker, J, Payne, S, Smith, P, and Jarrett, N. 2007. p2), as well as their current lifestyle, for example low income family (stressed), and/or poorly educated (lack of knowledge of how to quit etc). The implementation of a ‘theory of behaviour change’ or a ’behavioural change model’ will assist in the accurate and individualized process of behaviour and lifestyle modification.

Implementing a theory of behaviour change into the behaviour change process is more effective in achieving the modified behaviour more effective as they provide an understanding and identify the causes of risky behaviours eg. “Smoking is self-medication against anxiety and stress” (Walker, J. Ch9, p197), and in turn also provide models for the prevention of these risky behaviours. (Barkway, 2009, p2). Without professional assistance it is often harder to quit smoking as knowledge is not always ‘sufficient to produce changes in behaviour’ (Sinclair, J. Week 5 Lecture A, Slide 17). Transferring the knowledge that smoking is extremely bad for you, and the short and long term effects of continuing to smoke, from knowledge into action depends not only on internal and external factors such as the individuals’ environment, but also factors such as their individual values, attitudes, beliefs and motivation. (Sinclair, J. Week 5 Lecture A, Slide 17).

Health practitioners may facilitate the cessation of smoking in individuals by adopting the model of Health Action Process Approach (HAPA). (Barkway, 2009. P141-142). This behaviour modification theory highlights the role of self-efficacy, which affects an individuals’ intention to change and their ability to change with it. There are 3 phases of HAPA, the non-intentional phase, the intentional phase and the action phase. A similar model that can be incorporated for facilitating smoking cessation is the Transtheoretical model. This behaviour change model is currently commonly adopted specifically for the cessation of smoking and other addictive behaviours (Walker, J. Ch9, pg196). It further breaks down the process into 5 stages; pre-contemplation, contemplation, preparation, action and maintenance and acknowledges that relapses do occur and views these as challenges for the individual to overcome as opposed to ‘failing’ at quitting.

In the HAPA model, the non-intentional phase of facilitating smoking cessation revolves around developing the individuals’ intention to quit. At this phase of the process the individual may have not even considered quitting but it is the health practitioners responsibility within their health role to empower individuals towards better health, hence encouraging thoughts about quitting. In comparison, the transtheoretical model follows the stage of pre-contemplation. The individuals in question are either in denial that smoking is a health-risk behaviour, they are unmotivated to quit or they just aren’t ready. (Barkway 2009. pg138-139) Interventions that may be used by health practitioners to facilitate change in individuals in this non-intentional/pre-contemplation mind frame can include presenting relevant health education information about the effects of tobacco smoking such as stroke, cancer, emphysema, and the benefits that are possible to achieve by quitting this health-risk behaviour, such as reduction of breathlessness, hypertension, circulatory problems and stroke (Western Journal of Nursing Research. 1996). By actually going through educational materials with the individual, health practitioners can facilitate discussion as opposed to just allowing them to contemplate the materials on their own. (Western Journal of Nursing Research. 1996) For those individuals that are in denial that smoking is a health-risk behaviour because for example, their grandfather is 80, healthy, and he is a smoker, intervention may be more difficult and the health practitioner may have to find statistics that suggest ‘the grandfather’ is a rare case, or report on conditions that ‘the grandfather’ may have that may not obviously appear to be unhealthy but are signs and symptoms of being a smoker. This may illustrate more effectively to the individual about the long-term effects on their health.

At the HAPA intentional phase, health practitioners can facilitate the behaviour change by motivating the individual to move forward with the quitting process. Individuals who have progressed from the non-intentional to the intentional phase have formed the intention to quit smoking and need empowerment to reach this goal. In the transtheoretical model this phase is broken down into 2 stages; contemplation and preparation. The transtheoretical model recognises that these 2 stages are 2 different mind frames and different interventions are be necessary to effectively facilitate change in an individual. Individuals in the contemplation stage are now aware that smoking is a health-risk behaviour and are no longer in denial due to the success of the interventions utilised in the non-intentional (pre-contemplation) phase. To progress the individual from contemplating smoking cessation to actually preparing for smoking cessation and to motivate them to quit before they start to display any health problems as a result of their health-risk behaviour, health practitioners can intervene by means of performing pulmonary function tests, breathing tests and blood oxygen capacity tests to emphasise the symptoms and abnormalities that will progress if smoking behaviour is not changed. (Western Journal of Nursing Research. 1996)
The individual will reach the preparation stage of smoking cessation once they make a commitment to this behaviour change. Health practitioners are essential at this level to sustain the individuals’ motivation and empower them to quit through means of exploring plans of action and support bases. During this stage it is essential to facilitate change in the individuals’ perception of smoking and themselves as a ‘smoker’. For example, in the Western Journal of Nursing Research (1996), one man gives his example of this change in perception, describing how, once he had made the commitment to quitting, he really looked at ashtrays and realised how disgusting they look and smell and began to change his personal perception of being a smoker to foolish, stupid and displayed feelings of self-disgust. Common methods for preparing to quit involve purchasing nicotine patches/gum, telling family and friends so the individual has their support, realising the financial cost of smoking and increasing knowledge of what health benefits to look forward to as a non-smoker (Western Journal of Nursing Research. 1996)

The action phase of the HAPA, and the action stage of the transtheoretical theories are reached when the individual actively participates in their commitment to quit smoking. This may be by using nicotine products, enrolling and following a QUIT smoking course, or going ‘cold-turkey’ (Barkway. 2009. pg138-139). Health practitioners can facilitate the behaviour change of reaching smoking cessation by means of educating and counseling the individual about manipulating their environment and discovering alternative, or substitute behaviours. Alternative behaviours to replace the activity of smoking may include chewing on gum, sucking on lollipops, reading, completing crossword puzzles or going for a walk. Health practitioners play an important role in counseling individuals whilst behaviour change process is occurring and providing them with ideas on manipulating their environment for success in reaching their goal of smoking cessation. Individuals can manipulate their environment by controlling their access to cigarettes, and avoiding smoking situations especially during the initial time period of the action phase when keeping motivated is hardest. Personal examples provided in the Western Journal of Nursing Research (1996) for controlling access to cigarettes included saving the remaining cigarettes as a personal challenge to take out and look at and test their level of commitment to quitting. Or, as a contradiction, ceremoniously getting rid of the remaining cigarettes by throwing them out one by one, washing all ashtrays and noticing how bad it looks and smells and throwing them away too. This symbolises a ‘fresh start’ for the individual, allowing them to redefine themselves as a non-smoker. The transtheoretical model breaks the corresponding phase of the HAPA model into one additional stage, maintenance. The transtheoretical model acknowledges that the individual has maintained not smoking and has therefore effectively changed their behaviour and reached their goal of smoking cessation. The individual has transformed their perspective upon smoking from the thinking that it is enjoyable, relaxing and a pleasurable social activity (Western Journal of Nursing Research. 1996) to redefining themselves as a ‘non-smoker’. Health practitioners can still aid the individual at this stage by counseling them and reaffirming their commitment to smoking cessation and reminding them that relapses do occur, but should be thought of as a challenge as opposed to failure at behaviour modification. (Barkway. 2009)

Health practitioners play a significant role in facilitating behaviour change in an individual displaying a health-risk behaviour. Despite what theory or model of behaviour modification is adapted to the process of quitting smoking, the role of the health practitioner in facilitating this change is essential as they are the motivators, counsellors and providers of knowledge and resources that are vital to guide the individual through the process.
REFERENCES:

Barkway, P. (2009) Psychology for health professionals. Sydney: Elsevier

Brown, Janet M. (1996) Redefining smoking and the self as a nonsmoker. Western Journal of Nursing Research, volume 18.4 (1996) Retrieved from http://find.galegroup.com.ezproxy2.acu.edu.au/gtx/infomark.do?&contentSet=IAC=Documents&type=retrieve&tabID=T002&prodId=AONE&docId=A18977795&source=gale&srcprod=AONE&userGroupName=acuni&version=1.0

Sinclair, J. (2010) HLSC 111 Person Health and Wellbeing.
Lectures Wk 7, LA, Slide 3 and Week 5 LA, Slide 17

Walker, J., Payne, S., Smith, P., & Jarrett, N. (2007). Psychology for Nurses and the Caring Professions (3rd ed) Maidenhead: McGraw-Hill

References: Barkway, P. (2009) Psychology for health professionals. Sydney: Elsevier Brown, Janet M. (1996) Redefining smoking and the self as a nonsmoker. Western Journal of Nursing Research, volume 18.4 (1996) Retrieved from http://find.galegroup.com.ezproxy2.acu.edu.au/gtx/infomark.do?&contentSet=IAC=Documents&type=retrieve&tabID=T002&prodId=AONE&docId=A18977795&source=gale&srcprod=AONE&userGroupName=acuni&version=1.0 Sinclair, J. (2010) HLSC 111 Person Health and Wellbeing. Lectures Wk 7, LA, Slide 3 and Week 5 LA, Slide 17 Walker, J., Payne, S., Smith, P., & Jarrett, N. (2007). Psychology for Nurses and the Caring Professions (3rd ed) Maidenhead: McGraw-Hill