T H E C A R R O T O R T H E S T I C K ? E X P L O R I N G M O T I V A T I O N A N D B E H A V I O U R A L C H A N G E J A S D E E P D H I R , C L I N I C A L S P E C I A L I S T M S K B S C ( P T ) , T D P T, M C L S C ( M T ) F C A M P T - S P E C I A L T H A N K S T O D R . D A V E W A L T O N A N D J I M M I L L A R D F O R T H E I R P E R M I S S I O N S T O U S E J O I N T M A T E R I A L
OBJECTIVES OF THE WORKSHOP • Introduce the evidence and theories of behavioural change models • Discuss the main underpinnings behind behavioural change models • Discuss the application of behavioural change models as it pertains to to intervention and adherence • Demonstrate how these concepts can be threaded in teaching • Outline and apply Motivational Interviewing (MI) techniques
WHY DO PEOPLE CHANGE BEHAVIOURS?
WHY DO WE USE 10 billion trips have been completed THESE NOW? worldwide (July 2018).This figure is climbing rapidly, with 14 million Uber trips completed each day.
• In early 2018, Uber launched Express POOL. Similar to uberPOOL, Express POOL involves sharing a ride with other riders who are headed in the same direction. Longer wait time and had to walk a distance to a meeting point • Uber realized there were increased cancellations happening.
• “ In this case, we dove into the behavioral science literature to gather insights about people’s perceptions of time and waiting.” • The Problem • People dread idleness • Operational transparency, • People want to feel like they are advancing well towards their objective. • A Solution • highlighting progress during wait times by explaining each step going on behind the scenes, like identifying other riders traveling the same way and finding a car for the trip, explaining the arrival time estimate calculation—could be provided by clicking an info icon. • The Express POOL team tested these ideas in an A/B experiment and observed an 11 percent reduction in the post-request cancellation rate.
MOTIVES FOR USING AIRBNB IN METROPOLITAN TOURISM – WHY DO PEOPLE SLEEP IN THE BED OF A STRANGER? Natalie Stors & Andreas Kagermeier
W H AT P E R C E N TA G E O F P E O P L E A C T U A L LY S T I C K TO T H E I R N E W Y E A R ’ S R E S O L U T I O N ? 8%
UNDERSTANDING BEHAVIOUR CHANGE
WHAT IF THE GOVERNMENT OF CANADA ISSUED THE FOLLOWING PUBLIC HEATH ADVISORY • It has been discovered that cell phone use poses a major health concern. The present information states that using your cell phone (1) produces brain damage; (2) is unpredictable; (3) is cumulative based on continued exposure; and (4 ) we have no way of knowing how much exposure is too much, nor what will happen to people at their present level of exposure. However, for those who have not suffered any side effects to date, should stop using their cell phone until we have more information.
• How many of you 1. NOT SEE IT AS A would ….. PROBLEM 2. THINK ABOUT IT BUT NOT MAKE ANY CHANGE 3. CONSIDERING IT STRONGLY 4. WILL DO IT NOW
WHY …...? • What made you choose your stance? • What would you need to help you make a different choice?
WHAT IF…..? • You just heard that there is a case of brain damage in your city. – Who would this make you change your mind and to where? • You just heard that a relative of yours just got brain damage from cell phone use. – Who would move their section now and to where?
W H A T D I D Y O U C O N S I D E R W H E N M A K I N G Y O U R D E C I S I O N ? • T H E I M P O R TA N C E O F Y O U R C E L L P H O N E I N Y O U R L I F E . • T H E A M O U N T Y O U U S E Y O U R C E L L P H O N E • W H AT A C T I V I T I E S Y O U U S E Y O U R C E L L P H O N E F O R A N D W H AT N E E D S A R E F I L L E D I . E . W O R K , C O N N E C T I N G W I T H F A M I LY / F R I E N D S , B R A N D I N G , R E S E A R C H , E N T E R TA I N M E N T … . • C O U L D Y O U G E T T H E S E N E E D S M E T I N OT H E R W AY S ? • W H O I S P R O V I D I N G T H E I N F O R M AT I O N - R E L I A B L E S O U R C E ? • W H AT I S T H E S E V E R I T Y O F T H E B R A I N D A M A G E
TRANS- THEORETICAL MODEL OF CHANGE Pre- Contemplation Relapse Contemplation Maintenance Preparation Action
• Pre-contemplation -People in P R E - C O N T E M P L AT I O N this stage are not thinking about changing their behaviour and are not aware of their problem. They have no consideration for change.
• Contemplation -People in this C O N T E M P L AT I O N stage have thought about their problem and have devoted some thought to changing. They have not taken action to change however, they may be beginning to consider options for change.
• Preparation -People in this stage P R E PA R AT I O N have begun the process of change by examining possibilities and options.
• Action- People in this stage have AC T I O N taken steps to modifying their behaviour, experiences, or environment in order to overcome their problem. Action involves the most overt behavioural changes and requires a commitment of time and energy.
• Maintenance- People in this stage M A I N T E N A N C E consolidate the gains attained as a result of initial action through sustained involvement in the new behaviour, Adoption of the new behaviour usually requires a period of many weeks to months.
TRANSTHEORETICAL MODEL OF CHANGE- STAGES • Relapse - Inability to maintain the desired behaviour
WHAT MAKES PEOPLE MOVE FROM STAGE TO STAGE? H T T P : / / T H E H U B E D U - P R O D U C T I O N . S 3 . A M A Z O N A W S . C O M / U P L O A D S / 3 / 1 8 7 2 2 9 7 3 - F 8 0 F - 4 B 5 5 - 8 F F E - FA FA 4 4 C 2 1 9 7 9 / H E A LT H _ E D U C AT I O N . P D F # PA G E = 1 3 5
TRANSTHEORETICAL MODEL OF CHANGE- STAGES • Moving through the Stages of Change model is a process that requires both cognitive and behavioural changes • changes in attitude and awareness of one’s circumstances (cognitive—the way one thinks) • changes in actions to decrease the occurrence of undesirable activities, and actions to engage in new, desirable activities (behaviour—the way one acts)
UNDERPINNINGS OF CHANGE • Motivation- is a state of readiness or eagerness to change, which may fluctuate from one time or situation to another. • Is strongly influenced by internal and external factors. • Self-efficacy/ Ability- can be defined as the likelihood to see oneself as competent to cope with life’s challenges and to be deserving of happiness. • T o improve self-efficacy, a person must experience success relative to expectations. Specifically, the more realistic the expectation or goal is, the higher the degree of success will be.
EXPLORING OTHER BEHAVIOUR CHANGE MODELS • Deci and Ryan’s Self Determination Theory • Becker’s Health Beliefs Model • Ajzen’s Theory of Planned Behaviour
file:///Users/admin/Downloads/SDTandintmotive%20(1).pdf
SELF-DETERMINATION THEORY • According to SDT humans have basic psychological needs for autonomy (feeling fully volitional or free to engage in a behavior), perceived competence (feeling effective in one’s actions), and relatedness (feeling safe and cared for in one’s interpersonal relationships). • When these needs are supported, patients’ participation in treatment will be more autonomous and less controlled. • Autonomous motivation is characterized by perceptions of valued benefits and a willingness to participate. • In contrast, controlled motivation in the healthcare domain typically involves patient engagement in treatment due to external pressure, coercion, or feelings of guilt. • more autonomously motivated behaviors leads to greater psychological well- being and long-term behavioral persistence.
BECKER’S HEALTH BELIEFS MODEL
HEALTH BELIEFS MODEL • The model suggests that decision - makers make a mental calculus about whether the benefits of a promoted behavior change outweigh its practical and psychological costs or obstacles. • Individuals conduct an internal assessment of the net benefits of changing their behavior, and decide whether or not to act. • The model identifies four aspects of this assessment: perceived susceptibility to ill - health (risk perception), perceived severity of ill - health, perceived benefits of behavior change, and perceived barriers to taking action.
May change if Most likely to Yes perceived barriers change can be overcome Motivated No May change with Unlikely to change cognitive reframing No Yes Ability
MOTIVATION AND ABILITY • MOTIVATION • ABILITY • Decisional Balance • Determining self efficacy • Weighing the push/pull-what • Even if I wanted to change would happen if I engaged in (motivated) do I have the the behaviour? and what means to do so would happen if I did not? • Determine a level of importance to make the identified change
MOTIVATION-THE CARROT OR THE STICK? Trying to avoid an outcome Moving Towards and outcome
WHAT ARE THE CONTRIBUTING FACTORS FOR MOTIVATION AND ABILITY THAT CAN BE MODIFIED? • Personal (Motivational Interview) • Social • Physical/ Structural
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