Behavioral Change

Created by Stoy E. Proctor MPH, Mdiv Edited by Elie S Honore MD MPH MHA
April 2010

FUNDAMENTAL QUESTION
How do we move people from point A to point B? From poor lifestyles to healthy lifestyles? A? To B?

Not by Machiavellian Strategies

Machiavel was a 15th century prince who conceived of a plan to become a successful ruler, his strategies were:
1. Looking at good matters more than being good, 2. If it helps to achieve your goal, lie. 3. The end justifies the means. *
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Over the years there has been several approaches to behavioral change, some logical, reasonable and successful - others not so successful. *

In the next few minutes I will present the best approaches that my research has found.
1. 2. 3. 4. Principles of behavioral sciences Traditional approaches Biblical Principles Spirit of Prophecy guidelines

Barriers or enablers to change

Pre-disposing or Enabling factors :

The Person:
knowledge attitudes beliefs values perceptions cultural norms *

These factors facilitate or hinder a persons motivations to change.

Pre-disposing or Enabling factors :

The Society
Available health resources Accessibility Insurance Laws Health Skills - health professions *

Enablers or barriers created by social forces or systems:

Reinforcing factors:
Friends Relatives Peers Teachers Employers Health Providers Health Professionals*
Health Education Planning 1980, pp. 16-17
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Media

Stages of Change Levels of Intervention

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Your successful behavioral change targets the specific stages of contemplation and must be adaptable to the stage of change.

Pre-Contemplation Phase
Information Friends Media:
Newspaper television radio*

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Contemplation Phase
Cost Seriousness of illness Social pressure Restrictions*

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Preparation Phase
Physical Mental Social Spiritual *

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Action Phase
Change - success Positive support Maintenance Self support Family Peer *
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Negative pressure to return

Relapse Health Habits Addiction Peer pressure Advertisements Stressors
USDHHS, 1991, p. 345 Monograph #5 - NIH 1994
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Behavioral change is dependent on five characteristics:

1. 2. 3. 4. 5. Attention Comprehension Acceptance Retention Action
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The following slides are to assist the smokers participating in the Breathe Free Plan, to refine their behavioral strategies for better success in quitting.

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Refining Behavioral Strategies

1. Define your goals in concrete terms Ex: Not I would like to stop smoking Rather my goal is to stop smoking on Jan. 1, 2006 2. List the details of the problem so that you understand your problem

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 3. Observe your behavior, dont speculate about it or trust your memory. 4. Specify not only the situation and the fact that the desirable behavior is not occurring, but also the behaviors that occurs instead of the ones you want.
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 5. Your strategy should always be to increase some desirable behavior- one that is supportive of your primary goal. Ex. An exercise regimen 6. Specify the chain of events that will lead to the goal. Ex. Choosing alcohol and caffeine free beverages are helpful on your way to becoming tobacco free.
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 7. Observe people who are successful at what you are trying to do, and then try their tactics yourself .Ex. Smoking diary 8. Develop several alternative solutions to the problem and then select the best one to implement.
P.32-36 Watson Self Directed Behaviors-2002
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Self-Efficacy Beliefs
1. Believe in your ability and the power available to you to help participants stop smoking. 2. Believe in the ability, experience, and motivation of the participants to stop smoking. 3.Convince the participant that you believe they can stop smoking. 4. Help the participant believe they can stop smoking. 25 EGW Education 281

How to Increase your Self-Efficacy Beliefs

1. Choose a goal for which you can say yes or a strong maybe, one in which you believe you can reach. Ex. I can stop smoking.
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 2. Focus on the process of change, not as much on the final goal. Ex. In preparation for walking a mile or running a Marathon you begins with a few steps. Each step and each 100 yards you walk over a period of time will increase your confidence and improve your chances of success. 27

 3. Discriminate, between your past performances and the present project. In this new project you will develop new skills and you will be able to avoid past strategies that did not work.
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 4. In the process of focusing on the process, not the final goal, keep good records. Ex. A long list of your recorded successes Will help increase your belief in yourself
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 5. Endeavor to make these behavioral changes on rational reasons rather than on an emotional basis. Emotions can lower your selfefficacy beliefs irrationally.

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 6. Make a list of the specific kinds of situations which you expect to have greatest difficulty. Rank in order of difficulty from the least to the greatest and develop strategies to deal with each. In Breathe-free we start with Exercise, then coffee, then alcohol 31 and last tobacco.

Prepare for Relapses

1. Avoid situations you know may be tempting. 2. Ask your friends not to tempt you. 3. Try asking your friends for support. 4. Minimize the tempting quality if the situation. Ex. Fill up with water and fruit juices before you go to a party that is serving alcohol or carry around a drink of fruit juice. Now Pepsi Cola is producing a blue soft drink to match the color of wine coolers. P. 40 Watson-Self-Directed Behaviors2002

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Traditional Approaches
Inspiring
emotional pleas

Rules and regulations

right and wrong

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Traditional Approaches
Setting an example
parents teachers

Persuading and convincing

arguments favor

Limiting choice
choices*
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Traditional Approaches
Cultural or religious dogmas. Society norms.
Doctrines of the church, our people have always done it this way, this is the way we do it. Thus sayeth the Lord, the Bible says, Church tradition teaches

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Traditional Approaches
Appeals to conscience
still small voice
Values & Teaching, Ruths, pp. 39 & 40. 1996, Merrill Publishing, Columbus, OH*

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Behavioral change is a process, not an event

Biblical Behavioral Change Concepts

First Condition; you must believe that: 1. God is good and is not responsible for evil. Truly God is good to the upright, to those who are pure in heart. Psalm 73:1

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2. You are fully responsible for your behavior, it is your choice.

Everyone who knows what is the right thing to do and doesnt do it commits a sin.
JA 4:17 (JB)

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 1 Corinthians 10:13

3. You must believe that help is available

No temptation has overtaken you but such as is common to man, and God is faithful, who will not allow you to be tempted beyond what you are able, but with the temptations will provide the way of escape, also - that you may be able to endure it.

2 Peter 2:9
The Lord knows how to rescue the godly from temptation.*
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4. Believe that You can master anything. Phil 4:13 (TB)

There is nothing I can not master with the help of the one who gives me strength. Spirit of Prophecy Principles of Behavioral change.

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The End