Behavoural changes ie smoking censation

Behavoural assortments ie smoking censationBehavoural deepens ie smoking censationThis essay pull up stakes discuss the Behaviour Change pattern of Health education or The Trans-theoretical Model, (TTM) in relation to smoking cessation. As G. K. Chestertononce said, It isnt that they cant see the solution. It is that they cant see the line of work. Families, friends, neighbours, or employees, however, atomic number 18 often well aw be that the pre-contemplators render problems. Stages of ChangeProchaska DiClements transtheoretical model (1984,1986 Prochaska et al 1992) is important in describing the process of genial. The model derived from their work on advance change in addiction doingss, although it can be used to show that just about good deal go by means of lay outs when trying to change or master demeanours.American psychologists, Jim Prochaska and Carlo Di Clement,Termination.Process of change.Downloaded By Glasgow Caledonian University At 1449 12 July 20094 ADDICTIONS NURSING NETWORKNOLUME 5, NUMBER 1,1993In our studies using the discrete categorization standard of power points of change, we ask whetherthe individual is seriously intending to change theproblem behavior in the near future, typically insidethe next sestet months. If not, he or she is sort out as aprecontemplator. Even precontemplators can wish tochange, entirely this seems to be quite dissimilar fromintending or seriously considering change in the nextsix months. Items that be used to identify precontemplationon the continuous stage of change measureinclude As far as Im concerned, I dont go through all problems that need changing and I guess I look at faults, but theres nothing that I really need tochange. Resistance to recognizing or modifying aproblem is the hallmark of precontemplation .Splral Pattern of Change. Many New Years resolversreport pentad or more than years of consecutive pledgesbefore maintaining the behavioral goal for at least sixmonths (Norcr oss Vang atomic number 18lli, 1989). Relapse andrecycling through the stages occur quite frequentlyas individuals attempt to modify or cease addictivebehaviors. Variations of the stage model are beingused increasingly by behavior change specialists toinvestigate the fighting(a)s of relapse (e.g., Brownellet al., 1986 Donovan Marlatt, 1988).Because relapse is the rule rather than the censurewith addictions, we found that we needed tomodify our original stage model. Initially we conceptualizedchange as a linear gainion throughthe stages quite a little were supposed to progress simplyand discretely through each step. Linear progressionis a possible but relatively rare phenomenon withaddictive behaviors.Figure 1 presents a curl pattern that illustrateshow most people actually move through the stages ofchange. In this spiral pattern, people can progressfrom contemplation to preparation to action to upkeep,but most individuals will relapse. Duringrelapse, individuals regress to an preceding stage. SomeTERYINATION a YAHTENANCEPRECONTEYPLATIOW CONTEYPLATKJN PREPARATKJrelapsers feel like failures-embanassed, ashamed,and guilty. These individuals become demoralizedand resist thought process about behavior change. As a outgrowth,they return to the precontemplation stage andcan remain there for various periods of time. Approximately15% of smokers who relapsed in ourself-change research regressed back to the precontemplationstage (Prochaska DiClemente, 1986).Fortunately, this research indicates that the bigmajority of relapsers85% of smokers, for cause-recycle back to the contemplation or preparationstages (Prochaska DiClemente, 1984). Theybegin to consider plans for their next action attemptwhile trying to learn from their sensitive-made efforts. Totake another example, fully 60% of unsuccessfulNew Years resolvers make the same pledge the nextyear (Norcross, Ratzin, Payne, 1989 Norcross Vangarelli, 1989). The spiral model suggests thatmost relapsers do n ot resolve endlessly in circles andthat they do not regress all the way back to wherethey began. Instead, each time relapsers recyclethrough the stages, they potentially learn from theirmistakes and can try virtuallything different the nexttime around (DiClemente et al., 1991).On any ane trial, successful behavior change is curb in the absolute numbers of individuals whoare able to gain maintenance (Cohen et al., 1989Schachter, 1982). Nevertheless, in a cohort of individuals,the number of successes continues to increasegradually over time. However, a large numberof individuals remain in contemplation andprecontemplation stages. Ordinarily, the more actiontaken, the better the prognosis. Much more researchis needed to better distinguish those who attainfrom recycling from those who end up spinning theirwheels.Arguments for and againstConclusionInfluencing the people to change doingss such as how they eat,excersice ,drink, smoke requires a long term commoitment but it is a proce ss that they can sucseed. Nurses have a key role to play in influencing behaviour of their patients, and wellness promotion should be embedMAINTENANCE pull required for thenew behaviour to be consistently maintained,incorporated into the repertory of behavioursavailable to a somebody at any one time.ACTION people make changes, acting onprevious decisions, experience, information,new skills, and motivations for making thechange. cookery person prepares toundertake the desired change requiresgathering information, finding out how toachieve the change, as certain(a)ing skillsnecessary, deciding when change shouldtake place may include talking with others tosee how they feel about the likely change,considering impact change will have and whowill be unnatural.CONTEMPLATION something relegates toprompt the person to start thinking aboutchange perhaps hearing that someone hasmade changes or something else haschanged resulting in the need for furtherchange.PRECONTEMPLATION changing abehaviour has not been considered personmight not realise that change is possible orthat it might be of interest to them.Source The Behavior Change spiral from What do they penury us to do now? AFAO 1996ded in daily practice. E following reappraisal explores and considers some of the major theories of behaviourand behaviour change that may be pertinent to the development of effectiveinterventions in get behaviour, including theories and concepts from mainstreampsychology, and the associated sub-disciplines of health, leisure, recreation, physical legal action and course session psychology.For many years conceptual models of behaviour change, such as Banduras SocialCognitive discipline system (1986), Beckers Health Belief Model (1974), Azjen andFishbeins Theory of effectual Action (1975) have been applied across a widevariety of disciplines, including travel and road user behaviour.Considerable attention has been given in the literary works to models of individualbehaviour c hange per se but much less attention has been given to models ortheories that attempt to understand behaviour change within groups, organisations andwhole communities. The design of broadcasts to reach populations requires anunderstanding of how those communities work, their barriers and enablers to change,and what influences their behaviours in general.Stage Theories of Behaviour ChangeMounting evidence suggests that behaviour change occurs in stages or steps and thatmovement through these stages is neither unitary or linear, but rather, cyclical,involving a pattern of espousal, maintenance, relapse, and readoption over time.The work of Prochaska and DiClemente (1986) and their colleagues have formallyidentified the dynamics and body structure of staged behaviour change. In attempting toexplain these patterns of behaviour, Prochaska and DiClemente developed atranstheoretical model of behavioural change, which proposes that behaviour changeoccurs in five distinct stages through w hich people move in a cyclical or spiralpattern.The first of these stages is termed precontemplation. In this stage, there is no intenton the part of the individual to change his or her behaviour in the foreseeable future.The second stage is called contemplation, where people are aware that a problemexists and are seriously considering taking some action to address the problem.However, at this stage, they have not made a commitment to undertake action. Thethird stage is described as preparation, and involves both(prenominal) purpose to change andsome behaviour, usually minor, and often meeting with limited success.Action is the fourth stage where individuals actually modify their behaviour,experiences, or environment in effect to overcome their problems or to meet theirgoals. The fifth and final stage, maintenance, is where people work to prevent relapseand consolidate the gains attained in the action stage. The stabilization of behaviourchange and the avoidance of relapse are ch aracteristic of the maintenance stage.Prochaska and DiClemente further suggest that behavioural change occurs in acyclical process that involves both progress and periodic relapse. That is, even withsuccessful behaviour change, people likely will move back and forth between the fivestages for some time, experiencing one or more periods of relapse to earlier stages,before moving once again through the stages of contemplation, preparation, actionand eventually, maintenance. In successful behavioural change, while relapses toearlier stages inevitably occur, individuals never remain within the earlier stage toMAINTENANCE practice required for thenew behaviour to be consistently maintained,incorporated into the repertoire of behavioursavailable to a person at any one time.ACTION people make changes, acting onprevious decisions, experience, information,new skills, and motivations for making thechange.PREPARATION person prepares toundertake the desired change requiresgathering information , finding out how toachieve the change, ascertaining skillsnecessary, deciding when change shouldtake place may include talking with others tosee how they feel about the likely change,considering impact change will have and whowill be affected.CONTEMPLATION something happens toprompt the person to start thinking aboutchange perhaps hearing that someone hasmade changes or something else haschanged resulting in the need for furtherchange.PRECONTEMPLATION changing abehaviour has not been considered personmight not realise that change is possible orthat it might be of interest to them.Source The Behavior Change spiral from What do they want us to do now? AFAO 1996which they have regressed, but rather, spiral upwards, until eventually they reach astate where most of their time is spent in the maintenance stage.Further work undertaken and reported by Prochaska et el (1992) suggests thatbehaviour change can only take place in the mise en scene of an enabling or supportiveenvironment.P rochaskas and DiClementes model has received considerable support in theresearch literature. Their model has besides been shown to have relevance forunderstanding, among other things, patterns of physical activity betrothal andadherence and would have relevance in bringing about change in travel behaviours.Consistent with the above perspective, Sallis and Nader (1988) also have suggested astage improvement to explaining movement behaviour, particularly in family groups, withresearch aimed at understanding better the cyclical patterns of movement activitySOCIAL FEATURES nature of face-to-face elationships expectations of class, position, age, sexualityaccess to knowledge,information.CULTURAL FEATURES the behaviours and attitudes considered acceptable in given considerations eg. relating to sex, gender, drugs, leisure, participation.ETHICAL SPIRITUAL FEATURES influence of personal and shared values and discussion about moral systems from which those are derived can include ri tuals, religion nd rights of passage.LEGAL FEATURES laws determining what people can do and activities to encourage observance of those laws .POLITICAL FEATURES systems of governance in which change will have to take place can, for example, limit access to information and involvement in societal action.RESOURCE FEATURES affect what is required to make things happen covers human, financial and material resourcescommunity knowledge and skills and items for exchangeSource The Behavior Change spiral from What do they want us to do now? AFAO 1996involvement, including adoption, maintenance, and relapse, and interventions aimedat minimizing the amount of time individuals spend in the relapse stage as well asmaximizing time spent in action or maintenance.This stage approach is contrasted to the all or none approach to physical activityparticipation that often characterized early research on exercise adherence.such(prenominal) a staged approach sits well with any school found program th at is focussed ontravel behaviour change given that the context in which the program is to be appliedwould see fluctuations in the positive and negative influences according to such thingsas work and time demands of family members, weather, events or incidents in thelocal neighbourhood that may influence perceptions of safety.Parallel with the work of Prochaska and DiClemente, Rogers, (1983) also developed astage- found surmise to explain how new ideas or innovations are disseminated and follow at the community and population levels. Rogers identified five distinct stagesin the process of diffusion of any new initiative or innovation. These are knowledge,persuasion, decision, implementation, and confirmation. Rogers argued that thediffusion of an innovation is enhanced when the perceived superiority of aninnovation is high compared to existing practice (i.e. the relative advantage), andwhen the compatibility of the innovation with the existing social system is perceivedto be high (i.e. compatibility).Other important influences on the diffusion process are said to be complexity,triability, and observability, with innovations which are of low complexity, easilyobserved, and that are able to be adopted on a trial basis, being associated with greateradoption and swifter diffusion. Building success and comfort during the early stagesof the implementation of the TravelSMART Schools program will be paramount to itssuccess.Rogers classifies individuals as innovators, early adopters, early majority, latemajority, late adopters, and laggards, subordinate upon when during the overalldiffusion process they adopt a new idea or behaviour. While this model has not beentested empirically to date, it has been adapted and applied in health promotion settingsusually in conjunction with social education theory and/or self-efficacy theory, withsome success. It certainly warrants attention in the development of theTravelSMART Schools program.In summarizing the various stage mo dels of behaviour change that have beenproposed over the former(prenominal) two decades, Owen and Lee (1984) highlighted a number ofcommonalties they share.These authors propose an integrated stage-based model in which behaviour change isviewed as a cyclical process that involves five stages of awareness of the problem and a need to change motivation to make a change skill development to prepare for the change initial adoption of the new activity or behaviour, and maintenance of the new activity and integration into the lifestyle.In terms of a TravelSMART program this may meanFive stages of behaviour change Examples of content and processes Awareness of the problem and a needto changeProvision of, or ways to seek informationon the dependence on motorised travelevidence of the greenhouse effect issuesrelation to building relationships and physical fitness Motivation to make a change Benefits of increased personal fitnessbenefits of leaving the car at home eg.environmental and socia l Skill development to prepare for thechangeMapping of the local area to identify option forms of travel, ways tonegotiate with reluctant family membersor peers to manage the need to carrystrategies for trip chaining and travelblending Initial adoption of the new activity orbehaviourSelf monitoring of newly adoptedbehaviours to, opportunities forreflections and comparisons Maintenance of the new activity andintegration into the lifestyleProvision of feedback on how the changeis going, and an injection of new ideas orstrategyAn important aspect of both Prochaskas and DiClementes approach and thatsuggested by Owen and Lee is that each of the five stages of behaviour change is saidto involve different cognitive processes and require different treatments orintervention strategies for the overall change process to be successful. Prochaska andDiClemente (1992) outlined a number of cognitive change processes that have beenfound to be associated with each stage.Other researchers also propos e that different stages in the change process requiredifferent intervention strategies, and generally recommend a multifaceted,community-based approach to intervention in which all stages are addressed so thatindividuals at all stages of readiness for change can potentially be influenced. Thissits well with the overall TravelSMART programs TravelSMART Communities,TravelSMART Workplaces and TravelSMART Schools.A major insight offered by stage theories of behaviour change, then, is the emphasisthey place on matching interventions to the stage of readiness of the individual. This build of approach provides an excellent framework for understanding and examiningindividual differences in motivation for, and involvement in, change in travelbehaviours over time, including patterns of initiation, maintenance, relapse, andresumption.In summary, theories that conceptualise behaviour change in terms of a cyclicalprocess through which individuals move in stages, have received empirical support inthe research, and bug out to offer much promise for understanding travel behavioursand curricula to bring about changes in travel behaviour.A major strength of the Stages of Change model is that it has also been used inconjunction with a variety of other theories and models that are relevant to differentlevels of influence at an intrapersonal, interpersonal, institutional, community orpublic insurance level. (Glanz and Rimer (1995) as reported by Oldenberg et al (1999))Social Cognitive-Behavioural Theories and Similar TheoriesSocial Cognitive Theory explains human behaviour in terms of a triadic, dynamic andreciprocal model in which behaviour, personal factors, and environmental influencesinteract. It addresses both the psychological dynamics underlying behaviour and theirmethods for promoting behaviour change. It is a very complex theory and includesmany key constructs. Self-efficacy is one of the key concepts.Self-efficacy refers to ones confidence in the ability to take actio n and persist inaction. It is seen by Bandura (1986) as perhaps the private most important factor inpromoting changes in behaviour. Measures of self-efficacy and some of the other keyconcepts from Social Cognitive Theory have also been identified as key determinantsof movement through the stages of change, (Oldenburg, 1999).Self-efficacy expectations have been found repeatedly to be important determinantsof the choice of activities in which people engage how much energy they will expend on such activities and the degree of persistence they demonstrate in the face of failure and/oradversity.In general, higher levels of self-efficacy for a given activity are associated with higherparticipation in that activity.Similarly, and closely aligned to Social Cognitive Theory, Attribution Theoryproposes that individuals generally view their performance (and thus, their successesand failures) as dependent upon ability, effort, task difficulty, and luck. In addition,causal influences are seen a s either internal to the individual (e.g. personal ability), orexternal (e.g. barriers to community safety, lack of convenient and showy travelalternatives).The distinction between internal and external attributions is an important one, in thathow we attribute our personal successes and failures has been shown to be related tonot only our behaviour, but our self-esteem, our perceptions of personal control, ourself-efficacy for different tasks and/or performance situations, and our ongoinginvolvement in different activities.For example, a person who attributes their failure to change their dependence onmotorised travel to their inherent lack of ability to identify and use alternatives will beless likely to continue with the alternative modes of travel after the educationalprogram has ceased.A persons attributions for personal success and failure in a given situation, then,determines how that person feels about the task, as well as the amount of effort he orshe is likely to invest in the task the next time around. When failure is attributed tolow personal ability and a difficult task, individuals are more likely to give up sooner,select easier alternatives, such as using personal motorised travel, and lower theirgoals. Conversely, when failure is attributed to external factors such as freehanded luck,individuals are likely to have higher motivations to continue and to try again forsuccess.Attitudes and their potential relationship to behaviour also have been studiedextensively. In general, attitudes have not generally been found to be consistentlyrelated to behaviour. This failure to demonstrate a consistent relationship betweenattitudes and behaviour may be because situational factors also exert a powerfulinfluence on behaviour. In addition, how attitudes have been defined and measured indifferent studies varies considerably.Research has demonstrated consistently that an attitude is likely to predict behaviourwhen the attitude includes a detail behavioural i ntention when both the attitude and the intention are very specific and when the attitude is based on first-hand experience . These aspects of the behaviour-attitude relationship have been addressed in the Theory of Reasoned Action, which focuses on the role of context-specific attitudes in defining behaviour. In this model, behaviour is seen as a amour of a persons intention, which in turn is comprised of the individuals attitudes towards playacting the behaviour and the influence of perceived social norms concerning the performance of the behaviour. Attitudes are affected by the persons beliefs about the perceived consequences of performing a given action, and his or her subjective evaluation of each of the consequences.Drawing this together, any published individually rivet and community based health behaviour change and health promotion programs have generally been based on Social Cognitive theories utilising techniques that emphasise the cognitive and social mediators of beh aviour. Interventions based on cognitive learning theory punctuate self-management principles and strategies.Other Theories to ConsiderPersonality TheoriesPersonality theories explain behaviour largely in terms of stable traits or patterns ofbehaviour which are viewed as resistant to change and inalterable. Rogers, (1985),classification of individuals into the five categories of innovators, early adopters,early majority, late majority, late adopters, and laggards is an example of this kind ofapproach to understanding behaviour.A major limitation of personality theories is that they do not take account of importantaspects of the physical, social and economic environments, or the previousexperiences of the individual, which also are known to rigidly influence behaviour.For this reason, personality theories alone now are generally considered inadequate toexplain behaviour change.Learning and Behaviour TheoriesLearning theorists have demonstrated that behaviour can be changed by provi dingappropriate rewards, incentives, and/or disincentives. In learning or behaviouristapproaches, these rewards and incentives are typically incorporated into structuredreinforcement schedules, and the process of behaviour changes is often termedbehaviour modification.While effective in bringing about behaviour change, such approaches require a highlevel of external control over both the physical and social environment, and theincentives (or disincentives) used to reinforce certain behaviours and discourageothers. This kind of control is hard to maintain in real life settings, and thus, strictbehaviourist approaches are subject to a number of limitations.Social Learning TheorySocial learning theory is similar to learning and behaviour theories in that it focuseson specific, measurable aspects of behaviour. Learning theories, however, viewbehaviour as being shaped primarily by events within the environment, whereas sociallearning theory views the individual as an active participant in his or her behaviour,interpreting events and selecting courses of action based on past experience.Again, one important theory deriving from social learning theory which has had amajor impact on many flowing models of behaviour change is that of self-efficacy. Asstated earlier, self-efficacy expectations have to do with a persons beliefs in his or herabilities to successfully execute the actions necessary to meet specific situationaldemands. much(prenominal) expectations have been found to be consistently related to behaviouracross a wide range of situations and populations sub-groups.Social Psychological TheoriesSocial psychological theories are concerned with understanding how events andexperiences external to a person (i.e. aspects of the social situation and physicalenvironment) influence his or her behaviour.Emphasis is placed on aspects of the social context in which behaviour occurs,including social norms and expectations, cultural mores, social stereotypes, groupdynamics , cohesion, attitudes and beliefs. A number of useful concepts have emergedfrom social psychological theories, including attribution, locus of control, andcognitive dissonance, to pertain a few.Social Cognitive ApproachesSocial cognitive approaches combine aspects of social psychological theories withcomponents of both social learning theory and cognitive behavioural approaches.Social-cognitive approaches emphasize the persons subjective perceptions andinterpretations of a given situation or set of events, and argue that these need to betaken into account if we are to understand adequately both behaviour and theprocesses of behaviour change.A number of social psychological concepts have been found to be consistently relatedto behaviour change across a wide range of situations. For example, the social realityof a the group (e.g. peer group, school group, family group etc.) will affect anindividuals behaviour. All groups are characterized by certain group norms, beliefsand ways of be having, and these can strongly affect the behaviour of the groupmembers.Expectations of significant or respected others can also have a strong influence on apersons behaviour. This phenomenon has been most consistently demonstrated in theearly research on self-fulfilling prophecies, which showed that teachers expectationsof their students were consistently related to the students subsequent performance,even when these expectations were based on falsified information. Thus, support andencouragement, or conversely, low expectations from significant or respected others,can affect and bring about, (or not), changes in individual behaviour.Health Belief ModelThe Health Belief Model attempts to explain health-behaviour in terms of individualdecision-making, and proposes that the likelihood of a person adopting a given healthrelatedbehaviour is a function of that individuals perception of a threat to theirpersonal health, and their belief that the recommended behaviour will reduce thisthre at.Thus, a person would be more likely to adopt a given behaviour (e.g. walk or cycleregularly) if non-adoption of that behaviour (e.g. unclean air or confused trafficsituations) is perceived as a health threat and adoption is seen as reducing that threat.To date, the Health Belief Model has not received consistent or strong support inexplaining behaviour change. When the concept of self-efficacy is added to themodel, however, prediction of behaviour increases.Social MarketingAnother approach that has been used to bring about behaviour change is that of socialmarketing. The concept of social marketing is based on marketing principles andfocuses on four key elements, including development of a product the promotion of the product the place the price.As such, this approach is not so much a theory of behaviour change but a proposedframework, which situates people as consumer who will potentially buy into acertain idea or argument, given the appropriate selling techniques are applied. I t isthen assumed that the buying in to that idea by individuals will result in behaviourchange.Theory of Interpersonal BehaviourHabit strength is another concept that has been found to be important in predicting orchanging behaviour. Habit is an important element of the theory of interpersonalbehaviour, which proposes that the likelihood of engaging in a given behaviour is afunction of the habit of performing the behaviour the intention to perform the behaviour conditions which act to facilitate or inhibit performance of the behaviour.In turn, intentions are said to be shaped by a cognitive component, an affectivecomponent, a social component, and a personal normative belief. The theory ofi