The value of theory

Moving beyond the Stages of Change

Tips for theory-guided intervention

What is theory? Explains why a behaviour or phenomenon

occurs

Why use it? Effective methods for accomplishing behaviour

change Identify key factors + processes to target for change Measurable constructs allow for assessment of

change▪ Basis for detecting success/failure of an intervention

Key Premises

The environment in which one lives can restrict the range of behaviours that are possible

Multiple levels influence our behaviour (ex. physical environment, community, society, government)

Synergistic relationship between the environment and the individual

INDIVIDUAL ENVIRONMEN

TVs.

BehaviourChange Theories

MOTIVATION

ACTION

Precontemplation

Contemplation

Preparation

Action

Maintenance

Progression towards behaviour change

Predicting movement▪ Moving backwards?▪ Skipping stages

Arbitrary durations 6 months

Complexity of the behaviour Can be in different stages for various PA behaviours

Stage-targeted interventions may not produce longer-term behaviour change

Tips for theory-guided interventions Self-monitoring Gain-framed messages Goal setting Planning

2 Phases

1) Motivation Phase – getting ready to be active

2) Action Phase – engaging and maintaining PA

Self Efficacy

Risk Perceptio

ns

Outcome Expectanci

esGoals Planning

Recovery

Maintenance Initiative

MOTIVATION PHASE

ACTION PHASE

Self Efficacy

Risk Perceptio

ns

Outcome Expectanci

esGoals

MOTIVATION PHASE

Self Efficacy

Risk Perceptio

ns

Outcome Expectanci

esGoals

MOTIVATION PHASE

Self Efficacy

Risk Perceptio

ns

Outcome Expectanci

esGoals

MOTIVATION PHASE

How do we get people into the action phase?How do we get them to maintain this behaviour?

Planning

Recovery

Maintenance Initiative

ACTION PHASE

Self Efficacy

Risk Perceptio

ns

Outcome Expectanci

esGoals Planning

Recovery

Maintenance Initiative

MOTIVATION PHASE

ACTION PHASE

Self Efficacy

Risk Perceptio

ns

Outcome Expectanci

esGoals Planning

Recovery

Maintenance Initiative

MOTIVATION PHASE

ACTION PHASE

Self Efficacy

Risk Perceptio

ns

Outcome Expectanci

esGoals Planning

Recovery

Maintenance Initiative

MOTIVATION PHASE

ACTION PHASE

• Any effort by a human being to alter its own response

• Making sure actions are in line with the goals/intentions

Examined the role of self-monitoring in effective weight control

56 participants – weight loss program

Participants provided with self-monitoring booklet record all food consumption and calories eaten

throughout the week

Members stratified in terms of frequency of self-monitoring

Measured weight change

Self Monitoring and Weight Change

Weig

ht

Change

Self Efficacy

Risk Perceptio

ns

Outcome Expectanci

esGoals Planning

Recovery

Maintenance Initiative

MOTIVATION PHASE

ACTION PHASE

Gain-framed

Loss-framed

Loss-framed

Gain-framed

* *

0

200

400

600

800

1000

Week 2 Week 9

Ph

ysic

al acti

vit

y (

METS

m

in/w

k)

Gain

Loss

Mixed

* *

*p<.05

Self Efficacy

Risk Perceptio

ns

Outcome Expectanci

esGoals Planning

Recovery

Maintenance Initiative

MOTIVATION PHASE

ACTION PHASE

All participants (older adults 65yrs+)fill out a lifestyle assessment questionnaire

Intervention Group

Control Group

•15 min face- to-face counseling/feedback regarding activity + nutrition goal setting, monitoring, adjusting goals, sub goals• Counselors help participants create reasonable + obtainable goal

•Standard care • No feedback or counseling regarding goals

Measure Activity and

Diet

Health Behaviour Measures at 12 Week Follow-up

* Statistically significant

Self Efficacy

Risk Perceptio

ns

Outcome Expectanci

esGoals Planning

Recovery

Maintenance Initiative

MOTIVATION PHASE

ACTION PHASE

75 sedentary women (mean age = 48yrs) Randomly Assigned: 1) Action Plans 2) No Action Plans Measure PA at 8 week follow-up

Control Group (no action plans)

Experimental Group(action plans)

Given calendars

Asked to list possible activities they could do to become active

Given calendars

Asked to plan out and record WHEN, WHERE, and WHAT type of PA they planned to do in the next 8 weeks

All participants asked to record on calendars any PA they performed for 8 weeks

PERCEIVED BEHAVIOURAL CONTROL

SELF EFFICACY

Number of Weeks Participants Engaged PA 2days/week

# Weeks

ANTICIPATING POTENTIAL BARRIERSCREATING PLAN TO OVERCOME

BARRIERS

211 Patients with CHD Randomly assigned to one of 3 conditions

Measured PA levels at ▪ baseline ▪ 2 months following discharge

Standard Care (Control)

Action Planning Combined Planning

No action or coping plans

3 action plans 3 action plans +3 coping plans

Minutes of Strenuous Physical Activity Per week

Tips for theory-guided interventions Self-monitoring Gain-framed messages Goal setting Planning

Tips for theory-guided interventions Promote enjoyment

Determination

Motivation

TYPES OF MOTIVATION

Amotivation Extrinsic Intrinsic

• No motivation or complete lack of interest

• Motivation that comes from external sources (4 types)

•Doing something for your own interest or enjoyment

AmotivationIntrinsic

Motivation

Low Self-Determination High Self-Determination

Extrinsic Motivation

AmotivationIntrinsic

Motivation

Low Self-Determination High Self-Determination

Extrinsic Motivation

External Regulation

Engage in Behaviour for reward

orpunishment

AmotivationIntrinsic

Motivation

Low Self-Determination High Self-Determination

Extrinsic Motivation

External Regulation

Introjected Regulation

BehaviourImposed by self-

imposed pressure

AmotivationIntrinsic

Motivation

Low Self-Determination High Self-Determination

Extrinsic Motivation

External Regulation

Introjected Regulation

Identified Regulation

Engage in behaviourto achieve an outcome

AmotivationIntrinsic

Motivation

Low Self-Determination High Self-Determination

Extrinsic Motivation

External Regulation

Introjected Regulation

IntegratedRegulation

Identified Regulation

Engage in behaviourto confirmsense of

self

AmotivationIntrinsic

Motivation

Low Self-Determination High Self-Determination

Extrinsic Motivation

External Regulation

Introjected Regulation

IntegratedRegulation

Identified Regulation

Autonomy Competence Relatedness

Psychological Needs: Autonomy (self-determination) Competence (experience mastery) Relatedness (social interaction)

PERCEIVED BEHAVIOURAL CONTROL

SELF-EFFICACY

Testing a self-determination theory intervention for motivating tobacco cessation: supporting autonomy and competence in a clinical trial.

N = 1006 Adult Smokers

Intensive Interventi

onCondition

Community Care

Condition

• Public health booklet• List of cessation programs• Encouragement to enroll and speak with MD

• Same community care condition PLUS:• Meet with counselor 4x over 6months• Opportunity to speak with MD

(visits acknowledged patients’ perspectives, supported their initiatives, offered choice about treatment, provided relevant info, minimized pressure and control)

Tips for theory-guided interventions Promote enjoyment

The value of theory

Moving beyond the Stages of Change

Tips for theory-guided intervention