2014|Student Guide

BEHAVIOR CHANGE

This publication was made possible in part through the support provided by the United States Agency for International Development (USAID). The opinions expressed herein are those of the author(s) and do not necessarily reflect the views of USAID or the US Government. USAID reserves a royalty-free nonexclusive and irrevocable right to reproduce, publish, or otherwise use, and to authorize others to use the work for Government purposes.

SEAOHUN One Health Course – Student Guide

Module: Behavior Change

In this module, students learn about models of individual, organizational and community behavior change. Students will evaluate modules taken from the health care context and then develop a behavior change model for a One Health intervention. This model will recognize that human behavior change not only impacts human health, but also animal and ecological health. Key outcomes of this module are the ability to:

Understand the behavior modification concepts of change management theories.

Create behavior modification/organization and community change strategies for One Health interventions.

There are six sessions in this module:

Time Topic-- Pre-work: Personal Behavior Change Experience

60 Minutes Introduction to Behavior Change

60 Minutes Professional-Directed and Patient-Centered Behavior Change Approaches

60 Minutes Models for Patient-Centered Change: The Health Belief Model

120 Minutes Models for Patient-Centered Change: Readiness to Change and Motivational Interviewing

180 Minutes Models of Organization and Community Change: Kotter and Lewin

120 MinutesBehavior Change and One Health Interventions: Expanding Patient-Centered behavior Change Models Beyond the Human Health Context

90 Minutes Behavior Change in One Health Interventions

60 Minutes Learning Reflections and Evaluation

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Module: Behavior Change

Module Competencies

Competency #1 Learning Objectives to Develop CompetencyExplain behavior change theories and change management concepts.

Understand principles, concepts and theories in behavior modification by:

Defining behavior in observable measurable terms.

Explaining individual behavior modification theories and organizational change.

Reviewing stages of change.

Competency #2 Learning Objectives to Develop CompetencyAdapt and apply models for individual behavior change to One Health contexts.

Evaluate different models of behavior change and adapt the models for One Health.

Evaluate different models of organizational and community change and adapt the models for One Health.

Competency #3 Learning Objectives to Develop CompetencyDemonstrate cultural competency and professionalism in leading change.

Demonstrate sensitivity to context and professional integrity in adapting and implementing behavior modification/change models by:

Assessing the impact of culture, beliefs and values on behavior change.

Recognizing and responding appropriately to ethical issues in behavior change.

Competency #4 Learning Objectives to Develop CompetencyCreate behavior change strategies for One Health interventions in communities.

Create behavior modification strategies for One Health interventions by: Adapting and expanding behavior change

strategies for human health to address the human, animal, and ecological health interface.

Defining an individual or community readiness-to-change score.

Describing the complexity of behavior change in

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SEAOHUN One Health Course – Student Guide

the One Health context. Creating a catalog of foundational questions

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Module: Behavior Change

PRE-WORKPersonal Behavior Change Experience

Learning Objective:

Personal behavior change experience

Pre-work Assignme

nt

One week before you start this class, select a personal health or wellness behavior that you would like to change. For example, you may want to take at least a 15-minute break for lunch to de-stress or you may want to cut down on the number of cups of coffee that you drink each day or you may want to make sure to follow your doctor’s advice to limit your salt intake.

Write down the personal health or wellness behavior that you would like to change and then list three positive steps that you will take over the next seven days to accomplish this goal. Finally, write down some initial reflections on how you feel about making the change. Be prepared to share your experience on the first day of class.

For the next seven days, I am going to:

I will take the following steps:1.

2.

3.

Check how you feel:

This goal is…

o Not important to me o Somewhat

important to meo Very important

to me

I am . . . . . . .

o Not confident I can make this change

o Somewhat confident I can make this change

o Very confident I can make this change

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SEAOHUN One Health Course – Student Guide

I am . . . . . . .

o Not ready to start making this change

o Somewhat ready to start making this change

o Very ready to make this change

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Module: Behavior Change

BEHAVIOR CHANGE JOURNAL

How well did I do?

on a scale from 1 to 10

with 1=Not Well and10=Very Well

What made it easy

to do?

What made it hard

to do?

What do I need to continue to

do or do differently tomorrow?

How confident am I that I can

succeed?on a scale from 1 to

10with 1=Not

Confident and 10=Very Confident

Day 1

Day 2

Day 3

Day 4

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SEAOHUN One Health Course – Student Guide

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Module: Behavior Change

BEHAVIOR CHANGE JOURNAL

How well did I do?

on a scale from 1 to 10with 1=Not Well and 10=Very Well

What made it easy to do?

What made it hard to do?

What do I need to continue to do or do differently tomorrow?

How confident am I that I can succeed?on a scale from 1 to 10with 1=Not Confident and 10=Very Confident

Day 5

Day 6

Day 7

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Module: Behavior Change

Notes:

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SEAOHUN One Health Course – Student Guide

INTRODUCTION TO BEHAVIOR CHANGE

Learning Objectives:

Analyze attempt to change a personal behavior. Understand the role of behavior change in One

Health responses.

Source: tewn.files.wordpress.com

Personal Behavior Change Experience Debrief

Small Group

Activity

In your group, share your experiences in personal behavior change. Discuss the following questions:

What made your attempt at behavior change easy? What made your attempt at behavior change difficult? What can you do to help individuals that you work with

change their behavior?

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Module: Behavior Change

Notes:

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SEAOHUN One Health Course – Student Guide

PROFESSIONAL-DIRECTED TO PATIENT-CENTERED BEHAVIOR CHANGE APPROACHES

Learning Objective:

Understand principles, concepts and theories of individual behavior change.

Discover elements of patient-centered and professional-directed behavior change.

Experiencing Different Approaches to Change

Role Play

What role did you get? o Patiento Change Agent 1o Change Agent 2

In your trio, from the patient’s perspective, discuss: How likely he/she is on a scale of 1 to 10 to change the behavior. The effective elements of the Change Agent’s approach. The ineffective elements of the Change Agent’s approach.

Notes:

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Module: Behavior Change

What do you think?

Large GroupDebrief

What required skills do both approaches have in common? What skills did you see Change Agent 1 using? What skills did you see Change Agent 2 using? From a patient’s point of view, which method is most

effective?

Notes:

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SEAOHUN One Health Course – Student Guide

MODELS FOR PATIENT-CENTERED BEHAVIOR CHANGEThe Health Belief Model

Learning Objective:

Understand principles, concepts and theories of a patient-centered behavior change approach.

Health Belief Model

Lecturette

For a patient to change his/her behavior, the patient must: Know that they have a particular health condition. Believe that having the condition is serious and harmful. Perceive that the benefits of changing their behavior

outweigh the challenges. Feel that there are treatment options.

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Module: Behavior Change

Feels a ‘call to action’ to spark the change. Perceives that s/he can successfully perform the behavior.

Health Belief Model

What do you think are the strengths of the Health Belief Model? What do you think are the limitations?

Notes:

Factors Impacting Likelihood for Change in the Health Belief Model

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Notes:

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Module: Behavior Change

Notes:

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SEAOHUN One Health Course – Student Guide

Notes:

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Module: Behavior Change

MODELS FOR PATIENT-CENTERED CHANGEReadiness to Change and Motivational Interviewing

Learning Objective:

Understand principles, concepts and theories of a patient-centered behavior change approach.

Assessing Readiness to Change

Pre-work

Large Group

Activity

Read the article “Facilitating Behavior Change” and review the “Readiness to Change Instructions and Tool” in the reference section of this module.

Thinking back to the change you made as pre-work for this module, on the rulers below, circle on a scale from 1 to 10 how important you felt the change was, how confident you were you could make the change, and how ready you were to make the change.

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SEAOHUN One Health Course – Student Guide

What do you think?

Given what you read about Motivational Interviewing… How can asking about readiness, importance or confidence help an

individual in the behavior change process? In what scenario might you use these “rulers”?

Notes:

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Module: Behavior Change

Motivational Interviewing

Large Group

Discussion

Spirit of Motivational Interviewing: ACE

AAutonomy

Physicians demonstrate respect for patients’ ability to make their own decisions and adopt new behaviors. Simply telling people why and how to behave is not effective in helping them change. Acknowledging a person’s right NOT to change and freedom to choose how to change can limit defensiveness and encourage an open mind.

CCollaborati

on

Physicians and patients should work together as partners to reach a common goal. Clinicians view patients as experts in their own lives and create safe and collaborative environments. They encourage/facilitate joint decision-making and problem-solving.

EEvocation

Clinicians can draw out patients’ own ideas and motivations for change. Patients are more likely to change when they express their own perspectives and uncover personal values and goals that support health behavior change.

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Guiding Principles of Motivational Interviewing: RULE

RResist the Righting

Reflex

There is a tendency for health professionals to advise patients about the right path for good health. Motivational Interviewing requires clinicians to suppress this initial righting reflex so that they can explore a patient’s motivations for change. People often believe what they hear and say themselves, and can react in opposition to what others insist that they do.

UUnderstand

your Patient’s

Motivations

A patient’s own reasons for change will ultimately result in behavior change. By approaching a patient’s interest, concerns and values with curiosity and openly exploring the patient’s motivations for change, the practitioner gain a better understanding of the patient’s motivations and potential barriers to change.

LListen to

yourPatient

Effective listening skills are essential for identifying what motivates a patient, as well as what barriers an individual might face. Many answers lie within the patient.

EEmpower

thePatient

Patient outcomes improve when they actively participate in their treatment. Empowering patients involves exploring their own ideas about how they can make changes to improve their health and drawing on the patient’s personal knowledge about what has succeeded in the past.

Module: Behavior Change

Notes:

Individual Reflection

The key skills captured in the ACE and RULE mnemonics are critical to Motivational Interviewing. These skills are:

Empathizing Asking Questions Listening Informing

How skilled do you feel you are in each area below?

SkillCurrent Skills Where I Want to Be

Poor Accept-able Good Great Poor Accep

t-able Good Great

Empathizing O O O O O O O O

Asking questions O O O O O O O O

Listening O O O O O O O O

Informing O O O O O O O O

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Module: Behavior Change

Identify one skill from the above assessment that you would like to develop and create a personal change plan to develop that skill:

Personal Plan:

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SEAOHUN One Health Course – Student Guide

Notes:

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Module: Behavior Change

MODELS OF ORGANIZATION AND COMMUNITY CHANGEKotter and Lewin

Learning Objective:

Research two leading theories on organizational change.

Introduction to Two Theories of Organizational Change: Kotter and Lewin

John Kotter proposed eight essential steps for leading change:

1. Establishing a Sense of Urgency2. Creating a Guiding Coalition3. Developing a Vision and Strategy4. Communicating the Change Vision5. Empowering Board-Based Action6. Generating Short-Term Wins7. Consolidating Gains and Producing More Change8. Anchoring New Approaches in the Culture

Kurt Lewin proposed a three step model:

Your Assignment

Select one of the two models and learn more about it. Then, in small groups, prepare a 20-minute presentation to teach the model to the class. Get creative in your presentation: a role play, a video, a story…

Some references to get started include:

John Kotter

John Kotter’s Website, www.kotterinternational.com

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SEAOHUN One Health Course – Student Guide

John Kotter, “Leading Change: Why Transformation Efforts Fail,” http://hbr.org/2007/01/leading-change-why-transformation-efforts-fail/ar/1

John Kotter Explains the 8 Steps to Create Successful Change, http://hbr.org/web/tools/2008/12/kotter-8-steps

Kurt Lewin

Bernard Burnes, “Kurt Lewin and a Planned Approach to Change”. http://onlinelibrary.wiley.com/doi/10.1111/j.1467-6486.2004.00463.x/pdf

Lewin’s 3-Stage Model of Change: Unfreezing, Changing and Refreezing. http://education-portal.com/academy/lesson/lewins-3-stage-model-of-change-unfreezing-changing-refreezing.html

What do you think?

What did you like about each model? What more do you need to learn about each model? Are the models exclusive of one another? Complementary?

Notes:

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Module: Behavior Change

BEHAVIOR CHANGE IN ONE HEALTH INTERVENTIONSExpanding Patient-Centered Behavior Change Models Beyond the Human Health Context

Learning Objective:

Use concepts derived from patient-centered behavior change models to explore behavior change in the human, animal and environmental interface.

In Your Context….

Small Group

Activity

In your region, culture or discipline: How would the Health Belief Model work in your region or

culture? How would you modify Motivational Interviewing and

Readiness to Change to work most effectively in your region or culture?

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SEAOHUN One Health Course – Student Guide

Create a flipchart to share your answers with the class:

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Module: Behavior Change

What do you think?

As a member of a One Health team, what do you feel is your role in changing people’s behaviors?

Create a model for behavior change that you can use as part of a One Health team. Have this model relate to your specialty/discipline.

Notes:

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SEAOHUN One Health Course – Student Guide

BEHAVIOR CHANGE IN ONE HEALTH INTERVENTIONS

Learning Objective:

Develop behavior modification strategies for One Health interventions.

Create Your Model for Organizational Change for a One Health Initiative

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Module: Behavior Change

Individual

Reflection

Think of a situation you have faced or might face that involves changing individual and/or community behaviors. What is your model for change?

Spend the next 30 minutes reflecting on your ideas from the previous session in which you created your own personal model for behavior change and the two models for community change, Kotter and Lewin.

Summarize your model on a flipchart. At the end of the hour, we will share our models.

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SEAOHUN One Health Course – Student Guide

What do you think?

In looking at your classmates’ models, what elements might you want to adopt to ensure a successful One Health change initiative?

Notes:

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Module: Behavior Change

In one word, what you feel is your role in creating change?

LEARNING REFLECTIONS AND EVALUATIONLECTO Learning Objective:

Reflect on your learning in the Behavior Change Module. Provide feedback on what were the strengths of the module and which areas

in the module could be improved.

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SEAOHUN One Health Course – Student Guide

Self-Evaluation

Individual Learning

Assessment

How would you rate your level of the following

Behavior Change Module competencies: Und

erst

and

Appl

y

Eva

luat

e/C

reat

e

Explain behavior change theories and change management concepts.Adapt and apply models for individual behavior change to One Health contexts.Demonstrate cultural competency and professionalism in leading change.Design behavior change strategies for One Health interventions in communities.

Write down two or three things that you learned from the session. Think about: What did you learn in this module that was new to you? Have the lessons in this model led you to change any previously

held beliefds What are you still unsure about? Do you have any questions that

still need to be answered? What was interesting to you/what would you like to study in more

detail? Are there new behaviors that you will try based on this class? What topics from the class will you share with others outside the

class?

Notes:

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Module: Behavior Change

Sharing the Learning

Small Group

Discussion

In a small group, share: Your key learnings from the module. How you will apply the concepts, knowledge, skills you gained

from the module.

Notes:

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RESOURCES FOR STUDENTS

Background References Included in the Resource Folder

American Society on Aging and American Society of Consultant Pharmacists Foundation. (2012). Facilitating Behavior Change. Retrieved from www.adultmeducation.com/FacilitatingBehaviorChange.html.

Additional References

Multicultural Health and Support Service. (March 2008). Working with Culturally and Linguistically Diverse Communities on Issues Related to Blood Borne Viruses (BBV) and Sexually Transmissible Infections (STI). Retrieved from: http://www.ceh.org.au/downloads/mhss_resource_manual_april08_2nd_ed.pdf.

Bernard Burnes. (2004). Kurt Lewin and the Planned Approach to Change: A Re-appraisal. Journal of Management Studies, 31(6). Retrieved from http://onlinelibrary.wiley.com/doi/10.1111/j.1467-6486.2004.00463.x/full.

Plested, B.A., Edwards, R.W., and Jumper-Thurman, P. (2006, April). Community Readiness: A handbook for successful change. Fort Collins, CO: Tri-Ethnic Center for Prevention Research.

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