Evaluation of Behavior Change Techniques in the Program Change 4 Life - Essay Example

? Evaluation of Behavior Change Techniques in the Program ‘Change 4 Life’ Health psychology is the study of behavioral processes related to health, disease and management of disease (Johnston, 1994). Health and illness are not limited to biological factors only. Non-biological factors such as human behavior, environmental pressures and cultural influences play an important role in determining the effect and management of disease with respect to an individual. It is important to study these non-biological factors due to their importance with respect to an individual as well as a certain community or society when planning health campaigns and drives. These drives are aimed at individuals of different thought processes, cultures and priorities and in order for these campaigns to achieve maximum efficacy, behavioral techniques that are effective for maximum amount of people need to be used. In this assignment, we will be discussing behavioral techniques with reference to the program ‘Change 4 Life’. Change 4 Life is a public health campaign running in Great Britain under the domain of health department since 2009 (Sweney, 2008). This campaign aims to promote a healthy lifestyle among individuals by encouraging them to eat healthier foods and indulge in physical activity in order to live a longer and healthier life. It addresses family as the basic unit of society and focuses on how changes to diet and exercise within a family can lead to not only healthier adults but healthier children as well. With obesity becoming the biggest reason of morbidity in the developed world, Change 4 Life aims to decrease obesity in children as well as adults by suggesting modifications to food and physical activity. It aims to do so by encouraging the general population to increase its intake of fruits and vegetables, preferably in the form of 5 small portions throughout the day and increase physical activity on easy and regular basis. It has several subsidiary programs that promote swimming, biking, walking, dancing and taking breakfast. It also aims to convince people to decrease the intake of salt, fat and sugar in their daily diet as well as decrease alcohol consumption. These drives are aimed at children as well as adults. A more targeted campaign is also being run in parallel to this one under the banner of Change 4Life named Start 4 Life. This campaign is targeted specifically at pregnant women and babies and involves not only the mother and the child but also the father, friends and family and professionals. Change 4 Life utilizes all sorts of media while attempting to change the behavior of masses towards their existing lifestyles and adopt a new one. When running such campaigns, it is extremely important to keep in mind the psychological factors that are involved in bringing about the change in order to maximize the efficacy of the program. These psychological factors are manipulated as a part of behavior change techniques in order to bring about the desired result. Change 4 Life utilizes several of these techniques and the following analysis is based on those techniques. Out of the 26 BCTs described in the taxonomy of behavioral change techniques by Abraham and Michie (Abraham, et al., 2008), Change 4 Life uses 16 techniques during its campaign. These techniques will be discussed in the following literature along with examples and references to the theories that those techniques belong to. Internet seems to be the most important and most effective mode of dispersing information related to health and fitness but its effect is enhanced many fold by the use of concurrent use of other methods of communication (Webb, et al., 2010). Change 4 Life uses all forms of media whether it is print, electronic, social or personal to reach out to general population and inform them about the components of a healthy lifestyle. The campaign covers food and physical activity as the key elements of a healthy lifestyle and informs the public about what it is in accordance with BCT (1) provide information about behavior-health link which s described as general knowledge about behavioral risk. This is followed by a more targeted approach of weighing the pros and cons of the existing lifestyle against the one that is suggested so that the public gets an idea of the consequences of their actions and the benefits of altering their actions. This is in accordance with BCT (2) provide information on consequences. The next step is to motivate individuals to resolve to change their existing sedentary lifestyles. Change 4 Life does this by hitting upon the raw nerve called family. Throughout their campaign, Change 4 Life brings in the family to convince individuals that taking the right step will steer their families towards a longer healthy life. This makes use of BCT (4) prompt intention formation which is described as encouraging a person to set a goal. According to a systemic review in which 46 interventions were studied, the intention formation technique had the greatest effect in promoting cycling and walking among people (Bird, et al., 2013). One of the major barriers in opting for a healthy lifestyle is to deal with a new kind of food that doesn’t have as much fats, salts or sugars as earlier foods. Instead it has healthier alternatives. Children and adults are usually not fond of vegetables and fruits. Change 4 Life suggests the daily intake of fruits and vegetables to be divided into 5 small portions so they are easier to eat. Similarly, adults are often too busy or too tired to engage in rigorous physical activity. Change 4 Life suggests walking to work, a walk in the park with family instead of video games at home or dancing in order to engage in regular physical activity. In doing so, Change 4 Life recognizes these barriers and suggests ways to overcome these barriers. This is BCT (5) prompt barrier identification. Change 4 Life not only provides alternatives to the reluctant but also provides ways for the eager. Throughout its TV campaigns and on its website, Change 4 Life suggests healthy recipes, shopping tips and calorie counts. It also suggests the closest parks, gyms and recreational centers for those who are looking for outdoor activities along with tips on how to incorporate dancing, walking or running in one’s everyday life. Another aspect of Change 4 Life is to discourage alcohol consumption among public. It does so by suggesting alcohol consumption guidelines and healthier drink recipes thus utilizing BCT (8) provide instruction which is about telling the person how to perform the desired action. This technique along with BCT (10) has shown to have the greatest effect on changing physical activity behavior in general population (L, et al., 2011) . Change 4 Life has several commercial as well as non-profitable collaborations that are part of public’s everyday life. Kelloggs and Asda are two of their commercial collaborators through which they set examples of taking breakfast and practice swimming respectively. Similarly, Change 4 Life uses Olympics and Para-Olympic games as a source of inspiration and works with Rambler’s Association and British Heart Foundation by inviting their experts to inform people about how to build up stamina and how to improve upon their cardiac status respectively. This is the implementation of BCT (9) model or demonstrate the behavior. Change 4 life encourages people to chalk out their plan of action for their new lifestyle meticulously by adding no less than 5 portions of fruits and vegetables, ensuring they get milk and proteins, maintaining calorie count, sticking to a specific period of regular physical activity and ensuring no more than one serving of alcohol only 4-5 times a week. This setting up of detailed planning is an example of BCT (10) prompt goal setting. Change 4 Life has also introduced a free app named alcohol tracker app that allows one to keep a track of his drinks. Similarly, it also encourages people to keep a track of their daily calorie intake. This is an example of BCT (12) prompt self-monitoring of behavior. The use of screen savers and fridge door accessories with tips on good diet and plenty of exercise in the name of handy reminders is another way of using BCT (15) teach to use prompts or cues. BCT (19) provide opportunities for social comparison comes into action when we see that Change 4 Life not only interacts with local authorities, community centers and schools but also runs a chain of sports clubs across Britain in order to provide people the opportunity to not only indulge in physical activity but also meet others like them who have set similar goals. Not only does it motivate people but also gives them a reason to continue these activities. BCT (22) prompt self-talk is in action when Change 4 Life encourages people to amend their company or the place or time of their drinking according to their will. Thus the individual is given space to amend his environmental factors according to his will so that he completely owns his action. BCT (23) relapse prevention is another important technique with particular reference to Change 4 Life’s anti-alcohol campaign. This requires identification of factors such as peers or stress that push an individual towards indulgence in alcohol. Staying away from these factors or amending them is crucial to relapse prevention. Change 4 Life is aimed at general population which includes adults as well as children. With set routines and habits, it often becomes extremely stressful to change one’s lifestyle, particularly when it comes to quitting alcohol. BCT (24) stress management is at work in this instance. Change 4Llife suggests taking baths, finding hobbies, catching up with friends and listening to music suitable activities when it comes to handling the stress that comes with quitting alcohol. Each of the above mentioned techniques are part of several theories or models with considerable overlap between each theory. BCT (1), (2) and (4) are included in information-motivation-behavioral skills model. This model utilizes all the three domains of human behavior namely the cognitive domain, the effective domain and the psychomotor domain. With the provision of information, motivation and repetitive activity, each of these domains can be worked upon. This effect is enhanced by identification of obstacles and steps to overcome them. BCT (2) and (4) pertain to the theory of reasoned action. This theory relies upon attitudes and subjective norms for the eventual behavioral intention. Attitude is described as the sum total of all beliefs of an individual pertaining to a certain topic and subjective norm is described as the sum total of contradictory attitudes of people around an individual (Hale, et al., 2003). The sum total is entirely subjective so it is dependent upon the individual to choose and eventually shape his behavioral intention. BCT (2) and (4) are also a part of theory of planned behavior. This is a more complex form of theory of reasoned action. This theory suggests that behavioral beliefs lead to favorable or unfavorable attitude towards behavior, that normative beliefs lead to subjective norms and control beliefs result in perceived behavioral control. Attitude towards the behavior, subjective norm and perceived behavioral control are the real determinants of behavioral intention (Ajzen, 1991). BCT (2), (4), (5), (8) and (9) are part of social-cognitive theory. This is a learning theory and states that the behavior of an individual largely depends on his beliefs or cognition which is a result of his observation of his surroundings (Bandura, 1989). Thus cognition is not static or independent but in fact changes with the environment which can be worked upon in BCT by introducing certain factors repeatedly in a person’s surroundings. This social interaction can lead to change in cognition and eventually a change in behavior. BCT (9), (10), (11) and (12) are a part of control theory. This theory contradicts most of the other theories of behavior. This theory suggests that behavior is not a response to environmental stimulus but is in fact an attempt by an individual to control his perception. This may or may not be influenced by environmental factors. Thus, the individual controls his behavior and is not dependent upon external stimuli. BCT (15) is included in the theory of operant conditioning. This theory suggests that behavior is not dependant on stimuli but is actually spontaneous and whether the behavior will continue or not depends upon reinforcement, punishment or extinction. Desirable consequences of a behavior are defined as reinforcement and will result in increased frequency of behavior. Undesirable consequences or punishment will result in decrease in the frequency of behavior. A behavior without consequence or extinction will be terminated. BCT (19) is a part of social comparative theory. This theory suggests that individuals compare themselves to others in order to have a more accurate self-evaluation. BCT (23) is a part of relapse prevention therapy which consists of identifying an individual’s unique profile of risk factors that can precipitate a relapse and using suitable BCTs to prevent or manage relapses (Marlatt, et al., 2002). BCT (24) is related to stress theories which are based upon the fact that individuals have a variable amount of vulnerability to a given stress and are greatly influenced by psychological, genetic, biological and situational factors. Certain BCTs are not used in this campaign. BCT (6) provide general encouragement, (7) set graded tasks, (13) provide feedback on performance, (14) provide contingent rewards, (16) agree on behavioral contract (17) prompt practice and (18) use follow up prompts, have not been used. This could be due to the expanse of the audiences. Each of the above BCTs is to be implemented on individual basis and requires individual attention of campaigners which is not feasible or even possible considering the size of the target population. Change 4 Life does not seem to incorporate BCT (3) provide information about other’s approval, (20) plan social support or social change, (21) prompt identification as a role model and (25) motivational interviewing into its campaign. This could be due to the fact that Change 4 Life may be targeted towards masses but actually addresses individuals and urges them to change lifestyles on individual basis. Although the campaign mentions family in all of its drives, it does not provide the corrective measures with reference to the family and treats every member of its audience as an island. Thus, the need to be a model with a small unit or use friends and family as a support group is not mentioned and all the BCTs related them have not been used. This is one of the shortcomings of Change 4 Life campaign and if it were to incorporate the idea of smaller functional units of people other than families such as group of friends, employees of an organization or people in a given social center, the campaign can be made more effective. Another shortcoming of this campaign is the complete isolation of important factors like education, law, religion and work when asking people to change. This makes it difficult for certain considerably sized groups within the society to change in accordance with the campaign. Change 4 life was started only five years ago and keeping in mind its goals, it is too early to determine how far it has been successful. It has been seen in the past that although the public has welcomed such campaigns, they resulting outcomes have been disappointing. Motivation has faded exponentially and such campaigns seem far and few when compared to all other reasons of entertainment that lead to sedentary lifestyle and the countless number of options available and easily accessible in the market pertaining to food and alcohol. Also the fact that public perception and non-glamorous image associated with healthy food and physical activity greatly outweighs the flamboyance of an unhealthy lifestyle makes it all the more difficult to convince people to make healthier choices. Although it might be difficult to achieve the desired results in adults due to their strict and busy schedules as well as calculated and firm behaviors, Change 4 Life may be able to fare extremely well among children as the belief that healthy food and plenty of exercise are very common among adults but not widely practiced. However, the popular trend of enforcing parental beliefs on children might actually do good here and children will be made follow these regimens which will become their habits over the period of time. Thus, while the current generation of adults might not respond very well to this campaign, children will and the problem of childhood obesity in the developed world can be decreased. Works Cited Abraham Charles and Michie Susan A Taxonomy of Behavior Change Techniques Used in Interventions [Journal]. - London : American Psychological Association, 2008. - 3 : Vol. 27. Ajzen Icek The theory of planned behavior [Book Section] // Organizational Behavior and Human Decision Processes . - 1991. - Vol. 50. Bandura A Social Cognitive theory [Journal]. - [s.l.] : Annals of Child Development, 1989. - Vol. 6. Bird E L, Baker G and Mutrie N Behavior Change Techniques Used to Promote Walking and Cycling: A Systematic Review. [Journal]. - [s.l.] : US National Library of Medicine, 2013. Hale J L and Householder B J The theory of reasoned action [Book Section] // The persuasion handbook: Developments in theory and practice / book auth. P Dillard J and Pfau M. - Sage : Thousand Oaks, 2003. Johnston M Current trends in Health Psychology [Book]. - [s.l.] : The Psychologist, 1994. L Williams S and French D P What are the most effective intervention techniques for changing physical activity self-efficacy and physical activity behaviour--and are they the same? [Journal]. - Coventry : U S National Library of Medicine, 2011. - 2 : Vol. 26. Marlatt Alan and Parks George Clinical Guidelines for Implementing Relapse Prevention Therapy [Journal]. - Seattle : University of Washington, 2002. Sweney Mark Government unveils detail about 275 million pound Change 4 Life anti-obesity push [Article] // The Gaurdian. - London : [s.n.], 2008. Webb Thomas, Joseph Judith and Michie Susan Using the Internet to Promote Health Behavior Change: A Systematic Review and Meta-analysis of the Impact of Theoretical Basis, Use of Behavior Change Techniques, and Mode of Delivery on Efficacy [Journal]. - London : US National Library of Medicne, 2010. - 1 : Vol. 12. Read More