J.M. (2019). Lifestyle Medicine, 3ee. CRC Press, Taylor & Francis Group.10 Willett, W., Rockström, J., Loken, B. et al. (2019). Food in the Anthropocene: the EAT‐Lancet Commission on healthy diets from sustainable food systems. Lancet 393 (10170): 447–492. https://doi.org/10.1016/S0140‐6736(18)31788‐4. Epub 2019 Jan 16. Erratum in: Lancet. 2019 Feb 9;393(10171):530. Erratum in: Lancet. 2019 Jun 29;393(10191):2590. Erratum in: Lancet. 2020 Feb 1;395(10221):338. Erratum in: Lancet. 2020 Oct 3;396(10256):e56. PMID: 30660336.
CHAPTER 2 Fundamentals of Health Behaviour Change
Introduction
Behaviour change is the mainstay in the delivery of lifestyle medicine interventions. It is important that clinicians are familiar with behaviour change techniques that foster self‐efficacy and cultivate a therapeutic relationship to empower the change process. Knowledge of different theories is essential. Practising the different techniques with patients will enable clinicians to become proficient in them. The emphasis is on listening rather than informing the patient, motivating rather than convincing the patient, and collaborating with the patient rather than directing the patient.
This chapter tests the candidate’s knowledge of health behaviour, change theories, and how they can be applied in practice to help patients maintain healthy behaviour. It tests the candidate’s ability to apply motivational interviewing, cognitive behaviour therapy, and positive psychology techniques to the behaviour change process.
1 Which of the following best describes the ‘action’ stage of the Transtheoretical Model of health behaviour?The patient has been making changes within the last six monthsThe doctor assists with plans on specific changesThe patient intends to make changes within six monthsThe patient intends to make some changes within one month
2 Which of the following options best describes the Health Belief Model (HBM) of behaviour change theory?Different interventions should be used at different stages of behaviour changeGovernmental policies lead to health behaviour changeSelf‐efficacy and perceived susceptibility to health threat leads to behavior changeSocial reinforcement leads to a patient maintaining a healthy behaviour
3 Which of the following most appropriately describes the levels of influence on health behavior change?Community factors and social networkIntrapersonal, interpersonal, and institutional factorsIntrospective factors, beliefs, and personalityPublic rules, regulations, and policies
4 A 48‐year‐old woman attends for a review of her asthma and when you mention her BMI of 40 kg/m2, she informs you that she has been thinking of buying an exercise bike for her birthday in two months’ time and becoming more active. What stage of health behaviour change does this best describe?Action stageContemplation stagePrecontemplation stagePreparation stage
5 Which of the following management options will be most appropriate for a person on the precontemplation stage?Discuss health risks and benefits of a healthy lifestyleDiscuss mindfulness‐based stress reductionPersonalize their health risk based on medical historyReferral to a dietician for meal planning
6 The action stage of health behaviour change is best characterized by which of the following?The doctor gives a personalized analysis of risk based on the patient’s historyThe doctor maps out an action plan for the patient to endorseThe patient has been making specific health modifications within the past six monthsThe patient is encouraged to list out all the possible barriers to making progress
7 Which of the following would be the best practice in facilitating health behaviour changes?Aim to document a behaviour change plan in every patient’s health records every yearEnsure that every patient leaves with a clear relapse plan Making available a readiness assessment for patients to complete in advance in the waiting roomReview the patient’s completed readiness assessment form to prioritize lifestyle areas you want the patient to change
8 A health behaviour change theory that best explains the reciprocal influence of personal factors, environmental factors, and the health behaviour on the individual is:Health Review ModelSocial Learning (Cognitive) TheoryTheory of Reasonable BehaviourTheory of Socially Accepted Behaviour
9 Key behaviour theories have several similarities. Which of these options best describes the common features?Environmental influence, e.g. socially accepted norms guarantee behavioursMotivation and beliefs about risk and benefits of the health behaviour underpin changeOne’s confidence in ability to complete the behaviour change is keyRegular self‐criticism and reflection aids in behaviour
10 Which of these options is the most appropriate skill in facilitating sustainable behaviour changes at the early stages?Cognitive behaviour techniquesMotivational interviewingPositive psychologyReframing non‐productive thinking
11 Which of these options best represents the precontemplation stage of behaviour change?I am not thinking about making a change at allI have started a change within the last six monthsI am thinking of making a change within the next six monthsI have been making a change for more than six months
12 Which of the following is the most appropriate management in stage‐matched interventions?Offer an intervention that is acceptable to majority of patientsOffer an intervention that is tailored to the patient’s readiness for a specific actionOffer an intervention that is used by all patientsOffer an intervention that the patient has failed before so he can perfect it
13 Which of these options best represents the process in Stage‐Matched Interventions?Family support should not be solicited as this encourages dependenceIt is important that the patient completes every item at each stageThe degree of readiness is not an important factorThe doctor aims to help the patient move from one stage of readiness to the next
14 Thomas is considering becoming more active within the next 30 days to tackle his obesity. Which of these will be the most appropriate action?Check his level of confidence in his ability to carry out his plansDiscuss health risk associated with specific behaviourGive him a lifestyle prescriptionUse CBT to reframe unhealthy thought patterns
15 You are worried that Gabriel still smokes heavily despite his COPD. However, he tells you categorically that he is not willing to give up this habit. Which of these is the most appropriate action for his stage of readiness?You ask the patient to write down his unwillingness to change despite medical adviceYou provide a general healthy lifestyle adviceYou try some CBT techniques to see if you might change his mindYou try to problem‐solve his barriers to stopping smoking
16 Mike tells you that he is already making a change to tackle his unhealthy eating habits. Which of these is the most appropriate next step in his management?Develop a relapse prevention plan if he has been making the change for three monthsDiscuss health risks associated with his unhealthy eating habitGive him an action plan if he is not meeting his goal yetUse CBT to reframe any unhealthy thought patterns
17 Which of the following best describes the stages of readiness?CBT methods work best when started earlyPatients need one month of coaching to complete each stagePositive psychology is counterproductive at the beginning stageThe goal is to move the patient from his current level of readiness to the next stage
18 Which of the following would be most appropriate to include in Health Behaviour Change Readiness tool which a patient could fill while in the waiting room?An assessment of the patient’s confidence that he can improve his nutritionAn assessment of the patient’s marital status and political inclination An assessment of the patient’s perceived importance of lifestyle medicineAn assessment of the patient’s perceived importance of their intellectual abilities
19 Readiness
