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Michael T. Smith, Ph.D. JHU CENTER for BEHAVIOR 5510 Nathan Shock Dr., STE 100 Baltimore, MD 21224 410-550-7000 Phone Michael T. Smith,

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Presentation on theme: "Michael T. Smith, Ph.D. JHU CENTER for BEHAVIOR 5510 Nathan Shock Dr., STE 100 Baltimore, MD 21224 410-550-7000 Phone Michael T. Smith,"— Presentation transcript:

1 Michael T. Smith, Ph.D. JHU CENTER for BEHAVIOR 5510 Nathan Shock Dr., STE 100 Baltimore, MD 21224 410-550-7000 Phone Michael T. Smith, Ph.D. JHU CENTER for BEHAVIOR 5510 Nathan Shock Dr., STE 100 Baltimore, MD 21224 410-550-7000 Phone Behavior Change Self-Study: Self monitoring and Goal Setting

2 Aims 1)Brief review of take home messages from first lecture on principle of behavior change 2)Reinforce the Utility of Health Belief for the BMW Rotation 3)Introduce the Experiential learning component of the rotation Goal setting / Self Monitoring with FitBit tracker Physical activity or Sleep Duration Social Learning Dimension Activity Group Discussions (creating a community focused on facilitating behavior change) Incentives plan for posting

3 Take Home Messages Take Home Messages 1) Myth: Behavior change is hard 2) Start with targets where patient is ready, confident & able 3) Make it personal (appeal to the beast) 4) Set small realistic SMART goals (75% confident) 5) Use Prompts, triggers, & clear environmental path /barriers 6) Use social learning principles Make public a personal commitment Modeling Norms 7) Self monitoring: must be easy and informative

4 General Principles of Behavior Change: Health Belief Model General Principles of Behavior Change: Health Belief Model S eriousness of the risk / disease O dds it will happen to me ? A bility to change ? R eminders / Triggers Self - Efficacy is King To help patients make a health behavior change: 1) Teach patients how serious their related medical condition is and how behavior influences it. Convince patients that a bad disease outcomes are likely to happen / are happening to them personally. Bolster their perceived ability (confidence) to make the behavior changes. Teach them to use prompts in their environment to remind them to change.

5 Experiential Learning Component: Objectives Overall Objectives: 1)Increase empathy for the challenges of asking patients to change 2)Gain in insight into use of goal setting, self-monitoring, social determinants, and incentives as behavior change tools 1)Increase self-efficacy for helping patients make sustainable changes 1) Create a supportive culture of healthy behavior change We serve as models for ourselves and our patients 2)Establish enduring resources for the JHMI community for patients and healthcare professionals 3)Improve your own health / wellbeing and have fun

6 Experiential Learning Module: Overview Two Components Managed Online Via Fitbit Website: 1)Rotation-related Small Groups Goal Setting / Self-Monitoring Opt to view and discuss each others progress towards personal goals on line (sharing is optional) Aggregrate the data by cohort for comparison by other cohorts 2) General Discussion Groups (not personal goals) Physical Activity Eating Behavior / Obesity Substance Abuse / Alcohol Smoking / Tobacco Sleep General Health Behavior Change

7 Ground Rules: small group & general discussion groups Posting personal goals / sharing progress / data is optional Only open to Hopkins residents and CBH faculty / staff Absolutely No PHI Be Kind & Respectful of yourself, peers and patients No profanity No question is stupid Push yourself a little

8 Rotation-Related Small Groups Rotation-Related Small Groups Self-Monitoring If you can not measure it, you can not improve it. - Lord Kelvin Establishing a baseline to measure progress is critical Must be quick and easy: objective data is especially helpful Immediate real-time digestible feedback on behavior Can act as a prompt / reminder Easier to make small course corrections than deal with large setbacks

9 Strategies and tools : Preparation Strategies and tools : Preparation Goal Setting: Poorly crafted goal: “I want to lose weight.” Smart goal S pecific: M easurable: A ction - Oriented R easonable: T ime Delineated Long-term Goal “I want to lose 1 pound / week for 3 months by:” Short-term Goals / Steps 1) Decrease alcohol to 2 servings / week 2) Cut meal portion sizes by about 20% and limit red meat to 2X week 3) Limiting snacks to 100 calories of fruits & veggies between meals 4) Walking 10,000 steps, 4 days a week

10 Physical Activity Goal Setting a Long-term (3 – 6 month) PA Goal: where to start DHHS Guidelines Adults (18-64 years olds): 150 minutes / week of moderate-vigorous aerobic physical activity 30 Minute brisk walk, 5 days a week or more. Accumulate in intervals at least 10 minutes at a time shorter intervals do not have the same health benefits. Strengthening activities, like push-ups, sit-ups and lifting weights, at least two days a week.

11 Physical Activity Goal: Setting a Long-term PA Goal: a place to start Pedometer Programs Are Effective (several meta-analyses) Richardson et al. Annals of Family Medicine, 6(1), 69-77 & Bravata et al., JAMA, 298(19), 2296-304 10,000 Steps-a-day as a long-term target – Why? Individuals meeting 10,000 steps / day; likely to meet DHHS PA guidelines (LeMasurier et al., Res Q Exerc Sport, 74, 389-94) Lowers blood pressure in mild essential hypertension Iwane et. al., Hypertension Research, 23, 573-580 Produces weight loss over 36 weeks in sedentary overweight / obese adults Schneider et al., American Journal of Health Promotion, 21, 85-89 (2006)

12 Normative Data, Steps / Day: Bohannon, Physical Therapy, 87(12), 1642-1650 (2007) Canadian Amish Steps/Day: Males (aged 34 = 18,425/day & Females Aged 32 = 14,196/day Special Population Targets to Consider (Engel & Lidner, Diabetes Education, 32(1), 2006) Healthy older adults: 6000-8500 step / day Older Adults with disabilities and chronic illnesses: 3500-5500 steps / day

13 Physical Activity Goals: Approaches a) Percentage increase from baseline: e.g., 25% b) Graded approach If baseline: < 8000 step / day: increase by 10% every 2 weeks until 10K and hold 8000 - 10,000 / day: increase by 5% every 2 weeks until >10,000 If > 10,000 / day: Consider specific goals for exercise, e.g. 30 min/day of moderate to vigorous activity to include jogging 4 days/week for 30 mins. C) Increase by a constant from baseline: + 2000 steps - increasing 400 steps a week


15 If Sleep has no purpose, then it would be the biggest mistake evolution has ever made... Allan Rechtschaffen Sleep Duration Goal

16 38% of Adults Report Insufficient sleep (CDC) Mortality Risk Percentage Self-Reported Total Sleep Time Kripke et al. 2001, Arch Gen Psych

17 Sleep Duration Increases Diabetes Risk Experimental sleep restriction to 4 hrs/night for 6 days causes insulin resistance (Spiegel et al. (Lancet, 1999) Sleep duration impacts prevalence of diabetes Adjusted for age, sex, race, waist girth, caffeine, alcohol, smoking, and apnea-hypopnea index Gottlieb et al. (2005) Arch Intern Med

18 J of Sleep Research 2, 1-12 (2003)

19 Sleep Extension Goal Setting: Strategies/Approach Normal adult sleep ranges between 7- 8.5 hours / night This may be insufficient for some. Historically before advent of electric light, average sleep time was 8.5+/night Considerable individual variability in sleep need Make small weekly increments (5 or 15 minutes) Consider Chronotype (lark or owl) Generally easier to get up later than to go bed earlier Intrinsic clock is 24 hour +20 mins Getting up later is going with the grain unless phase advanced and / or older adult Stopping rule for sleep window extension Average weekly Sleep Efficiency (total sleep time / Time in BED * 100) drops below 85-90%

20 Sleep Extension Goal Setting: CAVEATS 1) Appropriate for insufficient sleep syndrome: Normal sleep that is curtailed due to choice, habits or environmental circumstances 2) Do not select this goal if you likely have a sleep disorder. Insomnia - trouble initiating or maintaining sleep with daytime consequences: Despite adequate sleep opportunity Sleep Extension will make Insomnia worse Sleep apnea Circadian Rhythm Disorders Periodic limb movement disorder Restless legs syndrome Narcolepsy/hypersomnia


22 General Discussion Groups 6 Content Areas: Moderated by CBH “champions”  Physical Activity  Eating Behavior / Obesity  Substance Abuse / Alcohol  Smoking / Tobacco  Sleep  General Health Behavior Change Open to all residents and CBH Faculty as soon as they they signup for their fitbit account. During Rotation must post at least 1 new question or comment a week in different categories that arise related to patient care General questions (no PHI) Seeking resources Issues / Concerns

23 CBH General Discussion Groups Discussion threads intended to be an educational resource only Not to be construed as psychological or medical advice/consultation Champions will log in at least once / week Gems and teaching points that are particularly useful will be edited into enduring materials to compliment the existing materials on the CBH website. Champions and CBH faculty will be encouraged to share their fitbit data with the general community Norms Role model

24 Incentivizing Discussion Behaviors Monthly $100 Prizes (must be health-related items) E.g. Exercise clothes, fruit, session with a personal trainer, etc To be eligible for a monthly prize (winner determined by lottery) Must make at least one substantive post during the month Earn up to one new entry in the monthly drawing per week Post can’t simply be a brief reply of encouragement (though this is encouraged) Must be a new thread / topic / query / issue / resource / thoughtful comment Grand Prize at end of the program = $1,000 value of a Health-related item or service year long membership at Maryland Athletic Club A bike Treadmill, etc. To be eligible for grand prize – must have at least 1 substantive post every month for 8 months Earn up to one new entry in grand prize drawing for every month in which all weeks had a least one post

25 Date of download: 1/16/2014 Copyright © 2014 American Medical Association. All rights reserved. From: Financial Incentive–Based Approaches for Weight Loss: A Randomized Trial JAMA. 2008;300(22):2631-2637. doi:10.1001/jama.2008.804 Effect of incentives may attenuate over time Best where short-term behaviors can have a major impact Incentivizing perinatal care, Physical Rehab, etc Extrinsic motivation might compromise intrinsic motivation in some personality types

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