1. Positive Choices / Positive Changes

2. COMING UP IN THIS CHAPTER
Identify the factors that influence your wellness behaviors
Develop strategies for increasing your motivation to change for the better
Apply techniques that match your stage in the change process
Develop a personalized plan for successful behavior change, including appropriate goals and strategies for overcoming barriers

3. Factors Influencing Health Behavior and Behavior Change
Why is behavior change so hard?
Behavior is influenced by many factors
Behavior: an observable action or response
Habit: a behavior that recurs, often unconsciously, and develops into a pattern

4. Factors Inside and Outside Your Control
Behavioral influences include:
Heredity/genetic makeup
Sex
Childhood and past experiences
Knowledge, skills, and abilities
Age
Beliefs
Attitudes
Values
Religious and cultural norms and practices
Socioeconomic status (income, education, occupation)
Environment

5. Figure 2-1 Factors that influence health behaviors

6. Predisposing, Enabling, and Reinforcing Factors
Is there some way I can bribe myself into making a change in my habits?
Predisposing factors: those factors that you bring to the table
Enabling factors: those factors that help you change your behavior
Reinforcing factors: those factors that follow a behavior and either encourage or discourage your new behavior
Internal or external

7. Figure 2-2 Factors affecting behavior change

8. Motivation for Behavior Change
How can I find motivation?
Motivation: energized state that directs and sustains behavior
Increased or decreased based on internal and external factors
Factors affecting motivation:
Locus of control
Self-efficacy
Goal setting
Decisional balance

9. Locus of Control: Do You Feel in Charge?
What’s the point of all the effort? Practically everyone in my family gets diabetes when they hit age 40.
Internal locus of control: belief that one’s personal outcomes largely depend on what one does and how hard one tries
External locus of control: belief that factors outside one’s control largely determine the outcomes of what one does

10. Self-Efficacy: Do You Anticipate Success?
I start a workout program for 2 weeks, and then just stop. How do I keep motivated?
Optimism: the expectation of success
SELF-EFFICACY EXPECTATIONS
Self efficacy: belief in one’s capability to perform a task that leads to a specific outcome

11. Self-Efficacy: Do You Anticipate Success?
How Self-Efficacy Develops— And Can Be Increased
Past performance
Direct experience is the most powerful influence on self-efficacy expectations
Observational learning
Persuasion
Interpreting internal cues

12. Self-Efficacy for Behavior Change
I’m discouraged because I have failed at my exercise goals in the past. Is there a way to improve my chances of success?
Start by rating your degree of confidence in reaching your goal
Set realistic goals and monitor your behavior
Identify obstacles
Find a role model, and ask for support
Visualize and celebrate success

13. Goal Setting: What Are You Trying to Achieve?
How do I come up with a good goal that fits me as an individual?
Use the SMART principle:
Specific
Measurable
Achievable
Realistic
Time-bound

14. Figure 2-3 Sample SMART goals

15. Decisional Balance: What Are the Pros and Cons of Change?
What if I don’t have any motivation to do anything?
Self-defeating behaviors accomplish one goal (usually a short-term one) but interfere with more important goals (usually long-term)
Analyze pros and cons of changes you want to make

16. Stages of Change
How do I get organized, motivated, and focused to change my behavior?
Transtheoretical model (TTM)
Precontemplation
Contemplation
Preparation
Action
Maintenance

17. Stages of Change PRECONTEMPLATION CONTEMPLATION PREPARATION
Not yet actively thinking about change; rationalizing behavior
CONTEMPLATION
“Thinking” stage
Weighing pros and cons
PREPARATION
“Planning and getting ready” stage
Move from thinking to doing

18. Stages of Change ACTION MAINTENANCE Implementing the plan
Behavior change begins
MAINTENANCE
Working to maintain new behavior and to avoid relapse
Seeking out and using social support

19. Stages of Change
Is it possible to modify behavior beyond the point of relapse?
Termination
Zero temptation and total self-efficacy
Not realistic for most
Considering oneself in a lifetime maintenance stage is a better option
Lapses and relapses are common

20. Figure 2-4 Stages of change in the transtheoretical model of behavior change

21. Processes and Techniques of Change
According to the questionnaire, I’m in the contemplation stage. Now what?
Consciousness raising
Emotional arousal (dramatic relief)
Self-reevaluation
Environmental reevaluation
Commitment (self-liberation)
More…

22. Processes and Techniques of Change
Helping relationships
Seek social support
Countering
Substitute the healthy behaviors
Reinforcement management (rewards)
Environment control
Remove cues and triggers
Social liberation
Seek different or additional social alternatives

23. Overcoming Common Barriers to Change
What is the greatest obstacle to overcome in dealing with behavior change?
I don’t have enough time
Practice time management
I can’t get motivated
Pros vs. Cons
I’ll get around to changing—later
Don’t procrastinate
More…

24. Overcoming Common Barriers to Change
I don’t know how
Seek reliable information
I don’t have enough money
Healthy lifestyles are generally less expensive than unhealthy ones
I lack will power
Avoid temptation
It is too hard—and no fun
Personalize your goal and develop a realistic goal
Make new health habits pleasurable
More…

25. Overcoming Common Barriers to Change
I’m too tired
Know your rhythms
I can’t say “no”
Be more assertive
I have a negative outlook
Reframe your self-talk
I don’t feel supported
Utilize support groups, family, friends
More…

26. Overcoming Common Barriers to Change
I do OK at first and then backslide
Know that lapses are a normal part of the process
Schedule check-ins with yourself

27. TABLE 2-2: EXAMPLES OF NEGATIVE AND POSITIVE PATTERNS OF SELF-TALK

28. Developing a Personalized Behavior-Change Program
What is the best way to start if I am trying to change a behavior?
Complete a pros-versus-cons analysis
Monitor your current behavior
Set SMART goals and plan rewards
Develop strategies for overcoming obstacles and supporting change
Identify helpers and resources
More…

29. Developing a Personalized Behavior-Change Program
What is the best way to start if I am trying to change a behavior?
Put together your program plan
Make a commitment and act on it
Track your progress and modify your plan as needed

30. FIGURE 2-5: SUMMARY OF BEHAVIOR-CHANGE STEPS

31. Figure 2-6 Sample pros-versus-cons analysis for behavior change

32. Figure 2-8 Sample behavior-change log

33. Developing a Personalized Behavior-Change Program
How much can I say or do to encourage a family member to quit smoking or lose weight?
Encourage, but don’t push
Recommend change frequently, but be patient
Discuss specific past instances of the problem
Acknowledge positive behavior change for healthy behavior