1. Behavior change to prevent chronic diseases through population
Umm Al-Qura University
Faculty of Public Health and Health Informatics
Health Education and Promotion Department
Behavior change to prevent chronic diseases through population
By: Dr. Ahmed Abdullah

2. Contents of the Lecture
Chronic diseases
Burden of The Chronic Diseases
Risk Factors
Prevention
Coaching and Motivational Interviewing

3. Chronic diseases
They are medical conditions mainly of non infectious etiology, and they are lifelong conditions (continuous for a long period of life more than one year). 
They are the illness and impairments that limits daily activities and functioning.
They are generally progressive.

4. Examples of The Common Chronic Diseases
Addison's disease
مرض اديسون
Asthma
الربو
Bipolar Mood Disorder
اضطراب المزاج الثنائي القطب
Bronchiectasis
توسع القصبات الهوائية
Cardiac failure
فشل القلب
Cardiomyopathy
اعتلال عضلة القلب
Chronic kidney disease
مرض الكلى المزمن
Chronic obstructive pulmonary disease
مرض الانسداد الرئوي المزمن
Chronic renal disease  
المرض الكلوي المزمن
Coronary artery disease
مرض الشريان التاجي

5. Examples of The Common Chronic Diseases
Crohn's disease
مرض كرون
Diabetes insipidus
مرض السكري الكاذب
Diabetes mellitus (type 1 and type 2)
داء السكري (نوع 1 ونوع 2)
Dysrhythmia (irregular heartbeat)
خلل النظم (عدم انتظام ضربات القلب)
Epilepsy
الصرع
Glaucoma
الزرق (المياه الزرقاء)
Haemophilia
سيولة الدم
Hyperlipidaemia (high cholesterol)
ارتفاع نسبة الشحوم (الكوليسترول المرتفع)
Hypertension (high blood pressure)
ارتفاع ضغط الدم

6. Examples of The Common Chronic Diseases
Hypothyroidism
خمول الغدة الدرقية (غير نشطه)
Hyperthyroidism
فرط نشاط الغدة الدرقية
Multiple sclerosis
التصلب المتعدد
Parkinson's disease
مرض الشلل الرعاش
Pulmonary disorder
اضطراب رئوي
Rheumatoid arthritis
التهاب المفاصل الروماتويدي
Schizophrenia
انفصام في الشخصية
Systemic lupus erythematosus (SLE)
الذئبة الحمامية الجهازية (SLE)
Ulcerative colitis
التهاب القولون التقرحي

7. Chronic Diseases
The development of chronic diseases is a combination of 3 factors:
Genetic
Exposure
Behavior

8. Burden of The Chronic Diseases
Now, the chronic diseases are the major cause of disability and death globally.
Chronic illnesses have a serious impact on individuals and on society in general. They affect the quality of life of individuals and can be a financial burden on those who are affected.

9. Burden of the chronic diseases
In USA, as of 2012, about half of all adults—117 million people—had one or more chronic health conditions. One of four adults had two or more chronic health conditions.
Seven of the top 10 causes of death in 2010 were chronic diseases. Two of these chronic diseases—heart disease and cancer—together accounted for nearly 48% of all deaths.

10. Burden of the chronic diseases
Arthritis is the most common cause of disability, 53 million adults with a doctor diagnosis of arthritis.
Diabetes is the leading cause of kidney failure, lower-limb amputations other than those caused by injury, and new cases of blindness among adults.

14. Chronic Diseases Prevalence in Saudi Arabia
Elevated BMI (11.64%)
Dietary risks (9.68%)
Elevated FPG (9.53%)
Elevated blood pressure (7.83%)
Physical inactivity (5.33%)
Smoking (3.02%)

15. Major Causes of Death in KSA
Cerebrovascular disease (13.20%)
Ischemic heart disease (6.23%)
Road traffic injury (11.75%)
Chronic kidney diseases (3.99%)
Diabetes mellitus (3.70%)
Hypertensive heart disease (2.37%)

16. Risk Factors
A number of risk factors related to an individual's lifestyle can contribute to the development of chronic diseases (e.g. cardiovascular diseases, chronic respiratory conditions and diabetes).

17. Modifiable Risk Factors
Unhealthy Diet
Physical Inactivity
Smoking

18. Healthy Lifestyle Practices
Adopting healthy lifestyle practices can prevent or control the onset of chronic diseases. Healthy lifestyle practices can be obtained by changing the behavior:
A healthy diet
Regular physical activity
Avoiding tobacco use

19. Health Risk Behaviors
Health risk behaviors are unhealthy behaviors you can change.
Four of these health risk behaviors:
Lack of exercise or physical activity.
Poor nutrition.
Tobacco use.
Drinking too much alcohol and other drugs.

20. Prevention
Prevention is effective in reducing the effect of chronic conditions and early detection results in less severe outcomes.
Clinical preventive services include:
Screening for the existence of the disease.
Counseling.
immunizations against infectious agents.

21. Primary Prevention
Primary prevention seeks to prevent the onset of specific diseases via risk reduction: by altering behaviors or exposures that can lead to disease.
Examples include smoking cessation and vaccination.

22. Secondary Prevention
It includes procedures that detect and treat pre-clinical pathological changes and thereby control disease progression.
Screening procedures (such as colonoscopy to detect early stage of colon cancer) are often the first step, leading to early interventions that are more cost effective than intervening once symptoms appear.

23. Tertiary Prevention
Once a disease has developed and has been treated in its acute clinical phase, tertiary prevention seeks to reduce the impact caused by the disease on the patient’s function and quality of life. Examples include cardiac rehabilitation following a myocardial infarction, assisting a cardiac patient to lose weight.

24. Positive Health Outcomes
Positive health outcomes for chronic illness require:
Effective treatments
Adherence to the treatments.

25. Coaching In Health Behavior Change
Coaching in health behavior change is defined as:
A method of patient education that guides and prompts a patient to be an active participant in behavior change.

26. Coaching In Health Behavior Change
For example: coaching for patients with coronary disease includes:
Assessment of the patient’s knowledge and practice of lifestyle.
Drug treatments.
Education of the patient about how to take the treatment.
Encouragement for the patient to reach the target goals.

27. Coaching In Health Behavior Change
Coaching used the theoretical frameworks of the Transtheoretical Model of Change. (Five stages of change).

28. Motivational Interviewing
Motivational interviewing is a technique used in some self-management programs to identify a client’s readiness to change and how barriers can be overcome.
The professional-client relationship during motivational interviewing is a partnership rather than an expert-recipient relationship and the counseling style is a quiet and eliciting one.

29. The Principles of Motivational Interviewing
Express Empathy
Develop Discrepancy
Avoid Argumentation
Roll with Resistance
Support Self-efficacy

30. Characteristics of Motivational Interviewing
1. Client centered 2. Non-judgmental 3. Expressing empathy 4. Building trust 5. Being collaborative 6. Reflective listening

31. Characteristics of Motivational Interviewing
7. Increasing discrepancy 8. Exploring ambivalence 9. Reducing resistance 10. Increasing readiness 11. Eliciting change talk 12. Increasing self-efficacy

32. Examples of Prevention Interventions
Disease
Intervention level
Primary
Secondary
Tertiary
Colorectal Cancer
Individual
Counselling on healthy lifestyles: dietary counselling for people at risk of colorectal cancer, etc.
Hemoccult stool testing to detect colorectal cancer early
Follow-up exams to identify recurrence or metastatic disease: physical examination, liver enzyme tests, chest x-rays, etc.

33. Examples of Prevention Interventions
Disease
Intervention level
Primary
Secondary
Tertiary
Colorectal Cancer
Population
Publicity campaigns alerting the public to the benefits of lifestyle changes in preventing colorectal cancers; promotion of high fibre diets; subsidies to help people access exercise programmes; anti-smoking campaigns
Organized colonoscopy screening programs
Implementation of health services organizational models that improve access to high-quality care

34. Examples of Prevention Interventions
Disease
Intervention level
Primary
Secondary
Tertiary
Metabolic Syndrome
Individual
Nutrition and exercise counselling
Screening for diabetes
Referral to cardiac rehabilitation clinics

35. Examples of Prevention Interventions
Disease
Intervention level
Primary
Secondary
Tertiary
Metabolic Syndrome
Built environment favorable for active transport (walking, bicycling rather than using a car)
Community level weight loss and exercise programs to control metabolic syndrome
Implementation of multidisciplinary clinics

36. Thank you