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Supporting Lifestyle Changes in Primary Care Introduction & Scene Setting Catriona Loots NHS Health Scotland Housekeeping Learning Outcomes Understanding of influences on health and health behaviour and the impact these have on the effectiveness of interventions. Understanding of health inequalities and the importance of facilitating access to a wide range of support agencies. Knowledge and skills in the delivery of person centred health behaviour change techniques. Topic specific knowledge on alcohol and physical activity to support the delivery of brief interventions. Knowledge of resources including e modules, DVDs & trainers to support further learning. RISK FACTORS to HEALTH 90% burden of disease in high income countries attributed to 4 risk behaviours WHO 2012 Ref: ISD Scotland Top Risk Factors in Scotland 42% exceed drinking guidelines 23% smoke 61% not active enough 2% of adults in Scotland had none of the risks 55% have three or more risk behaviours. 78% don’t eat enough fruit or veg 63% are overweight or obese Influences on Health & Behaviours c o n t r o l Health Inequalities ‘Unfair differences in health within the population across social classes and between different population groups. These unfair differences: • Are not random, or by chance, but largely socially determined • Not inevitable. Ref: A Fairer Healthier Scotland 2012-2017 Health Inequalities in Glasgow Trends in Health Inequalities in Great Britain 1921-2007 Male life expectancy at birth in the most and least deprived quintiles within each Scottish local authority area (2006-2010) Behaviour Change Theory • Personal - beliefs, knowledge, attitudes, self efficacy • Environmental/Social factors - culture, location, income • Behavioural factors – habit, or pattern of behaviour Social Cognitive Theory The rational human being! Automatic Example of Choice Architecture Evidence & Guidelines • National Institute for Health and Care Excellence: Behaviour Change (NICE PH6 & PH49) & Preventing type 2 diabetes: risk identification and interventions for individuals at high risk (NICE PH38) • Scottish Intercollegiate Guidelines Network (SIGN) • House of Lords Behaviour Change -committee (2012) • Academic research – Cochrane reviews, Marmotte (2010) Macintryre (2008), Michie et al (2009) Bull (2013) Kings Fund (2008) HBC Approaches • Population – Fiscal - taxation – Legislative/policy • Community – Social marketing – Asset based • Individuals – Brief advice/information Smoking Example • Legislation: availability, ban on advertising & smoking in public places, tax • Social marketing • Smoking cessation interventions • 1948 – 82% men smoked • 1972 -51% (M) 42% NOW 22% but 39% V 10% by (W) deprivation Obesity Interventions • Obesity is a major public (Biology & Behaviour) health problem • Complex picture • Product of modern lifestyles which have changed work patterns, transport, food production and sales • Requires action at all levels During our global trot – think of the rainbow and theories of change • What is influencing the health behaviours? • How could practitioners support change? Summary & Next Steps Catriona Loots NHS Health Scotland Summary Key Messages HBC • Influenced by many disciplines neuroscience, sociology, psychology & behavioural economics • NICE (2007, 2014) argue no particular model and the evidence of effectiveness varies. • Recommend a focus on generic competences and skills development & to use a range of methods and approaches according to best available evidence Behaviour Change recommendations (NICE 2007) • Take account of the circumstances in which people live, especially socioeconomic and cultural context and potential barriers circumstances may create • Aim to develop and build on people’s strengths or ‘assets’ and skills • Tailor interventions to tackle the individual beliefs, attitudes, intentions, skills and knowledge associated with the target behaviours Check it out! • Recording ESCRO – ABI HEAT STANDARD QOF – Smoking • Referral Finance Housing Citizens advice Social work Resources and E-modules Have we MAP U? Motivation – knowledge, values and attitudes, importance and confidence Action on Motivation – tools, planning and actions Prompts and cues – what will help you put it into practice What do you need to implement this in practice? Group discussions – 3 key points (10mins)