Health Behavior Facilitation
Helen is a 42-year-old mother of two children, a boy, and a girl. The two children are sporty and play soccer. Hellen is 5’2″ and weighs 164 pounds, and came to me, stating clearly that she wanted to lose 30 pounds. She has tried several diets to deal with the weight problem in the past, but all did not work. However, she noted that she got very motivated from her pattern of getting weighed every week, towards monitoring her weight loss.
I take her through the training exercise thrice a week, together with her husband. Helen also exercises on her own, by jogging. She and I held several meetings, to discuss her nutritious target, and to design a meal plan for her. After the discussion, I suggested to her several ways through which she can reduce her weight. First, I gave her various vegetable recipes and trained her on how to prepare them. Secondly, I suggested to her, that she should prepare a journal, to guide her in taking the recommended regular meals daily. After beginning to follow these recommendations, she reduced her consumption of snacks and planned her meals well.
Although she has lost up to 15 pounds since she came to see me, she has trouble losing the other 15 pounds. This has been caused by her hectic pattern, which often affects her daily exercise plan. To counter this, I’m planning to make more recommendations to her, including readjusting her journal, or strictly following the current one, and also, making more recommendations on the meals to take, or maintain the currently recommended meals, but be more serious and concentrate on their uptake schedule.
Description of the client and the target health behavior
As explained through the case study, the client was Helen, a mother of two, who is suffering from the feelings that she is overweight, which made her seek my advice, so she could lose 30 pounds of her weight. The health behavior targeted was the improper diet patterns kept, as a result of her busy schedule, in an attempt to meet her daily chores, in meeting the needs of the children, her homestead, and the husband. Due to the unplanned and unmanaged diet pattern, which is aggravated by her dislike for cooking, she has become predisposed to eating unhealthy meals, like potato chips, which have pushed her weight to dislikable levels. The behavior in question, which is targeted, is the recurrent unhealthy eating habits, which drive her into snack foods, mainly due to her tight schedule (Colditz, 1992).
The overall goal and specific objectives
The overall goal of the consultation was set by Helen, centered on losing 30 pounds within six weeks. The specific objectives from my part as a consultant, and Helen as the client, which were discussed in-depth, include setting weekly exercise and behavior targets/ goals for her. Considering her tight schedule, this was to be realized through the use of behavior contracts, which would help remind her of the set goals. The set objective here was, “I will avoid snack foods and will eat at least three meals full of fruits and vegetables while reducing on protein intake, this week.” The second objective was setting an easy recipe, presenting nutritious meals, which will likely interest the whole family.
These were recommended, and further information and recommendations were offered, during the meeting sessions. The third objective was taking cooking classes with the client, which I offered, as this would help her ability to cook tasty, healthy meals for the family. The fourth objective was ensuring that she maintained the recommended exercise routine, by requiring her to record her daily exercise. The fifth objective was keeping a food journal, which would keep her on the right dietary track (Flegal et al., 1998).
Plan design/ the behavior change strategy, theories influencing the plan
The plan design for Helen’s case was reshaping her daily and weekly diet patterns, by committing her to a strict diet pattern, which she must check, as this simplifies what she had to do every day. The planned design, involved offering her easy and quick diet options for healthy meals, to help her towards the realization of the set targets. The design also involved enhancing her meal planning and cooking abilities.
The plan involved the completion of daily routines, registering her daily exercise patterns. Lastly, the behavior change strategy involved keeping a food journal, which would offer instructions on the desired diet patterns. The behavioral change strategy was influenced by the Health Belief Model (HBM), which is a psychological approach explaining the predicted healthy behaviors to be adopted by Helen.
The barriers to be overcome
The theoretical model is grounded upon a consideration of the perceived susceptibility, for example, the possibility of increasing her weight, instead of reducing, in case she fails to shift to the recommended healthy patterns. There is perceived severity, where, in the case of Helen, she felt that becoming more overweight would lead her to rejection from family and friends, make her too heavy to manage her everyday commitments, as well as increase her vulnerability to weight-related conditions like high blood pressure. The perceived benefits in Helen’s case, include the improved self-image from having the desired body shape, capturing the interest of her husband, family, and friends, remaining fit enough to manage her tight schedule, and remaining healthy to manage her family, being a soccer mom.
The perceived barriers in Helen’s case, include her forgetfulness, which would be corrected by the journal; her laxity to exercise, which was offset by the conditions to fill the daily record; and her tight schedule, which would be managed using the behavior contract. The cues to activate readiness in Helen’s case, include the provision of a food journal, cooking lessons, exercise adherence charts, and the behavior contracts (Foreyt & Goodrick, 1993).
The second theory influencing the study was the theory of planned behavior (TPB), which states that the behavior of a person is dictated by their intention to exercise the given behavior. The intention is, on the other hand, a function of their outlook, towards the given behavior, and the subjective norms directing their actions. According to the model, the best predictor of behavior is the person’s intention, as it is the cognitive symbolism of the readiness of the subject’s readiness, to execute the required beneficial behavior. In the case of Helen, the intention was losing 30 pounds, which she felt was making her feel overweight, thus somehow unable to execute her daily activities for her family.
The intention was also based on her desire to be liked by the family and friends, as she viewed her being overweight as likely to make her unlikeable. Her desire was also fostered by her need to avoid weight-related health problems, like HBP. The intention was exhibited from her move of contacting me for help, on managing her weight. From that, as a specialist on behavior change, I only need to employ motivational tactics, professional support, and the demonstration of changeability from the realized results.
For example, so far, Helen has shed 15 pounds; therefore, it will only take motivation, cooperative work, professional support, and affirmation of her potential, and she will lose the other 15, which will motivate her for better healthy living (Ajzen, 1985, p. 11-39). Based on these two theoretical models, Helen’s case is very manageable, thus will have very few barriers in meeting her target and more.
Plan implementation
The implementation of the plan involved the drafting of a weekly exercise schedule and behavioral change goals, where the focus was simplifying her daily tasks and role demands, as she views her as responsible for upholding the welfare of her whole family. From their easy nature, she will not feel pressure on her daily schedule. Third, I kept track of her compliance with the exercise schedules drafted, where she was required to meet the demands of the adherence charts for every single week. Fourth, was the need to carry a food journal, which I would assess anytime I met her for a meeting or went to check on her (Foreyt & Goodrick, 1993, p. 699).
The real-world lessons learned from the case
The barriers to be overcome included the tight schedule of Helen, which pushed her into a diet pattern of snacks and desserts, especially potato chips. To overcome this barrier, I offered her lessons on easy, simple, fast, and tasty recipes, which were very healthy for her and her family. Making most of these meals was easier than going to the fast-food place for potato chips, as the food place was a five minutes’ walk from her home business place.
Another barrier was her lack of knowledge of proper, balanced diets, which was solved by requiring her to carry and use a food journal at all places and using it for direction on the preparation of meals. The other barrier was Helen’s general laziness and laxity, which made her exercise only at convenient times, on her own (Foreyt & Goodrick, 1993, pp. 670-671).
From the case of Helen, within two weeks, she was able to cut 15 pounds, which resulted from the change to avoid fast foods and snacks, especially, potato chips. The cut was also caused by her regular consumption of fruits and vegetables, and her ability to keep a balanced diet with the aid of the food journal. The goal of cutting 30 pounds was not met, because of her tight schedule, which we are currently working on, in regards to ways of creating time for healthy meals and the preparation of the recommended meals.
From the case, I learned the lessons that, to lose weight, a negative caloric balance must be maintained, which is to be kept through losing more calories on exercise, than those taken through food and drinks. I also learned that behavior contracts and food journals are very helpful in this area. From Helen’s case, it was demonstrated that there are people predisposed to being overweight, as the same pattern was maintained by another client, but no change was registered (Flegal et al., 1998).
Description of the health problem resulting from health behaviors
In the recent past, cardiovascular diseases have grown to become the leading cause of death in the United States, where the major issues related to the deaths resulting from these heart related conditions, include reduced circulation, caused by the narrowing of arteries (blood vessels), which puts the subjects at the risk of suffering from peripheral vascular conditions. These conditions further, lead to the obstruction of body arteries, especially, the large ones, like those located at the legs and arms, a condition that causes a varied nature of problems, including tissue loss, the pain of tissues, and gangrene. Another condition resulting in this increasing number of deaths is abdominal aortic aneurism, which is simply the weakening and swelling of the major artery of the human body, which runs through the stomach area (Center for Disease Control and Prevention, 2008).
From recent studies by the Center for Disease Control and Prevention (2008) and Mokdad et al. (2004), many people associate cigarette smoking with breathing conditions and the development of lung cancer. What many people do not know is that smoking is a major cause of heart diseases and coronary artery complications, which lead to an increase in the risk levels of the subjects to a heart attack.
This simply means that a chain smoker, from continual smoking, increases their level of vulnerability to the development of heart attack or other heart-related diseases. The level of risk to people who take a pack of cigarettes each day is placed at more than two times the risk of contracting heart-related complications, as compared to those who do not smoke. Besides the risk of heart diseases, the case is worse for women, who smoke and take birth control medication at the same time. This group is exposed to several times the risk facing non-smokers, with regards to suffering from stroke, heart attack, and peripheral vascular complications.
These studies suggest that the determinants of heart-related diseases, with regards to smoking, include the presence of nicotine in the smoke from the cigarette, which results in a decrease in the oxygen levels going to the heart. The presence of nicotine also leads to an increasing level of blood pressure, which is directly related to the development of a heightened heart rate, which leads to the development of heart-related diseases and complications.
The stated findings regarding the heart-related conditions resulting from smoking behaviors are supported by the study by Winstanley, Woodward & Walker (1995), which was administered in Australia, by offering a replication of the same results, as the study on the USA population. However, the second study further demonstrated the effect of the carbon monoxide contained in cigarette smoke, which causes further harm, especially, to the blood composition.
According to the study, the contents of the smoke, which is inhaled during smoking, particularly nicotine and carbon monoxide, damage the cardiovascular system. The impacts include a resultant increase in the effect of increasing blood pressure, cardiac output and coronary blood flow, and heart rates. The carbon monoxide contained in the smoke ties the hemoglobin, the blood component which plays the role of carrying oxygen to the other parts of the body, after sourcing it from the lungs, across the bloodstream. From this effect, the amount of oxygen ferried to the other parts of the body is reduced, which makes these tissues operate at less than their optimal functionality.
Research studies have led to the confirmation that smoking destroys blood vessels, especially the arteries. For example, a past study carried out in 1997, looked at the arterial composition of subjects between the ages 15 and 34, who had died from conditions like suicide, murder, and accidents. The focus of the study was the buildup of fatty components inside the blood vessels, as well as a measure of the cholesterol and thiocyanate, which is a component showing the levels of cigarette smoking; a marker for cigarette smoking. From the study, it was concluded that the subjects who had smoked, depicted earlier signs of the development of atherosclerosis, as compared to those who had not smoked before, as evidenced by the cigarette smoking marker (Winstanley, Woodward, & Walker, 1995).
Suggestions on determinants and solutions from the problem
From the diverse range of studies, it is evident that the social behavior of smoking is a direct cause of heart-related diseases and complications. However, the cause-effect relationship of smoking in leading to the development of heart diseases is complemented by several conditions, lifestyle, genetic and physiological, including high blood pressure (HBP), poor nutrition, for example, high alcohol and fat intake; high blood cholesterol levels, diabetes, overweight and obesity conditions; and subjects coming from families with a history of heart diseases.
The solutions to the contributory effect of smoking, towards the development of heart diseases or conditions, ranging from reducing the level of smoking to quitting. The recommendation cutting across the different studies is that stopping smoking will reduce the risk of death from heart-related diseases by half, after one year of stopping the behavior. After 15 years of not smoking, the victims are similar in terms of vulnerability to heart diseases as those who have never smoked.
Discussion of a relevant health behavior change model for the health problem in question
Using the health action process approach change model, the situation can be mended, through positively impacting behavior change among smokers, towards avoiding the negative effects of heart diseases. The model is designed as a product of two self-regulatory processes. One of these processes is the goal setting, also called the motivational phase, and the second is the goal-pursuit stage, where the volition of the decision-maker is engaged. The predictors of intention to change include outcome expectation and self-efficacy, which constitute the motivational phase. The effects of intentions are mediated through planning (Schwarzer, 2008).
After the subjects have developed a sense of sufficiency and ability to stop smoking, the next step is goal setting, where they are required to draw goals on when or after how long they expect to stop smoking. After this stage, they get into the volition stage, where they decide the action to take, at the pre-action stage, then the action stage, where they put these actions into practice.
Examples of these actions include keeping away from the company of smokers, writing down the situations that trigger their smoking habits, so they can avoid them; stopping smoking at given times, for example during breaks or lunch breaks, and making a list of the activities that they can do, instead of smoking. Implementing these change processes among a target group will leave the subjects in a situation where, they can effectively control and stop their smoking, thus develop healthier behavior (Schwarzer, 2008; Glanz, Rimer, & Lewis, 2002).
References
Ajzen, I. (1985). From intentions to actions: A theory of planned behavior. Heidelberg: Springer.
Centers for Disease Control and Prevention. (2008). Annual Smoking-Attributable Mortality, Years of Potential Life Lost, and Productivity Losses—the United States, 2000–2004. Morbidity and Mortality Weekly Report, 57 (45), 1226–8.
Colditz, G. A. (1992). Economic costs of obesity. American Journal of Clinical Nutrition, 55, 503S-507S.
Flegal, K et al. (1998). Overweight and obesity in the U.S.: Prevalence and trends. 1960- 1994. Journal of Obesity, 22, 39-47.
Foreyt, J., & Goodrick, K. (1993). Evidence for success of behavior modification in weight loss and control. Annals of Internal Medicine, 119, 698-701.
Glanz, K., Rimer, B.K., & Lewis, F.M. (2002). Health Behavior and Health Education. Theory, Research, and Practice. San Francisco: Wiley & Sons.
Mokdad, A., Marks, J., Stroup, D., & Gerberding, J. (2004). Actual Causes of Death in the United States. Journal of the American Medical Association, 291 (10), 1238– 45.
Schwarzer, R. (2008). Modeling health behavior change: How to predict and modify the adoption and maintenance of health behaviors. Applied Psychology: An International Review, 57 (1), 1-29.
Winstanley, M., Woodward, S., & Walker, N. (1995). Tobacco in Australia: Facts and issues 1995. Victoria: Victorian Smoking and Health Program Press.