behavior change in process

In an effort to understand the theories that we have been working with, the plan this week is to apply a mini-behavior change for ourselves or our family members.  The 3 tables below show how each of 3 different theories would address the change.

I demonstrated the Health Belief Model (HBM), Theory of Reasoned Action/Theory of Planned Behavior (TRA/TPB) and Transtheoretical Model and Precaution Adoption Process Model (TTM/PAPM).  In the first column, I explained the construct or guideline.  For the second column, I described the activity that would be used to enact that specific construct.  In the third column, I provided the rational for the actions.

For my behavior change, I decided that I would like to increase the amount of time I spend exercising with my children.  It would increase their exposure to this healthy behavior and incorporate it into their routine as well as improve my activity level on evenings when my husband is not home and I cannot make it to my regular exercise classes.  Increase exercise with children by 30-45 minutes 3 times per week

Health Belief Model (HBM)

Construct	Activity	Rationale
Perceived susceptibility: the degree to which a person feels at risk for a health problem	Review an article about the need to increase activity levels of children related to a decrease in physical education in schools	This article will emphasize the need to be proactive when it comes to teaching healthy habits to children specifically regarding incorporating fitness into our lives.  This is a habit that needs to be encouraged early in life.
Perceived severity: the degree to which a person believes the consequences of the health problem will be severe	Review statistics about the decrease in fitness levels of adolescent American students in the past 10 years and the increased health risks associated with this decrease. Ask the children to complete an exercise log for 1 week	If it is apparent that there is not enough physical fitness in schools, it will inspire me to increase their activities at home. I also want the children to see for themselves the severity of the situation and review our thoughts in a discussion.
Perceived benefits: the positive outcomes a person believes will result from the action	Look through the website www.letsmove.gov with the children for ideas for new activities.  This activity would also provide the time for the kids to see the importance of exercise.	Research indicates that exercising as a family leads to a ‘less-stress, more talk’ benefit for all members.  It would also provide an opportunity to commit to quality time together.
Perceived barriers: the negative outcomes a person believes will result from the action	Reorganize evening activities to allow for exercise time.  Plan ahead for dinner.  Make sure the children know to finish homework at extended day.	When life gets busy, extra activities get abandoned.  If the evening events are properly planned, nothing will get skipped because of busy schedules. Use of the incentive system to encourage the behavior.  Allow the children to work towards a reward.
Cues to action: an external event that motivates a person to act	Schedule the activities on Sunday nights for the following week.	The schedule of a busy family changes from week to week.  Taking the time on Sunday night to look at the whole week will best ensure the proper preparations have been made to be successful.  We will work together on this to employ the buddy-system.  Log of activities to track progress.
Self-efficacy: a person’s belief in his or her ability to take action	Track the exercises on Outlook calendar in a specified color so that it is easy to count the number of days per week. Put stickers on the calendar on the refrigerator so the children can track as well.	Working as a family will give us the chance to encourage each other to stay on track.  Weekly review of goals as well as incentives.  Also, we can incorporate review of role models that follow this health behavior.

Theory of Reasoned Action/Theory of Planned Behavior TRA/TPB

Construct	Activity	Rationale
Behavioral intention (BI):  perceived likelihood of performing the behavior (likely to unlikely scale)	Get some brochures that talk about the benefits of exercise for adolescents.  Discuss the healthy lifestyle choices that work best for our family.  Plan the events as fun ‘family time’ instead of required exercise time.	The children have to take accountability and be involved in the process.  They need to be included so they have ownership of the ideas.  An important construct as this is the strongest predictor of behavior.
Attitude toward behavior (Ab): evolution of behavior (good to bad scale)	Schedule the weekly plan together on Sunday evenings.  Put it on the calendars – both on refrigerator and Outlook.  Make sure the children think about how the behavior is good for them.  Plan an activity for them to identify incentives that will encourage their participation.	Evaluate the questions “is the behavior good? Cool? And easy?”  They need to feel confident in the changes. Will the activity be ‘cooler’ if there is a shopping expedition as a reward for my daughter or a new lego set for my son?
Subjective norms (SN): belief about whether each referent approves or disapproves of the behavior (disagree - agree)   Do others think I should behave this way?	Review the website www.letsmove.gov to find tips and suggestions for getting active as a family.  Show the children that many families are also attempting to make this lifestyle change.	Self-labels and self-identity are important determinants of behavior.  It helps to convince the participants that mom expects them to exercise (subjective norm), that this is part of how they would like to be defined (social identity) and for it to become part of how they define themselves (self-identity)
Perceived behavior control (PBC): overall measure of the perceived control over the behavior (up to me – not up to me)	Find stories about other adolescents that make this change, the ease of the transition and their positive accounts of how it made them feel.  Boost their confidence by allowing them to choose activities.  Make sure the children feel as though they have the tools necessary to accomplish our goals.	Maximize the control beliefs (perceived likelihood of occurrence of each facilitating or constraining condition) and perceived power (perceived effect of each condition in making behavioral performance difficult or easy) for the children.

Transtheoretical Model and Precaution Adoption Process Model TTM/PAPM

Construct	Activity	Rationale
Stage of change: precontempation/preparation	Discuss plan of action with children and talk to them about the initial stages of our plans.  Identifying the stage is a little difficult for us as a group because while I have been planning and am in the preparation stage, the children are likely in the pre-contemplation stage.  They do not realize this is something that I feel needs to change in such a direct manner.	I have certainly said to each of my children ‘you need to spend more time outside’ or ‘why don’t you run around the block’.  I don’t think they realize how serious I am about creating a plan to change their general attitude in regard to regular exercise.  It is something we need to tackle together as a family unit.
Process of change:
Consciousness raising          (precontemplation stage for children only)	Sit down with children and discuss concerns about the need for more daily exercise.  Make a plan to work together to incorporate more fun fitness activities into our week.	This is an opportunity to introduce the idea and highlight tips that will support the healthy behavior change.
Self-reevaluation (contemplation stage)	Identify role models that the children have that are active and healthy individuals.	Start the process of helping the children identify themselves as active.  It will be a little different for each of them.  My daughter, because she is older, is often in the neighborhood on her bike with her friends.  My son tends to gravitate to the television more than his sister but also will spend hours in the pool on the surfboard or with the snorkel gear on.
Self-liberation (preparation stage)	Activity schedule will be posted on refrigerator and Outlook calendar.  Stickers will reinforce the activity was accomplished.	Make a public commitment.  We will share the goals with family and friends.  Especially friends with common exercise goals for their children.
Helping relationship (action stage)	Find an exercise event to work towards with some family friends.	Use the buddy system.  My friend’s children and my children did a triathalon last spring.  Find a similar event for the kids to prepare for.
Decisional balance	As an activity, ask the children to list the pros and cons of more family fitness activities.	Must point out the benefits for the children while minimizing the cons.  Constantly remind them that they will feel better, look better, have more energy.  And remind myself that there is a strong correlation between exercise and academic performance.
Self-efficacy	Ask the children to write a story about the impact that exercise can have on their life, describing times when being healthy and fit will be to their advantage.	Constant reinforcement that the changed behavior is working.  Increase the children’s confidence in their improved fitness change and constantly look for opportunities to reduce temptation to skip exercising in lieu of television time.

The CDC offers a lot of information about getting kids moving.  There are powerpoint presentations on the website that can be used to explain new guidelines to educators and community centers.
http://www.cdc.gov/healthyyouth/npao/pdf/presentationslides.pdf 

There are even podcasts available about avoiding sodas, eating well at school, school policies and programs and keeping your kids moving.  It definitely is a good idea and a worthy use of family time.  So get your kids and get out there!  Keep them moving - it will help keep you moving as well!