A few years ago, Deakin University invited me to lecture in a Health Sciences subject about lifestyle behaviour changes to promote better health. It covered everything from fighting and preventing disease to diet changes, from drug and alcohol use to stress management.
Throughout the subject, students were required to choose a goal for their own health improvements and to diarise their behaviour changes over the duration of the trimester. In my opinion, it's an excellent way to learn and so, just for you, I'm going to make the ultimate sacrifice and take you on my lifestyle behaviour change to improve my diet and exercise routine over the next six months. At the same time, I'll be teaching you how you can do the same in a variety of scenarios in your own life.
Much of the information I provide will come from Health: The Basics Tenth Edition, by Rebecca J. Donatelle. The rest will be all me - warts and all. And it will hopefully be you too. This second half of 2017 is focussed on Health Psychology. There's room for a lot of discussion and collaboration between us all. I want to be guided by you and your questions regarding your own lives. So don't be shy, message me privately or comment publically, I don't mind. All I care about is helping you make the changes you've always wanted to make. Who's with me?
The Theory Behind It
We often hear people say things like, "as long as you have your health, you have everything" but what is health and how do we 'get' health?
What is Health?
Well, health isn't just one thing - it's a process - an ever-changing one. That means it's not something we get or have, at least not permanently, it requires ongoing effort.
Six key dimensions of health have been identified, including:
- Physical health - including our physical attributes and functioning, fitness levels and ability to recover from illness.
- Social health - our ability to be involved in meaningful relationships and create a satisfying social network.
- Intellectual health - the ability to use brainpower to effectively function through life's challenges.
- Emotional health - incorporating our ability to regulate our emotions and experience love, trust, self-esteem and self-efficacy etc.
- Spiritual health - this is all about having a sense of purpose and meaning in your life. This may include religion or it may not.
- Environmental health - this is about understanding the impact your environments have on your health and might include your home, work or nature environments for example. The impacts can be positive or negative, but awareness is key.
You'll notice that health and wellbeing will be about achieving a balance across all of the above factors - there's no one quick magic solution no matter how much we wish for one! Maintaining optimal health and wellness requires conscious decisions on a daily basis and that's possibly where most of us come undone.
So What Influences our Health?
There are five main groupings of health determinants:
1. Individual behaviour - there are four key (modifiable!) behaviours we engage in that continue to our likelihood of illness and shorter lifespans. They are: lack of physical activity; poor nutrition; excessive alcohol consumption; and, tobacco use. Other things that count include: vitamin intake, caffeine intake, substances, sexual behaviours, sleep, recycling and hand-washing.
2. Biology and Genetics - Unfortunately, these are not modifiable and include our gentically inherited traits, conditions and predispositions to diseases.
3. Social Factors - these are the social factors and the physical environments in which we're born or live, for example, availability of healthcare/education/employment, food, socioeconomic status, resources etc.
4. Policy Making - some examples of policies which impact on the health of individuals and communities include things like smoking bans, laws around seatbelt use when driving, helmets for bicycles, laws about drink driving or using mobile phones when driving, in Australia, the Slip, Slop, Slap, Seek campaigns to reduce skin cancer risk and even the old Life Be In It campaigns.
5. Health Services - access to quality health care including mental health services determines the health of individuals and communities. Sadly, there is no equality and significant consequences for not having immediate access to vital treatments and services as we know all too well in rural and regional Australia.
Choices we make everyday can make differences to our health and wellbeing now. Things like the amount of sleep we get can change our weight, ability to fight off colds, change our mood effect our driving!
When we're fit, rested, well nourished and free of tobacco, alcohol or other drugs, we are more likely to enjoy overall improved quality of life through avoiding illness, achieving more at work and school, enjoying healthier relationships and enjoying our down time.
The longer term rewards, which can often seem too far away to motivate us, include things like having a longer and healthier life. In terms of developing a chronic illness it's important to remember that it's usually never one factor alone that contributes to the onset of that illness, instead it's a combination of factors that align to kick start it. That's why it's so important to minimise the risk of as many of those factors as possible to hopefully prevent the illness all together.
As you may have read on the website, I have had breast cancer twice and carry the BRCA1 gene which predisposes me to cancer. I've taken preventative and curative action in relation to this but for my longer term health I have to remain conscious of so many things, including me stress levels, sleep quality, exercise and energy levels, diet and alcohol consumption. It's hard work being healthy!
Models of Behaviour Change
In health psychology there are several theories we rely on when assisting people to change problematic behaviours associated with their lifestyles.
The Health Belief Model (HBM)states that people have to believe that a health problem is first of all serious and that they are susceptible to that problem before being likely to change any associated behaviours. Not only that, but they also have to be reminded of the potential health problem before they'll take any action.
The Social Cognitive Model (SCM) - Albert Bandura proprosed that three factors interact to promote and motivate change. These are the social environment in which we live; our inner thoughts and feelings; and our behaviours.
The Stages of Change Model/The Transtheoretical Model. In what began with research on quitting smoking, Prochaska and DiClemente decided that when we begin with change instead of preparation for change, then we won't succeed. Hence why so many of us never follow through with our New Year's resolutions! They describe six stages of change:
1. Pre-contemplation - you have no desire to change the behaviour whatsoever!
2. Contemplation - you're starting to think there are pros and cons to the behaviour.
3. Preparation - you're close to taking action because the cons are outweighing the pros, there's even a plan to change.
4. Action - you're putting that plan into action.
5. Maintenance - you're making the actions permanent including engaging in relapse prevention and getting back on the wagon when the wheels fall off.
6. Termination - congratulations, your new behaviour is now automatic and has become a part of your lifestyle!
These stages can move back and forth and we can spend long periods of time in some of them but it's important to remember that on average it takes us three to five times attempting a change before we're successful at it, so don't give up.
I'm going to use my current goal to improve my diet as an example using the following steps as a guide for your own health behaviour change.
Step One: Increase Your Awareness
You need to know the pros and cons of your behaviour - what does the research tell you? What are you predisposed to? What elements of your social or physical environments could help or hinder your change?
I have a sweet tooth and little self-control when it comes to anything remotely tempting. We now know that excess sugar consumption is a significant health risk and contributes to liver disease among other things. Also, I have very high cholesterol levels despite not being terribly overweight. My family has a history of heart disease on both sides so it's not something I should ignore.
Step Two: Contemplate Change
Have a look at your current health patterns. Are they new? How serious are the consequences associated with them? Why do it you do it even if you know it's not good for you? What kinds of situations trigger that behaviour? Are there other people involved in it? How? Do you want to change the behaviour? Why or why not?
Mostly, at my age and stage of life, I'm noticing increased weight gain. I also have the habit of 'mindless' eating and using food as a reward to cope with stress or a difficult day, or any other reason I can come up with. I've yo-yo'd with my weight ever since gaining 10kg during chemotherapy. That weight gain plays on my mood, self-esteem and even my social life. It doesn't take much for me to cave, all someone has to do is suggest cake and coffee and I'm there. But the older I get, the more I realise it's now or never. It's never going to be easier to take control back over the choices I make regarding my diet than it is today (and sadly, it's not easy today!), so I have to make my mind up. 'Sugar belly' increases my health risks in a number of areas including cancer, so, I want to do something about it.
Identify a Target Behaviour:
What do I want? What is your ultimate goal?
Mine is to return to a healthy weight for my height and age which probably means losing five kilograms but more importantly, lowering my cholesterol levels which are too high thanks to my genetics and family history of heart disease.
Which change is your greatest priority at the moment?
You need to be specific here.
Mine is to limit the number of "cheat meals" (the less healthy options) to just two per week following The Robard's Method - 7-2-1 eating plan.
Why is this important to me?
Because I value my health, my appearance and my ability to live an active life for a long time to come! I feel so much better and have much more energy when I eat 'clean' and well.
Step Three: Prepare for Change
Set a realistic SMART goal. We've talked about SMART goals before. They're:
Specific - to limit my cheat meals to two per week
Measurable - I can measure the number of cheat meals I have per week, so it is measurable
Action-oriented - my action will be to make active choices to eat 'clean' meals the majority of the time
Realistic - it is realistic as it is not completely eradicating "cheat meals" all together
Time Oriented - I plan to start Monday and reassess my situation after three months.
Things like over-ambitious goals, self-defeating beliefs, lack of support and guidance, emotions and unresolved issues can all undermine your progress. If you're aware of them, you can plan for them and have a plan to reduce their impact or avoid them altogether.
Good role models, friends, family and professionals can be your allies in this change you're hoping to make.
Step Four: Take Action to Change
Visualise the new behaviour
Imagined rehearsal has been shown to help us reach our goals.
Learn to substitute an undesired behaviour for a desired one
For me, this will mean having less sugary products in the house, instead I'll have yummy snacks prepared and available to eat instead.
Know which situations are likely to trigger your unwanted behaviour and avoid them if possible, and if not, plan to manage them as well as you can. In my case, seeing too many clients in one day, feeling tired, not sleeping well will all contribute to my temptation to eat sugar around 3pm! So, I need to manage my workload better, reduce my stress, sleep well and look after myself to prevent the urge to indulge in sugar.
Change Your Self-Talk
Use rational, positive statements and practice managing your unhelpful thinking (see a variety of our articles on this topic.) In my case, it will also be about not focussing my attention on unhealthy foods. The more I think about it, the more I'll want it. I notice that if I start the day with my meals planned, it's much easy to stay focussed.
This is known as positive reinforcement.
Writing down your personal experiences, interpretations, ideas for improvement and results is an important skill for behaviour change. In my case, I'll be sharing my writing with you, making me extra accountable!
Okay, that's a good introduction to how to go about making changes to your lifestyle. Over the coming months, I'll be providing articles on various areas of life where we can make changes for both immediate and long term health benefits. I hope to hear from you and I hope you'll share this journey with me. Yours in good health, Jodie x