Emma McGleenan, School of Nursing and Midwifery, Queens University Belfast.
One in four adults are now obese and the Government has introduced several initiatives to combat this problem and its growing cost on NHS services. Examples of Government schemes include‘Nutrition Now’ https://www.rcn.org.uk/professional-development/publications/pub-003284; laws on food labels https://www.food.gov.uk/science/allergy-intolerance/label/labelling-changes and advertisements aimed at decreasing one’s waist circumference http://www.publichealth.hscni.net/news/men%E2%80%99s-health-week-watch-your-waistline-%E2%80%93-belly-fat-danger. But this alone is not enough to prevent cardiovascular disease. The Health Belief Model, when applied to nutrition and hydration, indicates that people are more likely to follow a healthy diet and make changes to their lifestyle if they feel that failure to change would increase their risk of developing a serious disease; the benefits of the change outweigh the barriers faced due to the change; they place enough value in their life to make the change and they are prompted to make the changes https://www.utwente.nl/en/bms/communication-theories/sorted-by-cluster/Health%20Communication/Health_Belief_Model/
The theory of planned behaviour http://www.sciencedirect.com/science/article/pii/074959789190020T addresses three aspects: the attitude, the subjective norm and the perceived behavioural control. The attitude is the values and judgement we hold about a healthy diet. The subjective norm refers to what is important to the patients’ family and friends. Perceived behavioural control is how much control the person believes they have over their ability to keep to a healthy diet i.e. whether or not they have the skills or resources to succeed.
These models assume all behaviours are based on conscious thoughts but people may not think of the ill effects to their health every time they eat an unhealthy meal. Many health related behaviours are used as coping mechanisms and when you get rid of the behaviour, this may result in an increase in stress levels. The change is therefore more likely to be unsuccessful. Perception of control should be increased to help people feel empowered and more likely to succeed. Those who take part in unhealthy eating may already understand the dangers of eating unhealthily and may already have ill health due to eating unhealthily but they enjoy the food and so continue. This can cause upset in an individuals’ mind known as cognitive dissonance. Nurses can use this to persuade the individual to make a change.
A good way of introducing the concept of change to the individual is by brief intervention. Brief intervention has been shown effectively when dealing with alcohol addiction within the primary care sector (Kaner et al, 2009). Minimal intervention is an opportunistic process where the health professional attempts to find out how the service user feels about the behaviour, challenge the persons’ views on eating healthy and helps them to weigh up the pros and cons of the a healthy diet. The main aim is to get the individual to engage cognitively about the behaviour. When linked up with the stages of change, the person moves into the contemplating stage of change and is more likely to change their behaviour and sustain change.
Nurses can help prevent cardiovascular disease by promoting a healthy diet and hydration. Brief intervention can introduce people to a new concept in a short time and has been proven to be effective. Further help could be offered by combining the Health Belief Model with the Theory of Planned behaviour. Within this, views should be challenged, coping mechanisms and perception of control examined and advice given, barriers identified, social networks and context discussed and the benefits reiterated. This should be a positive experience, leaving the individual empowered. Cognitive behavioural therapy may also be adapted and has been shown effective in preventing acute myocardial infarctions (Gulliksson, 2011).
Kaner EF.S., Dickinson HO, Beyer FR, Campbell F, Schlesinger C, Heather N, Saunders JB, Burnand B, Pienaar ED (2009) ‘Effectiveness of brief interventions in primary care populations’ The Cochrane Collaboration [Online] Available at: http://www.cochrane.org/CD004148/ADDICTN_effectiveness-of-brief-interventions-in-primary-care-populations (Accessed: 20/04/2015)
Gulliksson M, Burell G, Vessby B, Lundin L, Toss H, and Svärdsudd K. (2011) ‘Randomized Controlled Trial of Cognitive Behavioral Therapy vs Standard Treatment to Prevent Recurrent Cardiovascular Events in Patients With Coronary Heart Disease: Secondary Prevention in Uppsala Primary Health