Strategies for Effective Theory-Based Health Behavior Interventions

1 Plan strategies that can be used in a theory-based health behavior intervention Ashley Young Purdue Global University Essay Human Services January 9, 2024

THEORY-BASED HEALTH BEHAVIOR INTERVENTION 1 Plan strategies that can be used in a theory-based health behavior intervention Introduction The current paper highlights the intensity of obesity-related hypertension prevailing across currently and how theory-based health interventions can help counter the issue. It is vital as an observer and practitioner to understand the complexity of the problem, and in this regard, knowing the statistics about the issue is also necessary. A World Health Organization (WHO) report sheds light on obesity-related hypertension issues and explains the direct liaison between body mass index (BMI) and blood pressure. The WHO report claims that there are approximately 1.1 billion people suffering from hypertension worldwide, and a research study from Framingham Heart study shows that 78% of men suffer from hypertension due to obesity. The same study shows that 65% of women suffer from hypertension due to obesity. On a global scale, the obesity issue has increased three times since 1975, according to a WHO report. The situation is worse in all the corners of the world, and when researching statistics on China, one finds that obesity-related hypertension exists in 22.7% of the Chinese population that is over the age of 45 years. The severity of the problem and its continuous increase with time demands serious action to tackle the situation, and the following sections will explore the problem and provide theory-based intervention strategies that can help address the problem (Ali et al., 2023), (Zhang et al., 2022) & (Hall et al., 2021). Literature Review Plenty of literature is available on various theories that are perceived as beneficial in combating the issues of obesity-related hypertension; however, the current paper presents three theories as the most effective ones. The first theory of the three is The Health Behavioral Model (HBM), which forms the foundational element of the theoretical framework. The strategic

THEORY-BASED HEALTH BEHAVIOR INTERVENTION 2 incorporation of HBM helps enhance the significance of individual perception in influencing an individual's health issue responses. Physical activity promotion includes the HBM illuminating the ultimate impacts of perceived health risks susceptibility and severity of the various likely impacts of the sedentary lifestyle. The emphasis on the factors facilitates the model in stimulating enhanced awareness among the individuals on the likely significant threat from inactivity correlated to obesity and cardiovascular diseases (Barros et al., 2014) & (Martin et al., 2008). The second theory selected as part of the theoretical framework for the current paper is the Social Cognitive Theory (SCT), which complements the HBM by enhancing the framework and depicting the ultimate role of self-efficacy and observational learning in enhancing positive behavioral adjustment. SCT has emphasized the individual's belief as influencing effective behavioral change capabilities and the ultimate impact of the personal behavioral observation influencing one to change and adopt certain positive behaviors. The inclusion correlates to the extensive emphasis on enhancing empowerment and individual motivation in the regular physical activities engagement (Abdi et al., 2015) & (Adhikari et al., 2018). The third theory that is part of the theoretical framework is the Transtheoretical Model (TTM), which enhances the theoretical framework by emphasizing dynamic, positive behavioral change across various stages. TTM enhances the comprehensive and effective approach to positive behavioral modification in the physical activity enhancement drive by acknowledging the comprehensive behavioral modification (Logue et al., 2005) & (Motlagh et al., 2016). The rationale for selecting and using these theories as part of the theoretical framework is a holistic approach to comprehending the influence of the various complex psychological and social factors. There exists a close interrelation with regular physical activities among adults,

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THEORY-BASED HEALTH BEHAVIOR INTERVENTION 3 hence their enhanced overall health and well-being (Fox, 1999). Besides, the approach seeks to enhance the positive behaviors by nurturing the ultimate behaviors addressing the sedentary lifestyle-associated risks. The purpose of the proposed model is to create a complete strategy that can improve awareness about obesity-related hypertension and motivate people suffering from the problem to change their lifestyle related to physical activities. Moreover, combining these theories, including HBM, SCT, and TTM, will create an intervention that will address three aspects of health behavior. These are intrapersonal, interpersonal, and community-level aspects that can reduce obesity-related hypertension in the patients (Kelly, 2021). The visual representation of the theoretical framework is provided on the next page.

THEORY-BASED HEALTH BEHAVIOR INTERVENTION 4

THEORY-BASED HEALTH BEHAVIOR INTERVENTION 5 Goals and Objectives The first goal is to increase patients' awareness concerning obesity-related matters and assist them in accepting the nature of the problem and supplementary health risks. This goal and its objectives aim to address the issue that many patients face in fighting health-related problems, where they fail to understand their own part as a solution to the problem (Kelly & Barker, 2016). For example, the patients will focus on all the other things except their own contribution in fighting with obesity-related issues, which are actually very significant. Goal 1:  To promote awareness of the health dangers associated with obesity among patients. Objective 1:  To educate individuals about the various risk factors and preventive measures associated with the condition, for example through lifestyle changes, medication, and other interventions to effectively manage the disease (Artinian et al., 2010). Objective 2:  To organize educational sessions aimed at enhancing patients’ understanding of the nature of the health issues they face. The proposed theoretical framework focuses on inculcating self-belief in patients so they can overpower their problems. This can be done for example, by observing others and getting inspiration from role models in community-based exercise programs (Wallace, 2021). Goal 2:  To improve self-efficacy and expend observational learning to adopt healthy behaviors.

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THEORY-BASED HEALTH BEHAVIOR INTERVENTION 6 Objective 1:  Take part in a community-based exercise program by listening to motivational stories from role models. Objective 2:  To set realistic, individualistic goals and provide resources and support to patients. The third theory, the Transtheoretical Model (TTM), absorbs elements from the first two theories and encourages patients to create their own action plans and take ownership of their cure for obesity-related hypertension. Different research studies have shown that such an approach has shown promising results in promoting successful long-term behavior change (Pignataro & Huddleston, 2015). Goal 3:  To bring visible improvement in patients through an action plan by the principles of behavior change Objective 1:  To create interventions for patients that are made per current stage of behavior change. Objective 2:  To create support groups where patients can share their experiences and discuss strategies that help them achieve progress. Health Behavior Intervention This intervention plan is designed to take a comprehensive approach to address the issue. The proposed framework operates on a combination of theories that address intrapersonal, interpersonal, and community-level factors. These factors are crucial in ensuring positive outcomes for patients. From individual to social and behavioral aspects, the proposed

THEORY-BASED HEALTH BEHAVIOR INTERVENTION 7 intervention will likely yield fruitful and long-term health benefits for obesity-related hypertension patients. It is highly likely that the proposed framework will achieve the stated goals and objectives because it covers all the crucial aspects of patients' recovery. The proposed approach is expected to be an all-encompassing one, as it combines the advantages of three different theories that have been found to be effective in their own right based on research.

THEORY-BASED HEALTH BEHAVIOR INTERVENTION 8 References Abdi, J., Eftekhar, H., Mahmoodi, M., Shojayzadeh, D., Sadeghi, R., & Saber, M. (2015). Effect of the intervention based on new communication technologies and the social-cognitive theory on the weight control of the employees with overweight and obesity. Journal of research in health sciences , 15 (4), 256-261. Adhikari, C., Puri, A., Thapa, D., Thapa, R., Magar, S., & Sunil, G. C. (2018). Application of social cognitive theory in obesity prevention: a rapid review. Journal of Health and Allied Sciences , 7 (1), 53-62. Ali, N., Ahmed, S., Mahmood, S., Trisha, A. D., & Mahmud, F. (2023). The prevalence and factors associated with obesity and hypertension in university academic staff: A cross- sectional study in Bangladesh. Scientific Reports , 13 (1). https://doi.org/10.1038/s41598- 023-34574-1 Artinian, N. T., Fletcher, G. F., Mozaffarian, D., Kris-Etherton, P., Van Horn, L., Lichtenstein, A. H., ... & Burke, L. E. (2010). Interventions to promote physical activity and dietary lifestyle changes for cardiovascular risk factor reduction in adults: a scientific statement from the American Heart Association. Circulation , 122 (4), 406-441. Barros, A. A., Guedes, M. V. C., Moura, D. D. J. M., Menezes, L. C. G. D., Aguiar, L. L., & Xavier, G. A. (2014). Health behaviors of people with hypertension: health belief Fox, K. R. (1999). The influence of physical activity on mental well-being. Public health nutrition , 2 (3a), 411-418. Hall ME, Cohen JB, Ard JD, Egan BM, Hall JE, Lavie CJ, Ma J, Ndumele CE, Schauer PR, Shimbo D; on behalf of the American Heart Association Council on Hypertension; Council on Arteriosclerosis, Thrombosis and Vascular Biology; Council on Lifestyle and

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THEORY-BASED HEALTH BEHAVIOR INTERVENTION 9 Cardiometabolic Health; and Stroke Council. Weight loss strategies for prevention and treatment of hypertension: a scientific statement from the American Heart Association [published online ahead of print September 20, 2021]. Hypertension. doi: 10.1161/HYP.0000000000000202 Kelly, R. (2021). Preventing Obesity: A Social Ecological Exploration of Centers for Disease Control Prevention Strategies and Guidance toward Healthy Eating, Physical Activity, and Communities. Kelly, M. P., & Barker, M. (2016). Why is changing health-related behaviour so difficult?. Public health , 136 , 109-116. Logue, E., Sutton, K., Jarjoura, D., Smucker, W., Baughman, K., & Capers, C. (2005). Transtheoretical model‐chronic disease care for obesity in primary care: a randomized trial. Obesity Research , 13 (5), 917-927. Martin, M. Y., Person, S. D., Kratt, P., Prayor-Patterson, H., Kim, Y., Salas, M., & Pisu, M. (2008). Relationship of health behavior theories with self-efficacy among insufficiently active hypertensive African–American women. Patient education and counseling, 72(1), 137-145. Model. Northeast Network Nursing Journal, 15(3). Motlagh, Z., Hidarnia, A., & Kaveh, M. H. K. (2016). Improving Physical Activity for Hypertensive Patients: A Trans-theoretical Model-Based Intervention. Health Education and Health Promotion , 4 (1), 37-49. Pignataro, R. M., & Huddleston, J. (2015). The use of motivational interviewing in physical therapy education and practice: empowering patients through effective self- management. Journal of Physical Therapy Education , 29 (2), 62-71.

THEORY-BASED HEALTH BEHAVIOR INTERVENTION 10 Wallace, B. (2021). Reducing lifestyle diseases using community-based sport. Zhang, Y., Zhang, W.-Q., Tang, W.-W., Zhang, W.-Y., Liu, J.-X., Xu, R.-H., Wang, T.-D., & Huang, X.-B. (2022). The prevalence of obesity-related hypertension among middle-aged and older adults in China. Frontiers in Public Health , 10 . https://doi.org/10.3389/fpubh.2022.865870

THEORY-BASED HEALTH BEHAVIOR INTERVENTION 11 Appendix Annotated Bibliography: Obesity Today, many people around the world are suffering from obesity. Obesity is a multi- dimensional health risk and can now be considered an epidemic due to its widespread occurrence in individuals across the globe. The World Health Organization (WHO) defines obesity as a condition characterized by the accumulation of excess fat in the adipose tissue underneath the skin's dermis and predisposing a person to specific adverse health outcomes (WHO, n.d.) . It is not limited to a specific gender, age, or race and can be seen in any individual, although a preferable occurrence is in those living a sedentary lifestyle. Body mass index (BMI) is used as an indicator of obesity (CDC, 2022) . According to the WHO, an individual must have a BMI of 30 or more to be obese (WHO, n.d.) . Obesity is a complicated situation for an individual since it is a potent risk factor for many adverse health outcomes. One such outcome is hypertension, which is closely linked to obesity. For this reason, the clinical picture of a hypertensive adult is usually of an obese or overweight person. The relationship between obesity and hypertension stems from various physiological processes, such as the accumulation of fat, which contributes to an increase in blood volume, eventually forcing the heart to pump harder. Consequently, hypertension ensues (Seravalle & Grassi, 2017) . It is also believed that obesity may produce low-grade foci of chronic inflammation and an increased level of inflammatory mediators, leading to the development of hypertension. Seravalle, G., & Grassi, G. (2017). Obesity and hypertension. Pharmacological Research , 122 , 1–7. https://doi.org/10.1016/j.phrs.2017.05.013

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THEORY-BASED HEALTH BEHAVIOR INTERVENTION 12 The article” Obesity and Hypertension” by Guido Grassi and Gino Seravalle is a descriptive study. It highlights the underlying mechanisms leading to hypertension in an obese person and how specific components of the autonomic nervous system and renal abnormalities can significantly predispose an obese person to hypertension. It also sheds light on the end-organ damage in a person who has obesity and is concomitantly suffering from hypertension. Lastly, it elaborates on effective management strategies to counter and treat obesity and explains the use of anti-hypertensives in such individuals. The study has been written in a simple, descriptive manner and aims to refrain from esoteric concepts to offer good readability to general readers. It has been presented sequentially. Excerpts from the existing literature have been sprinkled throughout the study; e.g., proper quantifications and indicators of obesity have been explained vividly in the last paragraph of the introduction chapter. The study has built chiefly on the existing literature without presenting any out-of-the-box concepts. It reviews what is already known about the relationship between obesity and hypertension. However, I think that the writers have not adequately elaborated on the pathophysiology of the mechanisms involving hypertension in an obese person. The study also concludes that obesity and hypertension are closely linked and associated with increased morbidity. Shariq, O. A., & McKenzie, T. J. (2020). Obesity-related hypertension: a review of pathophysiology, management, and the role of metabolic surgery. Gland Surgery , 9 (1), 80–93. https://doi.org/10.21037/gs.2019.12.03 This article is a review based on emerging, novel concepts about the pathophysiology of obesity-related hypertension. It also provides insights into the various lines of treatment for obesity. The authors argue that weight loss should be considered the first line of treatment for an

THEORY-BASED HEALTH BEHAVIOR INTERVENTION 13 obese person. However, only a few succeed with weight-loss techniques such as a weight-loss diet and strenuous exercises. Therefore, the following line of treatment becomes conservative pharmacological therapy. Non-conservative therapy includes metabolic surgery, which has contributed to considerable weight loss in obese patients. The selected study is a review article discussing the breakthroughs in understanding the pathophysiology and line of treatments for obesity. The authors have provided a comprehensible flow chart in the middle part of the study that precisely links renal pathologies and excess fat deposition to bring about the pathogenesis of hypertension in individuals. The section "Definition of Obesity and its Association with Hypertension" draws on the numerical concepts of obesity and obesity-related hypertension in a well-articulated manner. Moreover, the study has evaluated the role of renal dysfunction in the pathophysiology of obesity-related hypertension in a detailed and well-elaborated way. It considers the role of the sympathetic nervous system and the renin-angiotensin-aldosterone system in inducing obesity-related hypertension. The part of the study dealing with pharmacological therapy lacks solid empirical evidence and is poorly written. The study has affirmed that obesity-related hypertension is a significant concern and that further research needs to be done to unravel effective lines of treatment for it. Leggio, M., Lombardi, M., Caldarone, E., Severi, P., D’Emidio, S., Armeni, M., Mazza, A. (2017). The relationship between obesity and hypertension: an updated comprehensive overview on vicious twins. Hypertension Research , 40 (12), 947–963. https://doi.org/10.1038/hr.2017.75 Obesity is a global epidemic and a potent factor in cardiovascular events. The condition sets the groundwork for systemic diseases such as diabetes type 2 mellitus. On the other hand, considering hypertension in isolation is a poor outcome for many patients, as it further exposes

THEORY-BASED HEALTH BEHAVIOR INTERVENTION 14 the individual to disastrous implications. It is a significant epidemic and demands therapies involving high costs. In addition to this, sedentary lifestyles and associated factors coalesce to create a clinical picture of hypertension that is not easily treatable. One such factor is abundant body mass, which serves as a basis for obesity-induced hypertension. Therefore, primordial prevention of obesity-induced hypertension is necessary, and further effective treatments need to be introduced to treat those already suffering from it. The initial parts of the study provide a comprehensive outlook to the readers by discussing major risk factors for hypertension and how obesity can lead to various pathologies. The epidemiological facts about hypertension are also well explained. The study has presented a thorough analysis of the various innovative concepts of the pathophysiology of obesity, such as the regulating pathways involved, the role of vasodilators and inflammatory mediators, and the involvement of brain centers. One of the negatives of the study is that the authors have avoided meaningful graphical representations to demonstrate the concepts explained. The study has only one flow chart, presented in a rather complex manner. The study maintains the fact that obesity is a potent risk factor for hypertension, and its control is a challenge in many states worldwide. .

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THEORY-BASED HEALTH BEHAVIOR INTERVENTION 15 References CDC. (2022, May 3). Defining Adult Overweight and Obesity. Retrieved November 24, 2023, from Centers for Disease Control and Prevention website: https://www.cdc.gov/obesity/basics/adult-defining.html#:~:text=If%20your%20BMI %20is%2018.5 Leggio, M., Lombardi, M., Caldarone, E., Severi, P., D’Emidio, S., Armeni, M., … Mazza, A. (2017). The relationship between obesity and hypertension: an updated comprehensive overview on vicious twins. Hypertension Research , 40 (12), 947–963. https://doi.org/10.1038/hr.2017.75 Seravalle, G., & Grassi, G. (2017). Obesity and hypertension. Pharmacological Research , 122 , 1–7. https://doi.org/10.1016/j.phrs.2017.05.013 Shariq, O. A., & McKenzie, T. J. (2020). Obesity-related hypertension: a review of pathophysiology, management, and the role of metabolic surgery. Gland Surgery , 9 (1), 80–93. https://doi.org/10.21037/gs.2019.12.03 WHO. (n.d.). Obesity. Retrieved November 24, 2023, from https://www.who.int/health-topics/obesity#:~:text=Overweight%20and%20obesity %20are%20defined

THEORY-BASED HEALTH BEHAVIOR INTERVENTION 16 Health Behavior Theory Goals and Objectives Introduction Collectively, these theories provide a holistic approach to comprehending the influence of the various complex psychological and social factors with the close interrelation with regular physical activities among adults, hence their enhanced overall health and well-being. Besides, the approach seeks to enhance the positive behaviors by nurturing the ultimate behaviors addressing the sedentary lifestyle-associated risks. Theoretical Framework The Health Behavioral Model (HBM) within the theoretical framework forms the foundational element whose strategic incorporation helps enhance the significance of individual perception in influencing an individual’s health issues responses. Physical activity promotion includes the HBM illuminating the ultimate impacts of perceived health risks susceptibility and severity of the various likely impacts of the sedentary lifestyle. The emphasis on the factors facilitates the model in stimulating enhanced awareness among the individuals on the likely significant threat from inactivity correlated to obesity and cardiovascular diseases. Embracing the Social Cognitive Theory (SCT) complements the HBM by enhancing the framework and depicting the ultimate role of self-efficacy and observational learning in enhancing positive behavioral adjustment. SCT has emphasized the individual’s belief as influencing effective behavioral change capabilities and the ultimate impact of the personal behavioral observation influencing one to change and adopt certain positive behaviors. The inclusion correlates to the extensive emphasis on enhancing empowerment and individual motivation in the regular physical activities engagement.

THEORY-BASED HEALTH BEHAVIOR INTERVENTION 17 Integrating the Transtheoretical Model (TTM) enhances the theoretical framework by emphasizing dynamic, positive behavioral change across various stages. TTM enhances the comprehensive and effective approach to positive behavioral modification in the physical activity enhancement drive by acknowledging the comprehensive behavioral modification.

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THEORY-BASED HEALTH BEHAVIOR INTERVENTION 18 Health Behavior Theory Goals and Objectives Health Behavior and Summary of Health Behavior Theory The Australian health system faces a critical challenge due to an impending substantial shortage of medical specialists, especially in rural settings. The accessibility of required medical services from general practitioners, especially in rural geographical zones, is strained. Therefore, a significant percentage of individuals located in rural areas do not have access to the services of general practitioners. The access issue can be viewed from a waiting time during hospital visits portraying unhealthy practice behavior. McIntyre & Chow (2020) noted that long waiting times for patients to receive care indicate a pressured health service. The Australian Institute of Health and Welfare (2023) noted that patients admitted to emergency units took different time ranges. For example, four hours and fifty-four minutes for those who needed non-urgent care compared to fifteen hours and thirteen minutes for those who needed instance care services. The issue may be further compounded due to the rising aging population. The healthcare system faces a unique challenge of escalated demand for medical care services amid the rise of the aged population. Such an observation may warrant adept evaluation and incorporation of behavioral change strategies such as improved workflow and an increased number of general practitioners in the care sector. In the health behavior theory, interventions aim to improve the overall care outcome through environmental changes or concomitant actions to achieve healthier habits (Sleet & Dellinger, 2020). Goals and Objectives The first goal would be increased practitioner retention. The goal would be achieved through offering competitive salaries to the practitioners. Secondly, newly graduated practitioners would be recruited in nursing residency programs to boost competency and

THEORY-BASED HEALTH BEHAVIOR INTERVENTION 19 confidence in their line of duty. The goals and objectives are well aligned with the behavioral change theory in that they portray a change in behavior plus an improvement in overall career satisfaction.

UNIT 9 ASSIGNMENT PU505 AY

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