Facilitating health behaviour change in looked after young people

Lorna Watson, NHS FifeHannah Dale, Health Psychologist, NHS FifePauline Adair, University of StrathclydeGerry Humphris, University of St Andrews

• Looked after young people (LAYP) have poorer health outcomes

• No reported interventions on LAYP evaluate on outcomes• ‘Hard-to-reach’ • Risk behaviours have been linked (Aicken et al, 2010)• Factors such as feelings of safety and belonging

(neighbourhood, school, family) may protect against multiple risk behaviours (Brooks et al, 2012)

• Physical activity associated with reduced risk for all substances and sexual risk behaviour (Nelson et al, 2006)

Background

Objectives were to develop and evaluate a health behaviour

change intervention for LAYP to improve their lifestyle around

multiple risk behaviours

Social and environmental determinants of health & wellbeing

Looked after

children & young people

Physical, sexual

& emotional abuse Living with

parentsabusing alcohol or drugs

Neglect

Absences & gaps in

schooling & low

attainment

Attachment issues

Disruptive nature of

placements

Socio-ecomonic

status

No consistent

positive adult

support

Being a child

of a teenage mother

Psychological determinants of health & wellbeing

Looked after

children & young people

Information

Social norms

Risk perception

Attitude towards

behaviour

Self esteem & confidence

Motivation

Reinforcement of

behaviour

Behavioural skill

Plans to help support positive

behaviour

3 main sources guided development:

Methods

Qualitative – focused on sexual health initially.

Needs assessment

Behaviour and behaviour change theories

Theory

3Effective interventions for young people around lifestyle.

Evidence

1. Needs assessment revealed gap between knowledge and behaviour, need for flexible services and interventions spanning all lifestyle issues

2. Theories include Social Cognitive Theory, Theory of Planned Behaviour and Health Action Process Approach

3. Evidence mixed for some areas, especially for vulnerable populations

2

1

Research, theory and evidence

around health behaviour

change

Behaviour change interventions

Consultancy

Teaching and training

What did we do?

• Delivered by a health psychologist in a personally tailored way to individuals

• Aimed to motivate and provide LAYP with the skills for change and is very flexible to needs, targeting:– Sexual health– Smoking– Activity– Healthy eating– Alcohol and drugs

• 2 phases – motivational and volitional• Young people involved in design of materials

Behaviour change interventions

With thanks to Jilly Martin

With thanks to Jilly Martin

• 39% self referral, social work team, NHS staff

• 942 appointments attended (average 5 per person)

• 75% seen at home

• Sexual Health, Smoking most frequent issues

• Detailed evaluation undertaken:

Opinion; quantitative

Summary of Service

Behaviour N in analyses Pre-score Mean (median)

Post-score Mean (median)

Significance value and effect size

Smoking (number/week) 38 26(0)

16(0)

p=0.01 r=-.30

Exercise (hours/week) 25 3(2.5)

6(5)

P=0.000r=-.52

Fruit and vegetable intake (number/day)

25 .98(1)

2.58(2)

p=.001r=-.48

N NIntention to use condoms Do not intend to Unsure Intend to Strongly intend to

236872

14126

p=0.003 r=-.44

Condom use Never Not very often About half the time Most of the time Always

923112

10134

P=0.026r=-.53

Pregnancy contraceptive Yes No

279 18

198

McNemar’s test p=0.006

Undertaken STI test Yes No

17314

89

McNemar’s testP=0.219

Alcohol (units per week) 24.52(.000)

.333(.000)

p=.715

Cannabis use (number/month) 22 0.18(.000)

0.00(.000)

p=.180

Wellbeing 19 Mean= 40.32Median= 39SD=11.28

Mean= 50.05Median= 53SD=10.68

p=.002r=-.49

47 techniques (33 from 40 item taxonomy of BCTs) used across sessions, most commonly (25+ sessions):

Audit of behaviour change techniques

• Goal setting (behaviour)• Action planning• Barrier identification/problem

solving• Set graded tasks• Review behavioural goals• Plan social support/social

change• Building confidence to say ‘no’

to sex• Provide general

encouragement

VolitionalTechniques

• Motivational interviewing• Provide information on

consequences of behaviour in general

• Provide information on consequences of behaviour to the individual

• Discrepancy assessment (between own standard and actual behaviour)

• Provide normative information about others’ behaviour

• Promoting positive values and attitudes towards sexual health and relationships

• Elicit aspirations about the future

Motivational Techniques

Discussion points

• Multiple health issues, whole person approach

• Due to the sometimes complex backgrounds of LAYP, many may require intensive tailored interventions to assist in behaviour change and include motivational elements

• Flexibility is also key in initiation and maintenance of engagement

• Consultancy and Training for staff well received

• Links created across NHS and other agencies

Conclusions

• The development of a tailored one-to-one service for LAYP around healthy lifestyle issues is, however, possible and can result in behaviour change

• Due to the difficult nature of engaging young people, training for staff and carers in behaviour change techniques important to embed learning from the project