MINDSET Health Behavior Changemedia01.commpartners.com/coke/sept_9_2009/090909_Slides.pdf · MINDSET A New Strategy for Health Behavior Change Carol S. Dweck, PhD Stanford University

A Continuing Education Program for Nursing and Nutrition Professionals

MINDSETA New Strategy for

Health Behavior Change

Carol S. Dweck, PhD

Stanford University

Author of Mindset: The New Psychology of Success

Lola Coke, PhD, APRN-BC, CNS

Rush University College of Nursing

Guest Speaker Moderator

Diane Quagliani, RD, MBA

Quagliani Communications, Inc.

Guest Speaker

Copyright © 2009 by the Preventive Cardiovascular Nurses Association

Thank you to our sponsor!

The Coca-Cola Company The Beverage Institute For Health & Wellness

This activity is presented by the Preventive Cardiovascular Nurses Association (PCNA) and sponsored by the Beverage Institute for

Health & Wellness


More Free CE Opportunities Online

From PCNA :

• Insulin Resistance

• Nutrition

• Women’s Health in Menopause

• Diabetes

• Triglycerides/HDL

• Angina

• Exercise Guidelines

To view these programs:

www.pcna.net

From The Coca-Cola Company Beverage Institute For Health & Wellness:

• Beverages & Bone Healthwith Dr. Robert P. Heaney

• Safety Review of Aspartame

• with Dr. Bernadene Magnuson

• Vitamin D & Chronic Disease Riskwith Dr. Michael F. Holick

To view these programs: www.thebeverageinstitute.org


Accreditation

• The Coca-Cola Company Beverage Institute For Health & Wellness is a

Continuing Professional Education (CPE) Accredited Provider with the

Commission on Dietetic Registration (CDR) – provider number #BF001.

Dietetic professionals (RDs/DTs) will earn 1.0 CE Credit for participating in

this program.

• The Preventive Cardiovascular Nurses Association is accredited by the

American Academy of Nurse Practitioners as an approved provider of

nurse practitioner continuing education. Provider number: 030602. This

program was planned in accordance with AANP CE Standards and Policies

and AANP Commercial Support Standards. RNs/NPs will earn 1.25 CE Credit

participating in this program.


• Use the MESSAGE box on the left of your screen to submit a question for the

Q&A Session

• Click on this icon for technical assistance.

• Click on this icon for program handouts.

• Click on this icon

before exiting this program today to access the Course Evaluation and

Obtain a CPE Certificate.* The CPE LINK will also be provided in a follow-up

email to all participants. Note: if you watched the webinar as part of a group

you will be able to obtain a CPE Certificate.

*This program is pre-approved for CPE for nursing and dietetic professionals. Other professionals may obtain a Certificate of Attendance by emailing [email protected]

or calling 1-800-274-9390

Housekeeping


Moderator

Diane Quagliani, RD, MBAQuagliani Communications, Inc.






Carol S. Dweck, PhD

Lewis and Virginia Eaton Professor

of Psychology

Stanford UniversitySpeaker


“I don’t divide the world into the weak

and the strong, or the successes and the

failures… I divide the world into the

learners and nonlearners.”

- Benjamin Barber


• When it comes to weight and health, many

people are non-learners.

• We ask them to change…




• When it comes to weight and health, many

people are non-learners.

• We ask them to change...but they don’t

really believe they can.

How can we help people believe in

change and become learners?


Mindsets

• Fixed Mindset: Your qualities are simply

fixed traits—you are what you are.

• Growth Mindset: Your qualities can be

developed—through effort and instruction.

…where you are now is just a starting point


Mindsets

• Which mindset is correct?

• Do people hold the same mindsets across

different areas?

• Can mindsets be changed?


How Do Mindsets Work?


#1

Fixed Mindset:

I’M FINE THE WAY I AMPEOPLE WITH A FIXED MINDSET STAY IN THEIR COMFORT ZONE

Growth Mindset:

LEARN, LEARN, LEARN BETTER HEALTH BEHAVIORS

PEOPLE WITH A GROWTH MINDSET SEEK AND ACCEPT CHALLENGES


How a Fixed Mindset Turns

People Away from Learning



Question “What is the capital of Australia?”

*Subject

types

response and confidence

1.5 s 2 s

*Correct

answer

1.5 s

Ability-Relevant

Feedback

Learning-Relevant

Feedback

1 s

Paying Attention to Learning

or


• People in a Fixed Mindset just want to

know they’re right

• People in a Growth Mindset want to know

what’s wrong and how they can fix it.


He blamed his genes.

He blamed his parents’

eating habits.

He blamed the stress he

was under.

He blamed the fast food

companies.

Nothing was his fault or

his responsibility


IN A GROWTH MINDSET, A

PERSON RECOGNIZES

THAT:

MAYBE HIS GENES AREN’T

IDEAL

MAYBE HIS PARENTS HAD

BAD EATING HABITS

MAYBE TEMPTATIONS ARE

EVERYWHERE

BUT HE CAN, OVER TIME,

LEARN A HEALTH REGIME

THAT WORKS FOR HIM


#2

Fixed Mindset:

DON’T WORK TOO HARD—IT SHOULD COME NATURALLY

Growth Mindset:

EXPECT TO WORK HARD (AND TO KEEP WORKING HARD), EFFORT IS KEY



#3

IN THE FACE OF SETBACKS…

Fixed Mindset:

GIVE UP, MAKE EXCUSES, HIDE FROM THE TRUTH

Growth Mindset:

EXPECT SETBACKS, CONFRONT THEM, LEARN FROM THEM


Mistakes = Lack of Ability, Bad

Person


IF THEY DO EMBARK ON A HEALTH REGIME AND

HIT SETBACKS…

FIXED MINDSET: IT WASN’T MEANT TO BE

IT WASN’T MY FAULT

IT DIDN’T HAPPEN…

GROWTH MINDSET:WHAT CAN I LEARN FROM THIS?

WHAT CAN I DO DIFFERENTLY NEXT TIME?



After a failure…


Where Do Mindsets Come From?

Messages About What Is Valued


Messages About What Is Valued

Person Praise: “Wow, that’s a really good

score. You must be smart at this.”

Process Praise: “Wow, that’s a really good

score. You must have tried really hard.”


Effects of Person vs. Process Praise

• Mindset: Fixed vs. Growth

• Goals: Comfort zone vs. Learning

After Setbacks:

• Confidence: Low vs. High

• Performance: Decreased vs. Increased

• Rampant lying after person praise


IMPLICATIONS

• Communicate that what is valued is not just

the end product (e.g., weight loss), or the

“goodness” of the patient.

• But the process of stretching, learning, self-

correcting and maintaining that process over

time.


Changing Mindsets

Brainology

www.brainology.us



Brain Experiments


The Learning Brain


Application to Health Behavior

• Neural/brain pathways (habits) can be trained, etc.

• Patients need to stretch beyond their “comfort

zone”

• Patients need learn that health behavior change is a

process

• Health care providers can develop a plan with the

patient to deal with the setbacks and failures.


Conclusion

The belief in personal growth

allows individuals to:

• Embrace learning and challenges (vs. stay in

comfort zone)

• Capitalize on mistakes and feedback

• Understand the role of consistent effort in

creating and maintaining change


Conclusion: Implications for Health Practitioners

• Teach about fixed and growth mindsets

• Focus on processes (effort, strategies,

learning) that can be maintained

• Teach patients to expect setbacks and to

capitalize on them


Food For Thought…

What might you do differently

now with your patients?


Lola Coke, PhD, APRN-BC, CNSAssistant Professor


MINDSET& Behavior Change Theories

- A Behavior Change “Toolkit”

Impact of Mindset on Behavior Change to Promote Weight Loss


Mindset

• Mindset can serve as a framework for Behavior

Change Theories:

– Assessment of Growth and Fixed Mindsets assist in

developing motivational strategies for behavior change.

– A Fixed Mindset impacts Precontemplation of the

Transtheoretical Model.

– A Fixed Mindset impacts Perceived Susceptibility in the

Health Belief Model.

– Self efficacy is better maintained in a Growth Mindset.


Behavior Change Theories:

Transtheoretical Model

♥ The Transtheoretical Model describes the stages of behavior prior to change.

♥ focuses on the individual’s decision making.

♥ involves the state of feeling, awareness, judgments, perceptions, and behavior.

♥ has been used in a variety of problem behaviors.

♥ five stages.


Behavior Change Theories:

Transtheoretical Model

♥ Precontemplation — The person has no intention to change or take action within the near future.

♥ Contemplation — The person intends to change within the next 6 months.

♥ Preparation — The person plans to take action within the next month.

♥ Action — The person has made significant modifications in his/her behavior and way of life.

♥ Maintenance —The person is not working as hard as the person in the Action mode, but is working to prevent a relapse. The person is confident of continuing to change.


Behavior Change

Theories: Social Cognitive

Theory and Self-Efficacy

Behavior

Personal Factors(cognitive, affective and biological events)

Environmental Factors

This clinical tool can be

used to evaluate patient

coping mechanisms and

confidence in ability to

change.


Behavior Change

Theories: Health Belief Model

♥ Reflects the psychological factors that effect a person’s

decision to participate with health services. It focuses

on the attitudes and beliefs of the individuals.

♥ Five areas that influence decision to seek assistance for

a health issue.

– Perceived Susceptibility

– Perceived Seriousness

– Perceived Benefits and Barriers

– Self Efficacy

– Cues to Action


Patient Case Study


Case Study: Johnnie B

♥ 68 year old African American female - works as a

grocery clerk part time

♥ Cares for 2 elementary school aged

grandchildren after school and full time during

the summer

♥ Referred to Preventive Cardiology for

cardiovascular risk factor reduction and

management of hypertension


Johnnie’s Cardiovascular

Risk Assessment

♥ Family history of hypertension and stroke on both maternal and fraternal sides. States “I was sure I would get high blood pressure."

♥ BMI = 32, waist circumference = 42

♥ BP = 150/98, Pulse = 88

♥ Chest X-ray shows left ventricular hypertrophy

♥ 68 years old, menopausal

♥ Remaining review of systems is negative except for renal insufficiency and hypothyroidism; Has +2 edema bilateral lower extremities.

♥Medications: Hydrocholorothiazide 50 mg, and Lisinopril 25 mg daily for Hypertension; Synthroid .150mcg daily for Hypothyroidism.


Johnnie’s Cardiovascular

Risk Assessment (con’t)

♥ Lifestyle Physical Activity: Stands when at work, no exercise

routine. Walks 3 blocks to bus stop and 1 block to the store 2

days a week when working.

♥ Diet: Was given a pamphlet about the DASH diet, but does

not follow it. States, “Food doesn’t taste good without salt.”

♥ Stress: “I am very stressed, especially when I care for my

grandchildren..they don’t listen to me.”

♥ Medications: “I don’t take them every day because I can’t

afford it. I don’t feel bad when I don’t take them, so I take

them every other day to make the bottle last longer.”


Laboratory Data

Lipoprotein Panel

TC 230 mg/dL

Trig 210 mg/dL

HDL 36 mg/dL

LDL 155 mg/dL

Non/HDL-C 194 mg/dL

Blood Chemistry Results

Potassium: 4.5 (3.5-5mEq/L)

Sodium: 155 (135-145 mEq/L)

Creatinine: 1.4 (.5-1.5 mg/dl)

BUN 67: (10-30mg/dl)

Fasting Glucose:103 (70-

110mg/dl)

What is Johnnie’s

Framingham Risk Score?

Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. JAMA. 2001;285:2486.

Age (yr)

Years Points

20-34 -7

35-39 -3

40-44 0

45-49 3

50-54 6

55-59 8

60-64 10

65-69 12

70-74 14

75-79 16

CHD Risk

Points 10-yRisk (%)

<9 <19 1

10 1

11 1

12 113 2

14 2

15 3

16 417 5

18 6

19 8

20 1121 14

22 17

23 22

24 27

≥≥≥≥ 25 ≥≥≥≥30

Systolic Blood Pressure

Untreated Treated

<120 0 0

120-129 1 3

130-139 2 4

140-159 3 5

≥≥≥≥160 4 6

HDL-C (mg/dL)

Points

>60 -1

50-59 0

40-49 1

<40 2

Score = 21

Risk = 14%

LDL-C goal:

<130 mg/dL

Total Age (yr)

Cholesterol

(mg/dL) 20-39 40-49 50-59 60-69 70-79

<160 0 0 0 0 0

160-199 4 3 2 1 0

200-239 8 6 4 2 1

240-279 11 8 5 3 2

≥≥≥≥280 13 10 7 4 2

Cigarette Smoking

Nonsmoker 0 0 0 0 0

Smoker 8 7 4 2 1


Patient Treatment Goals

♥ Dietary changes:

Reduce sodium to improve blood pressure

Reduce dietary fat

♥Weight loss:

Reduce caloric intake to decrease BMI and waist circumference

♥ Physical Activity

Initiate program of regular activity/exercise to assist with weight

loss, improve blood pressure and cardiovascular fitness.


Mindset Steps for Health Providers

• Teach about fixed and growth mindsets.

• Focus on processes (effort, strategies, learning) that

can be maintained.

• Teach patients to expect setbacks and to capitalize

on them.

• Communicate that what is valued is not just the end

product (e.g., weight loss), or the “goodness” of the

patient, but the process.

• The process of stretching, learning, self-correcting

and maintaining happens over time.


Using Mindset for Behavior Change

• Determine whether Johnnie has a Fixed or Growth Mindset

by asking questions like:

– How do you feel about your appearance?

– Does she think she is “doomed” because of her family history?

– Does she desire to learn more about changing her eating habits?

– How much of health has to do with your genes and heredity versus

your health practices and lifestyle?

– Do you think people are meant to be a certain weight and there is

nothing you can do to change it?

– How did you get to where you are (i.e. worked hard to maintain

weight but then gave up)?

– Doing well except when….?

– Do you feel in control…even with the stress?


Determine Level of Confidence

to Lose Weight

♥ Assess Johnnie’s confidence to begin weight loss.

• “On a scale of 0-10 with 10 being most confident, how

confident are you that you can lose weight?”

This clinical tool can be

used to evaluate patient

coping mechanisms and

confidence in ability to

change.


Begin the Process:

Assess Level of Knowledge

– What does she really know about her food intake

and habits?

– Does she really know how food and weight effects

health and why?

– Determine literacy level and present appropriate

educational materials.

– Develop a method to evaluate learning, feedback

loop.


Assess Current Habits

♥ Dietary

�Determine level of knowledge about food

�Assess current eating patterns using food

records and food frequency tools

�Determine changes she is willing to make?

♥Weight

�Determine her weight history


Set Goals

♥ Diet

�Develop small incremental goals based on food changes

♥Weight

�Develop small incremental weight goals

Setting Weight Loss Goals:

The S.M.A.R.T. Principle

♥ Specific: “I want to lose 2 lbs by week 2”

♥Measurable: State the goal with a way to measure it,

e.g., 2 pounds or reduce caloric intake to 1200

calories per day and record on a daily log.

♥ Adjustable: Adjust goals as needed.

♥ Realistic: Begin weight loss at the patient’s level and

set goals accordingly.

♥ Time-based: Small incremental timeframes.

Adapted from: Quinn E. Motivation and goal-setting for exercise. How to stick with your fitness program.,http://sportsmedicine.about.com/od/sportspsychology/a/motivation.htm Accessed Feb. 4, 2009.

Forms Guide:

Written Self-

Contract


Dietary Goals

♥ DASH Diet: Consume a diet rich in fruits, vegetables, grains and grain products,and low fat dairy products with a reduced content of saturated and total fat.

♥ Dietary Sodium Restriction:

no more than 100 mmol = 2.4 grams sodium or

6 grams sodium chloride.

♥ Weight Reduction = decrease caloric intake to lose 2 pounds per week.

The DASH Eating Plan can be accessed at Website:

www.nhlbi.nih.gov/health/public/heart/hbp/dash/index.html

Forms Guide:

Dietary Recall

Helps to evaluate

eating patterns as well

as estimate total

calories, % of calories

from fat and sodium.

Forms Guide:

Nutrition

Teaching Tools


Summary

♥ Mindset is a beginning framework for behavior change.

♥ The PCNA Forms Guide is a wonderful adjunct to patient

education and aids the health care professional facilitate

patient care.

♥ The forms used in this presentation are a few of the many

that are in the Forms Guide.

♥ The Forms Guide can be accessed online at www.pcna.net,

downloaded to your computer, and personalized for your

practice.


Diane Quagliani, RD, MBA

Quagliani Communications, Inc.

MINDSET A New Strategy for Health Behavior Change

Use the chat box located on the left side of your screen to ask a question.

What might you do differently now with your patients?

Questions?

Carol S. Dweck, PhD

Stanford University

Lola Coke, PhD, APRN-BC, CNS


Guest

Speaker

Guest Speaker Moderator


Thank you to our sponsor!

The Coca-Cola Company

The Beverage Institute For Health & Wellness

This activity is presented by the Preventive Cardiovascular Nurses Association (PCNA) and sponsored by the Beverage Institute for Health & Wellness


Nursing and Dietetic Professionals:

To Access to the Course Evaluation and Obtain a CPE

Certificate*

Click on this ICON on the lower right side of your screen before exiting this

program to access the Course Evaluation and Obtain a CPE Certificate.*

The CPE LINK will also be provided in a follow-up email to all participants.

*This program is pre-approved for nursing and dietetic professional CPE.

Other professionals may obtain a Certificate of Attendance

by emailing [email protected] or calling 1-800-274-9390.

Documents

MINDSET Health Behavior Changemedia01.commpartners.com/coke/sept_9_2009/090909_Slides.pdf · MINDSET A New Strategy for Health Behavior Change Carol S. Dweck, PhD Stanford University