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Stages of Change - Changing Sleep Behaviour

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Chloe Hampshire

on 4 November 2013

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Transcript of Stages of Change - Changing Sleep Behaviour

Using the Stages of Change Model for Increasing sleep
Introduction
My GOALS
Plan/Method
RESULTS
Health
Mrs Valerie Birchenall's Blog » Six Components of Health. (n.d.). Retrieved from http://birchenallv.ism-online.org/2010/08/13/six-components-of-health/
Stages of Change Theory
The Stages of Change model (also referred to as the Transtheoretical Model) (Prochaska 1979; Prochaska and DiClemente 1983; Prochaska et al 1992, as cited in Morris, Mazano, Dandy, O’Brien, 2012) is a widely recognised cognitive model which subdivides individuals between five categories that represent different milestones or ‘levels of motivational readiness’ (Heimlich and Ardoin 2008 p. 279, as cited in Morris et al, 2012), along a continuum of behaviour change. These categories/stages are Pre-contemplation, Contemplation, Preparation, Action and Maintenance. Although the model was first developed in regards to Smoking, it has widely been adapted to change many other behaviours and the rationale behind a Staged model is the belief that people who are in the same stage, will face the same problems and barriers and therefore can be helped by the same type of intervention. (Nisbet and Gick 2008) The Stages of Change model identifies ten ‘processes’ (See table 1 for processes and summary of Stages) and transition between stages depends on an individual’s self efficacy and decisional balance. (Morris et al, 2012)
Table 1: The Stages of Change Model - in a Health Psychotherapy Context,
adapted from (Prochaska et al. 1992, as cited in Morris et al, 2012)
In regards to lack of sleep and the Stages of Change theory, I started off in the contemplation stage. I was very well aware of the effects that lack of sleep was having on me, and knew that I needed to improve my sleeping habits. The issue was finding the motivation to actually take action on the behaviour and this happened when this assignment was introduced. The day that this assignment was discussed, was when the transition from contemplation stage to preparation stage happened. The motivation to improve my sleeping habits came from this assignment and I turned my serious consideration of changing the behavior to start planning how I was going to change it and getting prepared for the change.
Sleep effects....
Health is defined by the World Health Organization (WHO), as a ‘State of complete physical, mental, and social well being, and not merely the absence of disease or infirmity’ (WHO website, 2013). This concept of health also includes the concept of wellbeing. Health and wellbeing are affected by factors such as behaviour and lifestyle choices, food and nutrition intake and many different influences in the environment. (Goodacre, Collins & Slattery, 2007) Health and wellbeing consists of 6 components in order to attain ‘full’ health, these components include Physical, social, environmental, psychological and spiritual health. Over recent years we have realised how important sleep is to our health and wellbeing. With good nutrition and exercise, sleep is recognised as one of the necessities of good health. A lack of sleep can have a major impact on mood, concentration, memory and quality of life. In addition, medical sleep disorders such as obstructive sleep apnoea have been shown to contribute to other serious health problems such as high blood pressure, diabetes and heart disease. Having poor sleep is a major cause of lost productivity as well as accidents in the workplace, on the road and at home. (Sleep health Foundation, 1968) Due to lack of sleep in the past year, I have been feeling tired all the time, unable to concentrate during every day life or at uni and finding myself wanting to sleep at any chance rather than using that time for leisure activities or something of higher importance. Lack of sleep was greatly affecting my part time job, my studying, my physical activity levels, and my social and everyday life. This issue was affecting all components of health and directly inhibiting my ability to attain optimal health. Because of this, I decided to attempt to achieve more sleep by using the Stages of Change theory.
Goal Setting
Within the Preparation stage comes the importance of goal setting. Studies on the Goal setting theory (Locke & Latham, 1990, 2002, as cited in Locke & Latham, 2006) show that specific, hard goals lead to a higher level of goal performance than if the goal is ‘easy, vague or abstract.’ (Locke & Latham, 2006, p. 265) This shows the importance of S.M.A.R.T goals.
Process Goals:

1. Make time for sleep. Aim for being in bed before 11pm on weeknights.

2. Choose a wake up time and stick to it (7.00am)

3. No use of any kind of electronics within half an hour before bed time.


S.M.A.R.T goals
Achieve your goals, by being S.M.A.R.T.! (n.d.). Retrieved from http://dreamchoosers.com/s-m-a-r-t-goals/

Product Goal
My overall goal is to get more sleep and have a better sleeping routine by the end of Semester 2, 2013. (Have at least 8 hours of sleep 3 times a week and an average of 48 hours of sleep per week.)
Barriers
1: (Making time for sleep. Aim for being in bed before 11pm on weeknights.)

- Part time job. Hospitality, which means late night shifts.

-Studying. Psychologically I like to study more at night.

-Social events are generally late night orientated.
Barriers
2. (Choose a wake up time and stick to it -7.00AM-)

- My day to day routine varies. Some days I might need to get up earlier.

-Easy to sleep in if i have nothing important to wake up for.
Barriers
3. No electronics within half an hour of bed time.

- Breaking my habit of watching a documentary before bed

-Usually fall asleep using phone. (texting, facebook etc.)

Sleep log
In order to keep track of my progress towards achieving my goals, I kept a journal of my sleeping habits for each night which included the:

-Date
-Time went to bed
-Time woke up
-Total amount of sleep
-Notes about factors that influenced sleep
How do i use the diary?
-Fill out the diary every day for duration of intervention. (11 weeks including 1 week pre test)

-Do this each morning when you wake up and each night when you go to bed.

-Keep the diary beside your bed so it is easy to fill in.
How sleep diary relates to SMART goals
My 3 process goals and overall goal can be measured within the sleep diary.
Pre-Intervention sleep diary
Pre-Intervention sleep diary
-Total hours sleep: approx 44 hours

-avg per night: approx 6.2 hours
GOALS MET?
Goal 1
:
NOT MET
. not one day i was in bed before 11pm on a weeknight
Goal 2
:
NOT MET
. Didn't wake up at the same time every day (7.00am)
Goal 3
:
NOT MET
. Used phone most nights while in bed. Watched TV and a movie within half an hour of going to bed.
This Pre-intervention sleep diary was when I was In the preparation Stage: I had a plan of action but hadn't implemented lifestyle changes yet.
Main Obstacles affecting sleep
-WORK
-BOYFRIEND
-STUDYING
-WEEKEND FESTIVITIES
Addressing Barriers
-Don't participate in activities that are expected to go on after 10.30pm (on weeknights & excluding work)

-Set an everyday alarm for 7.00am

-Charge phone in separate room at night

-Program TV to automatically turn off at 10.30pm each night

-Make time for study before work

CONCLUSION
Overall
After 10 weeks of changing my sleeping behaviour to increase my health and well-being, I am currently in the Action stage of the Stages of Change theory. I Would consider myself in maintenance stage when I am confident of not having relapses occur and have implemented these lifestyle changes for over 6 months.
RESULTS SUMMARY
WEEK 10 of Intervention behavior change
Week 10
In Action phase! - implemented lifestyle changes and achieving my goals...
-Total hours sleep: approx 49.5 hours
-Avg amount of sleep per night: Approx 7
Week 10 - GOALS MET?
Goal 1
:
MET
. Went to bed before 11pm more than 3 nights.
Goal 2
:
MET.
Woke up at 7am every day.
Goal 3
:
MET.
Didn't use electronics within half an hour of going to bed
LIMITATIONS OF STAGES OF CHANGE MODEL
Does not consider:
-environmental factors
-social determinants

Focuses on primary prevention
-Reducing risks vs preventing risks

May not be applicable to:
-Specific populations
-Complex health behaviors
-Population health interventions

Strengths of Sleep Diary
-Useful for managing sleeping patterns and behaviours.
-Individual focus: can be personally tailored
-Recognizes behaviour change as dynamic and non-linear
-Can help identify readiness to change
-Link between stages & processes allows for targeted interventions

Limitations of Sleep diary:
-Not as detailed as it could be. Doesn't consider naps, caffeine intake, waking up during the night, PA levels, etc.

-Isn't 100% accurate. Based on approximate times, nearest to the half hour.
STRENGTHS OF STAGES OF CHANGE MODEL
Week 4- Intervention
References

Achieve your goals, by being S.M.A.R.T.! (n.d.). Retrieved from http://dreamchoosers.com/sm-a-r-t-goals/

Goodacre. S, Collins. C., Slattery.C. (2007) An Australian Perspective on Health and Human Development: VCE units 1 & 2. Cambridge, Port Melbourne: Cambridge University Press.

Locke, E.A.,& Latham, G.P. (2006). Current directions in Psychological Science: New directions in goal setting theory. Vol. 15, No. 5 (pp. 265-268)

Morris., J, Mazano.,M, Dandy.,N, O’Brien.,L, 2012. Forest Research: Theories and models of Behaviour and behaviour change. Retrieved October 2013 from:
http://www.forestry.gov.uk/pdf/behaviour_review_theory.pdf/$file/behaviour_review_theory.pdf

Mrs Valerie Birchenall's Blog » Six Components of Health. (n.d.). Retrieved from http://birchenallv.ism-online.org/2010/08/13/six-components-of-health/

National Sleep Foundation. (2013). Retrieved October 18, 2013, from http://www.sleepfoundation.org/

Nisbet, E.K.L. & Gick, M.L. (2008). Can Health Psychology Help the Planet? Applying Theory and Models of Health Behaviour to Environmental Actions. Canadian Psychology, 49, 296-303.

World health National Organisation (1948) WHO definition of Health, Preamble to the Constitution of the worl health Organisation as adopted by the international conference, New York. Retrieved from: http://www.who.int/en/

Week 4 - Intervention
Total hours sleep: approx 44 hours
Avg amount of sleep per night: 6.2
RELAPSE! lack of motivation (self efficacy & decisional balance) allowed me to fall out of good habbits from weeks 1,2 &3
Pre testing
- Showed bad behaviour habits & lack of sleep. (preperation stage)
Weeks 1, 2 & 3

- Showed 7am wake ups daily, 3 days a week of 8 hours sleep, 3 days a week being in bed (action stage) before 11pm and an avg of 49.5 hours sleep across the 3 weeks
Weeks 4&5
- Relapse. Showed random wake up times (turning off my alarm) falling asleep with electronic media, lack of sleep with an avg of 44 hours of sleep across the 2 weeks. (Relapse)
weeks 6-10
- Back on track. Mostly no use of electronics within a half hour of bed time, mostly 7am wake ups, an avg of 3.5 days where i went to bed before 11pm on weeknights. An average of 48.5 hours sleep per week.

Successful Product Goal
My overall goal is to get more sleep and have a better sleeping routine by the end of Semester 2, 2013. (Have at least 8 hours of sleep 3 times a week and an average of 48 hours of sleep per week.)
Achieving my goal...
The difference between the Pre-test and the last week of my Behaviour change Intervention was a + of 5.5 hours sleep. This is an extra half an hour per night.

Overall, in the 10 weeks program, avg amount of sleep per week was 48 hours, which is exactly the amount of hours i set in my goal.
6 out of the 10 weeks I achieved 8 hours of sleep 3 times per week.
= increased sleep ----> increased health and well-being.
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