Health Behavior Modification: Seat Belt Use, Case Study Example

1. Description of Problem

There are many behaviors that rational, logical people engage in everyday which have a profound negative impact on their health and safety. One of these is the general lack of use of seatbelts. In general more than 90% of drivers believed it is a good idea to fasten seatbelts, yet less than 14% actually do so. Furthermore, young adults (18-34) are less likely to wear seatbelts, and men are 10% less likely to wear them than women. This is a global trend with only about 25 countries around the world having some types of mandatory safety belt laws. This results in countless deaths and injuries each year. Furthermore, a three point seatbelt will serve to protect an individual’s bones, such as their ribs, spine, neck, and skull, along with internal organs, such as their heart and brain. In addition, a seatbelt will decrease the severity of conditions such as whiplash. Injuries that can result from not wearing a seatbelt correctly are damage to the skin, abdominal injuries (too low) and cervical or throat injuries (too high). Data from the National Highway Traffic Safety Administration shows that vehicle occupants exhibit a 50% higher rate of fatal injuries if their seatbelt is not worn correctly. Due to car accidents, on average there are 40,000 deaths each year in the United States. Therefore it is critical that steps be taken to understand how best to improve seat belt use and vehicular safety. The act of wearing a seat belt is a personal discipline, as no one will inspect passenger throughout his or her journey. To curb such a big number of deaths yearly on the roads, countries need to implement strict measures of ensuring people observe the road rules, as it is beneficial to their lives. This paper will examine how to motivate others to modify their behavior using the trans-theoretical model.

2. Behavior Desired

Behavior modification can be understood as adjusting an individual’s behavior pattern with the goal of improving their quality of life. This behavioral change includes a synthesis of positive and negative reinforcements and punishments. The way to do this is to isolate the specific behavior to be changed but to not adjust other habits at the same time. Unlike a diet or sleep habits, which is encoded into the brain and defines the type of person they are, behavior is much more plastic and possible to change. Each person is unique and as a result behavioral change may require more discipline or time investment for one person to succeed compared to another individual, due to the behaviors that are carrier out on a daily basis automatically.

The behavior, which will be examined in this paper, is how to change an individual’s behavior as it relates to proper seat belt use. Seat belts were invented in the early 19^th century; however, the first modern seat belt came to the market in the 1950’s. In conducting the research to bring the product to market, it was demonstrated that of 28,000 accidents in Sweden unbelted drivers resulted in crashes at all speeds while those with belts were protected from fatalities below sixty miles per hour. This evolved into the first mandatory seat belt laws in Australia during the 1970’s for everyone in the front seat. In contemporary society, it is critical that to reduce injuries and fatalities from driving that all people in a car wear a seat belt. Looking at health and safety data it is clear that everyone should use their seat belt when driving. The behavioral modification being sought is to ensure that a young male Saudi driver who does not wear a seat belt change his regular behavior to reduce the risk of injury from driving. If the drivers commits himself to wearing a seat belt each time he is driving for some time, after some time he will develop a habit that even while not driving, the first thing when he enters a car is to put on a seat belt. This is what is needed of everyone on the road.

3. Description of Client

In this paper, I will detail my experiences trying to modify the behavior of a 25-year-old Saudi male in regards to his seat belt use. The first time I met him, he appeared to be a good person who goes well with anybody might be because of how he was trained to handle patients. The individual has a history of not accepting advice even when clearly valid growing up as a teenager. The client is highly educated with a university medical degree and significant income that has enabled him gets one of the sleek cars that are not excessively dangerous in a crash or too fast. The client generally seeks to maximize his personal health by eating a healthy diet, exercising regularly, abstaining from drinking, and smoking and practicing safe sex. In addition, the client does not drive recklessly and has no driving tickets outside of his seat belt use. The client is unmarried and has no children. In regards to his vehicle safety, the client has completed all the required driving education courses. He is knowledgeable about his car and the risks involved in crashing his car without a seat belt. As a physician, he has seen patients with injuries in the emergency rooms directly due to not wearing a seat belt. This therefore, implies that he has direct experiences on the consequences but his adamant to change.

The client has never undergone behavior modification of this type prior to this intervention. He is skeptical that any behavioral technique will have an impact on his day-to-day routine. He feels that he is a man set in his ways and that despite pleas to his reason and regular warnings that he is most concerned with convenience and comfort when driving. The client is, therefore. at the pre-contemplation phase. This is a very dangerous phase in any decision-making situation, since this is when one makes crucial decisions on something. Thus, it is quite essential to raise his consciousness. This was done by making him aware during the preliminary negotiation to the hazards of his seat belt behavior. These included worse injuries in car crashes and more traffic tickets. His rebuttal was that he was a good driver who had never been in a major crash and that he had the funds to pay his tickets. During the second round of negotiation, I told him stories about the health benefits of seatbelt use and how being responsible would make him appear cool and mature to others. After a number of visits and discussions on benefits, dangers, and other related issues on the seat belt behavior, we settled on an agreement that he would wear the seatbelt every time he drove around.

4. Method of Approach

My approach will employ the practical project activity on an individual based on the outlines of current behaviors. This project evaluates the driver’s preparedness to work on a fresh gainful act, offering strategies on how he may attain them. I knew the model as it has been in existence for quite some time, and through it I may relate the theory it has and apply them on this project to change driver’s behavior. It has been applied for other areas and has been successful to a number of people. This project describes the relationships among stages of individual change; processes of change; decisional balance, or the pros and cons of change; situational confidence, or self-efficacy in the behavior change; and situational temptations to relapse. The central developments by which some other approaches are arranged are the five levels of change that need to be observed if the project follows them. If it succeeds, this project will have several advantages over the models. First, it describes the individual behavior to change as opposed to an event. Then from the TTM, I would break the change process down into stages that the driver should go through them to proof the model. Secondly, the project’s explicit focus on measurement of constructs has a strong foundation for my analysis. Across different problem behaviors and populations, different variables have been associated with stage movement for each stage of change. Levels of change are furtive and explicit functions, which individuals apply to advance by the stages. Levels of change offer fundamental directions for intercession schedules, because the steps are separate variables, which individuals require to utilize, or be involved in, to transform from one level to the next.

One aspect of this project is that the processes of change that drive movement through the stages of change. Individuals do not change their behavior all at once; they change it incrementally or stepwise in stages of change. The stages most commonly used across research areas include: Pre-contemplation, Contemplation, Preparation, Action, and Maintenance. Individuals do not typically move linearly from stage to stage, but often progress and then recycle back to a previous stage before moving forward again. This was evident in my project as the driver at first, when we settle on an agreement, he seems to have liked my suggestion but, after being left to act, he still could not make as planned. This change process is conceptualize demonstrate meaningfully as a spiral, which illustrates that even when individuals do recycle to a stage they’ve been in before, they may still have learned from their previous experiences. The Male Saudi driver went through the stages but his outcome indicate that he had not fully decided to change. Pre-contemplation describes individuals who for many reasons do not intend to change within the next six months. Some of these individuals may want to change at some future time, but just not within the next six months. Others may not want to change at all and, in fact, may be very committed to their problem behavior (e.g., a lifelong smoker or someone who regularly cultivates a deep tan). Contemplation describes individuals who are thinking about changing their problem behavior within the next six months. They are more open to feedback and information about the problem behavior than their counterparts are in Pre-contemplation stage.

The project as well integrates a sequence of interceding or product variables. These entails decisional equilibrium (the merits and demerits of change), self-reliant (courage in the capacity to change through issue circumstance fields), conditional enticements to participate in the issue act, as well as traits, which are certain to the issue field. Furthermore, to these intermediate or reliant variables may be some other environmental, psychology, biochemical, cultural psychological or even socioeconomic variables, or trait defined to the issue under study.

Individuals in the Preparation stage are committed to changing their problem behavior soon, usually within the next 30 days. These people have often tried to change in the past and/or have been practicing change efforts in small steps to help them get ready for their actual change attempt. The Action stage includes individuals who have changed their problem behavior within the past six months. The change is still quite new and their risk for relapse is high, requiring their constant attention and vigilance. Maintenance stage individuals have changed their problem behavior for at least six months. Their change has become more of a habit, and their risk for relapse is lower, but relapse prevention still requires some attention, although somewhat less than at earlier stages of behavioral modification.

From my understanding of TTM, I could definitively say that my 25-year-old Saudi male subject is at the pre-contemplation phase. This is because from everyone’s viewpoint, he has an issue that he even realizes and has no plans of changing. For him everything is still normal and has no reasons for alarm. Therefore, it was necessary to raise his consciousness. This was done by making him aware during the preliminary negotiation to the hazards of his seat belt behavior. These included worse injuries in car crashes and more traffic tickets. His rebuttal was that he was a good driver who had never been in a major crash and that he had the funds to pay his tickets. During the second round of negotiation, I told him stories about the health benefits of seatbelt use and how being responsible would make him appear cool and mature to others. We settled on an agreement that he would wear the seatbelt every time he drove. This would count as one point and that he would be positively reinforced by accumulating five points meaning he could go to the beach. On the other hand, if he did not wear the seat belt he would get no agreement points and be barred from exercising at the gym. Furthermore, posters and warnings would be placed in his car to remind him of his agreement with the TTM program and the project he is supposed to accomplish.

Decisional Balance, or the pros and cons of behavior change, describes the importance or weight of an individual’s reasons for changing or not changing. The pros and cons relate strongly and predictably to the stages of change. Individuals’ decisions to move from one stage of change to the next are based on the relative weight given to the pros and cons of adopting the healthy behavior. The pros are the positive aspects of changing behavior, or the benefits of change (reasons to change). In contrast, the cons include the negative aspects of changing behavior, or barriers to change (reasons not to change). Characteristically, the pros of healthy behavior are low in the early stages and increase across the stages of change, and the cons of the healthy behavior are high in the early stages and decrease across the stages of change. The pros and cons are particularly useful when intervening with individuals in early stages of change. Decisional balance is an excellent indicator of an individual’s decision to move out of the precontemplation stage. The relationship between the stages of change and decisional balance has been shown to be remarkably consistent across at least 12 different problem behaviors.

Not only has the relationship between stage and the pros and cons been replicated across problem behaviors, but the magnitude of the change across the stages of change has been replicated as well. Based on these data, the strong and weak principles of behavior change were formulated.

5. Seat Belt Log

First Day – Client placed warnings regarding seat belt safety in his car and signed the agreement that he would participate in the research contract. He heads to work wearing his seat belt and marks on his chalkboard that he wore it.

End of Week 1 – Client has struggled to participate in the agreement. Besides not wearing his seatbelt beyond the first day, he worked out despite this functioning as a negative inducement to seat belt usage.

End of Week 2 – Client has persisted in failing to wear his seat belt and violating the contract by exercising regularly. This contract was additionally violated as he went to the beach over the weekend despite this serving as a positive inducement. This highlights the difficulty in reaching individuals when a behavior is established and they do not feel that the risks and rewards of change are significant. Clearly, more motivations that are effective are necessary in dealing with this individual in modifying their behavior.

End of Week 3 – Patient persist in failing to wear his seat belt and violating the contract in multiple ways. What is interesting is that now he reports being conscious and slightly guilty of his not wearing the seat belt. This can be interpreted as a step forward according to the TTM model and possibly may evolve further. It is unclear if the signs in addition to speaking with me might serve as a negative inducement to wear his seat belt.

Final Day/Week 4 – On the last day of the study, the client reports that he ultimately never wore his seat belt. He says that he did think about it and felt bad for violating the agreement despite his regular exercising and going to the beach on the weekends. It is unclear if this individual was unique or could be interpreted as being representative of the larger social issues in play in improving seat belt usage worldwide. The client makes it unclear if the project might result in him eventually adopting better seat belt behavior in time.

6. Critique of Experience

Regarding my subject, he completely failed to progress using the established project. He never wore the seatbelt, went to the beach despite the agreement and worked out regularly. This was despite our agreement, our conversation discussing the benefits of seatbelts and the warnings in his car. This highlights the difficulty in reaching individuals when a behavior is established and they do not feel that the risks and rewards of change are significant. Clearly more effective means of motivation are necessary in dealing with this individual in modifying their behavior. It is unclear if this individual was unique or could be interpreted as being representative of the larger social issues in play in improving seat belt usage worldwide.

The self-efficacy construct utilized in my project integrates both self-efficacy and coping mechanisms in approaching individual behavior. These variables have undergone considerable elaboration over time, with situational temptation to engage in the unhealthy behavior often viewed as an equally important companion construct to the more commonly used situational confidence measures. Confidence and temptation function inversely across the stages, and temptation predicts relapse better. Research has demonstrated that both the confidence and temptation constructs can be conceptualized psychometrically as unifactorial and/or multifactorial. Structural modeling analyses have repeatedly revealed a global higher order construct (confidence or temptations) which is comprised of several lower order situation ally determined components. The lower order situational factors depend more strongly upon the problem behavior than the higher order construct. In practice, a global score is often useful as a general screening tool, while the situational subscale scores provide useful information for targeting intervention feedback to individuals at different stages of change.

In evaluating the twenty-five year old Saudi male subject, the intervention can be critiqued on multiple levels. Positively, the subject transitioned temporarily from precontemplation to contemplation via motivational posters and frequent reinforcement discussions. This resulted in his starting to wear the seat belt infrequently which was an improvement. Yet over a month, the subject failed to make any further progress. This was due to his not being ready to change. He needs more time and effort to grasp the importance of seat belt wearing. In addition, there was an inability to monitor him closely in the project activity, which resulted in his non-adherence to the agreement.

Theoretical models fundamentally guide both our current and future understanding of health behavior, as well as providing direction for our research and intervention development. As a metaphor, each project or theory provides a different roadmap of the health behavior territory. Of course, it is important to point out that the map is not the territory itself, and different maps (theories) describe the same territory differently. Even so, when we enter new territory, we still need a map. Even a roughly drawn or poorly scaled map is much better than none at all. The map points out the relevant landmarks (constructs) and how they are connected, and, perhaps, how far it is from one landmark to another. As different maps of the same territory evolves over time and are compared, the territory becomes clearer; thus, allowing better maps to evolve, perhaps integrating the clearest features of different maps. Therefore, it goes with theoretical development as well. There is no final or true map, only a map or theory that best meets our needs right now. Thus, as we evaluate different theories of behavioral modification, we should ask comparable questions of their efficacy.

To take this further various scientists have analyzed practical projects and behavior modification in its entirety. B.F. Skinner writes in Beyond Freedom and Dignity that unrestricted reinforcement can possibly produce the “feeling of freedom”; therefore removing the negative impetus may permit individuals “feel freer” while not actually being free (1972). Additional criticism focuses on the idea that an individual’s actions only occur when reinforced. Thus, if in my project I had supported the driver with physical activities, he may have changed fasters since he will condition his mind not to make any fault. This has been suggested that negative behaviors, such as violence, may occur organically without suggestion. Skinner, therefore, argues that an individual’s unique personality and experience is a synthesis of one’s behavior, environment, and psychology. In short, Skinner argues that behavior is not always a modifiable series of actions, but the product of a symphony of non-modifiable factors.

Furthermore, various authors have commented on the high level of education and training that goes into behavioral medication, through real life projects activities and supported by other theories. Particular criticism has been laid on those techniques which require averse, punishment-based or restrictive techniques. An area of concern relates to who should be in charge of implementing these programs and whether only licensed psychologists or medical personnel should be actively modifying the behavior of others. While others have argued that a unique certification and/or degree should be established to offer individuals seeking to change negative, dangerous or unhealthy behaviors to ensure that consumers receive quality and proven techniques and training. Hopefully, with time the study of behavioral modification will emerge into an established science with evidence-based techniques and proper certifications that will allow needy individuals to learn how to overcome those behaviors, which might negatively impact their health, relationships and or professional goals.

7. Baseline and Follow Up Assessment

As a baseline, the client reports that he never wore a seat belt while driving. He drove moderately but regularly received tickets for not wearing his seat belt. At follow-up after the four-week experience intervention, the patient had not significantly changed his behavior. However, he did move from what people knew of him to know being considerate sometimes like feeling guilty if he fails to where the belt. Here, the theory may be applicable as a guideline since the driver seems to be moving to the next stage. He says that he did think about it and felt bad for violating the agreement despite his regular exercising and going to the beach on the weekends. It is unclear if this individual was unique or could be interpreted as being representative of the larger social issues in play in improving seat belt usage worldwide. The client makes it unclear if the project might result in him eventually adopting better seat belt behavior in time.

As a follow up assessment, the four-week experience has several advantages over other models because this one applies to real life individual traits. First, it describes behavior change as a process, as opposed to an event. Then, by breaking the change process down into stages and studying which variables are most strongly associated with progress through the stages, this project provides important tools for both research and intervention development. Secondly, its explicit focus on measurement of constructs has provided a strong foundation for the project. Across different problem behaviors and populations, different variables have been associated with stage movement for each stage of change. These project findings inform the design of individualized, stage-matched, expert system interventions (see below) that target those variables most predictive of progress for individuals at each stage of change. One aspect of this project in relation to model outline that often goes unrecognized is that it is change project processes that drive movement through the stages of change. While behavior modification encompasses applied behavior analysis and typically uses interventions based on the same behavioral principles, many behavior modifiers who are not applied behavior analysts tend to use packages of interventions and do not conduct functional assessments before intervening. Through increasing our scientific, understand of behavioral modification, we can improve public health and save lives.