improved resourcefulness and self-efficacy, as well as reducing health service demand
(Department of Health, 2001). EPP was based closely on the previously evaluated
Chronic Disease Self-Management Course (Lorig, Gonzalez and Laurent, 1999b; see
also Bandura, 1999), which developed from the successful interventions with arthritis
patients. EPP was implemented throughout the NHS in 2007.
An EPP course comprises six weekly structured self-management training sessions
delivered to groups of 6–15 patients with heterogeneous health conditions, led by
trained, lay tutors with chronic health conditions. Patients also receive a self-help
manual containing further information. The programme includes information provision
and cognitive and behavioural modification techniques as well as prompting action
planning and problem solving, providing support for taking exercise and eating a
healthy diet as well as coping with depression. Course sessions are held in community
settings and tutors are volunteers, thus keeping administration costs low. Early
evaluations have been encouraging. Barlow et al. (2005) observed a number of benefits
including increased SE in managing symptoms, reduced fatigue and depressed moods
and better communication with doctors. Moreover, benefits were sustained 12 months
after attending an EPP course. A randomized controlled trial found improvements in
SE and psychological well-being, together with reduced anxiety and greater levels of
physical activity, at six-month follow-up (Kennedy et al., 2007).
SUMMARY
Health-related information needs to be accessible, originate from a credible source,
minimize use of jargon, be easily readable and answer the questions the target audience
are interested in. Simple techniques including logical order, explicit categorization and
repetition enhance recall.
Persuasion is a form of social influence that can be understood in terms of
underlying motives. We are motivated to access valid sources of information and
this facilitates informational influence. We are also motivated to feel positively about
ourselves and to have good relationships with others. This facilitates normative influ -
ence. Informational influence is strengthened by source credibility and expertise,
consistency and consensus. Normative influence is strengthened by positive relation -
ships, reciprocation and approval. Persuasion in groups can be understood in terms of
conformity and conversion (in the case of minority influence). Avoiding prohibition
and presenting advice as easy-to-implement choices can minimize reactance.
Attitude change based on systematic (or central route) processing is more stable and
less susceptible to counter-persuasion than attitude change following from peripheral
route processing. Central route processing is more likely when people are informed,
motivated (e.g. they think the message is relevant to them) and have the capacity (e.g.
distraction-free time to consider arguments) to process messages. During central route
processing the meaning or quality of arguments is critical to persuasion.
Self-efficacy is correlated with performance across a range of behaviours but tends
to be behaviour-specific. SE leads to greater effort, persistence and flexible responding.
SE needs to correspond directly to the challenges faced by particular individuals or
target audiences. SE can be enhanced by mastery experiences, vicarious experience
(i.e. modelling), verbal persuasion and perception of physiological and affective states.
CHANGING MOTIVATION 185