"If one does not believe in one's capability to perform a desired action, one will fail to adopt, initiate and maintain it".
Schwazer: Health Action process Approach
I thought it best to go to the official site to define MOHO here:
MOHO seeks to explain how occupation is motivated, patterned, and performed. By offering explanations of such diverse phenomena, MOHO offers a broad and integrative view of human occupation. Within MOHO, humans are conceptualized as being made up of three interrelated components: volition, habituation, and performance capacity. Volition refers to the motivation for occupation, habituation refers to the process by which occupation is organized into patterns or routines, and performance capacity refers to the physical and mental abilities that underlie skilled occupational performance. MOHO also emphasizes that to understand human occupation, we must understand the physical and social environments in which it takes place. Therefore, this model aims to understand occupation and problems of occupation that occur in terms of its primary concepts of volition, habituation, performance capacity, and environmental context.
Type 2 diabetes develops when the insulin-producing cells in the body are unable to produce enough insulin, or when the insulin that is produced does not work properly (known as insulin resistance).Insulin is a hormone. It works as a chemical messenger that helps your body use the glucose in your blood to give you energy. You can think of it as the key that unlocks the door to the body’s cells. Once the door is unlocked glucose can enter the cells where it is used as fuel.
This had some resonance with me and I began to consider these issues in relation to me as an occupational therapist and using the elements of MOHO in the change I asserted. The sections in red refer to the language of the HAPA framework, I have linked them together with where I believe MOHO best fits with these categories and then given some personal reflection as to what this meant to me in my experience.
- In order to consider change in healthy behaviour it was important to address and explore my relationship with food - values held, traditions practiced etc.
- Food was a social event, a treat, a marker of time, a consolation. A way of sharing an experience and showing care and consideration with friends and family, and a link to the past.
- This was all under threat and the advantages of change had to be weighed against the perceived effort and skill involved in making changes to all of this.
- The current stance by the NHS here in the UK is to approach the issue in a 'soft' way. Everything in moderation is the message. What I observed through this within an education session with a group of people with a recent diagnosis was that this did not clearly offer the importance of change. There was little consideration of what coping resources or skills might be required
- Utilising other sources from the internet and books, mainly from Australia (because in my view they seem to have a more well defined approach and attitude to the issue) I was able to find my way through often conflicting and usually complex messages to find a message that spoke to me enough to enable me to draw on coping strategies. The messages I found made me want to exert the effort required and make changes.
- Intrinsic motivation was also impacted by the future requirement of health care professionals to assess and judge my progress - I have never been able to easily accept being judged (I got through 3 driving instructors and 2 tests before I passed my driving test). So to avoid this I needed to adopt healthy behaviours.
- Schwazer explains this as outcome expectancies- subjective beliefs on positive and negative outcomes and perceived capability of a person to implement a certain behavior
- I had to learn to challenge an internal dialogue that stated such things as "I don't have time to do all that cooking of fresh food", " I couldn't possibly eat that....", "I don't like ....",
- I had to retrain my thinking on what was a treat, what was sociable, what was consolation etc. This was perhaps one of the hardest things, I had to identify my internal dialogue at each occasion where food was involved, what was I thinking, feeling about this. How did this fit with what I now knew to be "healthy" choice?
- I scoured cookery books and each week I planned exactly what I was to eat every day - breakfast, lunch, dinner and snacks and by doing so learned about the science of food, how different groups work together, understood the concept of low Glycaemic Load (GL) for slow release and complex combinations that slowed sugar release or enhanced insulin effectiveness. And I finally began to understand portion control.
- By doing this I created a new routine for eating incoporating more time for cooking. In this way I began to enjoy making meals, creating an ambient environment (is now the time to admit that my favourite 'goto' music for meal prep is Steps??)
- This was a bit harder to enforce. At first it was easier to avoid social situations where food would form part of the experience, but friends soon became slightly annoyed with me for this.
- Eventually this was impossible, but taking relearned coping strategies and with the support of friends and family I was able to find the confidence to ask questions of the food others had prepared and could make informed and healthy choices
- My first HbA1c test would take place 3 months after initial diagnosis, therefore this became my first goal. I intended to keep these new behaviours for this period of time and then re-consider dependent upon the outcome of the test reading.
- As mentioned I learned how to cook healthy food, how to put food together what and how much to eat
- I developed research skills to find and interpret the information available - there is much that is conflicting and complex in the available literature and learning to navigate through this is very difficult - and not something I have totally mastered to date I'm sure
- I became so successful at suppressing health-detrimental actions that at the point of trying to 'fall off the wagon' and have treat to celebrate my first 3 months reading - and choose a cream cake - I couldn't do it and actually ..... I didn't want to do it - and I haven't
- Human environment of support and personal networks of family friends and colleagues in both real and virtual world.
- NHS support and advice
This post is slightly away from the norm here as I feel I am exposing something more personal than I ususally do on this blog. I would welcome your comment and feedback as to whether this post was useful or interesting to your work or even personal circumstance. Any ideas for future posts would also be well received.