Abstract

Background: This is a self-case report of a 56-year-old Moluccan-Dutch woman, an independent behavioral scientist in Amsterdam, The Netherlands. It demonstrates an effect of a tailored lifestyle intervention in two sessions over a period of 6 months on blood pressure and cholesterol levels. The purpose of this report was to gain insight in a short-term health change process that may contribute future health care professionals to improve their practice initiatives. Moreover, this best practice report can be a positive stimulus to motivate patients to break old unhealthy patterns and to consciously live a healthy life.

Materials and methods: In a narrative design with descriptive statistics, this case report is an abbreviated illustrative representation. Additional to a specific GP consultation after unexpected falls in daily life, a blood and urine lab examination, and consultations with the GP’s somatic care practice nurse were conducted. Informative and instrumental support was provided. Further explanations about healthy eating, including overview lists for healthy foods, were given.

Result: (Self) observations, lab test outcomes and self-evaluation showed an improvement in blood, cholesterol and weight values. Lifestyle was adjusted in more exercise in the form of active walking 3 to 4 times a week and the diet was reduced to an acceptable level of clean eating.

Conclusions: This self-case report highlights the value of professional tailored informative consultations, including instrumental support, using motivational interviewing performed by a GP’s somatic care practice nurse. It illustrates that gaining trust and working together for an effective lifestyle change of an individual can play an important role in reducing a careless (un) healthy attitude. Besides, it could help to promote health awareness and to increase specific health knowledge among professionals and the public.

Keywords: Behavioral science; Best practice; Individual and public health; Lifestyle intervention; Promoting health awareness.

Citation: Buunk-Werkhoven YAB. “Practice what you preach!”: A self-case report effect of a lifestyle intervention. J Clin Images Med Case Rep. 2023; 4(9): 2597.

Introduction

Background: As a Moluccan-Dutch behavioral scientist (i.e., social psychologist and oral hygienist) [1], I believe that public health should be the art and science of promoting health awareness and improving people’s health, and their communities in the total society. Public health is concerned with promoting healthy lifestyles, preventing disease and organizing health services [2]. Likewise, it includes monitoring disease cases and health indicators, controlling infectious diseases and promoting healthy behavior [3]. To generate impact, I also believe it is important ‘to do what I say’ and to be able to be a role model for others with this professional and personal attitude [4]. So, I continue intrinsically motivated as an independent researcher and consultant various public (oral) health care projects nationally at home and abroad [5-8]. To clarify, a social psychologist studies the behavior of the individual; how a person stands in the world; how a person perceives and interacts with others, as well as looking at behavior in and of groups [9]. But just as sincerely, how is or do I view my own health behaviors and lifestyle?

Well, my own fascination with teeth, oral hygiene and health in general began when my sweet and good-humored grandfather Piet Jansen wore dentures and I came home after school and asked him to imitate that crazy mouth TV commercial of the time the Mona dessert [10], and he would actually take his teeth out. It got my serious attention when I fell on my teeth as a young girl of 12 years. My right front tooth died, turned black and eventually, as an adolescent girl, I got a porcelain crown. Thanks to the many nasty and painful treatments and the embarrassment I experienced then, because I thought everyone saw that I had a fake tooth I now know as a professional how important beautiful and healthy teeth are to one’s well-being [11]. Also from my artistic opinion, “the mouth radiates what you think, how you feel and who you are”. Smiling, laughing or experiencing positive emotions in general, such joy, love, and hope can help to promote resilience, improve mood, strengthen social bonds and foster a sense of meaning and purpose in life [10-13]. It is well known that behavior is the basis of any lifestyle change, but it is also clear that changing habits and behavior is inherently complex. Moreover, previous experiences, negative or otherwise, e.g., anxiety and stress, affect current behavior as well as behaviors to be unlearned or newly learned [14,15].

Objective: The purpose of this case study is to highlight a recent lifestyle change challenge and opportunity in a so-called N=1 study of individual and public health practice. This approach typically focus on the life of an individual as told through his/her own story. Also to gain insight into a short-term health change process that can help future healthcare professionals improve their practice initiatives.

Materials and methods

In a narrative design with descriptive statistics, in line with a previous N=1 study [16], this self-case report is an abbreviated illustrative representation. Like most people, my lifestyle was based on habits and routines and, frankly, until more than 9 months ago, I was not very aware of. I did things the way I’ve always done them. Since a year ago, early summer 2022, I fell “out of the blue” a few times, and at that time my working conditions were socially unsafe, insecure and uncomfortable. After a GP consultation, it turned out that my blood pressure was way too high. Also, a 30-minute blood pressure test, a blood and urine lab examination showed that my cholesterol level was too high. My heart rate was normal, my kidneys were functioning well, and I didn’t have diabetes. Upon inquiry, I was found to be afflicted with a family burden on both sides for cardiovascular disease and elevated cholesterol level. In an informational consultation with the GP’s somatic care practice nurse, my lifestyle, including my diet, was first examined. I received nutritional and exercise advice and had to return in 3 months (recall).

Results

During the first period, from November 2022 till February 2023, I strictly adhered to the healthy diet (clean eating, i.e., no fats, red meat, shellfish, sugars and salt). In the first days, I even experienced withdrawal symptoms related to sugar and sweets and after a while my taste changed, and I also didn’t like certain food anymore. In addition, I walked a lot, but did not focus on weight or intermediate blood pressure measurement. At the recall with the GP’s somatic care practice nurse, it turned out verbal reported to me that the blood pressure and cholesterol levels had been reduced, but not yet optimal. From self-observation (my clothing size was smaller) and measured on the scale, it turned out that I had also lost weight. It was agreed to continue the process and to return in the following 3 months, till May 2023. At the recall, after 6 months of ‘clean eating’ and walking every day, everything turned out to be fine again; my blood pressure and cholesterol had dropped to the desired values appropriate for my age. Less than the previous check, I had lost a little more weight. Moreover, I felt fit and well enough to continue and maintain my changed lifestyle. A follow-up recall in 6 months was recommended, and also to check sodium and potassium levels for possible risk of cardiac arrhythmias.

Than unexpected, during the holidays in the second period in March 2023, a piece (mesio-lingual) of my left second molar broke off, forcing me to go to the dentist. In April, at the dental consultation, it turned out that it had been 5 years since my last check-up. Compared to the X-rays from 2018, no caries or other disorders could be observed on the bitewings. My sugar intake was lowered and my own oral self-care turned out to be optimal, because my gums were healthy and the restoration of the tooth turned out to be a trifle.

Discussion

This self-case report described real success story from my own hand as a very passionate and experienced applied behavioral scientist. But why is changing behavior for a lot of people so difficult? I wholeheartedly endorse the statement: “There is nothing so practical as a good theory” (Kurt Lewin, 1951, founder of social psychology) [9]. For care providers, skills such as ‘treatment, observing, listening, supporting and motivating’ are the most important competences for appropriate care and guidance. With correct and appropriate arguments and to achieve maximum effectiveness, the approach to health problems should ideally be based on sound theory and research from social psychology [9]. These intervention-cases can be substantiated with the application of models such as Contact Theory, the Transtheoretical Model, Self Determination Theory, Theory of Planned Behavior, Motivational Interviewing, Provocative Coaching and Social Support [9,17]. Thus, to change lifestyle, knowledge and understanding of behavior, including applying theories must be the basis of any intervention [9,18,19].

In general, change is associated with feelings of loss or discomfort, which people naturally dislike. For instance, in this self-case report, the sugar, fat and energy in food were short-term rewards. Less or no exercise was often more rewarding than getting into action and alcohol even contains substances that give a quick reward. And as previous described, behavior involves emotions, and everything is about behavior and underlying patterns. It is important to consider thoughts, beliefs and feelings that come into play regarding lifestyle. How does a person think about his/her own actual behavior, what does it provide, what are the pros and cons? But most important: what habits and routines or attitude does someone have? [14,15,18]. Because in all sincerity: I never thought about it myself! I only did and ate what I felt like doing!.

Of course, in addition to the individual aspect, the environment also plays a major role [3,5]. The environment is one of the strongest triggers of behavior, and at the same time, it is not the easiest factor to influence, because it runs up against the limits of our own sphere of influence. However, it is possible to work on increasing people’s coping skills, for example by making someone aware of how the environment affects behavior, and give knowledge and tools to deal with it [9,11,16]. For a possible explanation that this intervention was successful, it is assumed that the combination of personal attention and very specific behavioral instructions may have accounted for the effects. Besides, I was very motivated to change my behavior, because the negative consequences, i.e., higher risk of heart and blood vessels and/or stroke related to a family burden were serious enough to be monitored.

Optimal approach is a combination, especially with focus on emotions, such as, thankfulness, which encourages us to focus on the positive aspects of our lives and can help reduce negative emotions such as envy, resentment and regret. Gratitude inspires kindness and generosity, which strengthens relationships and sense of community. Satisfaction, which helps us feel at ease and satisfied with our lives, which can promote feelings of inner peace and tranquillity [2,12,17]. When we enjoy the good things in life, they become integrated into our priorities and values. This creates a positive feedback loop because we will continue to seek and enjoy these good things [4,16]. Interest, that provides a sense of energy and anticipation that can motivate us to pursue our goals and take action to achieve them. As we learn and explore, we gain new knowledge. Be proud, because it increases our self-esteem and confidence and counteracts negative self-talk and self-doubt. Pride gives us the confidence to dream big, which helps us achieve greater things. The best is to be open-minded and look for inspiration; it helps promote creativity and motivation and can inspire us to pursue new goals and challenges. Inspiration and passion are important components of building grit [1,4,12,13].

References

1. De Psycholoog: The Moluccan soul, a portrait of psychologist Yvonne Buunk-Werkhoven. Retrieved June 15, 2023, from https://www.tijdschriftdepsycholoog.nl/artikelen/de-molukse-ziel/
2. Dental INFO: “One size fits all” oral health care approach not effective for behavioral change. Retrieved June 19, 2023, from https://www.dentalinfo.nl/kennis/one-size-fits-all-mondzorgbenadering-niet-effectief-voor-gedragsverandering/
3. Buunk-Werkhoven YAB, Reyerse E: What is the impact of oral (public) health promotion, and of interventions for oral (self) care awareness raising and behavior change? J Dent Oral Disord Ther 8: 1-4, 2020.
4. NieuwWij: ROLE MODELS, 70 Moluccan success stories. Retrieved June 19, 2023, from https://www.nieuwwij.nl/achtergrond/tegenwoordig-voel-ik-me-meer-verbonden-met-mijn-molukse-afkomst/
5. Nawang Palupi Pratamawari D, Ansya Balgies G, Buunk-Werkhoven YAB: How Effective Is Toothbrush Education through Environmental Changes in Elementary School Children. J Dent Hyg Sci 22: 30-6, 2022. https://doi.org/10.17135/jdhs.2022.22.1.30
6. Buunk-Werkhoven YAB, Gortzak JJC, Sjoerts JE, Frederiks A: ‘Outspoken’ Oral Hygienists Promote Oral Health Care Awareness at Public Events for (Pregnant) Women and Young Mothers. J Dent HygSci 21: 140-9, 2021. https://doi.org/10.17135/jdhs.2021.21.3.140
7. Burrekers SY, Doorman-Vasquez MC, Faes-Siebgens MJCM, Pascual RA, Buunk-WerkhovenYAB: Self-Perceived Behavior and Process Evaluation of Bocas Sanas Holanda-Maimón(BSHM, 2020): From the Past to the Future. Biomed J Sci & Tech Res 26(5), 2020. BJSTR. MS.ID.004422.
8. Buunk-Werkhoven YAB, Takrovskaja K, Steverink-Jorna LM: Kidsfabriek: Oral health awareness and promotion of oral self-care during a learning and play event for children and parents in The Netherlands. Annu Clin J Dent Health 7: 22-25, 2018.
9. Buunk AP, van Vugt M, Dijkstra P. Applying Social Psychology: From Problems to Solutions. London: SAGE Publications Ltd, 2021 - 280 p. - ISBN: 9781529757408 - Permalink: http://digital.casalini.it/9781529757408 - Casaliniid: 5017792
10. Mona: “Imitate a Mona dessert”. Retrieved June 19, 2023, from https://historiemelkvervoer.nl/zuivel-commercials-1/mona
11. Buunk, AP. Buunk-Werkhoven, YAB: Sense of Defeat, Social Status and Oral Health amongForensic Psychiatric Patients. Euro J Med Natural Sci, [S.l.], 2(1): 48-54, 2018. ISSN 2601-6400.
12. Dental INFO: Mouthy. The Science Gallery London. Retrieved June 19, 2023, from https://www.dentalinfo.nl/ondernemen/inzending-yvonne-buunk-werkhoven-voor-mouthy-londense-tentoonstelling-over-de-mond/
13. Assenstad: Former student hands over artwork to Quintus. Retrieved June 19, 2023, from https://www.assenstad.nl/assen/9082-oud-leerlingen-overhandigt-kunstwerk-aan-quintus
14. Verplanken B, Aarts H. Habit, Attitude, and Planned Behaviour: Is Habit an Empty Construct or an Interesting Case of Automaticity? Euro Rev Soc Psych 10(1):101-134, 2011. doi: 10.1080/14792779943000035
15. Lally P, van Jaarsveld CHM, Potts HWW, Wardle J: How are habits formed: modelling habit formation in the real world. Eur J Soc Psychol 40: 998-1009. 2010. https://doi.org/10.1002/ejsp.674.
16. Buunk-Werkhoven YAB, Dijkstra-le Clercq M, Verheggen-Udding EL, De Jong N, SpreenM: Halitosis and Oral health-related Quality of Life: A Case Report. Int J Dent Hyg 10: 3-8, 2012.
17. Dental INFO: Retrospective 2022 & Prospective 2023. Retrieved June 19, 2023, from https://www.dentalinfo.nl/kennis/scholing-tandheelkunde/retrospectief-2022-prospectief-2023/
18. Buunk-Werkhoven YA, Dijkstra A, van der Schans CP: Determinants of oral hygiene behavior: a study based on the theory of planned behavior. Community Dent Oral Epidemiol 39: 250-259, 2011. https://doi.org/10.1111/j.1600-0528.2010.00589.x
19. Shitu K, Alemayehu M, Buunk-Werkhoven YAB, Handebo S: Determinants of intention to improve oral hygiene behavior among students based on the theory of planned behavior: A structural equation modelling analysis. PLoS ONE 16(2): e0247069, 2021. doi.org/10.1371/journal.pone.0247069