IPE exam 2

Health Belief Model

• Known as a value expectancy theory. 

  • People will engage in healthy behavior if- 

1. They value the outcome of that behavior.

2. They think the behavior is likely to result in that outcome.

• But things can get in the way...

the health belief model

Health Behavior is Motivated by

• perceived susceptibility

• perceived severity

• perceived benfits

• perceived barriers

• self efficacy

• cues to action

Benefits Must outweigh Barriers

• Difficulty of behavior

• Work schedule

• Laziness

• No time- family, etc. 

• Unaware of health behavior

• Motivation and support 

• Lack of knowledge

• Weather

• Etc......

Critiques of HBM

• focuses on individual decisions

• lack of clarity  in how all components affect the changing of behavior.

Theory of Planned Behavior

Theory of Reasoned Action (foundations of TPB)

• Explores the relationship between people’s attitudes and their behaviors. 

• Focuses on rational, cognitive decision-making processes similar to HBM. 

Key Components
Of TRA/TPB

Intention to do a behavior based on the following: 

• Person’s attitude toward a specific behavior. 

• Person’s perception of the subjective norms associated with said behavior.

• What do we mean by subjective norms?

  • 
    

Subjective norms - This refers to the belief about whether most people approve or disapprove of the behavior. 

• It relates to a person's beliefs about whether peers and people of importance to the person think he or she should engage in the behavior.

Tra  reformulated to TPB

Behavior intention alone not predictor of behavior. 

• Perceived behavioral control composed of: 

1. Control beliefs - beliefs about factors that will make it easy or difficult to do the behavior. 

2. Perceived power - to facilitate or inhibit the behavior.

TPB as a Whole

Attitude:  a person’s beliefs, judgement on behavior. 

Subjective norms: beliefs on what others will think and               motitivation to conform. 

Behavioral intention: intent to do behavior, influenced by all                other factors. Most Predictive of All!

Perceived behavioral control: beliefs on what will make it                                easy/hard to do behavior. 

Perceived power: power a person believe they have on  behavior. 

Critiques of TPB

• Assumes behavior is the output of rational, linear decision-making processes.

• clarity of constructs

• time between intent and action is not considered

Transtheoretical Model

• Prochaska and DiClemente developed ‘stages of change’.

  • Useful in determining where a person is in relation to making a behavior change.

  • Self-efficacy is the key component of the model.

  • Focus on cooperation not compliance.

TTM /
Stages of Change

• stage 1 precomtemplaton

• stage 2 contemplation

• stage 3 preparation

• stage 4 action

• stage 5 maintenance

Precaution Adoption Process Model

Main difference from TTM is ‘taking a precaution’ against something. 

Developed in response to explain how people react to hazards. 

stages of Precaution Adoption Process Model

• unawear of the issue

• unengaed in the issue

• deciding about action

• decideing not to act

• decideing to act

• acting

• maintance

Critiques of TTM and PAPM

These 2 models say that a person will go from Stage 1 to Stage 2 in sequential order.

how do we mesausre what stage a person is in?

Information-Motivation-Behavioral Skills Model (IMB)

• Prevention information is important but not enough.

Self-Esteem Enhancement Theory

• Building self-esteem enhances resilience and promotes healthy behavior.

Self-Determination Theory

• Humans are innately oriented to growth and health

social groups

• Family and family-related groups

• Peer groups

• Occupational groups

• Clubs, civic associations 

• Social class - related groups, racial/ethnic groups

• Faith-related groups

• Risk behavior - related social networks

Assumptions about Groups and Behavior

• Group dynamics often over-ride individual motives. 

• People do things in groups they might not do on their own.

• Individual emotions can be shaped by a group. 

• Cost/benefit: People may view loss of group membership to be a risk, more than specific health consequences. 

Individual address internal factors

• Health Belief Model

• Transtheoretical Model

• Theory of Planned Behavior

Social/Env address external factors.

• Social Cognitive Theory

• Social Network Theory

• Diffusion of Innovations

• Social Marketing

Social Cognitive Theory

• Most well-known and productive theory in PH. 

• Began as a branch of behaviorism

• 1960s - Bandura and others proposed principle of operant conditioning - Social Learning Theory. 

• person learns behavior through -/+ reinforcement

Social Learning Theory

• key principle was learning by observation (vicarious learning). -

• Introduction of self-efficacy came shortly afterwards

• Renamed Social Cognitive Theory (SCT) in 1986

• Relates to how people change behavior.

• Concept of reciprocal determinism added.

• Behavior is part of a continuous interactive cycle that includes individuals and their social & physical environments. . 

Factors Involved in Changing Behavior

• 1. Individual (internal) characteristics

• 
  

• 2. Environmental (external) factors

• 
  

• 3. Interactive process of reciprocal determinism 

Social Cognitive Theory- individual factors

• Self-efficacy

• Behavioral capability

• Outcome expectations

• Outcome expectancies

• Self-Control

• Emotional coping

social cognitive theory- environmental factors

• Vicarious learning (modeling)

• Situation it takes place

• Reinforcements (+/-)

• Reciprocal determinism

social cognitive theory- reciprocal determinism

Using SCT in Health Promotion

• to boost self-efficancy

• social skill training

• education on risks and outcomes of behavior

• through vicarious learning

Critiques of SCT

• It is very complex.

  Viewed as less of a theory. 

• Components from earlier versions are still around, which makes for a sticky situation.

Social Network Theory

• Key Factor: 

  • Focus on relationships between and among individuals, and how the nature of those relationships influence beliefs and behaviors. Explanation for how random people are connected.

• Set of relationships that an individual participates in:

  • Family networks, work networks, social groups.

• Useful in the study of large groups and understanding how their members relate to others in the group. It provides insight into viral phenomena, such as viral content, the spread of diseases, etc.  

SNT requires research

• People in network = Actors

• Frequency of interactions

• Types of interactions

  • Work, social

Social Network qualities to assess role of a network on health behavior 

• Centrality vs. marginality of individuals in the network

• Reciprocity of relationships

• Complexity or intensity of relationships in the network

• Homogeneity or diversity of people in the network

• Subgroups, cliques, and linkages

• Communication patters in the network

Critiques of SNT

• Limited theory and approach.- Best used with small or defined group interventions. 

• Labor intensive and can be difficult.- i.e., Identifying networks and conducting interviews

Diffusion of Innovations

• Process by which a behavior/technology makes its way into a population and is (or is not) adopted. 

• Diffusion is the process by which innovation is communicated.

• Innovation is seen as the behavior or technology that is seen by the population as new.

DOI and Key Processes

• innovation develpoment

• dissemination

• adoption

• implementation

• maintenance

Innovation Development - doi

• Development of innovation itself.

• planning, formative research and testing

Dissemination- doi

• ‘Active knowledge of transfer’

  • Also, identification of communication channels and dissemination channels.

Adoption- doi

• Referred to as ‘uptake’ of behavior or technology. 

  • Must go through the following stages: 

    • Knowledge of the innovation

    • Persuasion or attitude development (about adopting)

    • Decision (to adopt)

    • Implementation 

    • Confirmation

To Adopt or Not- doi

• The following types of knowledge weigh-in the decision to adopt or not: 

  • Awareness knowledge (innovation exists)

  • Procedural knowledge    (how to use)

  • Principle knowledge (understanding how the innovation works)

Implementation- doi

• Initial use of the practice. 

  • Focus is on improving self-efficacy and skills of attended user

Maintenance- doi

• Focus on sustainability. 

  • This could also be referred to institutionalization of a behavior or technology.

Product Attributes

• Related to speed and extent of diffusion - 

  • Relative advantage

  • Compatibility

  • Complexibility

  • Trialability

  • Observability

Attributes that Might Need Consideration

• effect on social relations

• reversibility

• communicability

• time

• risk and uncertainty

• commitment

• modifiability

Critiques of DOI

• describes multiple constructs and processes embedded within processes as a whole not all constructs are incorporated

• as a theory, hard to test or pro

Social Marketing

Incorporates principles of marketing to help the consumer ‘buy’ a behavior change or product

Principles of Social Marketing

Social Marketing Constructs

Market segmentation- Purpose behind dividing groups for message to be delivered.

Targeting- Needs, attitudes, beliefs, and behaviors all taken into consideration when delivering message.

Critiques of Social Marketing

• Assessing the impact might be difficult. 

  • i.e. Behavior change is the goal

  • 
    

  • .If product introduced is the behavior change, easier to track. 

    • i.e. Use of birth control pills.

Communication OVERALL

• Spoken and written word

• Nonverbal communication including gestures & touch, facial & eye expressions, movement & distance, body signals and artistic symbols, appearance

• Telehealth

• Brief encounters can be effective.

• All behavior is communication.

• You cannot not communicate!

Therapeutic Communication

• Health promotion requires sensitivity to each person’s goals and values.

• Must get to “know” the individual/audience.

• Health promotion requires effective communication.

• Successful health promotion involves interpersonal skills, personal insight, accountability, mutual respect, and supportive working environment.

• Mutual learning experience = mutual respect.

• Is a dialogue- two way street! 

• Respects ethical and cultural differences of participants.

Simple Behaviors to Enhance Therapeutic Communication

• Being present and attending to patient

• Person-centered focus, respect culture

• Friendliness, smiling, use of humor

• Providing comfort, attend to needs

• Allow to “tell their story”

• Conversational interviewing style

• Mutual respect, empathy, confidentiality

• Giving information about health for decisions

Communication Theory

communication is an essential function of any organism, communication is symbolic

Communication channels

• Family, friends, health care practitioners, co-workers, teachers, counselors, faith leaders, coaches, etc. 

• Radio.

• Television.

• Newspaper.

• Flyers.

• Brochures.

• Internet.

• Social media tools (i.e., Twitter, Facebook, and YouTube)

Shannon-Weaver Model

• sender encodes the message

• sender transmits the message through a channel

• message might encounter interference

• receiver gets the message who interprets and decodes

• receiver can either provide feedback or a reaction

Other Factors to Consider about shannon weaver model

context or setting

relationship between sender and reciver

meaning attached to channel

process of encodeing and decoding

social context (group or individuals)

Communication as a Code

how do you speak to certain people or groups

understanding the receiver’s ability to decode

Critiques of 

Communication Theory

• Complicated and difficult to assess effect. 

  • i.e. Levels of impact

• Technology

Community and Organizational Change

• A change in health behavior is dictated first by change in community, system, or organization.

  • ex- cant give people all diabetes education on screening if no facilities to get it done.  

  • This can also support or inhibit these health behavior changes.

Community Mobilization

• community change often affected by political and social movements. 

  • Concept of empowerment. 

  • MADD, Women’s rights, HIV/AIDS activism

Key Issues in 

Mobilizing Community

• Defining community.

• Assessing, and working with, the community’s capacity for mobilizing. 

• Understanding the community agenda and selecting the right issue. 

• Identifying the best strategies for specific communities. 

Organizational and  Systems Change

• Health promotion, disease prevention, and health care accomplished through organizations and systems. 

  • Flip side, as much as can be a facilitator, can also be a barrier. 

  • ex: collaboration between fields. 

Focus of Organizational Change

• assessing and improving group dynamics within organization/ system

• encouraging shared goals and missions

• identifying impediments to change and unfreezing to move forward

• identify and implementing new polices and practices

Critiques of organizational change

• Mobilizing a community, or changing an organization, is a complex process.

• some factors can not be controlled

Culture overall

• A phenomenon that exists as a kind of whole that integrates patterns that links groups or ways of life.

• A relationship between what people know and believe and what they do.

• It is acquired, born with it and learn during your life.

• Shared between members of a group or society.

• Underlies our ability to interpret the world around us into meaningful actions.

Anthropology and Cultural Theory

• Understand the role culture plays in what people, groups, and societies do. 

  • Anthropologists involved in issues of health created new subdiscipline- medical anthropology. 

  • Culture: customs, social institutions, morals, beliefs, laws of a particular nation, people, or social group.