HCS Exam 4 PPT Material

_________ influences health outcomes

behavoir

The ______ and ______ environment influence behavior

physical

social

Personal health behavior

behavior that primarily affect the individuals own health

Health-related behavior

behavior that affects the health of others

Health-protective behavior

behavior undertaken with a specific concern for the health of others (e.g., policy, programs)

Socially-oriented health protective behavior

undertaken to improve the social conditions that contribute to health

Multi-level health promotion

individual level

interpersonal level

community level

societal level

Who does health promotion?

public health and education professionals

What are health promotion processes?

Services to improve health and behavior

Strengthen the environment

Facilitate healthful behavior

Health promotion change process

teaching, counseling, communication, social marketing, organizational change, community development and social capital, advocacy

Teaching (health promotion change process)

processes of facilitating change in knowledge, beliefs, attitudes, skills, and behaviors through information and learning activities in a group setting

Counseling (health promotion change process)

processes of facilitating change in knowledge, beliefs, attitudes, skills, and behaviors through information and learning activities with one individual or in a small group

Communication (health promotion change process)

Process of developing and delivering informative and persuasive messages

Social marketing (health promotion change process)

The application of marketing principles to achieve specific behavioral goals for a social good

Organizational change (health promotion change process)

The process by which desired goals of organizations are reached

Community development and social capital (health promotion change process)

Actions designed to improve community involvements, resources, programs, policies, and functioning; social support; social capital

Advocacy

Actions deigned to gain political commitment, policy support, and social acceptance for goal, program, policy, or practice. Advocacy actions include lobbying, organizing, and activism

What do health behavior theories help us do?

Guides the search for reasons why people do or do not engage in certain health behaviors

What is the process of studying health behavior theory? (4 steps)

1. understanding health and behavior

2. needs assessment

3. intervention development

4. interpretation of results

How would you define health behavior theories?

Set of concepts, definitions, and propositions that explain or predict an event or situation by illustrating relationships between variables

What are the 2 type of health behavior theories?

Explanatory theory

Change theory

Value-expectancy theories definition

individuals are more likely to engage in behavior if they believe that performing the behavior is likely to lead to desirable outcomes

*falls under explanatory theory*

Stage theories definition

view behavior change as a process and postulates that, in the process of moving from inaction to action, people pass through a series of stages

*falls under change theory*

What are examples of questions that would be asked when studying explanatory theory?

Why? What can be changed?

What are examples of questions that would be asked when studying change theory?

Which strategies? Which messages? Assumptions about how a program should work

Expectancies and reinforcements are __________

subjective

What are the different types of value-expectancy theories

1. rotter's social learning theory

2. theory of reasoned action (TRA) and theory of planned behavior (TPB)

3. health belief model

4. social cognitive theory

5 components of rotter's social learning theory

1. personality represents an interaction of the individual with the meaningful environment

2. human personality is learned

3. personality has a basic unity

4. motivation is goal directed

5. people are capable of anticipating events

Rotter's Social Learning Theory central notion

through life experiences, people develop expectations concerning the types of outcomes that are most likely to occur if they perform a particular behavior in a particular situation

Under rotter's social learning theory, individuals choose behavior that ....

maximize the perceived likelihood of obtaining desired outcomes while minimizing the likelihood of undesired ones

Predictive formula for rotter's social theory

BP = f(E,RV)

BP - behavior potential

E - expectancy

RV - reinforcement value

Behavior potential

the likelihood of engaging in a particular behavior in a specific situation

Expectancy

the subjective judgement of how likely the behavior is to lead to a specific outcome, or reinforcer

Reinforcement value

another name for the outcomes of our behavior; refers to the desirability of these outcomes

Psychological situation

represents Rotter's idea that each individuals experience of the environment is unique

Who developed the theory of reasoned action (TRA)?

Martin Fishbein and Icek Ajzen - in the 1970's

What does the TRA posit?

Behavioral intention is the best predictor of behavior - a persons self-rated likelihood of performing the specified behavior

What are two factors that influence behavioral intention?

Attitude toward behavior, subjective norms or social pressures associated with the behavior

*only things that directly influence behavioral intention - all other factors are external factors*

How do external factors influence behavioral intention?

Through their effects on attitudes and subjective norms

What are the 4 value expectancy theories?

1. Rotter's social learning theory

2. Theory of reasoned action and theory of planned behavior

3. Health belief model

4. Social cognitive theory

In the USPHS sponsored free TB screening, research suggested people were more likely to get an X-ray if:

1. they thought they were at risk for TB

2. thought they were susceptible to TB

3. if they believed there was a benefit in early detection of TB

The origination for HBM (health belief model) happened with what study?

In the 50's when USPHS offered free TB screening using x-rays in mobile clinics

Behavior is an outcome of...

1. Perceived susceptibility - the degree to which a person feels at risk for a health problem

2. Perceived severity - the degree to which a person believes the consequences of the health problem will be severe

3. Perceived benefits - the positive outcomes a person believes will result from the action

Elements of HBM

1. Perceived barriers - the negative outcomes a person believes will result from the action

2. Cues to action - an internal/external event that motivates a person to act

3. Self-efficacy - a persons belief in his or her ability to take action

The HBM primarily focuses on _____ decisions and does not address social and environmental factors, and assumes that individuals make ______ assessments

individual

rational

The HBM assumes that everyone has equal access to, and equivalent level of, information from which to make the ________

rational calculation

Social cognitive theory (SCT) was developed to ______ and _____ behavioral change

predict

understand

SCT expands on _______

value expectancy theory

emphasizes the interplay between individual and environmental factors

SCT asserts that people learn not only from their own ________, but by observing the actions others and the _____ of those actions

experiences

benefits

Cognitive variables

1. knowledge - objectively verifiable truth

2. belief - what is considered to be true

3. attitude - evaluation about the goodness or badness of an object or thing

4. social norms - the prevalence of behaviors within a society or group

5. value - evaluation of the relative importance of various factors, concepts and actions

reciprocal determinism

The dynamic interaction of the person, behavior, and the environment in which the behavior is performed

Behavioral capability

knowledge and skill to perform a given behavior

Expectations

anticipated outcomes of a behavior

Self-efficacy

confidence in one's ability to take action and overcome barriers

Observational learning

behavioral acquisition that occurs by watching the actions and outcomes of others behavior

Reinforcements (SCT)

responses to a person's behavior that increase or decrease the likelihood of reoccurrence

Quality of life is a consequence of illness, which is measured on 5 dimensions. What are they?

1. physical functioning

2. role and social functioning

3. psychological functioning

4. general health perceptions

5. other functions when assess the tx of a specific disease/condition (ie vision/glaucoma)

Outcomes research parameters include 3 main parts. What are they?

1. Clinical - medical events that occur as a result of a disease or treatment

2. Economic - direct, indirect, and intangible (pain) costs that are compared to the consequences of medical therapy alternatives

3. Humanistic - consequences of disease or treatment on patients functional status or quality of life along different dimensions (physical and psychological)

What are the 3 components of contemporary clinical decision making?

1. Clinical outcomes - mortality/survival, morbidity

2. Economics outcomes - cost-of-illness analysis, cost-minimization analysis, cost-benefit analysis, cost-effectiveness analysis, cost-utility analysis

3. Humanistic outcomes - QoL, patient preferences, patient satisfaction, willingness-to-pay

ICER

Incremental Cost Effectiveness Ratio

(Change in cost)/(Change in outcomes)

PRO per FDA guidelines

Patient reported outcomes - any report of the status of a patients health condition that comes directly from the patient, without interpretation of the patients response by a clinician or anyone else

The US _____ launched a guidance on ____ measures to support labeling claims in 2009

FDA

PRO

The US _____ and the ______ are increasingly being asked to review and approve clinical trial protocols that incorporate PRO measures as primary or secondary endpoints

FDA

European Medicines Agency (EMA)

Health-related quality of life (HRQL)

specific to health - it is restricted to only those aspects of life that may change due to illness

Quality of life (QOL)

a broad ranging concept - an individuals perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards, and concerns (WHO definition)

Both ______ and ______ focus on respondents perceived quality of life

QOL

HRQL

QOL and HRQL represent a truly patient centered approach - this is especially important in ______

chronic diseases

It is in the nature of HRQL or health states to ____

change over time

Predicting the HRQL of a specific individual is nearly _____ because cultural, social, and even spiritual factors may influence patients perception

impossible

What are two benefits of patient-reported outcomes or HRQL measures?

1. using evidence to inform the decision making process regarding alternative txs, not only to inform physicians regrind tx outcomes but also to assist policy makers to better allocate HC resources

2. gathering needed data about patients functioning and well-being to alert clinicians to problems that require intervention and ultimately improve patient outcomes

Know the clinical research phase studies as outlined in slide 15

...

Reliability is about ______ of the metric

consistency

Validity is about measuring ________ to measure

what is intended

Implications of value expectancy theories

1. generally better for explaining behavior, but not very explicit about how to change behavior, except for providing information

2. knowledge is important in each theory, but different knowledge is emphasized in each

3. some attitudes may be more amenable or more resistant to change. Only TRA/TPB emphasize the relative importance of certain cognitive variables

4. the term motivation is used in TRA/TPB to reflect attitudes

5. there is more than one expectancy values theories bc there are a lot of different kinds of behavior

6. expectancy values theories can be applied not only to personal health behavior, but also to health-related and health protective behavior

HBM focuses on _________ behavior

health care seeking

TRA/TPB are perhaps the most ______ applicable of the behavior theories

generally

Stage theories are based on .....

the idea that behavior changes is a natural process that typically involved passing through a series of stages

Effective interventions of stage theories

1. ID where a person is in the change process

2. tailor intervention tot he persons "readiness" to change

3. movement through stages require different time tables for different individuals

What are the 2 types of stage theories?

1. trans-theoretical model of change (TTMC)

2. Precaution adoption process model (PAPM)

The TTMC integrated various processes of ______ behavior change, characterizing the stages ______ typically passed through when changing or modifying behavior

individual-level

individuals

The TTMC theory was originally focused on ______ but has been applied broadly

addiction

Stage assessments help identify the __________ of the target population

educational needs

Interventions can be tailored and delivered according to the _____

stage

Evaluation of an intervention can be measured in terms of _______

stage advancement

There are 5 distinct stages in the stages of change model. What are they?

1. precontemplation - does not intend to take action

2. contemplation - thinking about change some time in the future

3. preparation - ready to do something

4. action - has done something

5. maintenance - made a significant change in their behavior in terms of health risk

People in the pre-contemplation stage have _________ in changing the behavior int he foreseeable future

no particular interest

Education for people in the pre-contemplation stage targets _________ of the risks of current behavior and/or benefits of the target behavior

raising awareness

People in the contemplation stage are _____ that change may be beneficial and are ______

aware

considering it

Education for people in the contemplation stage targets _____ towards action

persuasion

People in the preparation stage plan to ______ in the near future, usually defined as ______

take action

the next month

Education for the preparation stage may focus on ________ needed to establish lasting change

skills and resources

People at the action stage have __________ to their behavior in the past 6 moths

made specific modifications

Education for the action stage may focus on _______ and ways to sustain the behavior

management strategies

People at the maintenance stage work to _______ and consolidate the changes they have made

prevent relapse

Education for the maintenance sage focuses on ________ and long-term behavior maintenance

coping with relapse

termination

completed the process of behavior change

a person in the termination phase has truly ______ of behavior change. The poor health behavior is no longer part of that persons life.

completed the process

Many people do not make it to the ______ stage, but rather stay in the _____ stage

termination

maintenance

Self-efficacy

a persons confidence to change a specific behavior

environmental re-evaluation

when a person thinks about how something they do affects others in their social environment