Health Behavioral Theories Part 3

Aspect of Health Belief Model (HBM)

• Background

  • Originated in the 50’s from the work of U.S. Public Health Service (USPHS)

  • USPHS sponsored free Tuberculosis screening using x-rays in mobile clinics

• Research suggested it came down to ‘Motivation

  • People were more likely to get an X-ray if:

    • they thought they were at risk for TB

    • thought they were susceptible to TB

    • If they believed there was a benefit in early detection of TB

Behavior is an outcome of…

• Perceived Susceptibility: The degree to which a person feels at risk for a health problem

• Perceived Severity: The degree to which a person believes the consequences of the health problem will be severe

• Perceived Benefits: he positive outcomes a person believes will result from the action

• Perceived Barriers: The negative outcomes a person believes will result from the action

• Cues to Action: An internal/external event that motivates a person to act

• Self-Efficacy: A person’s belief in his or her ability to take action

Aspect of perceived susceptibility

• def: beliefs about the chances of getting a condition

• potential change strategies: define what populations are at risk and their levels of risk; tailor risk info based on person’s characteristics or behaviors; help person develop an accurate perception of his/her own risk

Aspect of perceived severity

• def: beliefs about the seriousness of a condition and its consequences

• potential change strategies: specify the consequences of a condition and recommended action

Aspect of perceived benefits

• def: beliefs about the effectiveness of taking action to reduce risk or seriousness

• potential change strategies: explain how, where, and when to take action and what the potential positive results will be

Aspect of perceived barriers

• def: beliefs about the material and psychological costs of taking action

• potential change strategies: offer reassurance, incentives, and assistance; correct misinformation

Aspect of cues to action

• def: factors that activate “readiness to change”

• potential change strategies: provide “how to” information, promote awareness, and employ reminder systems

Aspect of self-efficacy

• def: confidence in one’s ability to take action

• potential change strategies: provide training and guidance, use progressive goal setting, etc

What are the limitations of HBM

• The HBM primarily focuses on individual decisions and does not address social and environmental factors

  • Assumes individuals make rational assessments

    • The degree of risk

    • The costs and benefits associated with engaging or not engaging in the preventive or health-oriented behavior

• The HBM assumes that everyone has equal access to, and an equivalent level of, information from which to make the rational calculation

Aspect of Social Cognitive Theory (SCT)

• Developed to predict and understand behavioral change

  • Expands on value expectancy theory – emphasizes the interplay between individual and environmental factors

  • Asserts that people learn not only from their own experiences, but by observing the actions of others and the benefits of those actions

  • Environment, people, and behavior are constantly influencing each other

What are the cognitive variables?

• Knowledge: Objectively verifiable trut

• Belief: What is considered to be true

• Attitude: Evaluation about the goodness or badness of an object or thing (e.g., cigarettes are bad; smoking is enjoyable)

• Social Norms: The prevalence of behaviors within a society or group (e.g., 28% of high school seniors smoke)

• Value: Evaluation of the relative importance of various factors, concepts, and actions (e.g., I value the opinions of my best friend; I value my health too much to start smoking)

Aspect of reciprocal determinism

• def: the dynamic interaction of the person, behavior, and the
  environment in which the behavior is performed

• potential change strategies: consider multiple ways to promote
  behavior change, including making adjustments to the environment or influencing personal attitudes

Aspect of behavioral capability

• def: knowledge and skill to perform a given behavior

• potential change strategies: promote mastery learning through skills training

Aspects of expectations

• def: anticipated outcomes of a behavior

• potential change strategies: model positive outcomes of healthful
  behavior

Aspects of self-efficacy

• def: confidence in one’s ability to take action and overcome barriers

• potential change strategies: approach behavior change in small steps to ensure success; be specific about the desired change

Aspects of observational learning

• def: behavioral acquisition that occurs by watching the actions and outcomes of others’ behavior

• potential change strategies: offer credible role models who perform the targeted behavior

Aspect of reinforcements

• def: responses to a person’s behavior that increase or decrease the likelihood of reoccurrence

• potential change strategies: promote self-initiated rewards and
  incentives

What are the implications of value expectancy theories?

• Expectancy values theories are generally better for explaining behavior but not very explicit about how to change behavior, except for providing information

• Knowledge is important in each theory, but different knowledge is emphasized in each.

• Some attitudes may be more amenable or more resistant to change

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

• The term motivation is used in TRA/TPB to reflect attitudes

• There is more than one expectancy values theories
  because there are a lot of different kinds of behavior.

  • HBM focuses on health care seeking behavior

  • TRA/TPB are perhaps the most generally applicable

• Expectancy values theories can be applied not only to personal health behavior, but also to health-related and health protective behavior

Aspect of stage theories

• Stage theories are based on the idea that behavior changes is a natural process that typically involved passing through a series of stage

• Effective interventions

  • Identify where a person is in the change process

  • Tailor intervention to the person’s “readiness” to change

  • Movement through stages require different timetables for different individuals
    

What are the 2 type stage theories

1. Trans-theoretical Model of Change (TTMC)

2. Precaution Adoption Process Model (PAPM)

What is TTMC?

integrated various processes of individual-level behavior change, characterizing the stages individuals typically passed through when changing or modifying behavior

What are the implications of TTMC?

• The theory was originally focused on addiction but has been applied broadly

• Stage assessments help identify the educational needs of the target population

• interventions can be tailored and delivered according to the stage

• Evaluation of an intervention can be measured in terms of stage advancement

What are the 5 stages in the stage of change model?

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

Aspects of Pre-contemplation

• People at this stage have no particular interest in changing the behavior in the foreseeable future

• Education targets raising awareness of the risks of the current behavior and/or benefits of the target behavior.

Aspects comtemplation

• People at this stage are aware that change may be beneficial and are considering it

• Education targets persuasion towards action

Aspects of preparation

• People at this stage plan to take action in the near future, usually defined as the next month

• Education may focus on skills and resources needed to establish lasting change.

Aspects of Action

• People at this stage have made specific modifications to their behavior in the past six months

• Education may focus on management strategies and ways to sustain the behavio

Aspects of Maintenance

• People in this stage work to prevent relapse and consolidate the changes they have made

• Education focuses on coping with relapse and long-term behavior maintenance

Aspects of Termination

• Termination-completed the process of behavior change

  • A person in this stage has truly completed the process of behavior change

  • The poor health behavior is no longer a part of that person’s life

  • Many people do not make it to this stage but stay in the maintenance stage

What are the 3 abilities to move from one stage to another?

• Self-Efficacy

  • A person’s confidence to change a specific behavior

• Environmental re-evaluation:

  • When a person thinks about how something they do affects others in their social environment. (e.g., a mother who is motivated to quit smoking when she learns of the dangers of second-hand smoke)

• Counter conditioning:

  • When a person learns something to do that substitutes for the behavior they want to change and can be called on to counter the impulses to engage in the less desirable behavior (e.g., developing the habit of exercise instead of smoking)

Aspects of stage tailoring

• “Staging” can provide valuable information about readiness to change, enabling the tailoring of interventions to stage.

• Different interventions are used for individuals or groups at different stages to target the knowledge and skills they will need to move to the next adjacent stage.

Aspect of change dynamics

While the stages of
change model is depicted as a linear process, behavior change is NOT always linear and can cycle through adjacent stages over time

What is the Precaution Adoption Process Model (PAPM)?

An alternative to the TTMC, the Precaution Adoption Process Model (PAPM) is based on decision theory and useful in situations when deliberate action is required

What are the 7 stage of PAPM?

1. Unaware

2. Unengaged

3. Deciding about Acting

4. Deciding not to Act

5. Deciding to Act

6. Acting

7. Maintenance
   

Aspect of PAPM Stage one: Unaware of the issue

Not likely that a person will change a particular behavior or habit it they are not aware that there is a problem associated with it

Aspect of PAPM Stage two: Unengaged by Issue

Know but unengaged about doing anything with the problem or issue

Aspect of PAPM Stage three: Deciding about acting:

An intermediate stage in which people who are aware of and engaged in a health behavior problem, begin to make some decision as to whether they intend to do something about it.

Aspect of PAPM Stage four: Deciding not to act

• Speaks for itself—after thinking about it, people decide they are not going to do anything

• This stage takes people ‘out of the loop’ of behavior change

Aspect of PAPM Stage Five: Deciding to Act

• Speaks for itself

• After thinking about it, a person decides to take action. (not the same as actually taking action

Aspect of PAPM Stage Six: Actin

• making the action decided upon...for the first time

• Not yet maintaining

Aspect of PAPM Stage Seven: Maintenance

• Adopted from the same stage in the TTM model

• Refers to continuation of the behavior

Does the PAPM have a termination stage?

No

True or false: According to the Trans-theoretical Model of Change, the progression through stages of changes must be linear?

False