Midterm Review

What are the explanatory theories?

• health belief model (HBM)

• theory of planned behavior/reasoned action (TPB/TRA)

• precaution adoption process model (PAPM)

• social cognitive theory (SCT)

What are the change theories?

• trans-theoretical model (TTM)

• socio-ecological model (SEM)

• motivational interviewing (MI)

What are the categories of health-related behavior?

1. preventative

2. illness

3. sick-role

What are preventative health behaviors?

any activity undertaken by individuals who believe themselves to be healthy for the purpose of preventing or detecting illness in an asymptomatic state (self-protective behaviors too)

What are examples of preventative health behaviors?

• diet

• exercise

• smoking cessation

• vaccination

• contraception

What is illness behavior?

occurs when people notice the symptoms of illness in themselves, any activity undertaken of an individual who perceives himself to be ill, to define the state of health, and to discover a suitable remedy

What are examples of illness behaviors?

• taking medicine

• avoidance of physical or social activity

What is sick-role behavior?

when people have consulted a healthcare professional, received a diagnosis, and begun a course of treatment, management of chronic illness

Which category of health-related behavior involves dependent behavior and leads to some degree of exemption from usual responsibilities?

sick-role behavior

What are examples of sick-role behavior?

• use of therapies/sick leave

• taken care of

What are categories of health-related actions?

• primary (preventing the disease)

• secondary (early detection & treatment)

• tertiary (managing existing disease)

What is primary action to health?

actions to preventing contracting an illness or disease

What are examples of primary actions to health?

• vaccination

• masks

• education (diet, exercise, safety)

• screenings in health populations

• laws (seatbelts)

What is secondary action to health?

actions to detect and treat illness or disease early

What are examples of secondary actions?

• screenings (mammograms, colonoscopies, BP)

• physicals

• diagnostic testing

What is tertiary action to health?

actions to reduce impact of illness or disease

What are examples of tertiary actions?

• medications

• chemotherapy

• rehabilitation

• support

What are social determinants of health?

non-medical factors that impact health and longevity

What are examples of SDOHs?

• SES

• culture

• geographic location

• access to healthcare

• education

• skill

• gender

• beliefs/religion

• attitudes/values

What is motivational interviewing?

person-centered counseling style exploring ambivalence and targeting motivation to promote change

What is ambivalence?

the existence of mutually conflicting feelings about thoughts or ideas, mixed feelings/emotions, conflicting thoughts

What are examples of ambivalence?

• wanting to quit drinking, but only see friends at club

• excited about graduating, but scared for jobs/missing friends/ schedule change

• wanting to gym, but not knowing what exercises to do

What are the general principles of MI?

READS

What is READS?

• roll with resistance

• express empathy

• avoid argumentation

• develop discrepancy

• support self-efficacy

What is rolling with resistance?

expecting some extent of resistance (blaming, excusing, arguing, challenging, denial); psychological judo → use your client’s momentum to your advantage; involve client in behavior change

What skills are needed to roll with resistance?

• reflections (simple)

• summaries

• change talk (exploring ambivalence)

What is expressing empathy?

the capacity to understand or feel what another is experiencing; acceptance and understanding another’s perspective and feelings neutrally, without judgement or evaluation in any way

What skills is needed to express empathy?

reflections (simple)

What is avoiding argumentation?

arguing can invoke defensiveness which is not conducive to change; resistance → argumentation

What skills is needed to avoid argumentation?

• open-ended questions

• summaries

• affirmations (past successes)

What is developing discrepancy?

lack of compatibility with the way things currently are and the way a person would like things to be; allows client to become “unstuck” from ambivalence; encourage clients to clarify goals and explore consequences of behavior to create goals for change

What skills are needed to develop discrepancy?

• open-ended questions

• change talk (exploring ambivalence)

• reflections (double-sided)

What is supporting self-efficacy?

person’s belief in their ability to carry out a specific action or behavior; attitude: “can do” = make vs “can’t do” = break to behavior change

What skills are needed for self-efficacy?

• affirmations (past successes)

• assessment ruler (confidence)

What is the MI toolbox of skills?

OARS

What is OARS?

• open-ended questions

• affirmations

• reflections

• summaries

  • eliciting change talk

  • assessment ruler

How are open-ended questions helpful?

• helps client feel safe and able to express oneself

• provides more information

• puts client in an active role

How are affirmations helpful?

acknowledge a client’s strengths, efforts, and positive traits to build confidence and rapport; genuine, direct statements of support

How are simple reflections helpful?

restating/paraphrasing what a person has said without adding anything additional. can shift emphasis (client: i don’t have anything to say; counselor: you’re not feeling talkative today)

How are double-sided reflections helpful?

reflection on both sides of a person’s ambivalence, develops empathy (client: it would be so hard to stick to a meal plan; counselor: on one hand….., on the other hand…, your self-esteem may improve if you start walking)

How are summaries helpful?

communicate that what has been said and that you understand the big picture, helps keep sessions on track, provides an opportunity to empathize, after summary → am i getting this correct/what else would you add?

How might a counselor elicit change talk?

DARN

What is DARN?

• desire statements about preference for change (i want to/would like to/wish)

• ability statements (i could/can/might be able to)

• reasons statements given about considering a change (i would probably feel better if/that would give me more energy to)

• need statements about what is important (i ought to/really should/have to)

How would you elicit change talk vs sustain talk with desire?

• change → i want to lower my cholesterol so i can live to see my grandkids

• sustain → i don’t want to eat vegetables

How would you elicit change talk vs sustain talk with ability?

• change → i could use the stairs at work

• sustain → i can’t walk that far

How would you elicit change talk vs sustain talk with reason?

• change → i would probably feel better if i ate this

• sustain → eating this won’t lower my A1C

How would you elicit change talk vs sustain talk with need?

• change → my doctor told me i need to limit my sodium, i really should

• sustain → i don’t have a problem with my heart

What are examples of DARN questions?

• desire statements about preference for change (what would you want, like, wish, hope…?)

• ability statements (what is possible…? how could you do…? what are you able to do…?)

• reasons statements given about considering a change (what are the benefits of…? what would get better if…?)

• need statements about what is important (how important is this change? how much do you need to do this?)

What are assumptions in SEM?

• behaviors are influenced by intrapersonal, social, cultural, and physical environment variables

• variables are likely to interact

• need to address variables at multiple levels to understand and change health behaviors

What are the core principles of SEM?

1. multiple levels of factors influence health behavior

2. influences interact across levels

3. multi-level interventions may be most effective in changing behavior

4. SEM are most powerful when they are behavior specific

What are the constructs/levels of SEM?

1. intrapersonal

2. interpersonal

3. institutional/organizational

4. community

5. societal/policy

6. physical environment***

7. cultural affiliations***

Individual/Intrapersonal

• most basic level in health promotion

• focus is on individual characteristics that influence behavior

• requires the explanation of, and the influence over the behavior of individuals

What are factors at intrapersonal level?

• knowledge

• attitudes

• beliefs

• motivation

• personal physical characteristics

  • gender identity, age, race, height

Interpersonal

• assumes individuals exist within, and are influenced by social environment

• opinions, thoughts, behavior, advice and support of surrounding people influences one’s feelings and behaviors

• the individual has a reciprocal effect on those people

What does interpersonal include?

• family members

• coworkers

• friends

• health professions

• spiritual leads

Institutional/Organizational

• provides direct services for individuals

• sets standards for member

• has characteristics

• may collaborate with other organizations

  • worksite

  • places of worship

  • schools

  • healthcare providers

Community

social networks

• norms

• can be defined by:

  • neighborhood

  • ethnicity

  • social safety net programs

  • health professionals, community workers

Societal/Policy

local, state, federal policies and laws that regulate or support health actions and practices

• attention to interpretation and enforcement

  • how does one internalize the “no smoking on campus” regulations?

Physical Environment

man-made or natural environment, medium for transmitting disease, cause for stress, safety/danger, enabler for health behavior

Culture

a shared system of learned norms, beliefs, values and behaviors that differ across populations defined by region, nationality, ethnicity or religion

What are assertions of the institutional, community, and societal constructs?

multidimensional approaches should be used to promote healthy behaviors, supplement educational approaches with efforts to change the social and physical environment

What are the three constructs of the ecological perspective?

1. these initiatives are at the heart of public health approaches to preventing and controlling disease

2. they explore how social systems function and change and how to mobilize community members and organizations

3. they address individual, group, institutional and community issues

What is reciprocal causation?

the notion that an individual’s behavior is influenced by the environment / that the environment is influenced by individual behavior

What is the HBM designed to do?

to understand people’s use of preventive health services

Which level of influence does HBM focus on?

individual / intrapersonal

What does HBM attempt to do?

explain and predict behaviors, useful in changing behaviors, focuses on attitudes and beliefs

When was the HBM developed and by who?

1950s / Hochbaum and Rosenstock

What are the assumptions of HBM?

based on the supposition that a person will take a health related action if that person:

• feels the health condition is serious

• feels that are not immune to health condition

• feels that health condition is preventable

• has a positive expectation

• believes they can successfully take a recommended action

What is the premise of HBM?

value expectancy model, people will engage in healthy behavior if they value an outcome, if they think that behavior will result in a desired outcome

What are the constructs of HBM?

1. perceived susceptibility

2. perceived severity

3. perceived benefits

4. perceived barriers

What are cues to action?

strategies to activate “readiness” (bodily events, environmental events)

What aspect of HBM has not been in systematic studies?

cues to action

Self-Efficacy

confidence in one’s ability to take action

When can you use TTM?

• smoking cessation

• substance use

• HIV risk reduction

• weight loss

• stress management

What are the stages of change in TTM?

• pre-contemplation

• contemplation

• preparation

• action

• maintenance

• relapse*

• termination*

What can PAPM be applied to?

• osteoporosis prevention

• mammography

• colorectal cancer screening

• hepatitis b vax

• radon home testing