health promotion week 3

health promotion

interventions to increase health behaviors ( personal and collective)

• policy makers: implement policies and deploy resources to facilitate change at all levels

• clinicians and health psychologists - understand why ppl engage in unhealthy behaviors and design and administer interventions to change behavior

• close relations and community - encourage each others habits

• individuals - adopt and practice good heabits

Barriers to Health behaviors

1. behavior linked to emotions

   1. addictive/ pleasurable behaviors

   2. health msgs may cause distress and defensiveness, or distort one’s perceived risk,

2. behaviors can be independent

   1. need to treat behaviors 1 at a time due to various causes, various triggers

3. unstable

   1. Causes of the same health behaviour can change over time such as childhood vs adult etc —> difficult to maintain gd behaviours & prone to non-compliance or relapses

•Health Belief Model

1. Belief in health threat (knowledge) 

   1. general health value - i am concerned abt my health

   2. specific beliefs about vulnerability - i am at risk

   3. belief abt disorder severity

2. Belief in health behavior’s capability to reduce threat 

   1. measure can be effective 

   2. benefit of measure exceeds costs 

1+2 —> health behaviour

assumes attitude to bahaviour link

limitations 

• ignores importance of self efficacy (I can)

• belief —> behaviour link is not straightforward. Even if they believe they should stop smoking, they may not do it. They may require multiple nudges

•Theory of Planned Behaviour

1. attitudes towards action (i know)

2. subjective norms regarding action (i know)  

   1. normative beliefs (social pressure) 

   2. motivation to comply

3. perceived behavioural control (I can) 

1+2+3 —> behavioral intention (nudge) —> health behaviour 

•Self-determination Theory

•Commitment to change requires both ability (“I can change”) & autonomous motivation (“This is what I want for myself”)

•Personal choice increases commitment to change

•E.g., A woman who changes her diet because she personally wants to will be more committed to change than because her doctor told her to.

attitudes towards action + subjective norms + perceived bahvioural control + personal autonomy (I want) —> behavioural intention (nudge) —> health behaviour

•Implementation Intentions

•Explicit links between intention & behaviour

•Abstract intentions are translated into concrete plans.

•E.g., After I finish my dinner, I will go out for a 30-minute walk.

•Provides further “nudges” towards actually executing the behaviour.

attitudes towards action + subjective norms + perceived bahvioural control —> behavioural intention (nudge) + Implementation intentions (further nudge) —> health behaviour

Behavioural Change Interventions

•Individual-level: Cognitive Behavioral Therapy (CBT)

•Individual-level & beyond:

•Health Messages

•Social & Community Groups

•Social Engineering

Cognitive Behavioral Therapy (CBT)

1. self monitoring (identify the discriminative stimuli)

   1. learning to discriminate target behaviour (associated situations and sensations)

   2. chart behavior (time, location, people, feelings b4 and after incident)

2. stimulus control

   1. removing the discriminative stimuli (the situational urges by modifying location and conditions of behaviour)

3. self control of behaviour

   1. cognitive restructuring: modify internal dialogues to be motivating instead of demotivating

   2. self reinforcement (positive and negative reinforcement, positive and negative punishment)

   3. behavioral assignments: homework, and providing continuity (eg: logging progress and making arrangement for follow up)

4. social skills and relaxation training

   1. to decrease the anxiety/ stress that causes poor habits

   2. social skills and assertiveness training

   3. deep breathing and muscle relaxation exercises

5. relapse prevention

   1. identify situations that may lead to relapse in advance and learn coping skills 

   2. stimulus control intervention - remove environmental cues 

   3. constructive self talk 

   4. esp imp due to abstinence violation effect - loss of control when person has violated self imposed rules 

evaluating CBT 

•CBT is highly methodical; involves a set of very detailed & concrete techniques that address various aspects of a problem.

•The techniques in CBT are flexible; easy to adapt and tailor to individual’s problems & abilities.

 •The skills are translatable across various health behaviours

•The individual takes on a pro-active role; increases self-efficacy.(theory of planned behaviour)

•Requires strong commitment & effort from the individual

health messages

1. fear appeals - ppl may change to reduce fear

   1. only works for moderate fear?

   2. TB: may cause defensiveness

   3. Tannenbaum et a: Fear appeals work; positively impact attitude, intentions and behaviours

      No evidence that they backfire

   4. effective when efficacy statement included (fear + what can i do?

2. message framing - ppl will change depending on if positive (benefit. gains) or negative outcomes (discomfort/ loss) are emphasized

   1. positive framing works on general health practices

   2. negative behavior works better for behaviors with uncertain outcomes (health screenings) and with 1 time behaviors (vaccination) (illness detection)

3. educational appeals - gd information elicits change

   1. should emphasize case histories, be colourful, accessible language, clear, direct, emphasize main point at start and end, tailor to demographic culture 

   2. communicators shld be expert prestigious, trustworthy, similar to audience

   3. if audience is receptive, just emphasize positives. if not, emphasize pos and neg elements

behaviour modification

social support (family school and community) 

workplace interventions (gym, healthy food offerings) 

social engineering - modify the environment in ways that affect behaviour 

policies - strive for efficiency, but always hv trade offs. Must balance multilevel perspective to avoid creating another bigger problem