PSYC 3121 - Chapter 3: Health Behaviours

Health promotion

The process of enabling people to increase control over, and to improve, their health. Can be thought of as a sort of philosophy that suggests that wellness is both a personal and a collective achievement.

Health promotion is holistic and takes advantage of the _______________ method

Biopsychosocial

Disease prevention takes a ____________ approach and a negative view of health (absence of disease)

Biomedical

Individual involvement in health

Developing good health habits and continuing to use them throughout our lives

Medical practitioner involvement in health

Teaching people how to achieve this healthy lifestyle, help people at risk

Psychologist involvement in health

Development of interventions for healthy behaviours and change poor behaviour

Community involvement in health

Availability of health information, resources, facilities, etc.

Media involvement in health

Educating people about health risks

Legislation involvement in health

Mandating certain activities or behaviours

Health behaviours

Behaviours that enhance or maintain health

Positive health behaviours promote

Good health (ex: exercise)

Negative health behaviours increase

Risk of illness (ex: smoking)

Treatment related health behaviours are related to

A particular condition and contribute to improved health (ex: getting a mammogram)

Health habits

Behaviours that are firmly established, performed automatically, and very difficult to change. Usually develop in childhood and stabilize around age 11 or 12 through reinforcement learning. (ex: brushing your teeth or wearing a seatbelt

Primary prevention consists of

Measures that are designed to combat risk factors for illness before an illness has a chance to develop. It involves instilling good health habits and changing poor ones.

Two main strategies of primary prevention

Behaviour change methods targeting poor health behaviours.

Preventing development of poor health behaviours.

Health behaviours are important on a general level because

We want people to be healthy and avoid things that compromise their health and wellness

Health behaviours have become especially important because of an increase in chronic disorders, particularly what we can consider ___________ disorders

Preventable (ex: lung cancer, heart disease, illness related to alcohol and drug abuse)

Half of all deaths in Canada are caused by

Preventable behaviours

Maintaining good health behaviours and modifying bad ones can

Reduce death as a result of lifestyle-related diseases

Delay when we die

Allow us to live longer in a way where we are healthy and do not have the constraints of chronic disease

Social cultural and physical factors that can influence the practice of health behaviours include

Socioeconomic factors

Age

Gender

Values

Personal control (locus of control)

Social influence

Personal goals

Perceived symptoms

Access to health care

Place (rural vs. urban)

Supportive environment

Cognitive factors

Socioeconomic factors

Wealth and education associated with better health behaviours

Age factors influencing health behaviours

We are good at practicing positive health behaviours as children, get worse as adolescence, get better into adulthood and decline again in old age

Gender factors influencing health behaviours

Relationship depends on the behaviour (ex: girls eat healthier but are also more likely to practice unhealthy dieting behaviours)

Values factors influencing health behaviours

Likelihood to perform certain behaviours depends on how culturally acceptable they are (ex: it is not culturally acceptable for women to exercise in some places)

Personal control factors influencing health behaviours

If you believe your health is under control, you are less likely to engage in health promoting behaviours

Social influence factors on health behaviours

We can be influenced positively and negatively by family, peers, celebrities, influencers and the media

Personal goals factors influencing health behaviours

The goal you set for yourself can sometimes promote healthy behaviours (ex: running a 5k race)

Perceived symptoms factors influencing health behaviours

People who often choose to control their poor health behaviours when they notice the impact of them (ex; smoker develops a chronic cough)

Access to health care factors influencing health behaviours

Many health behaviours cannot be practiced without access to a health care provider (ex: pap tests)

Place factors influencing health behaviours

More remote locations have less access to health services

Supportive environment factors influencing health behaviours

Living in a community that is conductive to healthy living (ex: with accessible walking trails) promotes health behaviours

Cognitive factors influencing health behaviours

Beliefs of benefit, perceptions of risk (developing certain health problems), and attitudes toward the importance of health behaviours

Barriers to modifying poor health behaviours include

Timing - not knowing when to intervene

incentive

Instability

Different factors may control

The same health behaviour (ex: overeating for some people has a social origin but for others it is emotional)

Factors controlling a health behaviour may also _____ over the history of the behaviour, and across the lifespan

Change

Given the difficulty associated with modifying health behaviours, interventions are often targeted at young people, because

They are the most malleable and likely the most able to be helped

Socialization method proposed for intervening with children and adolescents

Learning from the people around us

Adolescents are vulnerable to poor health behaviours, more likely to take risks, because of this

Interventions with children/adolescents are high priority

Teachable moments

Unanticipated life events that offer important occasions for developing educational insights and lessons, as well as for personal growth

Early childhood is a good time to teach about:

Safety behaviours,

Nutrition,

oral hygiene,

Exercise, and

Appropriate behaviours.

Some teachable moments during adulthood are:

During a pregnancy,

With the addition of a new baby, or

When someone receives a new diagnosis.

Window of Vulnerability

A particular time when adolescents are more likely to develop health related

Junior high is a common one for many behaviours, like

Food preferences, smoking, and drug use

Certain vulnerabilities make the adoption of poor health behaviours even more likely, such as

Low self-esteem, low social support, and low socioeconomic status

Along with children and adolescents, another group considered vulnerable with regards to health behaviours are

Those who are at risk for health problems

Benefits for interventions targeted to at-risk people

Can lead to early detection and will avoid exacerbating a condition.

Knowledge helps people monitor situation and seek care as necessary.

Can develop targeted interventions aimed toward those with particular risk factors.

Allows us to identify other risk factors

Consequences/Problems of interventions with at risk people

Unrealistic optimism concerning vulnerability

Underestimate poor health behaviours; perceive a lower risk

Conversely, can also lead to overreaction and hyper-vigilant behaviour (e.g., removing all fat from diet when told they are at risk for heart disease)

Become defensive, minimize risk, avoid monitoring or availing of services

Ethical issues of interventions with at risk people

Could lead to psychological disturbance (e.g., self-esteem, distress, depression) in exchange for risk-reduction behaviours. May cause family complications, behavioural/emotional problems, and considerable stress

In the past, it was thought that focusing effort on health promotion on seniors was

A waste of time because they're going to pass soon anyways

Now we know that targeting elderly populations is critical so that

They can maintain a good quality of life especially now that our population is aging

Promotion has been focused on emphasizing exercise as a key component to healthy aging, as well as:

Controlling alcohol consumption

Identifying and managing depression

Providing vaccinations

Research shows that by the age of 80, quality of life is heavily determined by

Health habits

Attitudinal approaches

We assume that if we give people information about the impacts of their poor health habits, that will motivate them to change those habits

Communications are more effective when they

Are colourful, vivid, use stories and avoids stats or jargon

Have a credible source

Have strong arguments at beginning and end

Short clear and direct

Are extreme but not too extreme

Communications are effective when they emphasize

The potential risks and benefits of adopting certain habits.

With illness detection behaviours, it is better to emphasize _____, and for health promotion behaviours, it is better to emphasize _______

Risks, Benefits

For a ________ audience, provide only the benefits, while for a ______________ audience, you can provide both the risks and the benefits.

Receptive, Non-receptive

Fear appeals

Use the approach that people will change their behaviour based on fear of what it may do to their health

Criticisms of fear appeals are that

Too much fear alone may not be enough and recommendations for action may also be needed

Message framing can also impact

Effectiveness and persuasiveness of the message

Prospect theory

Uses the idea that the presentation of risk information will change people perspective and actions.

Three ways the prospect theory is used

Loss framed messaging

Gain framed messaging

Messaging related to personal motivation

Loss framed messaging is better for

High risk behaviors

Gain framed messaging is better for

Low risk behaviours

Messaging that is related to personal motivation is effective for

People who are motivated to perform behaviours to maximize rewards (approach oriented)

People who are motivated to do things to avoid losses (ex: avoidance-oriented)

People who are motivated to perform behaviours to maximize rewards (approach oriented) are more motivated by

Gain framed messages

People who are motivated to do things to avoid losses (ex: avoidance-oriented) are more motivated by

Loss-framed messages

Social Cognition Models propose that

Beliefs people hold about health behaviour will motivate their decision to change (or not change) a behaviour.

Social cognition models are in part based on

Expectancy Value Theory

Expectancy Value Theory suggests that

People will choose to engage in behaviours that they believe they will succeed in and have outcomes they value

Expectancy Value Theory also ties into the concept of Self Efficacy:

The idea that we are in control of our practice of behaviours, and more specifically that we are capable of engaging in the behaviours, and that doing so will result in a particular outcome.

If we have high self-efficacy, we will likely have positive beliefs about

Our behaviours and will value them, which means we are more likely to do them

The Health Belief Model

A social cognition model that attempts to explain why people engage in health behaviours.

The Health Belief Model suggests that health behaviours are determined by two main factors:

Perception of Threat

Perceived Threat Reduction

Recently, two newer factors have been added to The Health Belief Model:

Cues to Action

Self Efficacy

Perception of Threat factor (am i at risk?) is influenced by 3 factors itself:

Health values

Perceived susceptibility

Perceived severity of consequences of our behaviour

Perceived Threat Reduction (will this behaviour reduce my risk) is influenced by two factors itself:

Perceived benefits of behaviour

Perceived costs of behaviour

Cues to action

People, events, or things that activate readiness to engage in a behaviour. More related to perceived health threat. (ex: a smoker coughing after mild physical activity)

Self efficacy helps to explain why

Some people may not engage in a behaviour even when the other criteria of the model are satisfied. More related to perceived threat reduction. (ex: i can stop smoking)

Support for The Health Belief Model comes from its success in predicting

Dental care

Breast self exams

Dieting

High risk sexual behaviours

Drinking/smoking intentions

Criticisms of The Health Belief Model come from the fact that

Health beliefs alone are typically a modest determinant, and that it also fails to include emotional responses to perceived risk

Theory of Planned Behaviour

Driven by the belief that health behaviour is directly tied to behavioural intention.

According to the Theory of Planned Behaviour, three factors determine intentions

Attitudes towards the action

Subjective norms (social influence)

Perceived behavioural control (PBC)

Attitudes towards the action

Beliefs about the likely outcomes of the behaviour, and how we feel about that outcome. These beliefs are based on likely outcomes of the action and evaluation, whether positive or negative, of the outcome.

Subjective norms (social influence)

What we think important others think and how important their opinions are to us

Perceived Behavioural Control (PBC)

The extent that we feel we can perform the behaviour and that it will have the intended effect

Evidence to support the Theory of Planned Behaviour includes its ability to predict:

Condom use

Sunscreen use

Oral contraceptive use

Soft drink consumption

Breast cancer screening

Exercise

AIDS related risk behaviours

Social cognitive theories of health behaviour change help us to understand how we can strengthen people's intentions to make health behaviour change. However

Sometimes good intentions are not enough to ensure that the change will be successful.

Implementation intentions

Specific behavioural intentions that highlight the how, when, and where of a behaviour, and also include if-then contingency plans to deal with anticipated barriers to the behaviour

Example of implemetaion intentions

Instead of saying "I will eat healthier", sayingn"I will add one fruit or vegetable to every meal and snack I eat".

Contingency plan

Made in the event something comes up that may disrupt this implemented behaviour. Ex: "if someone asks me out to eat somewhere where healthy foods are hard to find, I will be sure to eat a serving of fruit or veggies before I go"

Implementation intentions have been shown to have a stronger effect on behaviour change than

Simply making general intentions to change behaviour

Some criticisms of Attitudinal and Social Cognitive Approaches are that they

Aren't successful at explaining sudden behaviour changes

Do not predict long term change well

Sometimes lead to defensiveness, avoidance, negative mood and inaccurate risk perception

Provide motivation to change behaviour but not skills required to do so

that Social Cognitive approaches fail to consider

The role that affective variables play in behaviour change

The transtheoretical model of behaviour change, or the stages of change model

Acknowledges that change does not happen all at once, and that there may be multiple stages associated with behaviour change. Outlines 5 stages of changing behaviour and suggests treatment for those in each stage.

The transtheoretical model of behaviour change was originally created to treat

Addictive disorders, like alcohol or drug use, but since then, it has also been applied to other health behaviours and habits

Five Stages of Changing Behaviour

Precontemplation

Contemplation

Preparation

Action

Maintenance

Precontemplation

No intention of changing behaviour, unaware of problem or in denial (even though loved ones may be aware). Only seek treatment if they are pressured to

Contemplation

Realize problem, not ready to commit to changing, weighing pros and cons of change (may last years)