[02.04] Health Behavior Modification V2.pdf

Health behavior modification

What field has had early successes in addressing health issues, promising further research?

Reducing preventable deaths

What did health behavior changes in the 1960s offer hope in achieving?

Tobacco use, sedentary lifestyle, unhealthy diet (associated with childhood obesity), alcohol and drug use

What specific health issues showed promising results in reducing preventable deaths through modification?

42% to 20%

By how much was tobacco use reduced between the 1960s and 1980s, over a 20-year period?

Work sites, hospitals, care settings, schools, communities

In what various settings did the application of theories contribute to theory building and vice versa?

Unhealthy lifestyle, fast food consumption and proliferation, pollution, AIDS prevention and safe sex, poverty associated health problems

What are some major health challenges that still persisted despite early successes?

Overcrowding, lack of safe water, unsafe neighborhoods, limited access to health care

What specific problems are associated with poverty and affect public health?

Evidence provided by science (i.e., evidence-based science)

What has been useful in addressing persistent health issues?

Technology advances

What has grown exponentially in health promotion, generating knowledge and offering rational planning?

Effective and sustainable behavior modification

What did the use of theory in crafting interventions provide?

Globalization, industrialization, and inequalities

What increasingly deters from fulfilling the promise of advances in medicine and health promotion?

Individual determinants of health

What dominated broader social determinants from the 1970s to 1980s?

Holistic approaches or "upstream approaches"

What were calls made for, aside from "downstream approaches," to look into health problems?

Upstream approaches

Which type of approach looks at what is causing health problems?

Downstream approaches

Which type of approach focuses on saving victims of particular inappropriate health behaviors?

Social justice

What is a concern and call for, alongside individual control and self-determination, in health?

Political, economic, and social factors

What factors influence health and are considered equally important as individual control?

Health education in communities, schools, and patient care settings

What explicit interventions were emphasized, based on actual research?

Psychology, sociology, anthropology, communications, nursing, economics, and marketing

What disciplines are involved in the call for interdisciplinarity and collaboration in health behavior modification?

Epidemiology, statistics, and medicine

What other fields is health education dependent on?

Identifying evidence-based interventions and disseminating them widely

What is there an increasing emphasis on in health education and behavior professionals?

Cochrane Collaboration and Centers for Disease Control and Prevention’s (CDC) Guide to Community Preventive Services

What are two examples of evidence-based groups that offer syntheses of behavioral interventions?

Improving diet, diversifying sources of fresh nutrient dense food, adding 5 to 6 servings of fruits and vegetables

What are examples of application of behavior modification in encouraging healthy behavior?

A set of interrelated constructs (concepts), definitions, and propositions that present a systematic view of phenomena by specifying relations among variables, with the purpose of explaining and predicting phenomena

What is the definition of a theory according to Kerlinger (1986)?

A systematic explanation for the observed facts and laws that relate to a particular aspect in life

What is the definition of a theory according to Babbie (1989)?

Principles

What are based on precedent history or research, serving as the basis of hypotheses about how to obtain a desired outcome?

Models

What draw on a number of theories to help understand a specific problem in a particular setting or context, informed by more than one theory as well as empirical findings?

Paradigms

What create boundaries within which to search for answers, delimiting what is important to examine in a field of inquiry?

Logical Positivism, Logical Empiricism

What paradigms reconcile extremes of induction/sensory experience or deduction/standard for verification or confirmation?

Constructive paradigms (e.g., social construction theories)

What type of paradigm relies more heavily on induction, a process of discovery rather than imposing organized theoretical positions?

Ethnography, phenomenology, grounded theory

What are examples of specific research approaches within constructive paradigms?

Meta-theory

What approach applies logical positivism but also looks into further understanding of interrelationships between the individual and social environment, predominantly used to explain health behavior with a concern for solving human problems?

Transtheoretical Model (TTM), Health Belief Model (HBM), Socio Ecological Model (SEM)

What are the three most common theoretical models for health behavior modification?

Socio Ecological Model (SEM)

Which of the three most common theoretical models has the least studies and needs further testing and more up-to-date research?

Transtheoretical Model (TTM) or Stages of Change Model

What model is also known as the Stages of Change Model, developed in the late 70s, 80s, and 90s?

Stages of Change, Process of Change, Decision Balance, Self-Efficacy

What are the core constructs of the Transtheoretical Model?

Precontemplation

In which TTM stage is there no intention to act within the next 6 months, perhaps due to not knowing, being uninformed, or being taken over by fear?

Contemplation

In which TTM stage does an individual intend to take action within the next 6 months, showing some awareness of pros and cons, but without a firm action yet?

Preparation

In which TTM stage does an individual intend to take action within the next 30 days, having weighed pros and cons, and has a clear intention?

Action

In which TTM stage have some behavioral steps been taken or overt behavior notably changed, such as reducing cigarettes or shifting brands?

Maintenance

In which TTM stage is an individual working to prevent relapse, typically lasting 6 months to 5 years?

7% after 5 years, 42% after a year

In cigarette smoking, what is the reduced relapse rate after 5 years, compared to the relapse rate after a year of no smoking?

Termination

In which TTM stage is there no temptation to relapse and a presence of some level of confidence that behavior will not revert?

Not always linear (can be circular, staggered, or drawn in different courses)

Describe the ideal flow of behavior change through the TTM stages.

The covert and overt activities people use to progress through stages

What is the TTM Process of Change?

Consciousness raising

Which process of change strategy focuses on increasing awareness of causes, consequences, and cures?

Dramatic relief

Which process of change strategy involves increased emotions, then reduced affect (relief)?

Self re-evaluation

Which process of change strategy uses values clarification, role models, and imagery techniques to move people?

Environmental reevaluation

Which process of change strategy involves personal affects on the social environment through empathy training, documentaries, testimonials, and family intervention?

Self liberation

Which process of change strategy involves the belief one can change, commit, and recommit, requiring willpower, like new year's resolutions or going public with a goal?

Social liberation

Which process of change strategy involves an increase in social opportunities or alternatives, empowering deprived or underserved individuals through advocacy, empowerment, or policy changes?

Counter-conditioning

Which process of change strategy involves learning healthier behaviors such as relaxation, assertion, desensitization, nicotine replacement, or positive self-statements?

Stimulus control

Which process of change strategy focuses on removing cues for unhealthy habits, through environmental reengineering or self-help groups?

Contingency management

Which process of change strategy provides consequences, such as punishments (e.g., fines) or rewards, for health behavior?

Helping relationships

Which process of change strategy combines caring, trust, openness, acceptance, and support for health behavior change, such as rapport building, counselor calls, or buddy systems?

Decisional balance

What TTM concept involves weighing the pros and cons of particular interventions?

Self-efficacy

What TTM concept refers to confidence in coping without relapsing, stimulating action and helping in coping?

Temptation

What TTM concept refers to the most common challenges to maintaining behavior change?

Negative affect, emotional distress (e.g., stress eating), positive social situations (e.g., smoking/drinking for bonding), and craving

What are the most common temptations identified in the TTM?

Smoking, diet, cocaine use, exercise, condom use, and sun exposure

For what health behaviors have TTM studies suggested practical applications?

Intrapersonal or individualistic factors, Interpersonal factors, Institutional or organizational factors, Community factors, Public policy factors

What are the five levels of influence for health-related behaviors in the Health Belief Model (HBM)?

To understand why people accept preventive health services or do not adhere to care regimes

What is the primary use of the Health Belief Model?

Perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cues to action, self-efficacy

What are the key constructs of the Health Belief Model?

Belief of likelihood of getting the disease

What is "perceived susceptibility" in HBM?

Feelings about the seriousness of contracting an illness if untreated

What is "perceived severity" in HBM?

Believing an action can reduce a threat (e.g., savings from quitting smoking, pleasing family, getting vaccinated)

What is "perceived benefits" in HBM?

Impediments to undertaking recommended behaviors (e.g., too costly, inconvenient, time-consuming)

What are "perceived barriers" in HBM?

Cues to action

What HBM construct refers to triggers for particular actions, other than perceived susceptibility or expectation?

Bodily event, environmental event, media publicity, posters, leaflets, flyers

What are examples of "cues to action" in HBM?

Conviction that one can successfully execute the behavior required to produce the outcomes

What is "self-efficacy" in HBM, quoting Bandura (1997)?

Feel threatened (perceived susceptibility and severity), feel the action will benefit them (perceived benefit), feel competent to overcome barriers and take action (self-efficacy)

What three things must people feel for behavior to change, according to HBM?

Believe their susceptibility is low because they have not been affected, did not see the benefit of early detection, believed that surgery causes cancer to spread

What specific beliefs about mammography were found in older African Americans?

Modesty

What was identified as a barrier for Asian American women getting mammograms?

Educational content for community-based interventions, e.g., campaigns focused on benefits of mammograms and early detection

How can knowledge of beliefs be applied in informing interventions?

Telephone counseling and printed information materials

What methods were used to target individuals who admitted to being fearful about mammograms?

Health workers put them in contact with other community resources (e.g., organizations providing services)

What action was taken when reasons for not getting mammograms were structural (too costly) rather than belief-based?

Increased mammography use

What has generally been the outcome of studies on interventions based on HBM?

Threat is not always a clear predictor (though clear with heightened threat), little is known about cues to action

What challenges remain for HBM in predicting health behavior modification?

When threats and benefits are high, and barriers are low

Under what conditions will HBM have greater influence in its application?

Outcome expectations

What is the main determinant of Social Cognitive Theory (SCT)?

Beliefs about the likelihood and value of the consequences of behavioral choices

What are "outcome expectations" in SCT?

Reciprocal determinisms

What SCT concept describes how environmental factors influence individuals and groups, who in turn influence environments and regulate their own behavior?

Personal ability to perform behaviors that bring desired outcomes

What is "self-efficacy" in SCT?

Beliefs about ability of a group to perform concerted actions that bring desired outcomes

What is "collective efficacy" in SCT?

Observational learning, Incentive Motivation, Facilitation, Self-regulation, Moral disengagement

What are other concepts included in Social Cognitive Theory?

Moral disengagement

What SCT concept refers to distancing oneself from moralizing?

Critical social theory, organizational theory, social psychological theories of power, and Foucault’s work on power

What theories does the Empowerment Approach combine?

To bridge the knowledge-practice gap to foster the empowerment of Public Health Nurses (PHNs) to challenge inequalities, disrupt the status quo, and raise awareness

What is the recognized need for practice within the Action Theory approach?

Recognizing the existence of oppression and its impact on nursing care delivery

What is the first step towards creating an emancipatory healthcare environment?

Freedom and power are determined by a willingness to accept responsibility for the future

What does Foucault attest about freedom and power?

Awareness of how health theories have been applied in broader communities

What should begin with the self and end with larger spheres of influence regarding health theories?

Capacity building, having resources, giving information, feedback on performance

What interventions would contribute to a structure of power where workers have power to be productive, with higher motivation and commitment?

An interpersonal process through providing resources that enable others to set and reach goals AND an outcome translated as autonomous decision-making, self-determination, and feelings of self-worth

How is empowerment described as a concept, especially at the community level?

Fosters autonomy, participation, better feelings, and self-efficacy, leading to better healthcare

What is the benefit of combining social and behavioral theories in empowerment?

A process of enhancing feelings of self-efficacy amongst organizational members through identification of conditions that foster powerlessness

How do Conger and Kanugo (1998) define empowerment?

Feeling powerless

What was something that contributed to whether nurses would help deal with health issues?

Participatory action strategies

What type of strategies are central to Action Theory?

Personal power, relationship with a multidisciplinary team, empowerment, and feeling right about oneself

What did Friere and Habermas, Fulton’s 1997 study reveal as important for nurses?

More control, took responsibility, and acted over their own practice

What happened when nurses perceived themselves as having access to resources, information, opportunities for career development, and support in their work?

Perception of workplace empowerment and accountability

What are two indicators of work effectiveness?