K453: Final Exam Review Class

Q: What are the two key assumptions underlying the study of health behaviour?

1. A substantial proportion of mortality is due to behaviour patterns

2. These behaviour patterns are modifiable

Q: Why do we target behaviour instead of factors like gender or genetics?

A: Because behaviour can be changed, whereas gender and genetics cannot

Q: Why is physical inactivity considered a major public health issue?

It contributes significantly to mortality and places a large burden on the healthcare system

Q: What are the major global consequences of physical inactivity?

• Increased mortality

• High healthcare costs

Physical inactivity is considered one of the top behavioral determinants of health alongside what?

Tobacco, alcohol and and nutrition

Q: What is the key challenge in promoting physical activity?

Intention-behavior gap:

Most people know it’s good for them, but many still do not engage in it

ie knowledge alone does not lead to behavior change

What is the “intention-behaviour gap”?

The disconnect between wanting/knowing to act and actually doing the behaviour

Q: Why is health behaviour not simply a matter of “just do it”?

Because behaviour is shaped by multiple biological, psychological, social, and environmental factors

Why is obesity considered a complex issue?

It is influenced by many interconnected factors, not just individual choice

What is an important consideration when working with individuals trying to change behaviour?

Acknowledge that behaviour change is difficult and influenced by many constraints

What are Social Determinants of health?

Social and economic factors that influence a person’s health

Why do people differ in their ability to engage in health behaviours?

Because of differences in social determinants (e.g., SES, education, racism)

Q: How do social determinants influence physical activity behaviour?

A: They affect access, time, safety, resources, and opportunities

Q: What do the levels of intervention describe?

A: When and how we intervene, and the goal of the intervention

Q: What are the five levels of intervention?

• Health Promotion

• Primary Prevention

• Secondary Prevention

• Tertiary Prevention

• Quaternary Prevention

Q: What is the goal of health promotion? Target? Example?

Enhance existing health and encourage individuals to take control of their health

Target: Healthy individuals with/without health conditions

e.g. SZ patients won’t be fixed by PA but indirectly will help SZ
Older adult social groups

Q: What is the goal of primary prevention? Target? Example?

A: To reduce the risk of developing a health condition before it starts

Target: Healthy individuals w/o disease

e.g. vaccinations

Q: What is the goal of secondary prevention? Target? Example?

A: Early detection in people who are at risk or screened positive

• it is detected early and may still be reversible

Target: Screened-positive or at-risk individuals

e.g. Cancer screening

Q: What does “screened positive” mean in secondary prevention?

A: The condition is detected early but not yet advanced

Q: What is the goal of tertiary prevention? Target? Example?

Manage an established condition and reduce its impact using PA

• Improving function and supporting treatment using PA

Target: Individuals with established conditions

e.g. Cardiac rehab

Q: What is the key difference between primary and secondary prevention?

• Primary = prevent disease BEFORE it starts

• Secondary = detect disease EARLY

Q: What is the key difference between secondary and tertiary prevention?

• Secondary = early detection

• Tertiary = manage established disease

Q: What is quaternary prevention? Target? Example?

A: Reducing harm from treatment

Target: individuals

e.g. PA to reduce fatigue from chemo, lead vest for x-ray

How to remember the 5 different levels of intervention

Promote → Prevent → Detect → Manage → Avoid harm

Q: What do upstream, midstream, and downstream approaches describe?

A: Different levels of public health intervention based on when and how we act

Q: What is an upstream approach?

A: Intervening before a problem starts (prevention, policy-level changes)

Q: What is the goal of upstream interventions?

A: Build health and prevent chronic conditions

Q: What levels of intervention does upstream include?

A: Health promotion + primary prevention

Q: Why is upstream intervention emphasized in public health?

A: It prevents problems before they occur

Q: What is a midstream approach?

A: Early detection and intervention

Q: What level of prevention is midstream most associated with?

A: Secondary prevention

Q: What is a downstream approach?

A: Managing established health conditions and reducing their impact

Q: What level of prevention does downstream correspond to?

A: Tertiary (and sometimes quaternary) prevention

Q: What is the main goal of public health interventions? (stream wise)

A: To move interventions upstream to reduce population risk

Q: Do physical activity guidelines guarantee no disease?

A: No—they reduce risk at the population level but do not eliminate it for individuals

Q: What is the main focus of physical activity in public health?

Focus is on meeting guidelines to reduce risk of chronic illness in the population level

Q: What is the key idea behind public health movement guidelines?

Behaviours should be balanced across the full 24 hours (not in isolation)

Q: What are the three main components of the 24-hour movement guidelines?

• Meet PA guidelines (MVPA + strength)

• Protect sleep

• Reduce sedentary time (especially screen time)

Q: What are the physical activity guidelines for adults?

• ≥150 min/week of moderate-to-vigorous physical activity (MVPA)

• Muscle strengthening ≥2 days/week

Q: What are the sleep guidelines for adults?

• 7–9 hours of good-quality sleep per night

• Consistent sleep/wake schedule

Q: What are the sedentary behaviour guidelines for adults?

• ≤8 hours/day sedentary time

• ≤3 hours/day recreational screen time

• Break up long periods of sitting

Q: What is an operational definition?

A: How a construct is measured, applied, or observed in practice

Q: What is the key difference between conceptual and operational definitions?

• Conceptual = what it means

• Operational = how it is measured

Q: Give an example of conceptual vs operational definition for self-efficacy.

• Conceptual: belief in ability to perform a behaviour

• Operational: rating confidence (e.g., 1–10 scale)

Q: What is self-report as a method of measuring physical activity?

A: Individuals report their own activity (e.g., questionnaires, logs, self-monitoring)

Q: What is a pedometer and what does it measure?

A: A device worn on the waist that tracks steps

Q: What is actigraphy and why is it useful?

A: A device worn on the hip/thigh that objectively measures movement (including sleep and sedentary behaviour) and provides more detailed data than pedometers

What are 3 big ways to measure PA?

1. Self report:

2. Actigraphy

3. Pedometers

Q: Is there a single “best” way to measure physical activity?

A: No—all measures have strengths and weaknesses; it depends on context

Q: What three qualities should all PA measures have?

• Validity

• Accuracy

• Reliability

Q: What is the relationship between psychology and physical activity?

A: It is bidirectional—psychology influences PA, and PA affects psychology

Q: Why is PA adherence considered a psychological issue?

A: Because maintaining behaviour depends on motivation, planning, identity, emotions, and social factors

Q: According to behaviour change theories, what determines behaviour?

A: Behaviour = Why (motivation) + How (self-regulation)

Q: What does “Why” represent in behaviour change?

A: Motivation (e.g., beliefs, attitudes, intentions, self-efficacy)

Q: What does “How” represent in behaviour change?

A: Self-regulation (how we organize ourselves to perform the behaviour)

Q: What is the Health Belief Model (HBM)?

A: A theory explaining behaviour based on perceptions of threat and evaluation of actions.

Threat perception + behavioral evaluation both lead to our decision to act (or not)

Q: What is threat perception in HBM? Q: What two components make up threat perception in HBM? TOP HALF

A: How likely and how serious a health risk feels

• Perceived severity: How scary is this risk?

• Perceived susceptibility: How likely am i to get it?

Q: What is perceived susceptibility?

A: Belief about how likely you are to get a condition

“I sit all day and my family has diabetes… I might actually develop it too.”

Q: What is perceived severity?

A: Belief about how serious the condition is

“Diabetes is serious—medications, complications, affects quality of life.”

Q: What is behavioural evaluation in HBM? What two components make up behavioural evaluation in HBM? BOTTOM

A: Weighing benefits vs barriers of taking action

• Perceived benefits (efficacy)

• Perceived barriers (costs)

Q: What are cues to action?

A: Internal or external triggers that prompt behaviour

“I’m too busy, gym is expensive, and I get tired after work.”

Q: In HBM, what leads to action? FLOW

Threat perception + behavioural evaluation (+ cues to action) = ACTION

Q: What factors influence HBM components? BACKGROUND FACTORS

• Demographics (e.g., age, SES)

• Psychological factors (e.g., personality, social pressure)

DRAWING SHORTCUT (VERY IMPORTANT)

Threat (susceptibility + severity)
+ Evaluation (benefits – barriers)
→ Motivation → Action
(+ cues to action)

Q: What is Protection Motivation Theory (PMT)?

A: A theory that says individuals:

• develop “protective motivations/behaviors” based on

  • threat appraisals (severity/susceptibility) + coping appraisals (self efficacy + response efficacy)

  • Minus the rewards and costs of doing them

  • Which leads to health actions/behaviors (or not)

Q: What makes up threat appraisal in PMT?

• Perceived vulnerability

• Perceived severity

• Intrinsic & extrinsic rewards (reduces threat)

Q: How do rewards affect threat appraisal in PMT?

A: They reduce perceived threat

Example:
“I know skin cancer is serious… but I look good tan and get compliments”
→ threat feels less urgent → less likely to change

Q: Give an example of full threat appraisal.

“I might get skin cancer (vulnerability), it’s serious (severity), BUT tanning looks good (reward)”
→ overall threat is reduced

Q: What determines coping appraisal in PMT?

A:

• Response efficacy

• Self-efficacy

• Response cost (reduces coping)

Q: How does response cost affect behaviour in PMT?

A: It reduces likelihood of action

Example:
“Yeah sunscreen works, and I can use it… but it’s sticky and annoying”
→ less likely to follow through

Q: What is response efficacy?

A: Belief the behaviour will work

“Sunscreen will actually protect me”

Q: What is self-efficacy?

A: Belief you can do the behaviour

“I can remember to apply sunscreen before going out”

Q: What is the full PMT logic?

• Threat = (severity + vulnerability) − rewards

• Coping = (response efficacy + self-efficacy) − cost
  → Protection motivation → Action

Q: What is a key difference between PMT and HBM regarding rewards?

• PMT includes intrinsic & extrinsic rewards (which reduce threat)

  • HBM does NOT include rewards

Example:
“I know it’s risky, but I like how it feels / looks” → only in PMT

Q: What is a key difference between PMT and HBM regarding cost?

A:

• PMT uses “response cost”

• HBM uses “perceived barriers”

Q: How do PMT and HBM differ in structure?

• HBM: Threat + benefits/barriers → action (+ cues)

• PMT: Threat appraisal + coping appraisal → protection motivation → action

Q: What is the Theory of Planned Behaviour (TPB)?

A: Behaviour is predicted by intentions, which are shaped by attitude, subjective norms, and perceived behavioural control

Q: What is the TPB flow of behaviour?

Behavioural beliefs → Attitude
Normative beliefs → Subjective norms
Control beliefs → Perceived behavioural control
→ Intentions → Behaviour

Q: What are the two types of attitudes in TPB?

A:

• Instrumental (cognitive): “PA is good for me”

• Experiential (affective): “PA is fun / enjoyable / helps me de-stress”

Q: Why are both types of attitude important?

A: People often know PA is good (instrumental) but need positive experiences (experiential) to continue

Q: What are subjective norms?

A: Social pressure influencing behaviour

Q: What are the two types of subjective norms?

A:

• Injunctive norms: What people think you should do

• Descriptive norms: What people actually do

Q: What is perceived behavioural control (PBC)?

A: The perceived ability to perform the behaviour (“Do I have control over it?”)

Q: What is the most proximal predictor of behaviour in TPB?

A: Intentions

Q: What determines intentions in TPB?

• Attitude

• Subjective norms

• Perceived behavioural control

Q: What is Social Cognitive Theory (Bandura)?

A: Behaviour is influenced by the interaction between person, behaviour, and environment

Q: What is triadic reciprocal determinism?

A: Three factors (person, behaviour, environment) all interact and influence each other bidirectionally

Q: What are the three components in SCT?

• Person

• Behaviour

• Environment

Q: What is the key idea of SCT regarding behaviour?

A: Behaviour is driven by beliefs in one’s ability to enact change (self-efficacy).

Agentive aspect, my belief in my ability to enact change which is reflected in SE

Q: What are the key constructs in SCT for behaviour change?

• Self-efficacy (SE)

• Outcome expectations (OE)

• Facilitators & barriers (FB)

• Goals
  → Behaviour

Q: What is self-efficacy?

A: Belief in your ability to perform a behaviour

Q: How does self-efficacy influence behaviour?

A: Higher SE → more challenging goals + more likely to act

Q: What are outcome expectations?

A: Beliefs about what will happen if you perform a behaviour

Q: How does self-efficacy influence outcome expectations?

A: SE shapes what we think will happen

Example:

• Low SE → “I’ll fail / something bad will happen”

• High SE → “This will help me”

Q: What are sociocultural facilitators & barriers?

A: Environmental factors that help or hinder behaviour

Example:
“Does my environment support me or get in the way?”

Q: How does self-efficacy affect perception of barriers?

A:

• High SE → see opportunities

• Low SE → see barriers everywhere

Q: What determines the goals we set in SCT?

A:
Self-efficacy + outcome expectations + sociocultural factors

Q: How do goals relate to behaviour in SCT?

A: Goals lead to behaviour