Module 7: Health Behavior Models and Behavior Change

Health Behavior Models and Behavior Change

Health Behaviors

  • Definition: Actions taken by individuals to maintain, attain, or regain good health and prevent illness.

Quick Write

  • Activity: Identify three behaviors considered most important for maintaining or attaining health and justify your choices.

Causes of Death Affected by Health Behavior

  1. Heart disease

  2. Cancer

  3. Chronic lower respiratory diseases

  4. Accidents

  5. Stroke

Theories of Health Behavior and Behavior Change

  • Overview of key models:

    • Health Belief Model

    • Theory of Planned Behavior

    • Stage models of behavior change

    • Transtheoretical Model

Health Belief Model (HBM)

  • Structure of the HBM:

    1. Susceptibility

    2. Severity

    3. Benefits

    4. Costs (Barriers)

    5. Cues to Action

    6. Self-efficacy

  • Susceptibility:

    • Definition: Belief about personal risk of experiencing a condition or disease.

    • Examples:

    • "The flu is very common and very contagious."

    • "I’ve never gotten the flu before—I have a really healthy immune system."

  • Severity:

    • Definition: Belief about the seriousness of the condition and its consequences.

    • Examples:

    • "Influenza is a serious disease that can lead to hospitalization and even death."

    • "I wouldn’t mind spending a week on the couch binge-watching Netflix."

  • Perceived Benefits:

    • Definition: Belief that taking a specific action would reduce risk or seriousness of negative outcomes.

    • Examples:

    • "The flu shot dramatically decreases your odds of getting the flu."

    • "The flu shot doesn’t really work."

  • Perceived Costs/Barriers:

    • Definition: Beliefs about the obstacles that might prevent taking recommended health actions.

    • Examples:

    • "The flu shot could prevent me from missing a week of classes this winter, and it will just take a minute to stop by the student health center."

    • "The flu shot doesn’t really work anyway, and I’m too busy."

  • Updated HBM Constructs:

    • Inclusion of Cues to Action and Self-efficacy

Bone Density Screening Intervention (HBM-Based)

  • Issue: Women under 65 are often not screened for bone density, despite the risk for osteoporosis.

  • Population: U.S. women aged 50–65 with no prior bone density test.

  • Design: Longitudinal experimental study (N = 203); treatment group received free BMD exam after baseline, control group after 12 months.

  • Measures: Changes in knowledge, self-efficacy, and health beliefs assessed using HBM constructs.

Osteoporosis Health Belief Scale

  • Constructs Used:

    • Perceived Susceptibility: "You are more likely than the average person to get osteoporosis."

    • Perceived Severity: "It would be very serious if you got osteoporosis."

    • Perceived Benefits (calcium): "Taking in enough calcium prevents problems from osteoporosis."

    • Perceived Barriers (calcium): "Eating calcium-rich foods requires changing your diet, which is hard to do."

Key Findings of Bone Density Screening Intervention

  • Treatment group showed increased perceived susceptibility to osteoporosis.

  • Improved calcium intake and use of preventive medication.

  • Conclusion: Personal experience with BMD exams enhanced health beliefs and prevention behaviors.

Evaluation of Health Belief Model

  • Strengths:

    • Includes useful constructs focused on individuals' beliefs.

  • Weaknesses:

    • Assumes behavior is rational, ignoring emotions.

    • Ignores social context of behavior.

    • Most relevant for preventative behaviors only.

Theory of Planned Behavior (TPB)

  • Key components:

    • Attitudes: Positive or negative feelings about engaging in behavior, influenced by beliefs about outcomes.

    • Subjective Norms: Perceived expectations and beliefs of significant others.

    • Intentions: Determination to engage in a behavior.

    • Perceived Behavioral Control: Belief about the ease or difficulty of performing behavior.

Evaluation of TPB

  • Strengths:

    • Addresses social aspects of health behaviors through norms.

    • Recognizes the role of individual beliefs about their ability to enact change.

  • Weaknesses:

    • Predicts intentions rather than actual behaviors.

    • Acknowledges that intention does not always lead to action.

Transtheoretical Model of Behavior Change (TTM)

  • Analyzes stages and processes individuals go through while attempting to change behavior. Initially developed for treating addictive disorders.

Stages of Change

  1. Precontemplation: No intention to change behavior.

  2. Contemplation: Aware a problem exists but no commitment to action.

  3. Preparation: Intent to take action.

  4. Action: Active modification of behavior.

  5. Maintenance: Sustaining change where new behavior replaces the old.

  6. Relapse: Returning to old patterns of behavior.

Techniques for Successful Change

  1. Providing information about the problem.

  2. Assessing personal feelings about the problem.

  3. Committing to actions.

  4. Substituting alternative behaviors.

  5. Avoiding risky situations.

  6. Rewarding self for success.

  7. Seeking help from trusted individuals.

  8. Experiencing feelings about the problems.

  9. Changing the environment.

  10. Increasing alternatives for healthy behaviors in society.

Evaluation of TTM

  • Strengths:

    • Practical since it does not force techniques into one theory.

    • Realistic as it acknowledges varying stages of change.

  • Weaknesses:

    • Does not provide new techniques.

    • Individuals may remain in the same stage for different reasons.

Common Themes Across Theories

  • Knowledge, perceptions, motivations, skills, and social context are essential in understanding behavior change.

  • Behavior is significantly influenced by cognition; knowledge is crucial but alone insufficient for behavior change.

Course Paper: Learning Objectives

  • Apply health psychology theory and research to everyday life.

  • Evaluate effectiveness of behavior change strategies related to personal health behaviors.

  • Develop skills to collect data and report findings.

  • Practice critical thinking and analytical writing.

Paper Description

  1. Choose a personally meaningful health-related behavior for change.

  2. Track baseline data for one week without alterations.

  3. Submit a proposal for behavior change after baseline tracking.

  4. Implement the plan for 2-3 weeks.

  5. Write a 3-4 page report analyzing the experience using course concepts.

  6. Follow formatting guidelines (12-point font, double-spaced).

Example Health Behavior Changes

  • Increasing sleep quantity or quality.

  • Increasing exercise.

  • Decreasing substance use.

  • Increasing fruit and vegetable intake.

  • Practicing stress management.

Techniques for Behavior Change

Cognitive Behavioral Approaches

  • CBT focuses on:

    • The behavior itself.

    • Conditions eliciting and maintaining the behavior.

    • Factors reinforcing it.

Self-Monitoring

  • Track frequency, stimuli, and consequences of target behavior.

  • Effective for short-term change but often leads to transient effects.

Goal Setting

  • Translates intention into action. Goals should be:

    • Objective: Observable and measurable.

    • Reasonable: Reflective of current life context.

    • Behavior-Based: Focused on specific actions.

  • Examples:

    • "Turn off screens by 10 PM on weeknights."

    • "Walk for 10 minutes twice this week."

SMART Goals

  • Components:

    • Specific, Measurable, Attainable, Relevant, Time-bound.

Quick Write – Drafting Your Goal

  • Choose a health behavior for change and draft a goal that meets the criteria of being objective, reasonable, and behavior-focused.

Behavior Modification Techniques

Stimulus Control

  • Poor health habits result from environmental cues.

  • Interventions can include:

    • Removing cues that trigger undesirable behaviors.

    • Introducing signals supporting healthy choices.

Operant Conditioning

  • Mechanism:

    • A behavior followed by rewarding or punitive feedback from the environment influences future behavior.

Cognitive Restructuring

  • Definition: Therapeutic process aimed at identifying and challenging maladaptive thought patterns.

  • Importance: Negative thoughts may lead to unhealthy behaviors.

  • Steps:

    1. Identify maladaptive thoughts.

    2. Challenge the validity of these thoughts.

    3. Replace with more positive and realistic thoughts.

Examples of Health-Related Cognitive Distortions

  1. All-or-Nothing Thinking: "If I can’t exercise for an hour, it’s not worth doing at all."

    • Restructured Thought: "Even a short workout is beneficial."

  2. Overgeneralization: "I failed to stick to my diet once, so I’ll never succeed."

    • Restructured Thought: "One setback doesn’t mean I can’t achieve my goals."

  3. Catastrophizing: "If I skip one day of tracking, I’ll completely lose control."

    • Restructured Thought: "Missing one day doesn’t mean I’ve failed; I can pick up where I left off.

Cognitive-Behavioral Strategies for Health Behavior Change

  • Incorporate at least three of the following strategies in your paper:

    • Self-monitoring to observe behavior and context.

    • SMART goals for clear and realistic targets.

    • Stimulus control to modify the environment.

    • Operant conditioning to reinforce progress.

    • Cognitive restructuring to challenge unhelpful thoughts.