Health Beliefs and Models of Health Behaviour Change
DTN2007/NUR3013 Health Psychology Lecture
Health Beliefs and Models of Health Behaviour Change
Instructor: Dr Peter Tay
Topics and Learning Outcomes
Lecture Topics:
The role and theories of health beliefs
Sociocognitive models of behaviour change
Stage models of behaviour change
Criticisms of behaviour change models
Integrating the models
Key Learning Outcome:
Explain health behaviours using the principal psychological models of health behaviour.
Understanding Health Beliefs and Behaviour
Definition of Health Beliefs
Mistra & Kaster (2012):
“What people believe about their health, what they think constitutes their health, what they consider the cause of their illness, and ways to overcome an illness.”
Importance of Understanding Health Beliefs
Mistra & Kaster (2012):
“Our thoughts and emotions follow our beliefs and create the attitudes, assumptions, expectations, and behaviors that determine how we react to life events and what we think is possible.”
“Similarly, health beliefs influence health behaviors and health outcomes.”
Key Theories for Health Beliefs (Ogden, 2012)
Attribution Theory (related: Health Locus of Control)
Perception of causality in health matters.
Risk Perception
Involves unrealistic optimism, risk compensation, and self-affirmation.
Motivation and Self-Determination Theory
Distinguishes between intrinsic vs. extrinsic motivation.
Self-Efficacy
Belief in one's capabilities to perform actions required for managing health.
Health Belief Theories – Attribution Theory
Original Theories
Understanding causality in health behavior: social world predictability and controllability (Heider, 1958).
Covariation Theory (Kelly, 1971):
Key Aspects:
Distinctiveness
Consensus
Consistency
Herzlich (1973):
“Health is regarded as internal to the individual and illness is seen as something that comes into the body from the external world.”
Redefined Theory – Dimensions
Internal vs. External
Internal: My failure to lose weight is due to willpower vs. External: Lack of healthy food in my neighborhood.
Stable vs. Unstable
Stable: I always fail to stick to my diet vs. Unstable: I fail to stick to my diet now due to current workload.
Global vs. Specific
Global: My failure to commit to my diet is like my inability to commit to relationships vs. Specific: Inability to commit to my diet is unlike other commitments.
Controllable vs. Uncontrollable
Controllable: I can manage my weight vs. Uncontrollable: I cannot manage it.
Note: Attribution to Cause vs. Solution:
Example: My failure to lose weight is due to willpower (cause), but dietician will help me lose weight (solution)
Health Belief Theories – Risk Perception
Components (Ogden, 2012)
Unrealistic Optimism
Inaccurate perceptions of risk and susceptibility.
Risk Compensation
Example: “I can overeat sweets because I run all the time.”
Self-Affirmation Theory
Protecting self-integrity; behavior may be defensive when sense of self is threatened.
Examples:
“My grandfather smoked and lived to 90, so I won’t die young.”
“My grandfather died young from lung cancer, so I’m likely to have lung cancer as well.”
Health Belief Theories – Self-Determination Theory
Motivation to Change
Deci and Ryan (1985, 2000):
Intrinsic Motivation: Engaging in behavior that fulfills personally relevant goals.
Extrinsic Motivation: Engaging in behavior for external rewards or to avoid punishments.
Key Needs and Types of Motivation
Amotivation:
A state of indifference; absence of intent to engage (Bartholomew et al., 2018).
External Regulation:
Engaging in activity for tangible gains (Bartholomew et al., 2018; Haerens et al., 2015).
Introjected Regulation:
Activity driven to attain self-worth or avoid guilt (Bartholomew et al., 2018; Haerens et al., 2015).
Identified Regulation:
Accepting and identifying with the goals underlying the activity (Markland & Tobin, 2010; Milyavskaya & Koestner, 2011).
Intrinsic Regulation:
Engaging purely out of interest (Markland & Tobin, 2010; Milyavskaya & Koestner, 2011).
Definitions of Needs:
A = Autonomy; C = Competence; R = Relatedness
Health Belief Theories – Self-Efficacy
Definition:
“The belief in one’s capabilities to organize and execute the sources of action required to manage prospective situations” (Bandura, 1986).
Relation to Behavior:
E.g., Confidence in stopping smoking is related to “I can stop smoking.”
Eating more vegetables relates to “I can eat more vegetables in the future.”
General Self-Efficacy Scale (GSE)
10-item Scale:
Scoring: Find the sum of all items; scores range from 10-40.
Higher scores indicate higher self-efficacy.
Sociocognitive Models of Behaviour Change
Major Models
Health Belief Model of Behavior (HBM)
Protection Motivation Theory of Behavior (PMT)
Theory of Reasoned Action (TRA)
Theory of Planned Behavior (TPB)
Characteristics of Sociocognitive Models
They examine predictors of health behaviours.
They adopt a continuum approach to behavior and change.
Emphasize rationality; individuals weigh costs and benefits.
They consider social context and social cognitions.
Health Belief Model of Behaviour (HBM)
Origin
Developed by Rosenstock in 1966, later expanded by Becker et al.
Purpose
To predict preventive health behaviours and responses to treatment.
Applications
Examples include:
Screening for hypertension
Screening for cervical cancer
Genetic screening
Exercise behaviour
Decreased alcohol use
Dietary changes
Smoking cessation
Components of HBM
Background Factors:
Socio-demographic factors (education, age, sex, race, etc.).
Perceptions of Threat:
Perceived susceptibility and severity of illness.
Expectations:
Perceived benefits minus perceived barriers to action.
Cues to Action:
Media, personal influence, and reminders that prompt behavior.
Self-Efficacy:
Belief in one's capability to perform the action.
Support and Criticisms of HBM
Support
Research supports barriers and benefits for individual factors.
Accurate predictions for behaviors such as vaccinations and dental visits.
Criticisms
Habits may not be conscious choices.
Lack of standard measurement for components.
Ignores socio-economic variables and emotional factors.
Excludes outcome expectations and self-efficacy changes.
Protection Motivation Theory of Behaviour (PMT)
Origin
Developed by Rogers in 1975 and 1985
Purpose
To extend HBM to include emotional components, specifically fear.
Applications
Cancer prevention, exercise, smoking/alcohol abuse, adherence to medical regimes, and vaccinations.
Support and Criticisms of PMT
Support
Behavioral intentions well predicted by self-efficacy, severity, and response effectiveness.
Criticisms
Similar to HBM: lacks standard measurement, ignores socio-economic and environmental factors.
Theory of Reasoned Action (TRA)
Focus
Examines predictors of behavior; relationship between attitudes and behavior (Fishbein, 1967; Fishbein & Ajzen, 1975).
Key Components
Behavioral intentions are influenced by:
Attitudes (beliefs and evaluations of outcomes).
Subjective norms (beliefs about others’ attitudes toward the behavior).
Theory of Planned Behaviour (TPB)
Basis
An extension of TRA that adds components of perceived behavioral control.
Key Components
Changing attitudes, subjective norms, and perceived behavioral control influences the intention and behavior.
Applications and Criticisms of TPB
Applications
Predicts various health behaviors including blood donation, safe sex practices, and exercise for the elderly.
Criticisms
Overlap between attitudes, control, and behavioral intentions.
Assumes all decisions are rational; ignores emotion’s role in decision-making.
Stage Models of Behaviour Change
Overview
Consider people in different ordered stages of behavior change.
Describe movement through stages, which include:
Transtheoretical Model (TTM): Prochaska & DiClemente (1982).
Includes stages: Precontemplation, Contemplation, Preparation, Action, Maintenance.
Example of a smoker's progression through stages is provided:
I am happy being a smoker → I should think about quitting → I will stop smoking → I have stopped smoking for five months.
Properties of Stage Models
Classification defining different stages.
Predictable ordering as individuals progress.
Similar barriers among individuals in the same stage.
Different barriers for individuals at different stages.
Health Action Process Approach (HAPA)
Origin
Developed by Schwarzer (1992).
Characteristics
Includes temporal elements; acknowledges motivational and maintenance stages.
Emphasizes self-efficacy as a determinant of behavior.
Support and Criticisms of HAPA
Support
Self-efficacy is the best predictor of behavioral intentions across contexts.
Criticisms
Ignores the role of social and environmental factors in cognition.
Precaution Adoption Process Model (PAPM)
Origin
By Weinstein et al. (1988).
Characteristics
Focuses on deliberate actions to reduce health risks with attention to pre-action stages.
Support and Criticism of PAPM
Support
Offers evidence-based research; better than SOC for pre-action stages.
Criticism
Less extensively tested than TTM; both models lack longitudinal data.
Integrating Models
Purpose
To combine the best of various models to predict and change health behaviours effectively.
Insights from Integration
Investigates overlaps across models and incorporates variables accounting for variance in health behaviours (Fishbein et al., 2001).
Effectiveness in Models Integration
Examples of effective integrations include predictions of exercise behavior through PMT and SOC and dietary behavior through TPB and SDT.
Issues in Integrating Models
Debate over small vs. large models: small models may be easier to test but miss important variables, while large models may overlook focused aspects but are less research-friendly.
The challenge of theorists' unwillingness to allow their model to be subsumed by another.
Review Key Terms – Week 5
Health belief
Social cognitions
Locus of Control
Causal Attribution/Covariation model
Risk perception & unrealistic optimism
Stages of Change (SOC) model
Health Action Process Approach (HAPA)
Health Belief Model (HBM)
Protection Motivation Theory (PMT)
Theory of Reasoned Action (TRA)
Theory of Planned Behaviour (TPB)