Health Behavior Change: History & Models

The study of health behavior change has evolved over the decades, influenced by various psychological and social models. Initially, the Health Belief Model (HBM) was developed in the 1950s to explain and predict health-related behaviors by considering individual perceptions of risk and benefits. Subsequently, the Transtheoretical Model (TTM) emerged in the 1980s, introducing stages of change that individuals go through when modifying behavior, including precontemplation, contemplation, preparation, action, and maintenance. Furthermore, Social Cognitive Theory (SCT) emphasized the role of observational learning and self-efficacy in behavior change, highlighting the importance of social influences and personal beliefs.

These models provide a foundation for understanding the complexities of behavior change, guiding interventions aimed at promoting healthier lifestyles across diverse populations.

what

Models of Health Behavior Change

  • Health Belief Model (1950s) → tuberculosis was a health concern

    • The earliest and most studied model

    • Vans around to test for tuberculosis, people werent participating and wanted to know why people didnt come

    • Suggests that people need to percieve a health threat and beleive that the recommended behavriors with reduce the threat

  • There are two reasons why someone might not engage with a behavior

    • Believing that the behavior is a threat

      • If there is no threat, there is not change

      • Come from valuing your health, increase susceptibility belief (knowing ur vulnerable to negative health conseuqeuesnces), severity belief (knowing that negative health behavior is bad enough to care about it)

  • Belief that the behavior will be able to reduce the threat

    • ex. quitting smoking to be healthier

    • you must belief that the behavior will be effective to health

    • you have to belief that the benefits outweigh the barriers

      • believing that going to the gym outweighs being tired

Application of the HBM with Mammograms

  • Health Threat Belief

    • increase health value → saying that those people want to live longer for their family

    • severity belief → “breast cancer is deadly” make people feel susceptible and threatened

  • Belief Behavior can reduce threat

    • Effective: saying that mammograms decrease breast cancer death

    • Benefits outweighing cons: Early detections have better outcomes

  • More women who were given the health belief model went to get a mammogram

Evaluating the HBM

  • Strengths:

    • Uses helpful constructs (ideas) to helo change behavior

    • Focuses on peoples beliefs and not just statistics to increase behavior change

  • Weaknesses:

    • Assumes people have the skills to alter behavior

    • Ignores social context of many health behaviors → condom use, takes two and power differences

    • Most relevant for preventative behaviors → getting tests, exercist, eating healthy

      • not substance abuse

Theory of Planned Behavior → most widely test

  • To change behaviors you must change intentions

    • You must change attitudes to change intentions

  • Suggests that attitudes, social norms, and control with indluence the behavioral intentions

  • Attitudes → Are you in support the behavior or no? (2 concepts) More broad

    • Beliefs about the outcome: understanding that if you stop drunk driving you won’t risk an accident

    • Evaulations of the outcome: you want people to want to live

  • Norms → two aspects

    • Norms: expectations and beliefs of people who matter

    • Motivation to Comply: People will have different motivation to comply with norms

      • rebellious people who want to smoke

  • Control → How much control you have to change the behavior, specific strategies to change behavior

    • thinking about can you do it

    • Capable of doing it: You need to feel capable of doing the behavior

    • Will have the intended effect: You need to belief that the action will have the intended effect

Main Idea

  • You have intentions that will control the engagment in the behavior

    • Attitudes (2 types) , Norms, and Control will impact your intentions

Example

  • Behavior: Exercise

  • Intentions:

    • Norm: Societal pressure to be fit, people living longer

    • Attitudes: Being fitter, stronger, healthier

    • Control: Introducing easier workout to make you feel capable of working out → instilling a feeling a control

Evaluation

  • Strengths:

    • Incorporates social aspect of health behaviors (norms)

    • doesnt’t assume people want to be healthy (attitudes)

    • Includes peoples beleifcs about their ability to change (control)

  • Weakness:

    • Predicts intentions → not behavior

    • People don’t always act on their intentions

Transtheoretical Model (Stages of Change Theory)

  • Helps with substance abuse

  • Recognizes that people are at difference stages of change, with different strategies at each step

  • Transtheoretical → seeing what works to allow for behavioral change

Ten Successful Techniques:

  1. Giving info about the problem

  2. Having people assess how they feel about the problem

  3. Committing to act

  4. substituting alternative behaviors

  5. avoiding risky situations

  6. reward self for success

  7. get help from trusted friends

  8. experiencing feelings about problems

  9. change the environment

  10. increase avialable alternative for healthy behaviors in society

Path to Behavior change

  • Not everyone is on. the same path of behavior change

    • Precontemplation: No intentions to change

    • Contemplation: Being aware with no plan to change

    • Preparation: Intentions to act

    • Action: Active modification of behavior

    • Maintenance: Sustain change is happening

    • Relapse: Engaging in the same behavior

  • Different Steps are associated with different techniques

Evaluation

  • Strength

    • Practical: doesnt force techniques into onto theory

    • Realistic: understands that people are at different stages

  • Weaknesses

    • Doesn’t give new techniques

    • People might be in the same stage for different reasons

Cognitive-Behavioral Therapy Approaches

  • Discusses effective approaches to modify health behaviors

  • Self monitoring

    • Looking at how much youre engaging with that behavior and why

    • set goals

      • should be measurable and long term and short term

    • effects can be short lived

  • operant conditioning and contracting- rewards and punishment

    • Conditioning → reinforcement and punishment, there should be a variable schedule (no punishment and reward all the time)

    • Contingency Contracting → creating a contract with someone to reward and punish

  • Stimulus Control:

    • Environment leads to those poor health habits

    • Stimulus Control

      • Remove the problem stimuli from the environment

      • Add new things to be the “discrimintative stimulus” (the stimulus that will promote the behavior

        • Ex. laying out your outfit to make you wake up