2. THEORIES IN HEALTH BEHAVIOR CHANGE PROMOTION AND HEALTH

Question 1

Behavior Change Theories

Emphasizes the interaction & interdependence between individual and environmental factors at all levels of a health problem.

Answer 1

ECOLOGICAL PERSPECTIVE

Behavior affects and is affected by multiple levels of influence

Question 2

Behavior Change Theories

autonomic dysreflexia develops in individuals with a neurologic level of spinal cord injury at or above the

Answer 2

sixth thoracic vertebral level (T6).

Question 3

Behavior Change Theories

(ecological) determinants → behaviors → disease outcomes

example

Answer 3

no walkability area → sitting at home watching TV → obesity

Question 4

Behavior Change Theories

5 levels of influence on health behavior

(key concept of the ecological perspective)

Answer 4

1. Individual/intrapersonal level (individual characteristics such as knowledge, attitudes, beliefs, and personality traits)

2. Interpersonal level (family, peers, and friends)

• Community level:

3. institutional factors: rules, regulations, policies

4. Community factors: social norms or standards

5. Public policy: local, state, federal

Question 5

Behavior Change Theories

APPLYING THEORY TO PROGRAM DEVELOPMENT. Decision begins with a thorough assessment of the situation:

Answer 5

1. Health problem: stress & anxiety
2. Target population: 1st-year college students
3. Type of behavior to be addressed: inactivity, {..}
4. Environment: LIU Brooklyn Campus

Question 6

Behavior Change Theories

An individual’s readiness to act and the decision to participate are based on an individual’s perceptions of the threat posed by a health problem, the benefits of avoiding the threat, and the factors influencing the decision to act (barriers, self-efficacy, etc)

Answer 6

HEALTH BELIEF MODEL

Question 7

Behavior Change Theories

THEORIES – LEVELS OF INFLUENCE:

Answer 7

• Individual/Intrapersonal level: Health belief model; Theory of planned behavior; Transtheoretical model (stages of change model)
• Interpersonal level: social cognitive theory
• Community level

Question 8

Behavior Change Theories

Health Belief Model: six constructs influence one’s decision to act, to prevent, screen for, or control disease:

Answer 8

1. Perceived susceptibility
2. Perceived severity
3. Perceived benefits
4. Perceived barriers
5. Cue to action
6. Self-efficacy

Question 9

Behavior Change Theories

It focuses on individual motivational factors as determinants of the likelihood of performing a specific behavior. It explores the relationship between behavior and beliefs, attitudes, and behavioral intention. Behavioral intention determines the behavior

Answer 9

THEORY OF PLANNED BEHAVIOR

or THEORY OF REASONED ACTION

(INDIVIDUAL/INTRAPERSONAL LEVEL)

Question 10

Behavior Change Theories

uses stages of change to integrate processes and principles of change from across major theories of intervention.

Answer 10

The transtheoretical model

Question 11

Behavior Change Theories

TRANSTHEORETICAL MODEL STAGES OF CHANGE

Answer 11

1. Precontemplation (not ready – have not thought about it)
2. Contemplation (getting ready)
3. Preparation (ready)
4. Action
5. Maintenance
6. *Termination

Question 12

Behavior Change Theories

no intention to act in the near future (six months), due to lack of information or demoralization from past attempts.

Answer 12

1. Pre-contemplation

Question 13

Behavior Change Theories

intention to change in the near future (3-6 months); aware of pros and cons of changing.

Answer 13

stage 2: contemplation

Question 14

Behavior Change Theories

intention to take action in the immediate future (1 month); have a plan of action

Answer 14

stage 3 preparation

Question 15

Behavior Change Theories

overt action is taken within the last 6 months

Answer 15

stage 4 action

Question 16

Behavior Change Theories

has changed behavior for more than 6 months. Working to prevent relapse; less temptation and more confidence.

Answer 16

stage 5 maintenance

Question 17

Behavior Change Theories

no temptation with 100% self-efficacy

Answer 17

stage 6 termination

Question 18

Behavior Change Theories

Core constructs of the transtheoretical model

Answer 18

• Stages of change: temporal dimension – a process
• Processes of change: covert and overt activities that unfold over time. people use to progress through the stages – they are important guides for intervention programs.
• Decisional balance: weighing pros and cons of changing.
• Self-efficacy: ability to successfully do something.

Question 19

Behavior Change Theories

Processes of change:

Answer 19

1. Consciousness raising – increasing awareness of facts related to the behavior.
2. Dramatic relief – experiencing negative emotions related to the unhealthy behavior.
3. Environmental reevaluation – realizing implications of the behavior on one’s social & physical environment.
4. Social liberation – realizing that social norms are changing to support the healthy behavior.
5. Self-reevaluation – realizing that the behavior change is an important part of one’s identity
6. Stimulus control – removing reminders of unhealthy behavior & adding reminders of healthy behavior.
7. Helping relationships – using social support for behavior change.
8. Counter conditioning – substituting a healthy behavior for the unhealthy one.
9. Reinforcement management – increasing rewards for positive behavior & decreasing those for unhealthy behavior
10. Self-liberation – making a firm commitment to change

Question 20

Behavior Change Theories

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

Answer 20

SELF-EFFICACY

Question 21

Behavior Change Theories

the relative weight people assign to the pros and cons of a behavior influences their decisions about behavior changes

Answer 21

DECISIONAL BALANCE

Decisional balance is derived via a comparison of the strength of perceived pros of the target behavior with the perceived cons.

Question 22

Behavior Change Theories

___________ and ___________ leads to individual behavioral acts.

Answer 22

Decisional balance and self-efficacy

Question 23

Behavior Change Theories

Chronic behavioral patterns are under some combination of

Answer 23

biological, social, and self-control

Stage-matched interventions have been designed primarily to enhance self-control.

Question 24

Behavior Change Theories

When behaviors are strongly associated with socioeconomic and educational status it is important to address the

Answer 24

behavior’s role in the broader social and physical context

Question 25

# Behavior Change Theories A dynamic, on-going process in which **personal factors**, **environmental factors**, and **human behavior** exert influence on each other.

Answer 25

**SOCIAL COGNITIVE THEORY** interpersonal level

Question 26

# Behavior Change Theories In the social cognitive model, the likelihood of a behavior change is determined by 3 factors:

Answer 26

1. Self-efficacy 2. Goals 3. Outcomes expectations (affected by the environment)

Question 27

# Behavior Change Theories Knowledge & skill to perform a behavior

Answer 27

Behavioral capability (self-efficacy)

Question 28

# Behavior Change Theories Dynamic interaction between person, behavior, and environment in which the behavior is performed.

Answer 28

**Reciprocal determinism** (SOCIAL COGNITIVE THEORY CONSTRUCTS, INTERPERSONAL LEVEL)

Question 29

# Behavior Change Theories Behavior modeling – behavior acquisition that comes from watching the actions and outcomes of others

Answer 29

**Observational learning** (Social Cognitive Theory)

Question 30

# Behavior Change Theories Confidence in one’s ability to take action

Answer 30

**Self-efficacy**

Question 31

# Behavior Change Theories Responses to the behavior that influence the likelihood of the behavior reoccurring.

Answer 31

Reinforcements | (Social Cognitive Theory)

Question 32

# Behavior Change Theories **Explanatory theory** describes the reasons why

Answer 32

a problem exists It guides the search for factors that contribute to a problem (e.g., a lack of knowledge, self-efficacy, social support, or resources), and can be changed. Examples of explanatory theories include the Health Belief Model, the Theory of Planned Behavior, and the Precaution Adoption Process Model.

Question 33

# Behavior Change Theories Examples of explanatory theories include the

Answer 33

Health Belief Model, the Theory of Planned Behavior, and the Precaution Adoption Process Model.

Question 34

# Behavior Change Theories **Change theory** guides the

Answer 34

development of health interventions Change theory helps program planners to be explicit about their assumptions for why a program will work. Examples of change theories include Community Organization and Diffusion of Innovations.

Question 35

# Behavior Change Theories Examples of change theories include

Answer 35

Community Organization and Diffusion of Innovations.

Question 36

# Behavior Change Theories Two key concepts of the ecological perspective help to identify intervention points for promoting health:

Answer 36

1. first, behavior both affects, and is affected by, multiple **levels of influence** 2. individual behavior both shapes, and is shaped by, the **social environment** (reciprocal causation).

Question 37

# Behavior Change Theories The second key concept (first being the levels of influence) of an ecological perspective is

Answer 37

**reciprocal causation** suggests that people both influence, and are influenced by, those around them.

Question 38

# Behavior Change Theories Beliefs about the chances of getting a condition

Answer 38

Perceived susceptibility

Question 39

# Behavior Change Theories Beliefs about the seriousness of a condition and its consequences

Answer 39

Perceived severity

Question 40

# Behavior Change Theories Beliefs about the effectiveness of taking action to reduce risk or seriousness

Answer 40

Perceived benefits

Question 41

# Behavior Change Theories Beliefs about the material and psychological costs of taking action

Answer 41

Perceived barriers

Question 42

# Behavior Change Theories this theory along and the associated Theory of Reasoned Action explore the relationship between behavior and beliefs, attitudes, and intentions.

Answer 42

**The Theory of Planned Behavior** Both the TPB and the TRA assume **behavioral** **intention** is the most important determinant of behavior.

Question 43

# Behavior Change Theories The **Theory of Planned Behavior** differs from the Theory of Reasoned Action in that it includes one additional construct:

Answer 43

**perceived behavioral control** this construct has to do with people’s beliefs that they can control a particular behavior. Azjen and Driver added this construct to account for situations in which people’s behavior, or behavioral intention, is influenced by factors beyond their control. They argued that people might try harder to perform a behavior if they feel they have a high degree of control over it.

Question 44

# Behavior Change Theories Stages of change model AKA

Answer 44

transtheoretical model of change

Question 45

# Behavior Change Theories Social Cognitive Theory Constructs

Answer 45

* Reciprocal determinism * Dynamic interaction between person, behavior, and environment in which the behavior is performed. * Behavioral capability * Knowledge & skill to perform a behavior. * Did pt understand why they are doing that HEP? * Expectations * Anticipated outcomes of a behavior. * Self-efficacy * Confidence in one’s ability to take action. * Observational learning * Behavior modeling – * behavior acquisition that comes from watching the actions and outcomes of others. * Hang out with those with the behaviors you want * Reinforcements * Responses to the behavior that influence the likelihood of the behavior recurring. * People telling you look good after stopped smoking