2. THEORIES IN HEALTH BEHAVIOR CHANGE PROMOTION AND HEALTH Flashcards
Behavior Change Theories
Emphasizes the interaction & interdependence between individual and environmental factors at all levels of a health problem.
ECOLOGICAL PERSPECTIVE
Behavior affects and is affected by multiple levels of influence
Behavior Change Theories
autonomic dysreflexia develops in individuals with a neurologic level of spinal cord injury at or above the
sixth thoracic vertebral level (T6).
Behavior Change Theories
(ecological) determinants → behaviors → disease outcomes
example
no walkability area → sitting at home watching TV → obesity
Behavior Change Theories
5 levels of influence on health behavior
(key concept of the ecological perspective)
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
Behavior Change Theories
APPLYING THEORY TO PROGRAM DEVELOPMENT. Decision begins with a thorough assessment of the situation:
- Health problem: stress & anxiety
- Target population: 1st-year college students
- Type of behavior to be addressed: inactivity, {..}
- Environment: LIU Brooklyn Campus
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)
HEALTH BELIEF MODEL
Behavior Change Theories
THEORIES – LEVELS OF INFLUENCE:
- Individual/Intrapersonal level: Health belief model; Theory of planned behavior; Transtheoretical model (stages of change model)
- Interpersonal level: social cognitive theory
- Community level
Behavior Change Theories
Health Belief Model: six constructs influence one’s decision to act, to prevent, screen for, or control disease:
- Perceived susceptibility
- Perceived severity
- Perceived benefits
- Perceived barriers
- Cue to action
- Self-efficacy
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
THEORY OF PLANNED BEHAVIOR
or THEORY OF REASONED ACTION
(INDIVIDUAL/INTRAPERSONAL LEVEL)
Behavior Change Theories
uses stages of change to integrate processes and principles of change from across major theories of intervention.
The transtheoretical model
Behavior Change Theories
TRANSTHEORETICAL MODEL STAGES OF CHANGE
- Precontemplation (not ready – have not thought about it)
- Contemplation (getting ready)
- Preparation (ready)
- Action
- Maintenance
- *Termination
Behavior Change Theories
no intention to act in the near future (six months), due to lack of information or demoralization from past attempts.
- Pre-contemplation
Behavior Change Theories
intention to change in the near future (3-6 months); aware of pros and cons of changing.
stage 2: contemplation
Behavior Change Theories
intention to take action in the immediate future (1 month); have a plan of action
stage 3 preparation
Behavior Change Theories
overt action is taken within the last 6 months
stage 4 action
Behavior Change Theories
has changed behavior for more than 6 months. Working to prevent relapse; less temptation and more confidence.
stage 5 maintenance
Behavior Change Theories
no temptation with 100% self-efficacy
stage 6 termination
Behavior Change Theories
Core constructs of the transtheoretical model
- 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.
Behavior Change Theories
Processes of change:
- Consciousness raising – increasing awareness of facts related to the behavior.
- Dramatic relief – experiencing negative emotions related to the unhealthy behavior.
- Environmental reevaluation – realizing implications of the behavior on one’s social & physical environment.
- Social liberation – realizing that social norms are changing to support the healthy behavior.
- Self-reevaluation – realizing that the behavior change is an important part of one’s identity
- Stimulus control – removing reminders of unhealthy behavior & adding reminders of healthy behavior.
- Helping relationships – using social support for behavior change.
- Counter conditioning – substituting a healthy behavior for the unhealthy one.
- Reinforcement management – increasing rewards for positive behavior & decreasing those for unhealthy behavior
- Self-liberation – making a firm commitment to change
Behavior Change Theories
the belief that one can successfully execute the behavior required to produce the outcomes
SELF-EFFICACY
Behavior Change Theories
the relative weight people assign to the pros and cons of a behavior influences their decisions about behavior changes
DECISIONAL BALANCE
Decisional balance is derived via a comparison of the strength of perceived pros of the target behavior with the perceived cons.
Behavior Change Theories
___________ and ___________ leads to individual behavioral acts.
Decisional balance and self-efficacy
Behavior Change Theories
Chronic behavioral patterns are under some combination of
biological, social, and self-control
Stage-matched interventions have been designed primarily to enhance self-control.
Behavior Change Theories
When behaviors are strongly associated with socioeconomic and educational status it is important to address the
behavior’s role in the broader social and physical context
Behavior Change Theories
A dynamic, on-going process in which personal factors, environmental factors, and human behavior exert influence on each other.
SOCIAL COGNITIVE THEORY
interpersonal level
Behavior Change Theories
In the social cognitive model, the likelihood of a behavior change is determined by 3 factors:
- Self-efficacy
- Goals
- Outcomes expectations
(affected by the environment)
Behavior Change Theories
Knowledge & skill to perform a behavior
Behavioral capability (self-efficacy)
Behavior Change Theories
Dynamic interaction between person, behavior, and environment in which the behavior is performed.
Reciprocal determinism
(SOCIAL COGNITIVE THEORY CONSTRUCTS, INTERPERSONAL LEVEL)
Behavior Change Theories
Behavior modeling – behavior acquisition that comes from watching the actions and outcomes of others
Observational learning
(Social Cognitive Theory)
Behavior Change Theories
Confidence in one’s ability to take action
Self-efficacy
Behavior Change Theories
Responses to the behavior that influence the likelihood of the behavior reoccurring.
Reinforcements
(Social Cognitive Theory)
Behavior Change Theories
Explanatory theory describes the reasons why
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.
Behavior Change Theories
Examples of explanatory theories include the
Health Belief Model, the Theory of Planned Behavior, and the Precaution Adoption Process Model.
Behavior Change Theories
Change theory guides the
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.
Behavior Change Theories
Examples of change theories include
Community Organization and Diffusion of Innovations.
Behavior Change Theories
Two key concepts of the ecological perspective help to identify intervention points for promoting health:
- first, behavior both affects, and is affected by, multiple levels of influence
- individual behavior both shapes, and is shaped by, the social environment (reciprocal causation).
Behavior Change Theories
The second key concept (first being the levels of influence) of an ecological perspective is
reciprocal causation
suggests that people both influence, and are influenced by, those around them.
Behavior Change Theories
Beliefs about the chances of getting a condition
Perceived susceptibility
Behavior Change Theories
Beliefs about the seriousness of a condition and its consequences
Perceived severity
Behavior Change Theories
Beliefs about the effectiveness of taking action to reduce risk or seriousness
Perceived benefits
Behavior Change Theories
Beliefs about the material and psychological costs of taking action
Perceived barriers
Behavior Change Theories
this theory along and the associated Theory of Reasoned Action explore the relationship between behavior and beliefs, attitudes, and intentions.
The Theory of Planned Behavior
Both the TPB and the TRA assume behavioral intention is the most important determinant of behavior.
Behavior Change Theories
The Theory of Planned Behavior differs from the Theory of Reasoned Action in that it includes one additional construct:
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.
Behavior Change Theories
Stages of change model AKA
transtheoretical model of change
Behavior Change Theories
Social Cognitive Theory Constructs
- 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?
- Knowledge & skill to perform a behavior.
- 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
- Responses to the behavior that influence the likelihood of the behavior recurring.
