3 health promotion - behaviour change Flashcards
What is Laudanska-Krzeminska (2015)s point of view of the basic principles all three major behaviour change theories contain?
They posit that
- behaviour is mediated by cognitions
- knowledge is necessary for, but not sufficient to produce most behaviour changes
- perceptions, motivations, skills and the social environment are key influences on behaviour
What groups of people may need to change in order to improve population health?
- healthy people who would benefit from reducing health-risk behaviours and increasing health-enhancing behaviours
- ill people who should adjust their behaviour to their circumstances and follow behavioural advice to prevent their condition from getting worse
- health professionals and others responsible for delivering effective, evidence-based care
What should the perspective be when discussing theories of behaviour change?
Behaviour is he outcome of behaviour change interventions
-> behaviour needs to be conceptualised
-> are all behaviours following the same patterns?
correlations between behaviours and health outcomes may vary depending on context (e.g. disease, treatment, …)
What is one definition of behaviour?
Anything a person does in response to internal or external events. Actions may be overt (motor or verbal) and directly measurable, or covert (e.g. physiological responses) and only indirectly measurable; behaviours are physical events that occur in the body and are controlled by the brain’ (Hobbs, Campbell, Hildon, & Michie, 2011)
What are behaviour change techniques?
standards for “active ingredients” and for designing and evaluating and reporting interventions
observable and replicable components
instruction, self-monitoring and practice
heterogeneous and complex
How efficacious are behaviour change techniques in interventions?
Dombrowski et al. (2012) and Taylor et al. (2012) found that the number of BCTs used did not predict efficacy but having a theoretical basis for the intervention did.
e.g. interventions including more BCTs that were
congruent with Control Theory (Carver & Scheier, 1982) were associated with greater
weight loss (in this case, a proxy for healthy eating) in obese adult patients,
Why is theory such an important fundament for successful behaviour change interventions?
Ideally, theories summarise the state of cumulative knowledge. They specify key constructs and relationships and the underlying scientific explanations of the
processes of change and link behaviour change to constructs in a systematic way.
They describe how, when and why change occurs. They allow investigators to understand why and how interventions succeed or fail.
What are the main characteristics of the theory of planned behaviour?
- general theory, not health specific (sake of parsimony (Sparsamkeit))
- constructs are clearly defined and causal relationships between constructs are clearly specified
- clear recommendations for operationalisation
- widely used to study health behaviours
- accounts for a useful amount of variance in intentions and behaviour
What is a social cognition model?
theories specifying the proximal cognitive determinants of behaviour
how do components of social cognition, influence or predict health related behaviour?
What are determinants of underlying behaviours?
Whether or not we engaged in behaviour: underlying factors → called determinants
Behaviour occurs in context → not only individual determinants, but also interpersonal determinants
Determinants → potential foundation to achieve behaviour change → selection of most important and changeable determinants
What models are there that study health behaviours determinants?
Stage models
-> classification system with ordered stages
-> stages have specific barriers and obstacles
Social cognition models
-> predictors of health behaviours: costs and benefits
-> consideration of social context
attempts at integrative models
What are the main components of the theory of reasoned action?
behavioural beliefs and evaluation of behavioural outcome
-> attitude
normative beliefs and motivation to comply
-> subjective norm
attitude + subjective norm
-> behavioural intention -> behaviour
What is the main principle of the TRA?
a person’s behavior is determined by their intention to perform the behavior and that this intention is, in turn, a function of their attitude toward the behavior and subjective norms (Fishbein & Ajzen, 1975)
cognitive theory and mathematical model
suggested as improvement of information integration theory
What exactly do the components in the TRA describe?
Beliefs usually describe the probability that a person thinks some action will cause a certain outcome;
→ probability that an object has some attribute
attitudes concern whether or not someone thinks that outcome is favorable or unfavorable;
→ evaluation of a behaviour
→ sum of belief strength multiplied by outcome evaluation for each of someones beliefs
subjective norms are the sum of all important ppl in someones life and wether they think those ppl would want them to perform the behaviour
normative belief = Whether or not someone believes that the other wants them to carry out an action
motivation to comply = Motivationto comply describes how much someone wants to do what the significant other wants them to do.
intention is the way that someone intends to behave in response to beliefs and attitudes
→ readiness to perform a behaviour
What are some external factors influencing attitude and subjective norm?
- demographic variables
- attitudes towards targets
- personality traits
- other individual difference variables
What are limiations of the TRA?
- risk of confounding between attitudes and norms
- limited ability and time of researchers to accurately measure factors that contribute to the models in theory
How should the behaviours be defined in the TRA and TRB?
in the context of
action
target - what is the behaviour directed towards? why do u wanna do the behaviour?
context
time
What does the TPB add to the TRA?
control beliefs + perceived behavioural control/power
-> perceived control
which also influences behavioural intention
What is the context of the TPB?
behaviour is determined by strength of the persons intention to perform that behaviour and the amount of actual control that the person has over performing the behaviour
intention = indication of a persons readiness to perform, considered the immediate antecedent of behaviour
perceived behavioural control
Banduras (1986)
construct of self-efficacy
persons perceptions of their ability to perform
strength of intention
- attitude toward the behaviour
- overall evaluation of performing the behaviour
- subjective norm (would important other want them to perform it?)
What same components do the TRA and the TPB have?
attitude toward the behaviour
total set of salient behavioural beliefs about the personal outcomes of performing the behaviour
belief strength for each salient outcome summed across outcomes
subjective norm
total set of salient normative beliefs
salient referent multiplied by their motivation to comply with that referenct
What can the TPB explain based on meta-analyses?
the TPB explains between 35 and 50 percent of the variance in intentions and between 26 and 35 percent of the variance in behaviour (Sutton, 2004).
Overall, how would you compare the TRA and TPB?
TPB is essentially a more current version
idea of perceived behaviour control
TPB is more applicable to a wider range of behaviours
accounts for situations were self-efficacy and external contraints may impact the behaviour
What are some of the main complexities about the TPB?
- selecting influential beliefs: difficulty in pinpointing which beliefs most impact behaviour
-> 10 or 20% of the sample have to have mentioned them - dividing them into intenders and non-intenders (selecting key beliefs)
- scoring scheme variations: different schemes can significantly influence prioritisation of beliefs
- changing beliefs for behaviour modification: alter resistant beliefs
- estimating the potential size of an intervention effect
What the main steps in developing a TPB-based health intervention?
- Decide on target behaviour and population
- identify modal salient beliefs (elicitation study)
- Decide which TPB components to target
- Decide on specific beliefs
- Develop and evaluate the intervention
What are some assumption the TRA is making?
- rational decision-making: individuals use information available in a rational way
- behavioural control: TRA assumes that behaviour is under volitional control
- predictive power: effective in situations where individuals have complete control over their actions
What is the underlying assumption of the HAPA?
Weinstein, Rothman, and Sutton (1998)
(1) individuals can be classified into different stages by a valid assessment procedure
(2) stages are ordered
(3) individuals in the same stage are more similar than those in different stages, face the same barriers
How can the HAPA be briefly explained?
HAPA has two layers: a continuum layer and a stage layer
distinction between: preintentional motivation processes that lead to a behavioural intention and postintentional volition processes that lead to the actual health behaviour
-> goal setting and goal pursuit
What is part of the motivational phase in the HAPA?
“I am going to do X”
preintentional phase
outcome expectancies
risk perception
task self-efficacy (subjective sense of control over environment and behaviour)
-> intention
How can the volitional phase be described?
postintentional
two volitional phases
-> those who have not yet translated the intention into action
and those who have different mindsets
action planning (when,where,how)
coping planning
-> operative mediator between intentions and behaviour
-> maintenance self-efficacy (coping with barriers)
external factors
recovery self-efficacy (overcome failure)
=> action
What empirical evidence supports the model of HAPA? what are mediating effects?
motivation and volition were found to be empirically different
preintenders have less self-efficacy, intention and planning than intenders
preintenders with high risk perception were much more likely to develop higher intentions
this effect was not found in intenders
planning is only benefitial in volitional stage
When addressing action planning and coping planning separately in interventions, different effects were found
distinguishing self-efficacy types makes predicting behaviour more specific
For whom does the model work? What are moderator effects?
stage is a moderator
a prediction model within one stage group operates in a different
way than a prediction model within an adjacent stage group
perceived self-efficacy
degree to which planning has an effect on subsequent behaviours
temporal stability of intention
age
⇒ The best way to demonstrate the mechanisms of health behavior change is the experimental manipulation of those variables that are supposed to produce behaviors or to move people from one stage to another
What are the basic principles of the COM-B model?
Capability (how to enact behaviour) -> Motivation (more attractive, habits) -> Opportunity (prerequisites for enactment?, make it possible)
<-> Behaviour
What is the main principle of the behaviour change wheel?
it has three layers:
inner layer: COM-B system (sources of behaviour)
every source has two categories
C: physical, psychological
O: social, physical
M: reflective and automatic processes
middle layer: 9 intervention functions aimed at addressing deficits in c o or m (education, persuasion, incentivization, coercion, training, restriction, environmental restructuring, modeling, and enablement)
outler layer: seven policy categories that enable interventions (guidelines, social/environmental planning, communication/marketing, legislation, service provision, regulation, fiscal measures like policies)
What conclusion did empirical testing yield for the Behaviour Change Wheel?
categorising interventions is easy, the connection of different COM components was less clear, some are related to the interventions, some not
-> this makes it possible to choose interventions for different behaviours or components
-> useful for policymakers and intervention designers
