Health Beliefs and Behaviours Social Theory

Question 1

What is a theory?

Answer 1

• Set of interrelated concepts, definitions, and propositions that present a systematic view of events or situations by specifying relations among variables in order to explain or predict the events
• Made of concepts/building blocks
  
  • Constructs and variables

Question 2

What is the difference between constructs and variables?

Answer 2

• Constructs are concepts specific to a theory; general ideas that are not measurable
• Variables are concepts used in a study or application of the theory; are measurable

Question 3

What are the six guiding principles for the application of theory to medication use?

Answer 3

1. There is no single theory that is appropriate for all medication use research
2. Behavioural science theories are probabilistic, not deterministic
3. Many factors outside of patient control influence medication use
4. Every patient is unique
5. Patient motivation is a fundamental ingredient required to optimize medication use, especially when maintenance of long-term behaviour is the goal
6. Health care providers can have a profound effect on patient medication use, and this effect can operate through several possible casual pathways

Question 4

Describe the premise of the guiding principle that there is no single theory that is appropriate for all medication use research?

Answer 4

• Best theory depends on the medication use problems, context, and variables
  
  • E.g., a single parent will present a context that is very different from the CEO of a company

Question 5

Describe the premise of the guiding principle that behavioural science theories are probabilistic, not deterministic

Answer 5

• Theories are probabilities, not determinants, but they can still be useful
• Similar to health
  
  • E.g., smoking and cancer:
    
    • Do all people that smoke have cancer?
    • Do all people with lung cancer smoke?
    • Would you recommend quitting tobacco to reduce the risk of lung cancer?

Question 6

Describe the premise of the guiding principle that many factors outside of patient control influence patient medication use

Answer 6

• Patients are at the center of many factors that can control their medication use, some of which they may have no control over
• For example:
  
  • Providers (e.g., their drug plan)
  • Family, friends, social groups
  • Their community, health care system
  • Social policy and government regulations (e.g., drug plans, cost)

Question 7

Describe the premise of the guiding principle that every patient is unique?

Answer 7

• Recognized by all good clinicians
• Often forgotten by researchers developing interventions
• Interventions are developed according to a one-size-fits-all model
  
  • Many studies may not even assess whether components of their study are necessary

Question 8

Describe the premise of the guiding principle that patient motivation is a fundamental ingredient?

Answer 8

• Even if patient has all the knowledge, skills, and resources to take a medication properly, problems can still arise if they are not motivated to take actions necessary to ensure safe and effective therapy

Question 9

Describe the premise of the guiding principle that health care providers can have a profound effect on medication use

Answer 9

• Possible mechanisms can include:
  
  • Exchanging information
  • Validating and responding to patients’ emotional needs
  • Managing uncertainty
  • Fostering a therpeutic relationship
  • Making treatment decisions that reflect patient values and preferences
  • Enabling patient self-management

Question 10

What is the sick role theory (1950s)?

Answer 10

• Behaviours expected of a person defined as sick
• Rights:
  
  • Freedom from blame for illness
  • Exemption from normal tasks and roles
• Duties:
  
  • Intend to get well
  • Cooperate with health care professionals

Question 11

What are four problems with the sick role theory?

Answer 11

1. The sick role is not necessarily temporary (e.g., with chronic illness)
2. The sick role is not always voluntary
   
   • Doctor may act as a gatekeeper to decide whether or not you are actually sick
3. Variability in sick role legitimacy
   
   • Social class, “fashionable illness”, some conditions are not considered an illness
4. Responsible for sickness
   
   • Some stigma surrounding AIDS, liver transplants, etc.

Question 12

What is social cognitive theory?

Answer 12

• Arose as a reaction to behaviouralism or learning from trial and error
• Person, behaviour, and environment influence each other to alter behaviour
• Stimulus - Response theory

Question 13

In social cognitive theory, what is self-efficacy?

Answer 13

• Defined as “people’s beliefs about their capabilities to produce a designated level of performance that exercises influence over the events that affect their lives”
• Specific to a behaviour and involves an evaluation of a person’s skill as well as their confidence in a skill

Question 14

What are the four sources of self-efficacy in social cognitive theory?

Answer 14

1. Physiological and affective states (may not be in proper state of mind)
2. Vicarious experiences (learn by watching others - more effective between similar people)
3. Social persuasion (encouragement)
4. Mastery experiences (helps give techniques to teach)

Question 15

Observational Learning/Mastery Learning in social cognitive theory

Answer 15

• Skill is modeled to “convey the basic rules and strategies”
• Learners practice the skill in a controlled environment and receive specific feedback
• Learners apply the skill in work situations that are expected to bring success

Question 16

What is the basis for social support theory?

Answer 16

• Social support = how networking helps people cope with stressful events
• Social relationships can have a great impact on health education and health behaviour

Question 17

What are the four types of social support?

Answer 17

1. Emotional support = sharing life experiences
2. Instrumental support = tangible aid
3. Informational support = advice, suggestions, and information that a person can use to address problems
4. Appraisal support = information that is useful for self-evaluation purposes: constructive feedback, affirmation, social comparison
   
   • Important for health care providers!

Question 18

In coping and stress, what are primary and secondary appraisals?

Answer 18

• Primary appraisal: Evauation of the significance of a stressor or threatening event
• Secondary appraisal: Evaluation of the controllability of the stressor and a person’s coping resources
  
  • I.e., can you manage the threat? What are the resources available to that person

Question 19

What are coping efforts? What are the two types of coping efforts?

Answer 19

• Coping efforts are actual strategies used to mediate primary and secondary appraisals
  
  • Emotional regulation: Strategies aimed at changing how one thinks or feels about a situation
  • Problem regulation: Strategies aimed at changing a stressful situation

Question 20

What are dispositional coping styles? What are the two types?

Answer 20

• Dispositional coping styles are generalized ways of behaving that can affect a person’s emotional or functional reaction
  
  • Optimism: Tendency to have generalized positive expectancies for outcomes
  • Information seeking: Attentional styles that are vigilant (monitoring) versus those that involve avoidance (blunting)

Question 21

What is the theory behind the transtheoretical model?

Answer 21

• Person is in one of 5 stages of readiness to change behaviour
  
  • RPh assesses and helps patient move to next stage (not necessarily to action)
  • Across all 5 stages, listening and empathy are important
  • In first three stages, patient weighs pros and cons

Question 22

What is the transtheoretical model used in? What are its assumptions (or lack thereof)?

Answer 22

• Smoking, diabetes, addiction
• Does not assume people are ready to change, rather people move through/cycle through stages of change
• If you push too hard for change, people will resist

Question 23

What are the five stages of the transtheoretical model?

Answer 23

1. Pre-contemplation
2. Contemplation
3. Preparation
4. Action
5. Maintenance

Question 24

What occurs during the pre-contemplation stage of the transtheoretical model? What is the pharmacist’s role?

Answer 24

• Pre-contemplation = Cons outweigh pros; patient will not consider change for a while
• Pharmacist should not persuade, listen for barriers, wait, be non-judgemental, and empathy
  
  • E.g., “when you are ready to quit, let me know”

Question 25

What is the contemplation stage of the transtheoretical model? What is the pharmacist’s role?

Answer 25

• Contemplation = Lower self-efficacy, think about changes in 6 months, open to information
• Pharmacist should listen reflectively, carefully question, discuss strategies to remove barriers, educate if open, empathize

Question 26

What is the preparation stage of the transtheoretical model? What is the pharmacist’s role?

Answer 26

• Preparation = Ready for action within thirty days and made one attempt so far; often are unsure if they can be successful
• Pharmacists role is to address patient’s concerns, break action down into small steps and consult, empathize
• Begin to discuss products, schedule for quitting, plan

Question 27

What is the action stage of the transtheoretical model? What is the pharmacist’s role?

Answer 27

• Action = Makes effort to change
• Pharmacist should address patient concerns, problem-solve how to avoid triggers for negative behaviour, begin using products, support positive behaviour

Question 28

What is the maintenance stage of the transtheoretical model? What is the pharmacist’s role?

Answer 28

• Maintenance = Engaged for at least six months, more able to identify situations that cause relapse, becoming the person who they want to be
• Pharmacist should listen empathetically, openly assess possible relapse factors, support, positive reinforcement, monitor how products work

Question 29

In what stages of change of the transtheoretical model is consciousness raising most emphasized?

Answer 29

• Between the pre-contemplation stage and contemplation
• Essentiall involves increasing awareness
• Experiential process of change

Question 30

In what stages of change of the transtheoretical model is dramatic relief most emphasized?

Answer 30

• Between pre-contemplation and contemplation
• Dramatic relief is an emotional arousal
  
  • E.g., I react emotionally to warnings about smoking cigarettes
• Experiential process of change

Question 31

In what stages of change of the transtheoretical model is environmental re-evaluation emphasized?

Answer 31

• Between the pre-contemplation and contemplation stages
• Involves social re-appraisal
  
  • E.g., considering the view that smoking may be harmful to people around them
• Experiential process of change

Question 32

What is social liberation in the transtheoretical model?

Answer 32

• An environmental opportunity
• E.g., finding ways in which society is changing to make it easier for non-smokers
• Experiential process of change

Question 33

In what stages of change of the transtheoretical model does self re-evaluation occur?

Answer 33

• During the contemplation stage
• Self re-evaluation is similar to self re-appraisal
  
  • E.g., my dependency on cigarettes makes me feel disappointed in myself
• Experiential process of change

Question 34

In what stages of change of the transtheoretical model does stimulus control occur?

Answer 34

• Between the action and maintenance stages
• Re-engineering occurs
  
  • E.g., removing things from home that remind them of smoking
• Behavioural process of change

Question 35

In what stages of change of the transtheoretical model do helping relationships play a role?

Answer 35

• Between action and maintenance stages
• Supporting role
  
  • E.g., I have someone who listens to me when I need to talk about my smoking
• Behavioural process of change

Question 36

In what stages of change of the transtheoretical model is counter conditioning important?

Answer 36

• Between action and maintenance
• Also known as substituting
  
  • E.g., I find doing stuff with my hands is a good substitute for smoking
• Behavioural process of change

Question 37

In what stages of change of the transtheoretical model is reinforcement management important?

Answer 37

• Between the action and maintenance stages
• Rewarding
  
  • E.g., I reward myself when I don’t smoke
• Behavioural process of change

Question 38

At what stage of change of the transtheoretical model is self-liberation important?

Answer 38

• During the preparation stage
• Committing
  
  • e.g., making a public commitment not to smoke - can cause cognitive dissonance
• Behavioural process of change

Question 39

What is self-regulation theory?

Answer 39

• “Common sense” model of illness
• Patients actively solve problems by seeking info from own experiences to form illness representations based on:
  
  • What is my symptom/illness?
  • What caused it?
  • How long will it last?
  • What will happen as a result?
  • Can this be controlled or cured?

Question 40

Schematic representation of self-regulation theory

Answer 40

• Health threat
  
  • Cognitive representation (understanding of threat influences how you act) –> coping procedure –> appraisal, OR
  • Emotional representation (e.g., how person feels taking med) –> coping procedure –> appraisal (what patient monitors to see if they feel better)
  • All stages are connected and switching between them can occur