Health Beliefs and Cognitions Flashcards
What is health behaviour? (ref?)
Any activity undertaken for the purpose of preventing or detecting disease, or for improving health and wellbeing (Connor & Norman, 2005)
Give examples of health impairing behaviours
smoking, alcohol use, high fat intake
Give examples of health enhancing behaviours
exercising, eating fruit and veg, condom use (primary prevention) Medication adherence (secondary and tertiary prevention)
What are the two assumptions of health behaviour pattern (HBP) research?
- An important proportion of the preventable mortality and morbidity is due to behaviour
- HBPs are modifiable
Based on the Alameda County Study (N=7,000) which took place over 10 years, which 7 behaviour patterns predict mortality? (ref?)
- Not smoking
- Moderate alcohol intake
- 7-8 hours sleep
- Regular exercise
- Maintaining healthy weight
- Avoiding snacks
- Eating breakfast
(Breslow & Engstrom, 1980)
Which factors were assessed by the UK population study? (ref?)
Not smoking, being physically active, moderate alcohol use and plasma vitamin levels indicating 5+ fruit and veg a day (Khaw et al., 2008)
What were the findings of the UK population study?(ref?)
After 11years 200,000 people were followed up and those who had performed all 4 behaviours studied were 4x more likely to be alive than those doing none of them. (Khaw et al., 2008). This was controlling for age, gender, BMI and SES.
Describe Yates et al’s (2008) study and their findings.
They studied more than 2000 70yo men over 20 years and found that:
- The average healthy 70 year old had a 54% change of living to 90
- This was reduced to 44% for those with sedentary lifestyle
- 26% if obese
- 22% if a smoker
In what four ways do health behaviours affect health?
- Direct biological benefits (e.g. exercise increases cardiovascular functioning)
- Protection against health risks (e.g. condoms and STI’s)
- Facilitation of early disease detection (help seeking)
Facilitation of treatment (adherence)
What are the six categories of predictors of health behaviour and who identified them?
Cummings et al (1980)
- Knowledge about disease
- Perception of threat
- Accessibility of care
- Attitudes to health care
- Social network characteristics
- Demographics
Some of the predictors of health behaviours are more _________ through ________ than others.
Modifiable/targeted health promotion
Social cognition models (SCMs) were developed to identify ______________.
Modifiable cognitive predictors of behaviour
Good ______________ is essential if SCMs are to provide targets for HP.
Predictive validity.
Model 1: Health beliefs model (ref?)
Becker (1974)
Describe the model diagram on card 5.
See card 5.
HBM as a predictive model: Outline the findings of Janz and Becker (1984)
Review of 18 prospective studies looking at the significance ratios for each of the HBM predictors and behaviour.
Severity = 65% (11/17)
Susceptibility = 82% (14/17)
Benefits = 81% (13/16)
Barriers = 100% (11/11)
- There were very few studies of cues to action and health motivation and therefore no support.
HBM as a predictive model: Outline the findings of Harrison et al (1992)
Meta-analytic review of 234 studies, only 16 met criteria for including the four major constructs and reliability checks revealed weak operationalisations.
Sample weighted average correlations:
Severity = 0.08
Susceptibility = 0.05
Benefits = 0.13
Barriers = -0.21
- Only 0.25-4.4% of behaviour variance explained by the HBM. However this study used extremely harsh inclusion criteria and potentially undermined combined effects.
HBM based interventions: Describe the study on persuading A&E asthma patients to visit their GP (PICO)
P = 74 patients presenting with asthma at A&E
I = 1. Health beliefs assessed 2. HBM advice given (susceptibility to asthma, seriousness of asthma and benefits of visiting the GP to obtain treatment and avoid complications)
C = group just advised to go to GP with no supporting information
O = % who made and who kept GP appointment
- Active group were both significantly more likely to make and keep GP appointment.
HBM based interventions: Describe the study on increasing compliance in ER patients using clinical and telephone intervention based on the HBM
P = 842 ER patients
I = 1. Routine care, 2. Hospital HBM intervention, 3. Telephone HBM intervention, 4. Combined intervention
O = % who scheduled/kept a GP appointment
Results: 1. 33%/24%, 2. 76%/59%, 3. 85%/59%, 4. 85%/68%
- This was a well conducted, effective HBM intervention
HBM overview: Health beliefs predict health behaviours but are __________.
Weak predictors
HBM overview: Can the model be improved?
Maybe by considering intention as a measure of health motivation, attributions and self efficacy.
HBM overview: The HBM has inspired many ____________.
Effective interventions.
Model 2: Theory of Reasoned Action/Theory of Planned behaviour (ref?)
(Fishbein, 1963/Azjen, 1991)
TRA: Attitudes depend on ___________ and ____________
- Beliefs about action outcomes
2. Evaluation of those outcomes
TRA: Subjective norms depend on ___________ and ______________
- Injunctive norms
2. Motivation to comply
TRA: Injunctive norms are _________________.
The extent to which a person or group is perceived to think one should perform X behaviour.
TRA: Motivation to comply is ____________.
The extent to which you want the approval of the person involved in the injunctive norm.
Attitudes and subjective norms are predictors of__________ which is operationalised by ____________.
Motivation/Intentions.
Describe the TRA model on card 6.
See card 6.
What is the problem with the TRA?
You and others might believe a behaviour is beneficial, but you still might not perform it.
Because of the limitations of the TRA, which model was developed? (ref?)
Theory of Planned Behaviour (Arjen, 1991)
Describe the TRA model on card 7.
See card 7.
What is Self Efficacy? (ref?)
Bandura (1977) introduced self efficacy as the conviction that one can successfully execute a behaviour.
What do those with high SE do, that those with low SE do not?
- Set higher goals
- Adopt flexible problem solving approaches
- Show greater effort/persistence
- Experience lower anxiety/stress during performance
TPB: Predictive Utility (Azjen, 1991)
Rsq I: .20
Rsq I + PBC: .26
TPB: Predictive utility (Goodin & Kok, 1996)
Rsq I: .21
Rsq I + PBC: .34
TPB: Predictive utility (Ermitage and Conner, 2001)
Rsq I: .22
Rsq I + PBC: .23
Who tested the TPB against the TRA?
Madden (1992)
Outline Madden’s (1992) findings
8 hours sleep: PBC - 3.14, RsqTRA - .13, RsqTPB - .41
Exercising: PBC - 4.16, RsqTRA - .31, RsqTPB - .44
Taking vitamins: PBC - 5.93, RsqTRA - .58, RsqTPB - .59
What do Madden’s (1992) findings suggest?
That the addition of PBC to the model adds most to the prediction of behaviours which are considered as generally less controllable.
TPB Intervention: Who looked at whether an evidence based leaflet can increase exercise motivation/behaviour among school students?
Hill, Abraham and Wright (2007)
PICO Hill, Abraham and Wright’s (2007) TPB intervention study
P - 503 6th form students with low exercise rates
I - 20 minute school session to read leaflet and answer questions on it included in a quiz
C - Control group with no intervention
O - Exercise change at three week follow up
Describe the leaflet used in Hill et al’s (2007) TPB intervention.
2 pages of persuasive arguments which:
- Raised awareness of types of exercise
- Emphasised their advantages
- Hilighted others exercising and approval of exercise by profiling admired sports personalities
- Bolstered SE ad control
- Set a goal (one more 30 min session per week)
- Quiz to help memory
Describe the outcome of Hill et al’s (2007) TPB intervention study.
Change in number of 30 min sessions over 3 weeks before and after the intervention:
- Intervention = +0.69 sessions
- Control = -0.14
Who conducted a Meta-Analysis on the efficacy of the TPB in prospective predictions of health behaviours?
(McEachan et al., 2011)
What analysis was used by McEachan et al (2011) in their Meta-Analysis on the efficacy of the TPB in prospective predictions of health behaviours?
Hierarchical exploration of moderators to avoid confounding.
How many studies were identified in McEachan et al’s (2011) Meta-Analysis on the efficacy of the TPB in prospective predictions of health behaviours?
237
In McEachan’s (2007) Meta-Analysis on the efficacy of the TPB in prospective predictions of health behaviours, __________ and _________ moderated the model’s predictive validity.
Behaviour of focus
Methodological moderators
In McEachan’s (2007) Meta-Analysis on the efficacy of the TPB in prospective predictions of health behaviours, how did behaviour moderate the models predictive validity?
Exercise and diet were the best predicted behaviours (23.9 and 21.2% of the variance explained respectively)
Safer sex and drug abstinence were the worst explained (13.8 and 15.3%)
In McEachan’s (2007) Meta-Analysis on the efficacy of the TPB in prospective predictions of health behaviours, how did methodological moderators moderate the models predictive validity?
Age of the sample - Students were better predicted for exercise, adolescents were better predicted for abstinence
Behaviours assessed in the shorter term and using self report rather than objective measures were better predicted (Power, demand char?)
Could the TPB be improved?
Many additions have been suggested including descriptive norms, moral norms, anticipated regret and other affective expectations - all of which go some way to improving the TPB (See conner & Abraham, 2001) (LOOK UP RAA)
Model 3: Social Cognitive Theory (SCT; ref?)
Bandura (1982, 1997)
Describe model on card 8.
See card 8.
The SCT has good __________.
Predictive validity
Though the SCT is theoretically distinct from the TPB, it has similar practical implications for HP if we presume that:
Goals = intentions
SE = PBC
Outcome expectations = Attitudes and SNs
_____________ may be important to behaviour change and the SCT may be more practical in presuming these have direct effects on ________ and _____ rather than being mediated by other cognitions, as assumed by the ____.
Sociocultural influences/ goals/priority/TPB
According to a summary SCM model, there are three factors which are necessary and sufficient antecedents to behaviour, what are they and who developed this model?
- Strong intention
- Skills necessary
- No environmental barriers
(Fishbein et al., 2001)
According to the summary model, what are the cognitive antecedents of strong intention?
- Belief that benefits outweigh costs (attitude)
- Perception of more social normative pressure to perform the behaviour than not to
- Perception that performance is consistent with self image
- Emotional reaction to performance is more positive than negative
- Believes self capable across a range of circumstances (PBC)
- Basically everything in the TPB
What are the advantages of using SCMs?
- Clear theoretical background for research
- Reliable and valid measures are available
- Can include in moderation/mediation analysis to clarify why intentions do/dont work
Do messages in leaflets promoting condom use target modifiable determinants of condom use? A content analysis of 36 UK and 35 german leaflets: Describe
- Coding manual used to analyse leaflets included 20 correlate representative categories which correspond to cognitive and behavioural correlates of condom use, identified by theory based research e.g. severity of disease, attitude to behaviour, self efficacy.
Do messages in leaflets promoting condom use target modifiable determinants of condom use? A content analysis of 36 UK and 35 german leaflets: Results
- Few content differences between english and german leaflets
- Both hi lighted intro on how people become infected with HIV and advice on contacting HCPs
- Few mentioned delaying or abstaining
- 25% included text of more than 10 correlate, this rose to 2/3 with 1SD above mean applied as a measure of ‘frequent’ inclusion.
= Not EBHP
