HL4 - Models of health behaviour Flashcards
1
Q
What is health?
A
- WHO (1948) definition of health as a:
- “State of complete physical, mental and social well-being…not merely the absence of disease or infirmity”
- Bircher (2005) defines health as
- “a dynamic state of well-being characterised by a physical and mental potential, which satisfies the demands of life commensurate with age, culture, and personal responsibility”
- Indigenous Australian people define health as
- “not just the physical well-being of the individual but refers to the social, emotional, spiritual and cultural well-being of the whole community. This is a whole of life view and includes the cyclical concept of life-death-life”
No one single definition- complex multifaceted concept extending beyond biological aspects of individual functioning
2
Q
What are the main models of health and illness used?
A
- Biomedical model of illness
- Symptoms of illness considered to have underlying pathology
- Removal of pathology»_space; restored health
- May be mechanistic, too reductionist- ignores the fact that different people respond in different ways to illness because of differences (e.g. personality, social support, cultural beliefs).
- Psychological and social factors can add to biological or biomedical explanations and understanding of health and illness
- Diseases and symptoms can be explained by a combination of physical, social, cultural, and psychological factors
- Employed in health psychology, allied health professionals, and increasingly in medicine
- Shift from biomedical model to biopsychosocial model of health
- Incorporating relational and psychological factors
3
Q
What is health psychology?
A
- Health psychology is an interdisciplinary field concerned with the application of psychological knowledge and techniques to health, illness, and health care.
- Devoted to understanding psychological influences on how people:
- Stay healthy
- Why they become ill
- How they respond if they do become ill
4
Q
Why are we looking at models of health behaviour?
A
- Because being healthy and well is good. For us as individuals, for us as families, as communities, and as a country. And we know that there are some behaviours that are connected with being more healthy, and some that are connected with being less healthy- or more risky.
- Theoretical models have been proposed and tested in terms of their ability to explain and predict why people engage in health risk or health enhancing behaviours.
- Why do individuals smoke? What factors predict whether or not someone engages in smoking?
- The models we will describe have identified many modifiable influences upon health behaviour that offer potential targets for health intervention - promotion and education
- Using models of health behaviour- we can design interventions to address the modifiable influences on a behaviour such as smoking (e.g. overcoming barriers, highlighting benefits, increasing confidence to quit).
- We want to underpin our research and interventions with evidence based theory
- E.g. Many health psychology honours theses are underpinned by these theories
5
Q
What are the different types of models?
A
6
Q
What is the transtheoretical model?
A
- Stage model of behaviour change- individuals can be at ‘discrete ordered stages’, each one denoting a greater inclination to change
- Transtheoretical model (Prochaska, 1979 Prochaska and DiClemente, 1984) provides a framework for explaining how behaviour change occurs as individuals move through stages of motivational readiness
- Makes 2 broad assumptions:
- People move through stages of change
- Processes involved at each stage differ
- According to this model there are five/seven stages of change
- Precontemplation
- Has no intention of taking action within the next 6 months
- Precontemplation
- Contemplation
- Intends to take action within the next 6 months.
- Preparation
- Intends to take action within the next 30 days and has taken some steps in this direction.
- Action
- Has changed overt behaviour for less than 6 months
- Maintenance
- Has changed overt behaviour for more than 6 months.
- Termination
- Behaviour change has been maintained for an adequate time for the person to feel no temptation to lapse
- Relapse
- Where a person lapses into their former behavioural pattern and returns to a previous stage (common, can occur at any stage)
7
Q
How are different interventions appropriate at different stages of health behaviour change?
A
- Precontemplation
- Individuals more likely to be using denial, may report lower self efficacy and more barriers to change
- Contemplation
- More likely to seek information and may report reduced barriers and increased benefits- although may still underestimate their susceptibility
- Preparation
- People start to set their goals and priorities, and some will make concrete plans. Motivation and self efficacy are crucial if action is to be elicited
- Action
- Realistic goal setting is crucial if action is to be maintained. Use of social support is important to receive reinforcement of change
- Maintenance
- Can be enhanced by self monitoring and reinforcement
8
Q
What are the criticisms of the transtheoretical model?
A
- An individual may be in several stages of change at one time (Budd & Rollnick, 1996 heavy drinking study)
- Perhaps too much focus on motivation and intention- past behaviour is a more powerful predictor of future behaviour (Sutton, 1996)
- Participants stage of change may not be predictive of success of intervention (Carlson et al., 2003 smoking intervention study)
- People can be at different stages of change at different times
- Model is not linear
- People can enter and exit at any point and some people may repeat a stage several times
- It implies that different interventions are appropriate at different stages of health behaviour change
- Implications for interventions»_space; little point in trying to show how to achieve change if in precontemplation; that type of intervention may be more beneficial if individual in planning (preparation) or action stage
- Can take a while to maintain a habit
- Doesn’t consider social aspects of health behaviour, severity of illness/disease/outcome, characteristics of the individual
9
Q
What is the health belief model?
A
Social-cognitive model
- The HBM is a social cognitive model that attempts to explain and predict health behaviours
- This is done by focusing on the attitudes and beliefs of individuals
- The HBM was first developed in the 1950s by social psychologists Hochbaum, Rosenstock and Kegels
- Since then, the HBM has been adapted to explore a variety of long- and short-term health behaviours
- Models framework
- A persons readiness to take a health action is determined by four factors
- Perceived severity or seriousness of the disease:
- I believe coronary heart disease is a serious illness contributed to by being overweight
- Perceived susceptibility of the disease:
- I believe I am susceptible to heart disease because I am overweight
- Perceived benefits of the health action:
- If I lose weight my health will improve, my risk of heart disease will decrease, and I’ll feel good
- Perceived barriers to performing the action:
- Finding the time to exercise and eat well in my current lifestyle will be difficult and possibly more expensive
- Original health belief model just focused on these factors
10
Q
What were the revisions made to the original health belief model?
A
- Becker and Mainman (1975) included general health motivation as a 5th factor.
- Revisions of the theory (Becker and Rosenstock, 1984) have also included further factors in the HBM
- Demographic variables
- Psychosocial variables
- Cues to action has been added as an additional explanatory variable
- e.g. recent advertisement on TV about the health risks of obesity worried me
11
Q
What are criticisms of the health belief model?
A
- Static model
- does not allow for staged or dynamic process of change in beliefs which later models show
- Assumption that individuals are rational information processors and decision-makers, which is not always the case
- Limited account of social influences on behaviour
12
Q
What is the theory of planned behaviour?
A
- Behaviour is thought to be proximally determined by intention
- Intention is influenced by a person’s attitude towards the behaviour (outcome expectancy, outcome value) and their perception of social pressure regarding the behaviour (subjective norm).
- Perceived behavioural control (a persons belief that they have control over their own behaviour in certain situations- similar to self efficacy) can directly or indirectly influence health behaviour
- Attitude is made up of two components and outcome evaluations
- Outcome expectancies: the expected consequences of the health behaviour (e.g. smoking cessation, healthy eating). Can be +/-
- Outcome evaluation: your evaluation of the favourableness of expected consequences of a behaviour
- e.g. If I eat breakfast I will gain weight (outcome expectancy), which would be bad (outcome evaluation)
- e.g. If I eat breakfast I will have more energy and vitality (outcome expectancy), which will be great (outcome evaluation)
- Subjective norm is made up of two components
- Normative beliefs your perception of how other people regard your performance of a behaviour
- Motivation to comply your desire to comply with the wishes of others
- e.g. My friends think I should binge drink alcohol more often (normative belief), I want to do what my friends think is cool (motivation to comply)
- e.g. My “friends” think I should binge drink alcohol more often (normative belief), I think my friends are idiots and I don’t really care if they think I’m cool (motivation to comply)
- Perceived behavioural control
- Perceived behavioural control is quite similar to concept of self-efficacy
- Perceived behavioural control- your beliefs about the extent of your control over your behaviour (especially in the face of barriers)
- e.g. I believe it will be difficult for me to eat low fat food because my boyfriend will want to eat hot chips
- e.g. I believe that I can correctly and consistently use a condom, even if its ‘in the heat of the moment’
- Intention
- Intention is the readiness of plans to perform a behaviour
- Intention is thought to be the most proximal predictor of behaviour - with attitude and subjective norm (and most of perceived behavioural control) influencing behaviour through their effect on intention.
13
Q
What are the strengths and criticisms of theory of planned behaviour?
A
- The theory of planned behaviour addresses many of the criticisms of the health belief model
- The relationship between variables is well defined
- Includes consideration of the social influences on behaviour
- Considers whether the individual feels able to perform the behaviour
- However….. Prediction of behaviour from TPB variables is significantly lower than the prediction of intention
14
Q
What is the intention-behaviour gap from the theory of planned behaviour?
A
- Although intentions are an important part of predicting future behaviour— not all intentions are translated into behaviour (Abraham, Sheeran, Norman, Conner, de Vries, & Otten, 1999).
- The inconsistency between strong behavioural intentions and subsequent behaviour has resulted in a theoretical ‘intention behaviour’ gap
- There are two main approaches to addressing the intention behaviour gap
- Adding extra variables (e.g. to the theory of planned behaviour-moral norm, self regulation, habit)
- Developing new models to explain post-intentional behaviour
- Some researchers have developed new models to explain what happens after you form an intention to perform a behaviour
- Focus on post intentional behaviour
- Health Action Process Approach (HAPA)
- Temporal Self Regulation Theory
- Focus on post intentional behaviour
15
Q
What is the health action process approach?
A
- HAPA attempts to fill the ‘intention-behavior gap’ by highlighting the role of self-efficacy and action plans (Schwarzer, 1992).
- It is particularly influential because it suggests that the adoption, initiation and maintenance of health behaviours must be explicitly viewed as a process that consists of at least
- A pre-intentional motivation phase
- A post-intentional volition phase
- It emphasises the importance of self efficacy
- Requires two separate processes
- Motivation (intention)
- Volition (action)
- First, an intention to change is developed, in part on the basis of self-beliefs
- Second, the change must be planned, initiated, and maintained, and relapses must be managed
- Motivation phase
- HAPA proposes that self-efficacy and outcome expectancies are important predictors of goal intention (as found in studies with the TPB and perceived behavioural control).
- Perceptions of threat severity and personal susceptibility (perceived risk) are considered a distal influence on actual behaviour, playing a role only in the motivation phase
- Volition phase
- To turn intention into action - planning has to take place
- Gollwitzer’s (1999) concept of implementation intentions- when, where, how plans to turn goal intention into specific plan of action
- Self efficacy also involved
- Initiative self efficacy: individual believes they are able to take initiative when planned circumstances arise
- Coping/maintenance self efficacy: Belief in ones ability to overcome barriers and temptations
- Recovery self efficacy: Important to get individual back on track if they suffer a setback
17
Q
What is the temporal self-regulation theory?
A
- Temporal self-regulation theory (TST) addresses criticisms of the theory of planned behaviour
- Adds variables to explain the intention-behaviour gap
- It is novel in that it incorporates behavioural pre-potency (habits), and individual differences in self-regulatory capacity
- TST posits that health behaviour is proximally determined by three factors:
- Intention strength
- Behavioural pre-potency
- Self regulatory capacity
- The latter two constructs are theorised to have direct influences on behaviour and also to moderate the intention-behaviour link.
- Intention strength is a function of
- Connectedness beliefs
- Anticipated connections between one’s behaviour and salient outcomes (i.e., connectedness beliefs);
- The valence of outcomes can range from negative (costs) to positive (benefits).
- Temporal proximity - beliefs are weighted by temporal valuations
- E.g. a health behaviour might include eventual benefits (e.g. improved appearance, better health status), but more temporally proximal –therefore more heavily influential-immediate costs (e.g. inconvenience, monetary costs, time costs)
- Connectedness beliefs
- Temporal valuations
- TPB and other social-cognitive models (HBM, PMT) may not predict adequate intention-behaviour consistency because they have no temporal (immediate vs distal) weighting of anticipated outcomes
- Differing relationship between the proximity and valence characteristics
- Two important moderating and direct effect on health behaviour are
- Self-regulatory capacity
- Self regulation includes impulse control/management of short term desires.
- Composed primarily of executive functioning resources through the prefrontal cortex.
- Executive functioning refers to the ability of an individual to exert control over cognition, emotion, behaviour, and physiology.
- Behavioural pre-potency
- Behavioural pre-potency examines the strength of past performance in similar contexts.
- It is thought to represent a quantifiable value reflecting frequency of past performance and/or presence of cues to action in the environment
- The combination of self regulation and behavioural pre- potency determines the likelihood that intentions will be translated into behaviour, and each also has direct influences on behaviour itself regardless of intention.
- Self-regulatory capacity
