Individual, Interpersonal, Community, and Societal Models on Risk Behaviour and Behaviour Change

Question 1

The Individual Level

Answer 1

1. At the individual (intrapersonal) level, the cognitive (mental) perspective is commonly used for understanding risky behaviour
2. Intrapersonal factors include knowledge, attitudes, beliefs, motivation, self-concept, developmental history, past experience, and skills
3. Together with interspersonal, community, and society perspectives, individual level theories are very commonly used to study human behaviour, especially to study health behaviour

Question 2

The Health Belief Model

Answer 2

1. The HBM was one of the first models that adapted theory from the behavioural sciences to understand health problems
2. It was developed in the 1950s by psychologists working in the US Public Health Service and it remains one of the most widely recognised conceptual frameworks of health behaviour
3. It was developed with the specific purpose of helping to understand why people did not participate in public health programmes
   - Interested in preventive health behaviours
4. The HBM focuses on six constructs that influence how a person will act in a given situation
5. Before someone engages in any behaviour, they will consider the health risk of the situation in terms of these concepts and this accounts for that person’s readiness to act
6. In terms of the model, action is also moderated by a number of personal factors
   - Such as age, sex, personality, culture, education, etc.

Question 3

The Health Belief Model: Assumptions

Answer 3

1. Individuals are active and rational decision makers always acting on what is in their interest
2. The decisions they make are influenced by perceptions of the usefulness of the actions/behaviour
   Maximise benefits and reduce costs

Question 4

Self-Efficacy

Answer 4

1. Their confidence in being able to successfully perform a behaviour
   - Tobacco user’s confidence in their ability to terminate use of tobacco
   - Strengthening self-efficacy via guidance in quitting
   - -> i.e. Demonstrating proper use of nicotine patch/gum, etc.

Question 5

The Stages of Change Model

Answer 5

1. Developed as a framework to study addictive behaviours including smoking, and alcohol and drug abuse
2. Health behaviour change is a process rather than an event
3. As individuals prepare to change their behaviour, they move through a series of five stages
   - Each stage is associated with different attitudes, intentions, and behaviour

Question 6

The Stages of Change Model : Assumptions

Answer 6

1. Behaviour change follows a predictable process
2. Perceptibly distinct stages, often no overlaps, and few people meet the ideal
3. People need to pass through the stages to reach desired goal
4. Individuals engage in behaviour change through discreet ordered stages

Question 7

The Stages of Change Model

Answer 7

1. Each stage has its own challenges and barriers, experienced differently by different people
2. The model is circular in that people may enter the change process at any stage, relapse to an earlier stage, and begin the process once more
3. They may cycle through this process repeatedly

Question 8

levels of the stages of change model

Answer 8

1. the precontemplation
2. the contemplation stage
3. the preparation stage
4. the action stage
5. the maintenance stage

Question 9

1. the precontemplation stage

Answer 9

1. no intention of changing their behaviour
2. might be unaware of the risk they are placing themselves under or that their behaviour represents a problem
3. at this stage their is considerable resistance to change
   - individuals unwilling to stop smoking
   - not thinking of quitting in the next 6 months

Question 10

2. The Contemplation Stage

Answer 10

1. Once they become aware of their problem behaviour and start to consider doing something about it, they are in the contemplation stage
2. Although they are aware that their behaviour represents a problem, they do not take any action to initiate change and they tend to struggle with indecision about changing their behaviour
   - Individual is ambivalent
   - But thinking about quitting within 6 months

Question 11

The Preparation Stage

Answer 11

1. In the preparation stage, people begin to take small steps towards changing their behaviour
2. They begin to formulate specific intentions to change their behaviour soon
   - Individual is getting ready to stop within the next 30 days
   - Has set stop smoking date
   - Has made a 24 hour quit attempt in the last 12 months

Question 12

4. The Action Stage

Answer 12

1. Once they take significant steps to change their behaviour, they are in the action stage
2. They invest considerable time and energy in their actions and persevere with the changes
   - Individual has quit smoking within past 6 months and are actively applying cessation skills

Question 13

5. The Maintenance Stage

Answer 13

1. During the maintenance stage, people make every effort to prevent relapse and continue with successful strategies that helped them to successfully change their behaviour

• Individual has quit for more than 6 months
• Integrating smoke-free living into their routine

Question 14

The Stages of Change Model

Note about the Example

Answer 14

1. Quit rates aren’t the only measure of success
2. Moving from one stage to another can be considered a success as it is one step closer to a quit attempt
3. It is important to keep in mind that the process of quitting smoking is not always linear
   - Most smokers will cycle through the stages 3 to 4 times before quitting for life
4. Relapse is a normal event in the process of making behavioural change

Question 15

The Theory of Reasoned Action

Answer 15

A person’s intention to carry out a behaviour is determined by a combination of:

1. The person’s attitude towards the behaviour
2. The person’s subjective norms
   - Beliefs about what others whose opinions are valued think
   - Beliefs about whether key people approve or disapprove of that person’s behaviour

Question 16

The Theory of Reasoned Action: Assumptions

Answer 16

1. Human behaviour is under the voluntary control of the individual
2. People think about the consequences and implications of their actions and then decide whether or not to do something
   - intention is highly related to behaviour

Question 17

The Theory of Reasoned Action

Attitudes

Answer 17

Attitudes towards a behaviour are determined by people’s beliefs about the outcome of the behaviour, and their evaluation of that outcome

1. What one thinks of the behaviour
2. The desirability or undesirability of the behaviour
   - - A direct attitude about the target behaviour of smoking cessation may be one in which a patient thinks quitting is good or bad
   - - An indirect attitude is one in which a patient believes a peripheral outcome (such as weight gain) may or may not occur as a result of the target behaviour

Question 18

The Theory of Reasoned Action

Subjective Norms

Answer 18

Subjective norms are determined by what people think other people who are important to them want them to do, and their motivation to comply with these important people’s wishes

1. Normative beliefs
   - Whether other people approve or disapprove of the behaviour
2. Motivation to comply
   - How much and why their approval or disapproval of the behaviour matters
3. Involves what others think of a given behaviour
   - A physician or other health care provider may have encouraged the patient to quit smoking, and this will positively influence the patient’s willingness to quit
4. Also involves whether the patient thinks key people approve or disapprove of a given behaviour
   - The patient may also feel disapproval of smoking by others, further reinforcing the desire to quit

Question 19

The Theory of Planned Behaviour

Answer 19

1. The TRA was expanded into the TPB to include influences at the community and societal level, which includes the element of perceived behavioural control
2. Together with attitudes and subjective norms, perceived behavioural control is thought to influence intentions to as perform a given behaviour
3. This theory thus recognises societal influences but emphasises the individual’s subjective evaluation of these influences
4. Perceived behavioural control is the extent to which people believe that they have control over their behaviour

• Involves whether patients believe they can exercise control over tobacco use in the presence or absence of facilitators and barriers to quitting
• • Perceived likelihood of various events occurring that will act to facilitate or thwart tobacco use or cessation, and the perceived impact that such events will have in making tobacco use or cessation difficult or easy

Question 20

Criticisms of the Models at the Intrapersonal Level

Answer 20

1. Too individualistic
   - Lack of actionable understandings of the ways in which community and social contexts impact on health
2. Assumes that people make rational decisions
   - However, most people do not approach risk taking from a logical perspective
   - - Emotional, interpersonal factors, economic, and power relations in society often play an important role in determining risk behaviour

Question 21

Interpersonal Level

Answer 21

1. At the interpersonal level, behaviour is influenced by:
   - People’s interactions with other people in their social world
   - -e.g. family members, friends, co-workers, health, professionals, and others
   - Cognitive factors
2. As well as by the interaction between these factors

Question 22

The Social-Cognitive Model

Answer 22

1. Useful for understanding behaviour at this level because it explores the reciprocal interactions of people and their environments, and the psychosocial determinants of health behaviour
2. Reciprocal determinism between:
   - Thought
   - Behaviour
   - The environment

Question 23

The Social-Cognitive Model

Answer 23

1. This approach emphasises the importance of intervening thought processes
   - These include aspects of cognition such as information acquisition, storage, and retrieval
2. The interaction between the tobacco user, smoking, and the environment in which the behaviour is performed
   - Environmental factors can have an effect on the tobacco user
   - The tobacco user can also have an effect on the environment
3. The SCM maintains that behaviour is determined by cognitive expectations and incentives
   - Cognitive expectations are beliefs about the likely results of an action in terms of positive or negative outcomes
   - – e.g. Studying hard for your exams as you believe it will lead to good marks
4. Incentives are anticipated rewards that encourage a particular behaviour
   - e.g. Receiving a prize/monetary reward from your parents/school/university for your good marks
5. Most learning occurs through observing others
   - People are likely to perform the behaviour they observe
   - Particularly in if the model is similar to themselves in age, gender, or race, and when the behaviour selves results in desirable social, psychological, or material consequences
   - Furthermore, high-status individuals have been found to exert a stronger influence on behaviour than low-status individuals
   - e.g. The behaviour of a matric leader is more likely to be copied as a model than that of a new Grade 8 learner in a school
6. However, self-efficacy is also important in the SCM
   - i.e. A person’s conviction that they can perform a particular behaviour successfully
7. Criticism
   - While individual and interpersonal factors are often taken into consideration in understanding high-risk behaviour, the role of broader issues occurring at a community and societal level is often neglected

Question 24

The Community Level

Answer 24

1. Where social and cultural factors influence the ways in which people conceptualise and deal with risk
   - Rather than responding as autonomous agents to the risks they perceive, people act as members of social network
   - - Examples of social networks would be extended family, school peers, work colleagues, etc.
2. These networks positively or negatively influence the capacity of these individuals to respond to high-risk situations

Question 25

The Community Level

Social Capital

Answer 25

1. Community social networks can act as a protective factor
2. Social capital
   - Refers to people’s memberships of social groups or networks
   - - Their degree of connectedness
3. Social capital gains certain interpersonal and/or material benefits for an individual
4. Trust and reciprocity between members of a social group allow members to call on favours, share socio-economic resources, circulate privileged information, and gain better access to opportunities
5. Communities whose members have high levels of social capital are also:
   - Better able to resist disruptive forces
   - More likely to identify external threats as a group problem and marginalised groups, as collectives, can sometimes mobilise effectively to pressure decision-makers to address their concerns
6. A South African study in an informal settlement in KwaZulu-Natal found that girls and women felt particularly vulnerable to sexual abuse given the lack of supportive community networks and controls in place to protect them
7. In order to build relational ties, health promoters may promote self-help organisations
   - These organisations promote a sense of community and they empower group members to be able to give and receive help and share their problems

Question 26

The Community Level

Answer 26

1. A study looking at marital, employment status, individual or household income, baseline social class, and general or psychological health
2. Support mechanisms (only via marriage and employment)andelements social capital (measured by trust and social participation) are independently and positively associated with smokingcessation
   - Continual lack of active social participation and remaining single are associated with smokinginitiation

Question 27

The Societal Level

Answer 27

At this level, theorists consider the role that society plays in determining risk. These approaches can be broadly categorised into:

1. Cultural Perspectives
   - Our cultural value systems are always relevant in the ways we judge risk, danger, or acceptable behaviour
2. Structuralist Perspectives
   - Inequalities (such as class, gender, ethnicity, and position) affect health risks
   - - The disadvantaged have fewer opportunities to avoid risks because of their lack of economic and political resources
   - people who are socially and economically privileged tend to make healthier lifestyle choices in terms of nutrition and exercise
   - - this may be due to differences in life opportunity and lifetime exposure to hardship
   - thus, social class, gender, ethnicity and position in a person’s life are important structuring factors that may not allow some people the opportunity yo have as much control over their actions as others

Question 28

Cultural Perspectives

Answer 28

1. When people engage in activities they know to be labelled as risky (e.g. having sex without a condom when unsure of the HIV status of their sexual partner), this behaviour cannot only be attributed to a poor understanding of the dangers of contracting HIV/AIDS through unprotected sex
2. For instance, students have reported that they still engage in risky sexual practices, despite having a thorough understanding of HIV transmission
   - This is attributed to strong cultural beliefs that sex without a condom is more pleasurable
   - This notion is reinforced by shared cultural expectations of acceptable sexual behaviour and what constitutes risk

Question 29

Structuralist Perspectives

Answer 29

1. What chance does a young, single mother have to consider her behaviour?
   - She may put her-self at risk of contracting HIV because her promiscuous boyfriend is her only source of income
   - How much freedom from poverty does this mother have to self-construct her own life narrative?