L17 Health Psych Models Flashcards
What is health?
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
Health psychology
• 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:
o Stay healthy
o Why they become ill
o How they respond if they do become ill
• 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).
Biopsychosocial model of illness
- 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
Why are models of health behaviour important?
• 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.
• The models we will describe have identified many modifiable influences upon health behaviour that offer potential targets for health intervention- promotion and education
o 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
• Stage based models
Transtheoretical model
• Social cognitive models
Health belief model • Theory of planned behaviour
• Models focusing on post intentional behaviour
Health action process approach • Temporal self-regulation theory
• Transtheoretical Model
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:
o People move through stages of change
o Processes involved at each stage differ
transtheoretical five/seven stages of change
Precontemplation
o no intention within the next 6 months
Contemplation
o Intends next 6 months.
Preparation
o Intends next 30 days and has taken some steps
Action
o changed overt behaviour less than 6 months
Maintenance
o changed overt behaviour more than 6 months.
Termination
o maintained for an adequate time no temptation to lapse
Relapse
o lapses into former behavioural pattern, returns to a previous stage (common, can occur at any stage)
Transtheoretical • Implications for interventions
The 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 is in planning (preparation) or action stage
Transtheoretical model- tailoring intervention version of the model (only 5)
• Precontemplation
using denial, lower self efficacy and more barriers
• Contemplation
seek information, reduced barriers and increased benefits- although may still underestimate their susceptibility
• Preparation
set their goals and priorities,some make concrete plans. Motivation and self-efficacy crucial if action is to be elicited. “Smart goals”, achievable.
• Action
Requires realistic goal setting to maintain action. social support important for reinforcement of change
• Maintenance
Can be enhanced by self-monitoring and small levels of reinforcement
NSW Health Quit Smoking Intervention Guide for Health Professionals
(Based on Transtheoretical Model)
- Ask
- Advise
- Assess
- Assist
- Arrange Follow-Up
Criticisms of the model: transtheoretical
- 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)
- Doesn’t consider social aspects of health behaviour, severity of illness/disease/outcome, characteristics of the individual
• Health Belief Model
Deomgraphic Variables e.g. gender, age ->
- Perceived Susceptibility to the disease
- Perceived severity
- Perceived benefits
- Perceived barriers
- Cues to action
- Health motivation
- > Likelihood of behaviour
How does HBM work?
a social cognitive model that attempts to explain and predict health behaviours
• 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
According to the model, a person’s readiness to take a health action (e.g. quit smoking, start exercising, practice safe sex) is determined by four main factors:
four main factors of HBM
• 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:
• 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
Becker and Mainman (1975) included general health motivation as a 5th factor.
• Revisions of the HBM (Becker and Rosenstock, 1984)
- 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
(Becker and Rosenstock, 1984) version of Health belief Model
We have individual behavior on the right, and the action you want to elicit and then demographics feeding into individual perceptions of disease, their own self-efficacy (their perceived control over change) and then perceived benefits weighed up.
All of these combined, lead to changes in the individual.
HBM- criticisms
- 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
• Theory of Planned Behaviour
- 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 person’s belief that they have control over their own behaviour in certain situations- similar to self-efficacy) can directly or indirectly influence health behaviour.
Attitude in TPB
Attitude is made up of two components: outcome expectancies and outcome evaluations
• Outcome expectancies: the expected consequences of the health behaviour (e.g. smoking cessation, healthy eating). Can be positive or negative
• 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)
Tpb Subjective norm
Subjective norm is made up of two components: normative beliefs (what you believe is usual) and motivation to comply
• 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 is in tpb
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 tpb
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.
• Intention- your readiness (or plans) to perform a behaviour
• e.g. I intend to eat 2 pieces of fruit every day from now on
• e.g. I intend to stop smoking socially when drinking with my friends
Theory of Planned Behaviour- Strengths and Criticisms
• The theory of planned behaviour addresses many of the criticisms of the health belief model
o The relationship between variables is well defined
o Includes consideration of the social influences on behaviour
o 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
Intention-behaviour gap
- 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 (explain things that happen after you’ve made an intention)
Post-intentional models
- 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
• Health Action Process Approach
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
o A pre-intentional motivation phase
o A post-intentional volition phase
o It emphasises the importance of self efficacy
Requires two separate processes
• Motivation (intention)
• Volition (action)
HAPA- Motivation phase
The 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.
HAPA- Volition phase
- HAPA proposes that in order 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
The Health Action Process Approach Criticisms
- The body of literature applying HAPA to behaviour is still limited
- Too rational? - emotion may be neglected
- The social and environmental influences are not considered as directly affecting behaviour, but rather as cognitions
• Temporal Self Regulation Theory
1. Motivation Shpere Connectedness beliefs (outcome behaviour) Temporal valuation (value of outcome) Leads to intention
- Ambient temporal contingencies (social and psychical environment)
Behavioural prep-potency (habit)
Self-regulatory capacity
Leads to observed behaviour
Pros of TST
Similar to the HAPA but more focused on beliefs.
• 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 prepotency (habits), and individual differences in selfregulatory capacity
To really establish and maintain a habit its 42 days to 6 months
TST posits that health behaviour is proximally determined by three factors:
• Intention strength (how much you want to change)
• Behavioural pre-potency (strength of your habit)
• Self-regulatory capacity (how much can you monitor and change your behaviour?)
The latter two constructs are theorised to have direct influences on behaviour and also to moderate the intention-behaviour link.
Temporal Self Regulation Theory- Intention
Intention strength is a function of:
• Connectedness beliefs:
o anticipated connections between one’s behaviour and salient outcomes (i.e., connectedness beliefs);
o the valence of outcomes can range from negative (costs) to positive (benefits).
• Temporal proximity: beliefs are weighted by temporal valuations.
o 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).
Temporal Self Regulation Theory- 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
Health risk behaviours
-Immediate benefits and delayed costs
Health protective behaviours
-Largely delayed benefits but immediate costs
Temporal Self Regulation Theory- Self regulation
In addition to intention, two important moderating and direct effects on health behaviour performance are:
(1) 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
Still a black box that we need to learn more about
(2) behavioral prepotency
• 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 prepotency determines the likelihood that intentions will be translated into behaviour, and each also has direct influences on behaviour itself regardless of intention.
Temporal Self Regulation Theory- Criticisms
• The body of research using temporal self-regulation theory is small (but growing!)
• We are still trying to find good ways to measure self-regulation and behavioural pre-potency
• It is unclear whether the model is better than the theory of planned behaviour (but it seems likely)
Does seem to capture some concepts more effectively than TPB.
