Lecture 1 - Explaining Health Behavior Flashcards
Biopsychosocial model:
3 elements
= health
Biopsychosocial model: - biology - psychology - social context = health
How does the Biopsychosocial model work?
Body and mind in interaction determine health and illness
What is included in the 3 different factors of the Biopsychosocial model?
- Biological
(genes, pathogens) - Psychological
(emotions, cognition and behavior) - Social
(norms, social cultural background)
Prevention (3 subcategories)
- Primary prevention
- Secondary prevention
- Tertiary prevention
Primary prevention (between which two stages)
Between the stage of “healthy person” and “early symptoms”.
Secondary prevention know as screening / early treatment (between which two stages)
“early symptom (reversible)” and “later symptoms (irreversable)”.
the stage of revalidation (between which two stages of PREVENTION)
“later symptoms (irreversable)” and “illness”.
Primary prevention:
- Phase:
- Target group:
- Prevention of problem, illness or casualty
- healthy people
Secondary prevention:
- Phase:
- Target group:
- Tracing illness in an early phase, for early treatment / prevention of more serious complaints
- (healthy) people with an increased risk for disease
Tertiary prevention:
- Phase:
- Target group:
- Prevention of complications / worsening of symptoms through optimal care (including self-regulation
interventions) - ill people
- Cohort studies -
Alameda 7 – seven health factors for longevity
- Exercising
- Drinking less than five drinks in one sitting
- Sleeping 7-8 hours a night
- Not smoking
- Maintaining desirable weight for height
- Avoid snacks
- Eating breakfast
Types of health behaviors
• Matarazzo (1984) makes a distinction between:
- Behavioral pathogens
- Behavioral immunogens
- Behavioral pathogens (health risk behaviors)
- Behavioral immunogens (health protective behaviors)
Behavioral pathogens
…such as…
smoking, alcohol and drug-abuse, sharing needles, multiple sex partners, unsafe sex, drunk driving, no ear protection, etc.
Behavioral immunogens
…such as…
physical activity, healthy nutrition (e.g., low in fat, sugar and salt, vegetables and fruit), sun-protection, bicycle helmet, vaccinations, medication, etc.
Why influence
health behavior?
Reason 1:
Health behavior is
related to morbidity and mortality
Morbidity:
Mortality:
Morbidity: illness or disease.
Mortality: death.
Why influence
health behavior?
Reason 2:
Socio-demographical
differences in health behavior
increase socio-economic
differences
Why influence
health behavior?
Reason 3:
The prevalence of risk
behaviors is high
Why influence
health behavior?
Reason 4:
Health behavior is not
always an informed choice
How can we understand health
behavior? (3 steps)
- Getting motivated
- Preparing for action & starting to change
- Staying on track
Getting motivated…
1 model / 1 theory / 1 approach
- Health Belief Model
- Social Cognitive Theory
- Theory of Planned Behavior/Reasoned Action Approach
Health Belief Model (Becker, 1974)
…dv & pc influences ps&s, pb&b & hm, which affets a…
1a - Demographic variables (age, class, gender, etc.)
1b - Psychological characteristics (personality, peer/group pressure, etc.)
…influences…
2a - Percieved susceptability & Percieved severity
2b - Percieved benefits & Percieved barriers
2 c - Health Motivation
…which affects….
ACTION (cues to action)
Social Cognitive Theory (Bandura, 1977, 1989)
Person -(a)-> Behavior -(b)-> Outcome
Cognitive processes:
(a) - self-efficacy expectations
(b) - outcome expectations
Behavioral processes:
(a) - (reciprocal effects - both ways) behavioral initiation and maintenance
(b) - (one way - outcome exp –>) behavioral initiation and maintenance
Social Cognitive Theory (Bandura, 1977, 1989) Self-efficacy - Participant modeling: - Live modeling: - Suggestion: - Attribution:
- Participant modeling:
direct experiences –> choice (approach vs. avoid) - Live modeling:
indirect experiences –> effort & persistence - Suggestion:
verbal persuasion –> thinking & decision making - Attribution:
emotional arousal –> emotional reactions (anxiety, stress)
Theory of Reasoned Action (Fishbein & Azjen, 1975)
Theory of Planned Behavior (Azjen, 1988)
Reasoned Action Approach (Fishbein & Azjen, 2010)
(5 steps, 3 subgroups)
1 - Background factors 2 - (a) Behavioral beliefes (b) Normative beliefes (c) Control beliefs 3 - (a) Attitude toward behavior (b) Percieved norm (c) Percieved behavioral control 4 - Intention 4,5 - Actual control (interacting with 3c) 5 - Behavior (interacting with 2abc)
Getting motivated:
1 model, 1 theory, 1 approach
- Health Belief Model
- Social Cognitive Theory
- Theory of Planned Behavior/Reasoned Action Approach
Preparing for action & starting to change:
1 theory, 1 approach
- Self-Determination Theory
* Health Action Process Approach
Self-Determination Theory (Deci & Ryan, 1985; 2000) Level 1 (x3 categories) Level 2 (x6 categories, in 2 subgroups) Level 3 (x6 categories)
Level 1:
- Amotivation
- Extrinsic motivation
- Intrinsic motivation
Level 2:
- Non-regulation
- External regulation (Controlled motivation)
- Introjected regulation (Controlled motivation)
- Identified regulation (Autonomous motivation)
- Integrated regulation (Autonomous motivation)
- Intrinsic regulation (Autonomous motivation)
Level 3: - Impersonal - External - Somewhat external - Somewhat internal - Internal - Internal (Internalization & Integration)
Self-Determination Theory (Deci & Ryan, 1985; 2000)
- Basic Psychosocial Needs -
- Relatedness
- Competence
- Autonomy
Health Action Process Approach (Schwarzer, 1992)
- Preintenders
- Intenders
- Actors
Health Action Process Approach (Schwarzer, 1992)
…3 steps (2 incl. a+b) leading to disengagement
- Intention
(task self-efficacy, outcome expectancies, risk perception, “barriers & resources”: social support)
2a. Action planning
(task self-efficacy, maintenance self-efficacy)
2b. Coping planning
(“barriers & resources”: social support)
- Action control
(maintenance self-efficacy, recovery self-efficacy, “barriers & resources”: social support)
= Disengagement
Dual Process Theories:
Type 1 process (xxx)
Type 2 process (xxx)
Type 1 process (intuitive)
Type 2 process (reflective)
Dual process theory:
Type 1 process (intuitive)
Type 2 process (reflective)
- Does not requier working memory
- autonomous - - Does requier working memory
- cognitive decoupling; mental stimulation -
Dual process theory:
Type 1 process - 9 things
Type 2 process - 10 things
Type 1 process (intuitive) fast high capacity parrallel nonconscious bias responses contextualized automatic experience-based decision making independent of cognitive ability
Type 2 process (reflective) slow limited capacity serial conscious normative responses abstract controlled rule-based consequential decision making correlated with cognitive ability
Dual process theory:
Type 1 process –> old mind
Type 2 process –> new mind
Old mind: - Evolved early - Similar to animal cognition - Implicit knowledge - Basic emotions New mind: - Evolved late - Distinctively human - Explicit knowledge - Complax emotions
Reflective Impulsive Model
Strack & Deutsch (2004)
—> two systems: engaged/disengaged
- Both systems operate in parallel.
- The impulsive system = engaged.
- The reflective system = disengaged –> high amount of cognitive
capacity.
“Conflicts may arise if behavioral schemata are activated that are incompatible and inhibit one another […] The resolution
of the conflict depends on the strength of the activation for each schema”
Reflective Impulsive Model, Strack & Deutsch (2004) Impulsive system (AAIUU) vs. Reflective system (ECCR)
Impulsive system:
> Implicit, uncontrolled, unconscious, automatic, associative
> habits
> impulses
Reflective system:
> Explicit, controlled, concscious, reasoned
> Knowledge, facts, values
> intentions
Two systems: which one wins?
“The resolution of the conflict depends on the strength of the
activation for each schema” (Strack & Deutsch, 2004)
(6 subcategories)
- Cognitive Capacity/ working memory
- Self-control
- Impulsivity
- Alcohol
- Emotions
- Habit Strength (highlighted)
What is Habits?
How does Habits develop?
Once something is a Habit…
= Mental association between cue and goaldirected response.
= Develops when repeatedly performing a
specific behavior in a stable situation.
…No intention or planning is required.
Why are Habits beneficial?
> efficient?
> easy?
> Efficient: I can use my attention
+ resources for other things
> Easy: I Don’t have to think about it or make difficult decisions
Why can habits be bad?
- Automatic activation
» difficult to change - Despite having strong intentions!
- Even if intentions change»_space; no effect on the strength
+ automatic nature of the cue-response association
COM-B Model
- 4 parts
- Capability
- Motivation
- Opportunity
- Behavior
COM-B Model
Capability:
affecting –>
interacting –>
- Actual control (RAA)
- Affecting motivation
- Interacting with behavior
COM-B Model
Motivation:
affected –>
interacting –>
- Automatic & reflective processes
(Dual process theories), selfefficacy & outcome expectations (SCT) - Affected by capability & opportunity
- Interacting with behavior
COM-B Model
Opportunity:
affecting –>
interacting –>
- Cues to action (HBM), Perceived norms, perceived behavioral control, Actual control (RAA)
- Affecting motivation
- Interacting with behavior
COM-B Model
Behavior
result of:
affecting:
Result of: capability, motivation & opportunity
Affecting: capability, motivation & opportunity
Theoretical Domains Framework 6 subgroups (divided into 3 groups)
source of behavior + TDF (theoretical domains framework)
- 2x capability (psychological & physical)
- 2x motivation (automatic & reflective)
- 2x opportunity (social & physical)
Three models to understand getting motivated
- Health Belief Model
- Social Cognitive Theory
- Reasoned Action Approach (& Theory of Planned Behavior)
Theory to understand content of motivation
• Self-Determination Theory
Theory that moves beyond motivation and highlights importance of
volition (=own will)
• Health Action Process Approach
Theories that distinguish between automatic and reflective processes
• Dual process models
INTEGRATIVE models for understanding (health) behavior
- COM-B model
* Theoretical Domains Framework
