lecture 2

Question 1

what are the cognitive determinants of behaviour?

Answer 1

1. Awareness
2. Knowledge
3. Attitudes
4. Beliefs

Question 2

What are the Socio-cognitive models of health behaviours?

Answer 2

1. Health Belief model (Rosenstock, 1966)
2. Theory of Reasoned Action (Fishbein, 1967) / Theory of 3. Planned Behaviour (Ajzen, 1985)
3. Transtheoretical model (Prochaska and DiClemente, 1982)
4. COM-B model (Michie et al, 2011)

Assume behaviour is a result of conscious decisions, based on knowledge, information, etc

Question 3

What is the outcome of greater awareness and greater knowledge?

Answer 3

greater enactment of health behaviour

Appleton et al, 2010, Kristal et al, 1990, Wardle et al, 2000.

Question 4

Explain the Gibson, et al, 1998 study.

Answer 4

Aims: The contribution of a variety of psychosocial and environmental factors to consumption of fruit and vegetables by children aged 9-11 years was explored. Method: Ninety-two mothers and children (48 girls and 44 boys) were recruited via urban primary health-care practices. Socio-economic and educational level, nutritional knowledge and health- and diet-related beliefs and attitudes were assessed in mothers and children by questionnaires and semistructured interviews. Mothers diets were measured by a food frequency questionnaire, while children’s diets were assessed by 3-day diaries .
Results:
Children’s fruit intake predicted by:
mother’s fruit intake, mother’s nutritional knowledge, mother’s attitudes
Children’s vegetable intake predicted by:
children’s vegetable likings, mother’s attitudes
Children’s confectionary intake predicted by:
mother’s confectionary likings, children’s attitudes.

Question 5

Explain the Kristal et al, 1990 study.

Answer 5

Aims: This looked at the development and evaluation of scales that assess nutrition knowledge, attitudes about diet and perceived norms associated with selecting low-fat diets.
Method: Participants were 97 women, aged 45–59, with a broad range of dietary fat intakes. Usual dietary patterns were assessed with a food frequency questionnaire, 8 days of food diaries and an 18-item questionnaire on fat-related diet behavior. Participants completed a questionnaire with 125 items. A Q-sort, and item and factor analyses were used to develop three knowledge, two attitude and four norms scales.
Results: Strong relationship between dietary behaviour and dietary knowledge and perceived norms
Weak relationship between dietary behaviour and attitudes

These findings support the inclusion of components that enhance practical food knowledge and change dietary behavior norms in nutrition education programs.

Question 6

Explain the Appleton KM, McGill R, Neville C, Woodside JV. (2010) Barriers to increasing fruit and vegetable intakes in the older population of NI: Low levels of liking and low awareness of current recommendations study.

Answer 6

Telephone survey on FV consumption and barriers / facilitators to FV consumption of 1000 individuals over the age of 65 years, living in Northern Ireland.

Results based on 426 respondents, representative of the target population

Question 7

what were low fruit and vegetable intakes were associated with in the results?

Answer 7

1. low levels of liking
2. low awareness of current recommendations
3. low willingness to change
4. demographic variables

Question 8

Explain the Wardle, Parmenter & Waller. (2000) study.

Answer 8

Assessed nutritional knowledge (110 items), diet (FFQ) and demographics in 1040 UK men and women.
Results:
Fruit and vegetable intakes were associated with:
1. gender
2. age
3. occupation
4. education

Question 9

Explain the Ashfield-Watt P (2006). Fruits and vegetables, 5+ a day: are we getting the message across? study.

Answer 9

Aim: Two surveys to investigate the value of the 5+ a day campaign for fruits and vegetables in New Zealand

Household surveys 1999 – 200 ppts, 2000 – 520 ppts.

Results:

1. High awareness of campaign, high recognition of the logo
2. High awareness of a need to consume more fruits and vegetables
3. Increased intentions to consume more fruit and vegetables

Question 10

Explain the Eboh LO, Boye TE. (2006). Nutrition knowledge and food choices of Primary school pupils in the Niger – Delta Region study.

Answer 10

Aims: 3 week school based nutrition education program on nutrition knowledge and healthy food choices

Control group (N=102) received no nutrition education 
Experimental group (n = 95) received 40 minutes of nutrition education, 4 days a week for 3 weeks.

Results:
experimental group scored significantly higher in nutrition knowledge score and showed significant change in meeting Dietary Guidelines and recommendations.

Question 11

Explain the Morris JL, Zidenberg-Cherr S. (2002). Garden-enhanced nutrition curriculum improves fourth-grade school children’s knowledge of nutrition and preferences for some vegetables study.

Answer 11

Aim: Evaluated the effectiveness of a nutrition education programme based on vegetable gardening and growing

Method:
Lessons consisted of looking at serving sizes, food labels, goal setting, physical activity, snack preparation, gardening to plant and harvest their own vegetables.

Results:
Increases in children’s knowledge (33%)
Increases in children’s preferences for several vegetables
Increases in consumption of vegetables

Question 12

What does more more positive attitudes and beliefs lead to?

Answer 12

More healthy behaviours
Gibson, et al, 1998
Kristal et al, 1990
Hearty et al. 2007

Question 13

Explain the Hearty, et al. (2007). Relationship between attitudes towards healthy eating and dietary behaviour, lifestyle and demographics in a representative sample of Irish adults study.

Answer 13

Method: Measured attitudes towards healthy eating and diet in 1379 men and women
Results:
1. Positive attitudes towards healthy eating were associated with healthier diets
2. Positive attitudes towards healthy eating were associated with females, increasing age, higher social class, higher education, non-smoking, lower BMI and higher activity

Question 14

Explain the McCann et al (1990) Promoting adherence to low fat, low cholesterol diets study

Answer 14

Aim: Evaluated the effectiveness of a programme to improve the consumption of low fat, low cholesterol diets

Method:
Learning about portion sizes, learning recipes and tasting sessions, shopping strategies, learning to read food labels, problem solving strategies for specific situations, e.g. in restaurants.
Results:
Improvements in the consumption of low fat, low cholesterol foods

Question 15

Health Belief Model (Rosenstock, 1966)

Finish this statement:
Behaviour is a result of a set of core beliefs, as a result of perceptions of….

Answer 15

1. Susceptibility to illness
2. Severity of illness
3. Costs of carrying out the behaviour
4. Benefits of carrying out the behaviour
5. Cues to action
6. Readiness to be concerned about health (health motivation)
7. Perceived control

These factors predict likelihood that a behaviour will occur

Question 16

Explain the Deshpande et al (2009) study

Answer 16

Applied the heath belief model to predict the likelihood of

healthy eating among 194 University students. Data strongly supported the HBM.

Question 17

Explain the Vassallo et al (2009) study

Answer 17

Used the Health Belief Model to predict willingness to use
functional breads, across four European countries: UK (N = 552),
Italy, Germany and Finland. HBM fit was similar across the countries and products in terms of significant predictors (the perceived benefits, barriers and health motivation).

Question 18

Explain the O’Connell et al (1985) study

Answer 18

Used HBM to predict obesity in 69 obese and 100 nonobese US students.
Results:
Benefits of Dieting was the most powerful predictor of dieting behaviour for the obese
Susceptibility to the causes of obesity best explained present dieting behaviour of nonobese.
Exercising behaviour of obese was best explained by Cues to Exercising.

Question 19

Explain the Wrightet al. International Journal of Sexual Health, 2012 study.

Answer 19

Used an Expanded Health Belief Model (EHBM) to understand condom assertion
Results:
Condom-assertive females: more faith in the effectiveness of condoms, believe more in their own condom communication skills, perceive that they are more susceptible to STDs, believe there are more relational benefits to being condom assertive, believe their peers are more condom assertive, and intend to be more condom assertive.

Question 20

Explain the 3 main assumptions of the Theory of Reasoned Action (Fishbein, 1967)

Answer 20

1. Assumes actions arise from reasoned (deliberate/conscious) choices
2. Behaviour is a function of Behavioural Intentions (BI)
3. Attitudes predict intentions

Question 21

Does it consider a role for society?

Answer 21

Yes
Members of a society
Friends, family, partners, peers are important
BUT
Wider society and the environment not taken into account

Question 22

Explain the Richardson, et al (1993) study.

SUPPORT

Answer 22

Aims: Tested TRA for red meat consumption.
Results:
Attitudes positively correlated with reduced red meat consumption, and future consumption. Attitudes most highly correlated with behaviour. Attitudes were considered the most important factor of TRA in predicting eating behaviour

Question 23

Explain the McCarthy, et al (2004) study.

SUPPORT

Answer 23

Aims: Tested TRA for meat consumption.
Results:
Found for poultry consumption: 74% variance of behavioural intention explained by attitude, 15% by subjective norm, and Behavioural Intention explained 46% of actual behaviour. For pork: 64% variance of behavioural intention explained by attitude, 11% by subjective norms, Behavioural Intention explained 69% of actual behaviour

Question 24

Theory of Planned Behaviour (Ajzen, 1985)
Extension of Theory of Reasoned Action

Does it consider a role for society?

Answer 24

Social environment

Friends, family, partners, peers
Culture, e.g. Tradition – feasts, celebration
Religion – Christianity, Islam, Hinduism, Buddhism

Physical environment

Question 25

Explain the Ästrøm and Rise (2001) study.

SUPPORT

Answer 25

Aims: Used TPB to predict intention to eat fruit and vegetables.
Results:
Found 52% of variance predicted. Intentions predicted by attitudes, (norms) and perceived behavioural control.

Question 26

Explain the Bogers, et al (2004) study.

SUPPORT

Answer 26

Aims: Used TPB to predict fruit and vegetables consumption
Results:
46% variance predicted. Intentions predicted by attitudes, norms and perceived behavioural control. Consumption predicted by intentions and perceived behavioural control.

Question 27

Explain the Verbeke & Vackier (2005) study

SUPPORT

Answer 27

Aim: Used TPB to predict fish consumption.
Results:
Intentions predicted by attitudes, norms and perceived behavioural control. Consumption predicted by intentions and perceived behavioural control.

Question 28

Explain the Messina, et al (2004) study

NO SUPPORT

Answer 28

Used TPB to predict consumption of sugar-free products in Italian adolescents.
Results:
Found no significant associations.

Question 29

what are the stages of the Transtheoretical model (Prochaska & DiClemente, 1982)

Answer 29

1. precontempation
2. contemplation
3. action
4. maintenence
5. relapse

Question 30

Explain Precontemplation

Answer 30

no awareness of any problems, no intention to change behaviour

Question 31

Explain contemplation

Answer 31

awareness of problems, considering change, no commitment to act

Question 32

Explain preparation

Answer 32

firm intention, begining to make change

Question 33

Explain Action

Answer 33

changing behaviour in order to overcome the problem

Question 34

Explain maintenence

Answer 34

sustaining the change, consolidation of gains made during action, preventing relapse

Question 35

Explain Relapse

Answer 35

regression to earlier stages and behaviours

Question 36

What are the stages of the model characterised by?

Answer 36

Earlier stages characterised by focus on negative beliefs and outcomes, and low self-efficacy

Later stages characterised by focus on positive beliefs and outcomes, and high self-efficacy

Question 37

Explain the DiClemente et al, 1991 study.

Answer 37

1466 US smokers followed up for 1 and 6 months after completing measures on: perceived stress; tolerance to nicotine; pros and cons of smoking; confidence in not smoking; stage of change (TTM); demographics.
Results:
Those in preparation – smoked less, less addicted, higher self-efficacy, more quit attempts than those in contemplation;
Those in action – more pros, less cons than those in preparation

Question 38

Explain the components of the COM-B Model (Michie et al, 2011)

Answer 38

1. CAPABILITY
   Physical and psychological ability to enact the behaviour
2. OPPORTUNITY
   Physical and social environment that enables the behaviour
3. MOTIVATION
   Reflective and automatic mechanisms that activate or inhibit behaviour

all link to behaviour

Question 39

Is there much empirical support for the COM-B model?

Answer 39

Limited published research available

Question 40

What are the limitations of the socio-cognitive models?

Answer 40

1. Assume behaviours are a result of conscious thought
2. Little room for emotions, hedonics, habits, past behaviour
   Inadequate explanation of behaviour
   Variation between studies
   Variation between outcomes
   Intention – behaviour gap
3. Conscious thought can be faulty
4. Optimistic bias / Unrealistic optimism

Individuals tend to believe that in comparison with others they are less likely to experience negative events and more likely to experience positive events, and negative events will be less negative (Miles & Scaife, 2003)

Weinstein (1980) Only a small proportion of respondents reported to be at a higher risk for a given disease while a large proportion assessed their risk as being lower

Sparks et al (1995) Respondents claimed to eat less high fat foods than the average person.