Models Of Health Behaviour Flashcards
Distal influences of health behaviours
Age
Gender
Culture and ethnicity
Socioeconomic status
Personality
Age as a distal influence:
In adolescence, more credence is given to the attitudes, beliefs, values and behaviour on one’s peers(and siblings) than to the advice or attitudes of parents or teachers
We all tend to listen to messages from others when they are congruent to our pre- existing beliefs
Gender as a distal influence
Reiner et al(2016), makes perceived behaviour as less risky, took more risks, we’re less sensitive to negative outcomes and we’re less socially anxious than female participants
Reasons for gender differences in behaviour
Perhaps differences relate to projections of masculinity and a desire to be seen as ‘strong’, as suggested with regards to drinking alcohol excessively(visser and smith 2007), or avoiding seeking health care which is an issue in older men as well as in adolescents
Did the more deprived group from males aged 18-24 consume the most ready meals and fast food (birch et al)
Yes
What group were more likely to consume harmful levels of alcohol (birch et al 2019)
Older men 65+ years
What group were most likely to be sedentary (birch et al2019)
Older women
Environmental influences in health behaviour
- culture/ society
- family
- subculture/ peer group
- media
Mediating factors
Religion- normative beliefs and values not drinking
Social class- attitudes- exercise
Culture - gendered roles and norms- exercising
Gender - perceptions- smoking
Age- normative beliefs - amphetamine use
Distal influences for personality (3factors Eysenck 1970)
-extrasversion
- neuroticism
- psychoticism
Distal influences for personality (‘big 5’ 5 factors McCrae and Costa 1990)
- neuroticism
- agreeableness
- conscientiousness
- extra version
- openness
Openness as a personality factor for health behaviour
Openness to new experience can associate with greater risk- taking
Conscientiousness and agreeableness and personality health behaviour
Typically associated with positive health behaviour and outcomes(smith and Paekhurst 2018) associated with less risk-taking/ more health- protective behaviours (Joyner et al 2018)
Extra version and health behaviour
Typically associated with risk behaviour
Neuroticism and health behaviour
Tends to increase some negative health behaviour
Eg, emotional over eating or underrating
High use of health care
Anxiety and health behavior
Reduce risk taking (Joyner et al)
Distal influences cont trait like cognition
• locus of control
-internal accountability
- external accountability
• multidimensional health locus of control, Wallston LOC specific to health beliefs
- internal: determine own health
- external: matter of luck/ fate
-powerful others: health determined by doctors/ surgeons
Locus of control findings
Generalised LoC dimensions, proved to be modest predictors of behaviour, with relationships differing depending on the behaviours addressed
Steptoe and Wardle (2001)
Analysis of 7000+ students across 18 countries
- the odds of healthy behaviour increased by 40% amongst those high in internal HLOC compared to those low in internal HLOC , and reduced by 20% in those high in chance HLOC compared to low in chance LOC
- internal associated with health- protective behaviour
Initial hypotheses for locus of control findings
Initial hypotheses that people must value their health in order to engage in health protective behaviour not consistently shown
Proximal influences
Attitudes
Beliefs
Expectations and goals
Motives
What are ‘attitudes’ in proximal influences
- orientations to objects/ people/ events
- in attitude-object relationship there are three components: thoughts, behaviours and feelings
• cognitive- beliefs about attitude
• emotional- feelings toward object
• behavioural- intended action
What is ‘risk perception/ unrealistic optimism’
How we perceive our risk for illness in comparison to others
It’s important with who we compare ourselves with
Four factors involved in unrealistically optimistic appraisals of personal risk (Weinstein,1987)
• lack of personal experience
• Belief that action can prevent problem (behavioural control)
• belief that if problem has not occurred, it won’t in future
• belief that problem is uncommon
What do studies need to measure with perceived risk
Studies need to measure ‘perceived risk’ in relation to ‘actual risk’
Goals and motivations
Goals focus our mind and direct out behaviour(self- regulation)
- outcome expectancies within social cognition theory(carver and Scheier)
Social cognitive theory(SCT) Bandura
According to Bandura, behaviour is determined by three types of individual expectancies:
• situation-outcome expectancies
• outcome expectancies
• self- efficacy beliefs
What does Bandura mean by ‘situation-outcome expectancies’
Whereby a person connects a situation to an outcome
For example, smoking to heart attack
What does Bandura mean by ‘outcome expectancies’
For example, believing that stopping smoking would reduce the risk of a heart attack
What does Bandura mean by ‘self-efficacy beliefs’
For example, the extent to which the person believe they can stop smoking
Behavioural beliefs, Self-efficacy in depth (3)
• “A belief in one’s capabilities to organise and execute the sources of action required to manage prospective situations”- Bandura (confidence)
• Believing that a future action is within your capabilities is likely to generate other cognitive and emotional activity
• these cognitions and emotions in turn affect actions
Psychosocial factors (7)
- demographic factors
- personality
- social norms
- attitudes
- risk perception and unrealistic optimism
- goals and motivation
- self-efficacy
What did Van Capellen et al and the ‘upward spiral theory of lifestyle change’ suggest
Considers the role of positive affect and implicit motives in relation to health behaviour change, perhaps particularly relevant to the maintenance of behaviour change
Models of health behaviour 1
• continuum models
- health belief model(HBM)
- Theory of Reasoned Action (TRA)- theory of planned behaviour(TPB)
- implementation intentions
The importance of models (7)
- theories can be modelled
- models are rudimentary- most theoretical frameworks are not sufficiently detailed to fully explain observations
- constructing models to test hypotheses
- generate research
- predict behaviour and explain data
- solve problems
- models describe associations, theories explain them
Caveats to modelling health behaviour
Different health behaviours are controlled by different external factors
Gives examples to how different health behaviours are controlled by different external factors:(5)
- attitudes towards health behaviours vary within(as well as between) individuals
- motivating factors may differ for different health behaviours
- motivating factors may change over time
- individual differences in attitudes and motivations are in part explained by life stage and the associated perceived norms
- the social context can trigger or alternatively limit behaviour
Early theory of health behaviour change
Information -> Attitude change ->behaviour change
Health belief model assumptions (Becker)(3)
Assumption 1- ‘situation outcome beliefs’- a situation is connected to an outcome
Assumption 2- ‘outcome expectancies’ - by taking a recommended positive action, an individual can avoid a negative health condition
Assumption 3-‘self-efficacy beliefs’- individual believes they can smoothly and successfully take action to prevent a negative health consequence (draws on ‘subjective utility theory)
Health behaviour model, mechanisms of behaviour: (4)
- perception of threat
- behavioural evaluation
- cues to action
- health motivation
Health behaviour model- cues to action: (3) and when was it added
1975
• internal cues, eg symptom of illness
• External cues - TV programme, other people’s experience
• cues to action will predict health behaviour directly and indirectly
Health behaviour model- health motivation (1) and when was it added
1977
- how important is health to me- will directly predict health behaviour
Health behaviour model limitations (7)
- several versions- different content depending on time used
- may better predict preventative behaviour uptake, than risk behaviour reduction
- components studies independently but may interact and vary in salience - weightings
- over-estimates the time of threat- overuse of fear arousal can be counterproductive
- static model- excludes change in beliefs/perceptions
- does not include emotions- scientists have increasingly recognised the importance of affect in understanding health behaviour (kiviniemi et al)
- removing barriers is not always sufficient to increase behaviour (Rhodes)
Theory of planned behaviour (Azjen,1985,1991)
1) social cognition model - Bandura
2) assumes people’s social perceptions, expectations and beliefs in social situations determine behaviour
3) the TPB addresses the psychological processes linking attitude and behaviour by incorporating wider social influences and perceived norms, beliefs in personal behavioural control, and the necessity of intention formation
4) added perceived behavioural control (PBC) to Earlier theory of reasoned action- PBC directly influences both behaviour intention and behaviour
What is TPB (theory of planned behaviour) (4)
- attitude
- perceived subjective norm
- perceive behavioural control
- intention
Attitude example and subjective norm example
Attitude: smoking is dangerous, stopping will reduce chance of cancer/ other illness (outcome expectancies) and my health is important- I play sports (outcome value)
Subjective norm: my pals in sports team don’t smoke, they are always in at me to stop (normative beliefs) and I want to be as fit as them(motivation to comply)
What is the internal control for TPB
Skills/ abilities/ information
What’s so is the external control for TPB
Obstacles/ opportunities
How is an indirect relationship in TPB modelled
Via intention
Direct relationship between PBC
Behaviour is also possible if perceptions control were accurate
If a person believes that they have control over their diet and actually do, then behaviour is likely to change; but if food preparation is under someone else’s control, behavioural change is less likely even if a positive intention had been formed
Sutton and White 2016 systematic review method
Systematic review and meta-analysis of 38 studies of predictors of sun- protection intentions and behaviour
Sutton and white 2016 study for PBC results
• attitudes were the strongest predictors of intentions
• and intentions were stronger than PBC sub terms of predicting behaviour
Limitations of TPB (4)
- does not acknowledge bi-directional relationships between IVs and DVs
- research evidence of a strong link between behavioural intentions and behaviour over- relied on cross- sectional data
- assumption that the same factors that lead to initiation of health behaviours also maintain them- not much evidence on maintenance
- intention theorised as the critical precursor of behaviour change, but intervening to increase intention has not had a huge effect on behaviour
Gollwitzer implementation intentions
- increases commitment
- good outcome when goals are valued, and self-efficacy is high
- work well whether goal is more proximal or distal
Stage model
Transtheoretical model
Health action process approach (HAPA)
Stage theories and Weinsteins 4 properties
1) classification system to define stages
2) ordering of stages
3) common barriers to change facing people within same stage
4) different barriers to change facing people in different stages
Transtheoretical model TTM (prochaska and Diclemente1986)
Stages of change - developed from smokers who quit
Stage quitters move through when stopping
Different processes involved at each stage
The Transtheoretical model (8)
1) precontemplation
2) contemplation
3) preparation
4)action
5)relapse
6) maintenance
7) relapse
8) termination(6 months)
Health action process approach (HAPA,Schwarze)
- a hybrid model, having both ‘static’ and staged, temporal qualities
- distinguishes motivational and volitional phases
• volitional phase: 2 phases in which individuals first decide to act and then make plans to begin- maintain behaviour
• motivational phase: self- efficacy, outcome expectancies and risk perceptions
Volition phase is dived further into:
• planning phase
• action phase
• maintenance phase
SELF EFFICACY IS CRUCIAL IN BOTH PHASES
Met- analysis of 95 studies using HAPA:
• Confirmed the predictive role of both action and maintenance( motivational and volitional) self efficacy
• and of outcome expectancy
• the effects of outcome expectancies and action self-efficacy were, as hypothesised, mediated by intentions, and by action and coping planning
• NB meta analysis points to different strength if effect depending on the behaviour studied eg, action self-efficacy had a larger effect on physical activity intentions and behaviour than it did on dietary change
Positive affect and enjoyment in behaviour change maintainencae
Positive affect and enjoyment may be necessary conditions for behaviour change maintainenance
