Public health Flashcards
Principles of Health Belief Model
Individuals will change if they:
• Believe they are susceptible to the condition in
question (e.g. heart disease)
• Believe that it has serious consequences
• Believe that taking action reduces susceptibility
• Believe that the benefits of taking action outweigh
the costs
Failures of HBM
Alternative factors may predict health behaviour, such as
outcome expectancy and self-efficacy
HBM does not consider the
influence of emotions on behaviour
differentiate between first time and repeat
behaviour
Cues to action are often missing in HBM research
Theory of planned behaviour principles
An expansion of the earlier Theory of Reasoned Action (TRA)
- Proposes the best predictor of behaviour is ‘intention’
- Intention determined by:
• A persons attitude to the behaviour
• The perceived social pressure to undertake the behaviour,
or subjective norm
• A persons appraisal of their ability to perform the
behaviour, or their perceived behavioural control
TPB model
Attitude – I do not think smoking is a good thing • Subjective Norm – most people who are important to me want me to give up smoking • Perceived Behavioural Control – I believe I have the ability to give up smoking • Behavioural Intention – I intend to give up smoking
Principles of helping people to act on their intentions
Perceived control – Fisher & Johnson (1996), Patients with chronic back pain took
part in a lifting task. Recalled success predicted success in the task
• Anticipated regret – Abraham &Sheeran (2003), increased anticipated regret was
related to sustained intentions
• Preparatory actions – Stock & Cervone (1990),dividing a task in to sub-goals
increases self-efficacy and satisfaction at the point of completion
• Implementation intentions – Gollwitzer (1999) “if-then” plans facilitates the
translation of intention in to action (specify a time and a context)
• Relevance to self
TPB critiques
Criticisms include the lack of a temporal element, and the lack of direction or
causality (Schwarzer, 1982)
• TPB is a “rational choice model”. Doesn’t take in to account emotions such
as fear, threat, positive affect, all of which might disrupt “rational” decision
making
• Model does not explain how attitudes, intentions and perceived behavioural
control interact
• Habits and routines - which Simon (1957) referred to as “procedural
rationality” - bypass cognitive deliberation and undermine a key assumption
of the model
- Assumes that attitudes, subjective norms and PBC can be measured
- Relies on self-reported behaviour
Steps of the transtheoretical Model
Precontemplation – no intention of giving up
smoking
• Contemplation – beginning to consider giving up,
probably at some ill-defined time in the future
- Preparation – getting ready to quit in the near future
- Action – engaged in giving up smoking now
• Maintenance – steady non-smoker,
i.e. state of change reached
Three main health behaviours related to health
Health Behaviour: a behaviour aimed to prevent disease
(e.g. eating healthily)
• Illness Behaviour: a behaviour aimed to seek remedy
(e.g. going to the doctor)
• Sick role Behaviour: any activity aimed at getting well
(e.g. taking prescribed medications; resting)
Two main groupsof bias
Selection bias
Information bias
Types of selection bias
A systematic error in:
the selection of study participants
the allocation of participants to different study groups
Types of information bias
A systematic error in the measurement or classification of:
exposure
outcome
Sources of information bias
observer (e.g. observer bias)
participant (e.g. recall bias)
instrument (e.g. wrongly calibrated instrument)
Criteria for causality
Strength of association
the magnitude of the relative risk
Dose-response
the higher the exposure, the higher the risk of disease
Consistency
similar results from different researchers using various study designs
Temporality
does exposure precede the outcome?
Reversibility (experiment)
removal of exposure reduces risk of disease
Biological plausibility
biological mechanisms explaining the link
Reverse causality
When all data taken at a single time point, either could have caused either
What is the prevention paradox
A preventive measure which brings much
benefit to the population often offers little to
each participating individual
