Public health - health beliefs and service evaluation Flashcards
Health belief model.
a) Says that individuals will change if they… (4 criteria)
SCAB
b) The model says that the most important reason for poor health behaviours is..?
a) Individuals will change if they:
• S - Believe they are SUSCEPTIBLE to the condition in
question (e.g. heart disease)
• C- Believe that it has serious CONSEQUENCES
• A - Believe that taking ACTION reduces susceptibility
• B - Believe that the BENEFITS of taking action outweigh the costs
b) Perceived barriers
Health belief model.
a) Internal cues
b) External cues
c) Self-efficacy
a) Physiological (pain, attitude)
b) Media, peers, information, GP advice
c) Belief in the competence to change
Health belief model: critique
what the model ignores
Ignores alternative factors that may predict health behaviour, such as:
- outcome expectancy (whether the person feels they will be healthier as a result of their behaviour)
- self-efficacy (the person’s belief in their ability to carry out preventative behaviour)
- influence of emotions on behaviour
- does not differentiate between first time and repeat
behaviour
- Cues to action are often missing in HBM research
Health belief model:
a) What health behaviours could it explain?
b) What is the most important factor for addressing behaviour change in this model?
a) Successful for a range of health behaviours (breast
self-examination, vaccinations, diabetes
management, adherence to medication, cancer
screening)
b) Perceived barriers have been demonstrated to be
the most important factor for addressing behaviour
change in patients
Theory of planned behaviour:
a) What are the three factors that lead into intention (which leads into behaviour)
b) However, what 5 things are important for bridging the intention-behaviour gap? PRIAP
a) Attitude, subjective norm, perceived control
b) P - Perceived control
R - Relevance to self
I - Implementation intentions
A - Anticipated regret
P - Preparatory actions
Theory of planned behaviour
- example of smoking
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
Theory of planned behaviour. Examples for: a) Perceived control (chronic back pain) b) Anticipated regret (exercise) c) Preparatory actions (marathon) d) Implementation intentions (taking medications; kettle) e) Relevance to self
Perceived control – Patients with chronic back pain took part in a lifting task. Recalled success predicted success in the task
• Anticipated regret – increased anticipated regret was
related to sustained intentions (e.g. anticipated regret if they failed to exercise)
• Preparatory actions – dividing a task in to sub-goals
increases self-efficacy and satisfaction at the point of completion (e.g. marathon, start with 5k)
• Implementation intentions – “if-then” plans facilitates the translation of intention in to action (specify a time and a context)
• Relevance to self
Theory of planned behaviour.
Critique
Lack of a temporal element, lack of direction or causality
• 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 - 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
Theory of planned behaviour.
a) Useful for predicting ______ but not so good for predicting ______.
b) Health intentions it can predict
c) Versus health belief - takes into account…?
a) Intentions; behaviours (due to intention-behaviour gap)
b) TPB can predict intentions for a wide range of health behaviours (smoking, self-examination, abortion, diet, condom use)
c) Takes in to account the importance of social pressures and norms as well as perceived control
• Useful for predicting people’s intentions but not as
successful for actual behaviours – techniques to bridge the gap between intentions and behaviours
Stages of change/Transtheoretical model
- 5 stages
At each stage there is a risk of _____
Precontemplation, contemplation, preparation, action, maintenance
(Not ready yet, Thinking about it, Getting ready, Doing it, Sticking with it)
Relapse!
Stages of change/transtheoretical model.
Example of smoking
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. steady state reached)
Transtheoretical model.
Advantages
Advantages • Acknowledges individual stages of readiness (tailored interventions) • Accounts for relapse • Temporal element (although arbitrary)
Transtheoretical model.
Disadvantages
Not all people move thorough every stage, some people move backwards and forwards or miss some stages out completely • Change might operate on a continuum rather than in discrete stages • Doesn’t take in to account values, habits, culture, social and economic factors
Nudge theory
a) what is it?
b) How might it be used to counteract obesogenic environment?
a) ‘Nudge’ the environment to make the best option the easiest –e.g. opt-out schemes such as pensions,
b) placing fruit next to checkouts
Social norm theory.
a) Explain the background (perceived norms vs actual norms)
b) Who might it be more effective in?
c) When might it not be effective?
d) How it applies to health promotion
a) Peer influences are affected more by perceived norms (what we view as typical or standard in a group) rather than on the actual norm (the real beliefs and actions of the group). The gap between perceived and actual is a misperception, and this forms the foundation for the social norms approach.
b) Adolescents, students
c) When the majority are not engaging in the health behaviour
d) Get the truth out there with surveys, etc. (“95% students believe smoking is bad”)
