Week 2: Health Beliefs, Behaviour Change And Promotion Flashcards
What are the three types of health related behaviour
Health behaviour: aims to prevent disease (eating a healthy diet)
Illness behaviour: aims to seek remedy (going to the doctor)
Sick role behaviour: aims at getting well (taking medication, resting)
What are the two ways in which health behaviours are defined
Health impairing habits or behavioural pathogen such as smoking or eating a high-fat diet
Health protective behaviours or behavioural immunogens such as attending a health check
Where did the term health beliefs come from
Health promotion emphasises the role of knowledge however it is now accepted that knowledge is not enough and that what people believe is more important
Health beliefs are the key predictors of behaviour
What are the four types of beliefs that relate to health behaviours
- Attributions
- Risk perception
- Motivation and self-determination
- Self-efficacy
All of these beliefs have been used to study and change all types of health behaviours and have also been incorporated into models of health beliefs and behaviour
Individuals are motivated to….. (attribution)
See their social world as predictable and controllable
How do you attributions relate to the health locus of control
Individuals differ as to whether they tend to regard events as controllable by them an internal locus of control or uncontrollable buy them an external locus of control
Health locus of control has been shown to be related to whether in individual changes their behaviour. The state of health is regarded as internal to the individual and illness is seen as something that comes into the body from the external world
Explain risk perception in relation to health beliefs
Sense of whether or not they are susceptible - may overestimate or underestimate the risk of illness
Reason why people continue to practice unhealthy behaviours, due to inaccurate perceptions of risk and susceptibility (unrealistic optimism)
People also think that risky behaviours can be neutralised or compensated for by another (risk compensation)
What is an example of underestimation of risk
People may believe that because their grandmother smoked all her life and died at age 85 they are not at risk of lung cancer if they smoke
What is an example of overestimation of risk
Believing that obesity runs in the family and that there is little they can do to prevent themselves from becoming overweight
What is an example of risk compensation
I can eat chocolate because I play tennis
Explain motivation and self-determination in relation to health beliefs
Motivation to carry out behaviour - self determination theory
SDT involves autonomous motivations - engaging in behaviours that fulfill personally relevant goals such as eating healthy food or exercising
tend to be positively correlated with a sense of well-being and the persistence of health related behaviours
Self efficacy?
Self efficacy is very closely related to feeling confident in one’s inability to engage in any given behaviour therefore stopping smoking would be associated with the belief I am confident that I can
What are the 3 categories or models for health beliefs?
- Stage models
- Social cognition models
- Integrated models
What are the two stage models of health beliefs and what do they generally mean as a whole
Stages of change model
Health action process approach
Consider individuals to be a different ordered stages and describe how they move through the stages as they change their behaviour
What is the stages of change model
It is based upon the following stages:
- Precontemplation: not intending to make any changes
- contemplation: considering a change
- preparation: making small changes
- action: actively engaging in a new behaviour
- maintenance: sustaining the change over time
However these changes do not occur in a linear fashion in the theory describes behaviour changes being dynamic they may move back and forth several times before progressing
Strengths of stages of change model?
It has been effectively applied to several health related behaviours such as smoking, alcohol use and exercise
It is also increasingly used as a basis to develop interventions that are tailored to the particular stage of the specific person concerned
Explain how the stages of change model would be used for smoking for example
The precontemplation stage would include them thinking they’re happy being a smoker and they intend to continue smoking
Contemplation I have been coughing a lot recently perhaps I should think about stopping
Preparation I will stop going to the pub and I will buy lower task cigarettes
Action I have stopped smoking
Maintenance I have stop smoking for four months now
Explain the health action process approach
This has an emphasis on self efficacy and attempts to predict both behavioural intentions in actual behaviour
It makes a distinction between motivational/decision making stage and an action/maintenance stage
What does the decision-making and motivational stage of the health action process approach model consist of
Self efficacy for example I’m confident that I can stop smoking
Outcome expectancy is for example stopping smoking will improve my health
Threat appraisal which is composed of beliefs about the severity of an illness and perceptions of individual vulnerability
What is the action and maintenance stage of the health action process approach model
There is a volitional cognitive aspect or an action plan (if offered a cigarette I will imagine what the tar will do to my lungs)
An action control mechanism (I can survive being of a cigarette by reminding myself that I am a non-smoker)
There is also a situational factor consisting of social support (the existence of friends to encourage non-smoking) and the absence of situational barriers (financial support to join an exercise club)
What are the social cognition models of health beliefs
The health belief model
Protection motivation theory
Theory of planned behaviour
These theories examine the predictors and pre-cursors to health behaviour and take a continuum approach to behaviour change.
What else are social cognition models based upon
They are based upon social cognition theory developed by Bandura suggesting that behaviour is governed by expectancies, incentives and social cognitions
Expectancies include that a behaviour maybe dangerous or can reduce the harm to health. There is also self efficacy expectancies that the individual is capable of carrying at the desired behaviour
Incentives are a motivational factor referring to the perception of the consequences of a given behaviour
Social cognitions reflect someone’s views on how others perceive behaviour
What is the health belief model
Predicts that the health behaviour is a result of a core set of beliefs.
These include susceptibility to illness, severity of illness, the costs involved in carrying out the behaviour, the benefits involved in carrying out the behaviour, cues to action which maybe internal or external
Health motivation and perceived control were a late addition to this model
Explain an example of the health belief model to predict regular cervical cancer screening
An individual perceives that she is highly susceptible to cervical cancer (susceptibility)
Cervical cancer is a severe health threat (severity)
The benefits of regular screening a high (benefits)
The costs are comparatively low (cost)
She is subjected to cues to action that are external such as the leaflet in the doctors waiting room or internal such as the symptom perceived to be related to cervical cancer such as pain or irritation (cues to action)
She is confident that she can do so and if she is motivated to maintain her health (health motivation/perceived control)
Explain the protection motivation theory
This theory is like the health belief model however it has the addition of fear as an emotional component into the understanding of health behaviour
Components include:
- severity
- susceptibility
- response effectiveness (changing my diet would improve my health)
- self efficacy
- fear
What is the theory of planned behaviour
Emphasises behavioural intentions as the outcome of a combination of several beliefs:
- Attitude towards a behaviour: either a positive or negative evaluation of a behaviour and beliefs about the outcome
- subjective norm: composed of the perception of social norms and pressures to perform a behaviour, and evaluation of whether the individual is motivated to comply with this pressure
- perceived behavioural control; which is composed of the belief that the individual can carry out a particular behaviour based upon consideration of internal control factors and external control factors both of which relate to past behaviour
These three factors predict behavioural intentions which are then linked to behaviour it also states the perceived behavioural control can have a direct effect on behaviour without the mediating affective behavioural intentions
Explain the theory of planned behaviour and apply it to alcohol consumption
High intentions to reduce alcohol intake would be predicted if:
- an individual believed that reducing the alcohol intake would make their life more productive and beneficial to their health (attitude to the behaviour)
- believed that the important people in their life wanted them to cut down (subjective norm)
- believed that they were capable of drinking less alcohol due to their past behaviour and evaluation of internal and external control factors (high behavioural control
What are the integrated models Of health belief
COM-B
Capability/opportunity/motivation/behaviour
An attempt to create a definitive model that uses the most useful cognitions and can be used to predict and change health behaviours
COM-B?
The key components are:
- capability (derived from the individual psychological or physical ability to enact the behaviour)
- opportunity (reflecting the physical and social environment that enables the behaviour)
- motivation (describing the reflective and automatic mechanisms that activate or inhibit the behaviour)
Explain COM–B if applied to cooking to eat healthier foods
People cook because they are capable of cooking and have cooking skills
Because they have the opportunity to cook for example they have the food and ingredients at home
Because they are motivated to cook they want to cook and believe that it is the right thing to do
Why do we need to change behaviour?
To prevent illness
To manage illness
To reduce physical symptoms
To improve wellbeing
Which theoretical perspectives underpin facilitating behaviour change
Learning and cognitive theory
Social cognition theory
Stage models
Interventions based on changing affect
Explain learning and cognitive theory
Much of our behaviour is shaped by learning.
Cognitive theory to be adds to this approach by exploring how people think.
This combination can be used to design powerful strategies for behaviour change
What are the aspects of the learning component of learning and cognitive theory
- reinforcement
- incentives
- exposure
- associative learning
- modelling
What are the aspects of the cognitive component of learning and cognitive theory
- CBT
- Relapse prevention
Explain reinforcement
One way to change the behaviour is to positively reinforce the desired behaviour and ignore or punish the less desired behaviour
What are incentives
They are based on the notion of reinforcement but they’re more subjective and are powerful influences
Incentivising can take the form of government changes to the cost of products such as cigarettes fatty foods and fizzy drinks or directly paying people to stop smoking
Explain modelling
Modelling influences behaviour for example a child is more likely to smoke if their parents smoke
Explain classical conditioning
We learn associations between unconditioned and neutral stimuli
This method is used in marketing as a means to make relatively neutral objects such as perfume or cigarettes seem more positive by pairing them with something attractive
Explain exposure
One of the best predictors of future behaviour is past behaviour
one of the simplest ways to change your behaviour is the exposure to the behaviour practice or skills training
Explain cognitive behavioural therapy
Maladaptive behaviour is maintained by distorted cognitions and a vicious cycle between thoughts and behaviours which is perpetrated by irrational self talk
CBT focuses on challenging and changing unhelpful cognitive distortions and behaviors, improving emotional regulation, and the development of personal coping strategies that target solving current problems.
What is an example of selective abstraction
Drinking alcohol is the only way I can unwind after work
Give an example of dichotomous reasoning
If I’m not in complete control I will lose all control
Give an example of overgeneralisation
I failed last night so I will fail today as well
Give an example of magnification
Stopping smoking will push me over the brink
Give an example of superstitious thinking
If I do exercise I will have another heart attack
Give an example of personalisation
They were laughing they must be laughing at me
How will a therapist challenge irrational thoughts?
Normally the therapist will ask smart questions aimed to facilitate a change in thinking for example what evidence do you have to support your thoughts and when you say all the time can you think of times when this is not the case
Explain the gap between intention and behaviour
To close this gap between attention and behaviour behaviour change interventions based on these models have used implementation intention interventions which describe the what and the wind of a particular behaviour
So for example I intend to eat healthily becomes I will start to eat healthily by having a salad tomorrow at lunchtime
What is the main criticism towards many approaches to behaviour change?
That they do not address an individual‘s emotions and consider people to be just rational processers of information
However using fear appeals are designed to raise fear as a means to change how people behave- touches on emotion
What is the main problem with using fear messages in health behaviour change models
Blocking
When people resist block avoid ignore or find faults in these messages
What is health promotion
Any event, process or activity that facilitates the protection or improvement of the health status of individuals, groups, communities or populations
What is the objective of health promotion
To prolong life and to improve quality of life by preventing or reducing the effects of impaired physical and or mental health in those individuals who are directly or indirectly affected
What are the two aspects of health promotion
This can either be through a behaviour change approach to the individual
Public health interventions community development approach workplace public health and school-based interventions
What does the community development approach aim to improve
Improve and promote health by addressing socio-economic and environmental determinants of health within the community
These recognise the close relationship between individual health and its social environment which consequently become the target for change
What are the key barriers people identified for community health and well-being
Lack of access to local facilities and services that are affordable, including education and medical services, and lack of access to money food and housing
Community attitudes including a lack of confidence, awareness, motivation, trust and behaviour
Lack of connection between people in groups
Time management is competing priorities
