Week 3 - Models of Health Behaviour

Question 1

How did the COVID pandemic change our view of health behaviour?

Answer 1

We were able to look at behaviours such as hand washing, mask ventilation, and vaccination not just individually but in a group (nationally and globally).

Question 2

What are distal influences of health behaviour?

Answer 2

Not direct predictors of the behaviour, but these are contextual, more distant factors that shape and influence your experience, expectations, understanding, beliefs, and motivations.

Question 3

What are some examples of distal influences of health behaviour?

Answer 3

Age, gender, sociocultural norms (culture/society, family, ethnicity, religion, subculture/peer group, media), socioeconomic status (living arrangements, employment status, income), personality

Question 4

In adolescence, whose attitudes, beliefs, values, and behaviours do we give the most credence to, according to Mercken et al. (2011)?

Answer 4

One’s peers and siblings over the advice and attitudes of parents or teachers (Mercken et al. 2011). This shows that people’s expectations of health and responses to social pressure differ with age. The initiation of risk behaviour decreases with age.

Question 5

What did Renier et al. (2016) find regarding male health behaviour?

Answer 5

Males perceived behaviour as less risky, took more risks, were less sensitive to negative outcomes (present or future), and were less socially anxious than female participants.

Question 6

What did Visser and Smith (2007), Calisanti et al. (2013), and Marcell et al. (2007) find regarding male health behaviour?

Answer 6

Males may drink alcohol more excessively then females and avoid seeking health care (older men and adolescents alike) due to projections of masculinity and a desire to be seen as ‘strong.’ E.g. testicular cancer is often found at stage 3.

Question 7

In Birch et al. (2019), what did a study of a representative UK adult sample find regarding the role of age and gender in health behaviours?

Answer 7

Males aged 18-24 years consumed the most ready meals and fast food. Older men (65 years+) were more likely to consume harmful levels of alcohol. Older women were more likely to be sedentary. The influences on all of these may vary/are complex (distal vs. proximal, micro vs. macro).

Question 8

What are the big 5 factors of personality according to McCrae and Costa (1990)?

Answer 8

*Neuroticism, *Extraversion, Agreeableness, Conscientiousness, Openness (top 3: agreeableness, conscientiousness, and openness = *psychoticism)

Question 9

What personality factors are associated with greater risk-taking and negative health behaviour?

Answer 9

Openness to new experiences, extraversion typically associated with risk behaviour (e.g. drinking), agreeableness may mean you are more amenable to social pressures, neuroticism tends to increase SOME negative health behaviours (e.g. emotional over/undereating) and is associated with anxiety which may increase risk behaviours (e.g. drinking or smoking)

Question 10

What personality factors are associated with less risk-taking/more health-protective behaviour?

Answer 10

Openness can be associated with healthy diet, conscientiousness and agreeableness typically associated with positive health behaviour and outcomes, neuroticism associated with high use of healthcare which may mitigate against negative health outcomes (overrepresented in heartcare statistics)

Question 11

What is a multidimensional health locus of control (MHLOC)?

Answer 11

Internal or external accountability over your life/health. May differ depending on culture.

Question 12

What is internal HLOC?

Answer 12

We determine our own health. It is a matter of our habits

Question 13

What is external HLOC?

Answer 13

Health is a matter of luck/fate/genes/weather. Powerful others, such as doctors/surgeons/professionals/God(s), may determine our health.

Question 14

_____ HLOC is associated with reduced risk behaviour and health-protective behaviour

Answer 14

Internal

Question 15

In Steptoe and Wardle’s (2001) analysis of 7000 students across 18 countries, what did they find?

Answer 15

The odds of healthy behaviour was increased by 40% amongst those high in internal HLOC compared to those low in internal HLOC. It was reduced by 20% in those high in chance/external HLOC compared to low in chance HLOC.

Question 16

True or False: people must value their health in order to engage in health protective behaviour

Answer 16

False. People will engage in health protective behaviour even if health isn’t in their top life values.

Question 17

What are some examples of proximal influences on health behaviour?

Answer 17

Attitudes (orientations to objects/people/events… e.g. may like the taste of alcohol but not the effects), beliefs, expectations and goals, motives

Question 18

What are the three components in an attitude-object relationship?

Answer 18

Thoughts/cognitive: beliefs about attitude-object (e.g. smoking is weak/dangerous).
Feelings/emotional: feelings toward object (e.g. smoking is disgusting/scary).
Behavioural: intended action (e.g. will not smoke)

Question 19

What is unrealistic optimism?

Answer 19

Our tendency to have unrealistically optimistic appraisals of our personal risk. We tend to have biased risk perception as we tend to compare ourselves with the groups that make us come out better.

Question 20

What is self-preservation bias?

Answer 20

Our tendency to protect ourselves by comparing ourselves to people who look okay, but have worse/similar health behaviours. E.g. “I know someone who’s smoked and drank all their life - never had a day’s illness.”

Question 21

What are the four factors involved in unrealistic optimism (Weinstein, 1987)?

Answer 21

Lack of personal experience with behaviour/problem/health outcome, belief that action can prevent problem (behavioural control), belief that if problem has not occurred then it won’t in the future (bias of youth), belief that problem is uncommon.

Question 22

What is one limitation of unrealistic optimism studies?

Answer 22

They have yet to measure ‘perceived risk’ in relation to ‘actual risk’

Question 23

What is behavioural self-regulation theory?

Answer 23

We have motivations and do things for a reason. Outcome expectancies help us set goals. These goals are what focus our mind and direct (most of) our behaviour (self-regulation) towards achieving these goals

Question 24

What is a challenge of behavioural self-regulation theory?

Answer 24

Habits challenge the idea that we are doing things for a reason because they are motivated by unconscious goals.

Question 25

What is Social Cognitive Theory (SCT) according to Bandura (1977, 1986)?

Answer 25

Behaviour is determined by three types of individual expectancies: situation-outcome expectancies whereby a person connects a situation to an outcome (e.g. smoking to a heart attack); outcome expectancies (e.g. believing that stopping smoking would reduce the risk of heart attack); self-efficacy beliefs - these are critical (e.g. the extent to which the person believes they can stop smoking).

Question 26

What is self-efficacy according to Bandura (1986)?

Answer 26

“A belief in ones capabilities to organise and execute the sources of action required to manage prospective situations.” In other words, it is the belief and confidence that a future action (e.g. weight loss) is within your capabilities.

Question 27

What cognitive and emotional activities is self-efficacy likely to generate?

Answer 27

Goal-directed behaviour (i.e. the setting of high personal goals), positive outcome expectancies, and reduced anxiety about future (this is one of the main reasons people don’t try). These cognitions and emotions in turn affect actions (e.g. dietary change, exercise, and promoted perseverence).

Question 28

What are some psychosocial factors that appear in various models of health behaviour?

Answer 28

Demographic factors, personality, social norms, attitudes, risk perceptions and unrealistic optimism, goals and motivation, self-efficacy

Question 29

What is the ‘upward spiral theory of lifestyle change’ that was proposed by Van Capellen et al. (2018)?

Answer 29

This considers the role of positive affect and implicit, nonconscious motives in relation to health behaviour change, perhaps particularly relevant to the maintenance of behaviour change.

Question 30

What is the difference between models and theories? What are the similarities?

Answer 30

Models describe associations, theories explain them. They generate research, predict behaviour, help explain data, and solve problems.

Question 31

How/why do we test models?

Answer 31

Take an underpinning theory that can be assessed quantitatively, and test it empirically against another concept/theory that can be tested quantitatively, then look at correlations, associations, and predictions.

Question 32

What are the caveats to modeling health behaviour?

Answer 32

Different health behaviours are controlled by different external factors (e.g. smoking is socially sanctioned against nowadays, while exercise is being socially promoted). Attitudes towards health behaviours vary within (as well as between) individuals (e.g. drinking vs. smoking cigs). Motivating factors may differ for different health behaviours (e.g. exercise for fitness vs. aesthetic reasons). Motivating factors may change over time (e.g. motivation to drink as an adolescent vs. adult). Individual differences in attitudes and motivations are in part explained by life stage and the associated perceived norms (e.g. a teen may diet for aesthetic reasons while a middle-aged person may diet to avoid heart disease). The social context can trigger or alternatively limit behaviour (e.g. you might binge drink with friends but not family).

Question 33

What is the health belief model (Becker, 1974)?

Answer 33

The likelihood that somebody will engage in a particular health behaviour depends on the demographic factors (the distal things) as well as perceived threat (severity and susceptibility) of the endpoint and weighing the perceived barriers and benefits of carrying out the behaviour. Combined, these will trigger the likelihood of the behaviour change taking place. Added cues to action (1975) - internal or external - to directly or indirectly predict health behaviour and health motivation (1977) to directly predict health behaviour.

Question 34

What are the assumptions of the Health Belief Model (Becker, 1974)?

Answer 34

Situation outcome beliefs: a situation is connected to an outcome (e.g. smoking is related to heart attack). Outcome expectancies: by taking a recommended positive action, an individual can avoid a negative health condition (e.g. if I stop smoking I can reduce my risk of a heart attack). Self-efficacy beliefs: individual believes that they can smoothly and successfully take action to prevent a negative health consequence (e.g. I can manage to sop smoking). Assumes the greater the threat, the more the action… the opposite can be true.

Question 35

What is subjective expected utility theory?

Answer 35

Individuals are active and generally rational decision-makers influenced by the perceived utility (usefulness to them) of certain actions/behaviours. In other words, how we make decisions rationally based on pros and cons of action.

Question 36

What are some limitations to the HBM?

Answer 36

Several versions over the years. May better predict preventative behaviour uptake than risk behaviour reduction. Components studied independently but may interact and vary in salience. Over-estimates the role of threat (overuse of fear arousal can be counterproductive… increasing stress and the behaviour). Static model - excludes change in beliefs/perceptions. Does not explicitly include emotions. Removing barriers is not always sufficient to increase positive behaviour. It is user-friendly, easy-to-assess, and quite intuitive, but it hasn’t been highly predictive.

Question 37

What is the Theory of Planned Behaviour (Azjen, 1985, 1991)?

Answer 37

Comes from social psychology and Bandura’s 1986 Social Cognition Theory that presumes any behaviour is explained by intention, which is explained by your attitudes, outcome expectancies, beliefs in control, and normative beliefs. Addresses the psychological processes linking attitude and behaviour by incorporating wider social influences and perceived norms (motivation to comply), beliefs in personal behavioural control (similar to self-efficacy), and the necessity of intention formation.

Question 38

Theory of Planned Behaviour can explain ____ of the variance in people’s intentions from their attitudes, perceived behavioural controls, and subjective norms.

Answer 38

~45%

Question 39

How does perceived behavioural control relate to intention?

Answer 39

Internal control = skills/ abilities/ information. External control = obstacles/ opportunities. If a person has less control than they perceive, behavioural change is less likely even if a positive intention had been formed.

Question 40

What were the findings of Sutton and White’s (2016) systematic review and meta-analysis of 38 studies of predictors of sun-protection intentions and behaviour?

Answer 40

PBC and subjective norms proved significant but attitudes were the strongest predictors of intentions and intentions were stronger than PBC in terms of predicting behaviour.

Question 41

What are the limitations of the Theory of Planned Behaviour?

Answer 41

Does not acknowledge likely bi-directional relationships between independent and dependent variables. Research over-relied on cross-sectional data instead of longitudinal studies. 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 (e.g. by targeting normative of PBC beliefs) has not had a huge effect on behaviour.

Question 42

What did Rhodes and Dickau’s (2012) meta-analysis of TPB find?

Answer 42

Medium-sized changes in intention only resulted in trivial-sized changes in behaviour.

Question 43

If goals are valueed and self-efficacy is high, what can be done to further change behaviour according to Gollwitzer (1993, 1999)?

Answer 43

Write an implementation intention action plan. This increases commitment. These plans work well whether the goal is more proximal or distal (longer-term).

Question 44

According to Weinstein et al. (1988), a stage theory has 4 properties:

Answer 44

Classification system to define stages, ordering of stages (e.g. early, mid, and late stage), common barriers to change facing people within same stage, different barriers to change facing people in different stages.

Question 45

What two models are stage models?

Answer 45

Transtheoretical model and Health Action Process Approach (HAPA)

Question 46

What is the transtheoretical model (Prochaska & Diclemente, 1986)?

Answer 46

A stage model that progresses from precontemplation, to contemplation, to preparation, and finally to action. Sometimes people fall off, relapse, and exit the model. Some come back and maintain for a bit then relapse. This may result in termination of the behaviour change. This change doesn’t necessarily have to last forever.

Question 47

What is the evidence of the efficacy of the transtheoretical model?

Answer 47

This model has been shown to be useful clinically. When it comes to intervention, you can intervene at stages and help people move more towards behaviour and different interventions to deal with relapse.

Question 48

What is the Health Action Process Approach or HAPA (Schwarzer, 1992)?

Answer 48

A hybrid model, having both ‘static’ and staged, temporal qualities. It distinguishes motivational and volitional phases. Self-efficacy is not static, it’s a process that is crucial in each phase. It feeds in and influences all phases.

Question 49

What are the motivational phases of HAPA?

Answer 49

Self-efficacy, outcome expectancies, and risk perceptions.

Question 50

What are the volitional phases of HAPA?

Answer 50

Following the motivational phase, individuals decide to act and then make plans to begin/maintain behaviour as well as deal with failure. This further subdivides into planning phase, action phase, maintenance phase.

Question 51

What did the meta-analysis of 95 studies using the HAPA (Zhang, Zhag, Schwarzer, & Hagger, 2019) confirm?

Answer 51

It 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 mediated by intentions, action, and coping planning.

Question 52

What did a meta-analysis of 81 studies by Brewer et al. (2016) reveal about how anticipatory regret predict intention and behaviour?

Answer 52

Anticipatory inaction regret (i.e. regret from not doing something) is a stronger predictor of intention and behaviour than anticipatory action regret (i.e. regret from doing something).

Question 53

*There are four factors involved in unrealistically optimistic appraisals of personal risk (Weinstein, 1987). What is not a factor?

Answer 53

Belief that no action can prevent the problem.

Question 54

*According to Bandura (1977, 1986), behaviour is determined by individual expectancies. What is one of the three types of individual expectancies outlined by Bandura?

Answer 54

Outcome expectancies