Seeking Health Care ISeeking Health Care I

Modeling Health-Related BehaviorModeling Health-Related Behavior

Health-Related BehaviorHealth-Related Behavior

Behavior toward the goal of maximizing Behavior toward the goal of maximizing health and minimizing disease/disabilityhealth and minimizing disease/disability Health maintenance behaviorsHealth maintenance behaviors Seeking medical advice/interventionSeeking medical advice/intervention Risk behaviors and/or lack thereofRisk behaviors and/or lack thereof

Theories attempt to explain factors Theories attempt to explain factors predictive of these myriad behaviorspredictive of these myriad behaviors

Theories and Models in Theories and Models in PsychologyPsychology

Theory – A set of Theory – A set of related assumptions related assumptions from which testable from which testable hypotheses are drawnhypotheses are drawn

Model – Theory in Model – Theory in progressprogress

Uses of Models and Uses of Models and TheoriesTheories Generate ResearchGenerate Research Organize and explain Organize and explain

observationsobservations Guide practitioners in Guide practitioners in

predicting and predicting and modifying behavior modifying behavior

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Evaluating TheoryEvaluating Theory Is it comprehensive? Is it logical Is it parsimonious (simple, not too simple)? Does it agrees with empirical research? Does it generate ideas/research? Is is disconfirmable?

Part of the evolution controversy This is why most scientists believe that ID is not

a science Is it practically useful?

Models of Health BehaviorModels of Health Behavior

The Health Belief ModelThe Health Belief Model

Assumption: People hold certain beliefs Assumption: People hold certain beliefs about… about… personal vulnerabilitypersonal vulnerability the severity of the disease the severity of the disease the costs of taking actionthe costs of taking action benefits of taking actionbenefits of taking action

These beliefs motivate individuals to a These beliefs motivate individuals to a greater or lesser degree to modify high-greater or lesser degree to modify high-risk behaviors or seek help in doing so.risk behaviors or seek help in doing so.

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Health Belief ModelHealth Belief Model

Demographic & Demographic & PsychosocialPsychosocialFactorsFactors

Perceived Perceived SeriousnessSeriousness& Susceptibility& Susceptibility

Cues to ActionCues to Action

PerceivedPerceivedBenefits &Benefits &BarriersBarriers

Perceived ThreatPerceived Threat

Health-Health-RelatedRelatedBehaviorBehavior

Studying the HBM Studying the HBM Support for model:Support for model:

Flu shotsFlu shots Breast self-examinationBreast self-examination Seat belt useSeat belt use Diet Diet SmokingSmoking

No support for the model:No support for the model: ExerciseExercise

Critique of the HBM

• Leaves out emotions, habit, social norms, and other motivations (e.g. appearance)• What about context?

• Does not define how to test relationships between different elements

Is the HBM useful?

• Comparison of different behaviours and populations

• Identifies most salient beliefs (i.e. barriers, susceptibility)

• Interventions: health education, risk appraisal, decisions balance sheets, relapse prevention plans

Theory of Planned BehaviorTheory of Planned Behavior General theory of behavior – Not specific to health General theory of behavior – Not specific to health

behaviorbehavior Assumption: People are reasonable and use information Assumption: People are reasonable and use information

to freely choose behavior. Behavior happens secondary to freely choose behavior. Behavior happens secondary to an to an INTENTIONINTENTION..

The intention to perform a behavior is an interaction The intention to perform a behavior is an interaction between between AttitudeAttitude Subjective Norm – Social PressureSubjective Norm – Social Pressure Perceived Behavioral ControlPerceived Behavioral Control Actual ControlActual Control

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Theory of Planned BehaviorTheory of Planned Behavior

AttitudeAttitudeTowardTowardBehaviorBehavior

SubjectiveSubjectiveNorm forNorm forBehaviorBehavior

PerceivedPerceivedBehavioralBehavioralControlControl

IntentionIntentionHealth-Health-RelatedRelatedBehaviorBehavior

Critique of TPB For some behaviors

attitudes, norms and perceived control independently predict intentions

In some contexts intentions predict behaviour

Attitudes shown to be independently related to perceived control

Perceived control independently predicts behaviour

Perceived control is the strongest predictor

Environmental influences (access to healthcare)

Social support Adoption versus

maintenance of behaviour

Competing behaviours (weight loss versus smoking cessation)

What interventions are related to the TPB?

• Attitudes: education

• Norms: public health campaigns

• Perceived control: relapse prevention planning

The Transtheoretical ModelThe Transtheoretical Model

Stage model of general behavior changeStage model of general behavior change Assumption: People utilize a number of Assumption: People utilize a number of

processesprocesses of change to move through of change to move through 5 5 stages of changestages of change ProcessesProcesses

Consciousness Raising, Dramatic Relief, Contingency Consciousness Raising, Dramatic Relief, Contingency Management, Stimulus Control, Self-libertation Management, Stimulus Control, Self-libertation

StagesStages PrecontemplationPrecontemplation ContemplationContemplation PreparationPreparation ActionAction MaintenanceMaintenance

The Behavior Change SpiralThe Behavior Change Spiral

Pre

-con

tem

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tion

Con

tem

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Pre

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Act

ion

Mai

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Precontemplation: changing a behavior has not been considered;person might not realise that change is possible or that it might be of interest to them

Contemplation: something happens to prompt the person to start thinking about change - perhaps hearing that someone has made changes - or something else has changed - resulting in the need for further change

Preparation: person prepares to undertake the desired change - requires gathering information, finding out how to achieve the change, ascertaining skills necessary, deciding when change should take place - may include talking with others to see how they feel about the likely change, considering impact change will have and who will be affected

Action: people make changes, acting on previous decisions, experience, information, new skills, and motivations for making the change

Maintenance: practice required for the new behavior to be consistently maintained, incorporated into the repertoire of behaviors available to a person at any one time

TMTM

PePeople often use dople often use different processes ifferent processes during stages and dduring stages and different stages require ifferent stages require different interventionsdifferent interventions PrecontemplatPrecontemplation – Consciousness Raisingion – Consciousness Raising Contemplation – Environmental Re-evaluationContemplation – Environmental Re-evaluation Preparation – Self Re-evaluation, Preparation – Self Re-evaluation, Action – Contingency Management, Stimulus Action – Contingency Management, Stimulus

ControlControl Maintenance - Maintenance - Contingency Management, Contingency Management,

Stimulus ControlStimulus Control

TM – Empirical FindingsTM – Empirical Findings

Quitting SmokingQuitting Smoking Alcohol and DrugsAlcohol and Drugs ExerciseExercise Safe sexSafe sex MammographyMammography

Critique of Models of Health Critique of Models of Health BehaviorBehavior

All have produced substantial researchAll have produced substantial research All are predictive of health-related behaviors. Some All are predictive of health-related behaviors. Some

behaviors more-so than othersbehaviors more-so than others Do not explain how people judge thing like susceptibility, Do not explain how people judge thing like susceptibility,

or go from stage to stageor go from stage to stage Lack coherence:Lack coherence:

Models simply list variablesModels simply list variables No overall model of the personNo overall model of the person

Assessment is and issueAssessment is and issue Adherence is a separate processAdherence is a separate process Barriers are innumerable and not adequately researchedBarriers are innumerable and not adequately researched