Theories

of Health Behavior

Har0ah Haroen

 Behavior Change in Health

Some ques5ons:
What factors predict health behaviors?
e.g., Why do you oss every night? or why not?
How do people change their health behaviors?
Why dont people change? What are some of the
barriers?
Theories, Models, and Prac5cali5es
 Behavioral Immunogens and
Pathogens
Behavioral Pathogen
A health-compromising behavior or habit
smoking, excessive ea5ng, substance abuse, dangerous
driving, risky sexual behavior
Behavioral Immunogen
A health-enhancing behavior or habit
exercising regularly, using sunscreen, healthy ea5ng,
prac5cing safe sex, wearing seatbelts
What influences Health Behaviors?

Fig. 6.1, p.177

Health Promo5on Means Changing Behavior
at Mul$ple Levels
A Individual: knowledge, aNtudes, beliefs,
personality !
B Interpersonal: family, friends, peers !
C Community: social networks, standards,
norms !
D Ins0tu0onal: rules, policies, informal
structures
E Public Policy: local policies related to
healthy prac5ces
 The Purpose of Theory

Predict
to an5cipate events

Explain
to account for what has happened

Focus
to limit op5ons and reduce waste of eort

Simplify
to manage complex systems, tolerate ambiguous contexts, and
prepare for unpredictable threats
 A: Individual-Oriented Models
Individual most basic unit of health promo5on
Individual-level models components of
broader-level theories and approaches
Models
Stages of Change Model
Health Belief Model
The Planned behavior


 Stages of Change Model
Precontempla5on

Maintenance Contempla5on

Ac5on Decision
 Stages of change

The transtheore5cal model of

behavioural change
People are at dierent stages of
readiness to change
Four components:
stages
self-ecacy
decisional balance
processes of change
Prochaska 1994
 Stages

Pre-contempla0on I wont
Contempla0on I might
Prepara0on I will
Ac0on I am
Maintenance I have been
Self-ecacy

Self-dened ability or condence to

engage in the behaviour
Key determinant of eorts to change
Condence increases as people move
through stages
 Decisional balance
Two-part analysis of pros and cons of
change
Ini5ally cons outweigh pros
Pros gradually increase
Usually cross in prepara5on

Pros

Cons

Pre-c Cont Prep Act Main

Change processes

Derived from models or theories that

have been integrated into this
framework
Ac5ons or interven5ons which assist
the person to make the change
 Processes
Consciousness Self-libera5on
raising Social libera5on
Drama5c relief S5mulus control
Suppor5ve Counter-condi5oning
rela5onships Reinforcement
Self re-evalua5on management
Environmental re-
evalua5on
Processes
Pre-contemplation Contemplation Preparation
Action
Increasing Higher
confidence confidence
Confident
Self- temptations
confidence
Cons >Pros Cons <Pros
Cons <Pros
Cons >Pros
Self-evaluation Self-
Environmental liberation Stimulus
evaluation Social control
Dramatic relief liberation
Consciousness raising Counter-
conditioning
Supportive relationships
Relationships
 Stage iden5ca5on
Question Stage if yes

Have you been _______ for Maintenance

more than the past six months?

Have you been _______ for less Action

than six months?
Are you planning to start Preparation
_______ in the next month?

Have you been thinking about Contemplation

starting _______ in the next six
months?
Do you intend to start Pre-contemplation
_______in the next six months?
Pre-contempla5on
No change for at least six months
Lack of knowledge or conscious
decision
Low self-condence
Cons > pros
Interven5ons
consciousness raising
drama5c relief
suppor5ve rela5onship
Contempla5on

Thinking about it
Self condence increasing

Cons > pros

Interven5ons
self re-evalua5on
environmental re-evalua5on
list pros/cons
 Prepara5on

Preparing to make the

change
Self-condence increased
Cons = pros

Interven5ons
self-libera5on (contract)
social libera5on
suppor5ve rela5onships
 Ac5on

Ac5vely involved in making the

change
Condence is high
Cons < pros

Interven5ons
s5mulus control
counter-condi5oning
suppor5ve rela5onships
Maintenance

Con5nua5on of change
Risk of relapse

Interven5on
reinforcement management
Health belief model
Factors considered important in healthcare
decisions
Perceived severity
Perceived suscep5bility
Value of the treatment
Barriers to treatment
Cost of treatment physical and
emo5onal

Richards 1997
 Premise of the HBM
Individuals will take ac5on toward o, to screen
for, or to control an ill health condi5on if:
1) they regard themselves as suscep5ble to the
condi5on
2) they believe it to have poten5ally serious
consequences
3) they believe a course of ac5on can reduce the
suscep5bility and seriousness
4) they believe the costs of the ac5on are outweighed
by its benets
 Health Belief Model
Individual Perceptions Modifying Factors Likelihood of Action

Variables Perceived Benefits of

Preventive Action
Demographic
minus
Sociopsychological
Perceived Barriers to
Structural
Preventive Action

Perceived
Susceptibility to Perceived Threat of Likelihood of Taking
Disease X Disease X Recommended
Perceived Seriousness Preventive Health
of Disease X Action

Cues to Action
Health belief model
Health belief model can predict users of
healthcare services
Barriers and costs most signicant reasons
for not making changes
People calculate return on investment
based on own percep5ons
Perceived severity
Ask people what they know about the
condi5on
How serious do they think it is
What they know about complica5ons

Interven5ons
give basic informa5on on the
condi5on
do not threaten or scare
Perceived suscep5bility

How likely is it that

The condi5on will get worse
That complica5ons will develop

Interven5ons
discuss with pa5ent
stay posi5ve - good management will
reduce likelihood
Value of treatment

Percep5on of ecacy
Knowledge of treatment op5ons

Interven5ons
discuss possible regimens
explore fears
give choices
Barriers to treatment

Time
Money
Side eects

Interven5ons
pros and cons of treatment
resources to confront barriers
long-term support
Theory of Planned Behavior (Reason ac0on)
Finsbein & Ajzen

Attitude
Toward
Behavio
r

Ibehavioral
Subjective
ntention Behavior
Norm

Perceived
Behavioral
Control
Theory of Planned Behavior
 B: Interpersonal Level:
Social Learning Theory
Interac5on of individual factors, social
environment, and experience
Reciprocal dynamic
Observa5onal learning
Capability of performing desired behavior
Percep5on of self-ecacy


 Interpersonal Level:
Social Learning Theory (cont.)
Three strategies for increasing self-ecacy
SeNng small, incremental goals
Behavioral contrac5ng: specifying goals and
rewards
Self-monitoring: feedback can reinforce
determina5on to change (keep a diary)
Posi5ve reinforcement: encouragement helps

!
Source: Albert Bandura, Social Founda$ons of Thought and Ac$on (Englewood Clis, NJ: Pren5ce Hall, 1986).

 Social Cogni5ve Theory
Bandura
The Dierence Between Ecacy and Outcome Expecta0ons

Person Behavior Outcome

Efficacy Outcome
Expectations Expectations
 C: Community-Level Models
Analyze how social systems func5on
Mobilize communi5es, organiza5ons, and
policymakers
Use sound conceptual frameworks
Community Mobiliza5on
Organiza5onal Change
Diusion of Innova5ons Theory


 Community Mobiliza5on
Encompasses wider social and poli5cal
contexts
Community members assess health risks, take
ac5on
Encourages empowerment, building on
cultural strengths and involving
disenfranchised groups

Source: Na5onal Cancer Ins5tute, Theory at a Glance: A Guide for Health Promo$on: 18; Paolo Freire, Pedagogy of
the Oppressed (New York: Con5nuum, 1970.); Saul Alinsky, Rules for Radicals: A Pragma$c Primer for Realis$c
Radicals (New York: Vintage Books, 1971; revised edi5on, 1989).
 Organiza5onal Change
Organiza5onal Stage Theory Organiza5onal Development
Theory

Dene problem

Organiza5onal structures
Iden5fy solu5ons

Ini5ate ac5on

Allocate resources Worker behavior and mo5va5on

Implement

Ins5tu5onalize
 Diusion of Innova5ons Theory
How new ideas, products, and behaviors
become norms
All levels: individual, interpersonal,
community, and organiza5onal
Success determined by: nature of
innova5on, communica5on channels,
adop5on 5me, social system

Source: Everep M. Rogers, Diusion of Innova$ons, 4th ed. (New York: The Free Press, 1995).
 Diusion of Innova5ons (cont.)
Nature of innova5on
Rela5ve advantage over what is being
replaced
Compa5ble with values of intended users
Easy to use
Opportunity to try innova5on
Tangible benets
 Diusion of Innova5on Theory
Rogers

40

20
Time
0
Laggards Late Late Majority Early Early Innovators
Adopters Majority Adopters
 Diusion of Innova5ons (cont.)
Communica5on channels
Mass media (enhanced by listening groups,
call-in opportuni5es, and face-to-face
approaches)
Peers
Respected leaders
 Diusion of Innova5ons (cont.)
Adop5on 5me
Awareness Inten5on Adop5on Change
Gradual
Movement through groups
Pioneers
Early adopters
Masses
 Diusion of Innova5ons (cont.)
Social system:
Iden5fy inuen5al networks to diuse
innova5on: health systems, schools, religious
and poli5cal groups, social clubs, unions, and
informal associa5ons
Iden5fy opinion leaders, peers, and targeted
media channels to diuse innova5ons
What inuences the adopter categories?

Apributes of the Characteris5cs of

Innova5on Adopter
Rela5ve advantage Beliefs
Compa5bility Values
Complexity Experience
Trialability
Observability
 Models that Inuence H.E.
PRECEDE-PROCEDE
Generalized Model for Program
Development
Model for Health Educa0on Planning and
Resource Development (MHEPRD)
Model for Health Educa0on Planning
(MHEP)
 Precede Proceed
L. W. Green & M. W. Krueter

Predisposing
Factors

Health Promotion

Reinforcing Behavior
Health Education
Factors and Quality
Lifestyle Health of Life

Policy
Regulation Enabling Environment
Factors
Organization
Programma0c and Intrapersonal Determinants of
Sexually Abs0nent
Behavior
Program Deliverer
Intrapersonal Factors
Preparation Positive Emotions
Competence Environmental
Self-Standards/Comfort Constraints/Barriers
Positive Attitudes

Abstinent Behavior
Attitudes
Social Norms

Sexually
Self-Efficacy
Social Norms INTENTION
Time on Task
(program dose/exposure)
Self-Efficacy
Curriculum Used Ability/Skills
(school-based programs)
Self-Standards
Fidelity of
Implementation

Program Factors Participant Factors

Conceptual Model for Health Educa5on
Planning and Resource Development
Bates & Winder Health Education
Plans

Evaluation
Process
Research Evaluation Information Evaluation Demonstration
Programs Process and Statistics Process Programs
Evaluation
Process

Operational
Programs
 Generalized Model for Program
Development
J. F. McKenzie and J. L. Smeltzer

Assessing Identifying Setting

Need the Goals and
Problem(s) Objectives

Implementin
Evaluating Developing an
g the
the Results Intervention
Intervention
 Applica5on Exercise

Please choose a health behavior and popula5on

Assume you are an adver5sing specialist contracted to develop

a persuasive communica5on (poster, news adver5sement etc.)
to improve the health behavior for the popula5on

Create a message that includes severity, suscep5bility,

response ecacy, and self-ecacy for the target popula5on