Hbhe600 2008 01 Intro Measurement

HBHE 600: Psychosocial
Factors in Health-Related Behavior
Victor J. Strecher, PhD

Professor, HBHE
School of Public Health
University of Michigan
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH

• Introduction
• Course Syllabus
• Description
• Objectives
• Flow
• Readings
• Grading
• Academic conduct
• Diversity issues
• Why we’re here…
HBHE 600 DESCRIPTION
HBHE 600 provides an overview of the

social-psychological determinants of
behavioral risk factors that affect health.
We address these determinants within
conceptual frameworks and models of
health-related behavior. These
determinants are the building blocks of
intervention and program planning.

HBHE 600 OBJECTIVES
By the end of the course, participants

should have a general understanding of:
1. THE MAJOR PSYCHOSOCIAL MODELS AND THEORIES USED
IN THE FIELD OF HEALTH BEHAVIOR AND HEALTH
EDUCATION
2. THE ROLE OF PSYCHOSOCIAL FACTORS IN PREDICTING A
RANGE OF HEALTH-RELATED BEHAVIORS
3. USING PSYCHOSOCIAL MODELS AND DETERMINANTS TO
DEVELOP A CONCEPTUAL FRAMEWORK OF HEALTH
BEHAVIOR CHANGE
4. INTERVENTIONS TO CHANGE PSYCHOSOCIAL
DETERMINANTS

HBHE 600 FLOW
Theory
Health Belief Model
Determining and
measuring relevant Theory of Reasoned Action
psychosocial factors Theory of Planned Behavior
Social Cognitive Theory
Transtheoretical Model
Self-Determination Theory
Chaos Theory
Motivational Interviewing
Building conceptual
Behavior Modification
frameworks for health-
Goal Theory related behavior.
Social Support
Elaboration Likelihood Model
Cognitive Load Theory
Cognitive Schema

HBHE 600 READINGS
In HBHE 600 CourseTools

HBHE 600 GRADING
• Mid-term exam (40%)
• Final exam (60%)
Content of the examinations will come from

class lectures and the required readings.

HBHE 600 ACADEMIC CONDUCT
Students should expect faculty and

graduate assistants to treat them fairly,
showing respect for their ideas and
opinions and striving to help them achieve
maximum benefits from their experience
in the School of Public Health.
Similarly, courtesy, honesty, and respect

should be shown by students toward
faculty, graduate assistants, and fellow
students.

HBHE 600 ACADEMIC CONDUCT
Student academic misconduct refers to

behavior that may include plagiarism,
cheating, fabrication, falsification of
records or official documents, and aiding
and abetting the perpetration of such
acts. Preparation of the mid-term and
final examinations must represent each
student’s own effort.

HBHE 600 DIVERSITY ISSUES
Language
Culture
Background
1st /2nd /3rd generation college?
Comfortable speaking up, asking questions?
Is class a comfort zone or an alien environment?

10 leading causes of death in the United States
Deaths
Cause Estimated #
Heart disease 720,058
Cancer 505,322
Cerebrovasc. disease
144,088
Unintentional injuries
91,983
Chronic lung disease
Pneumonia/ Influenza 86,679
Diabetes 79,513
Suicide 47,664
Chronic liver disease 30,906
HIV infection 25,188
1,757,188
McGinnis JM, Foege WH. Actual causes of death in the United States. JAMA. Vol 270, #18, 1993.

Actual causes of death in the United States
Deaths
Cause Estimated # % Total
Tobacco 400,000 19
Diet/ activity patterns 300,000 14
Alcohol 100,000 5
Microbial agents 90,000 4
Toxic agents 60,000 3
Firearms 35,000 2
Sexual behavior 30,000 1
Motor vehicles 25,000 1
Illicit use of drugs 20,000 <1
Total 1,060,000 50
McGinnis JM, Foege WH. Actual causes of death in the United States. JAMA. Vol 270, #18, 1993.

10 Priorities of Nation’s 2010 Objectives
 Physical activity  Mental health
 Overweight and obesity  Injury and violence
 Tobacco use  Environmental quality
 Substance abuse  Immunization
 Responsible sexual  Access to health care
behavior

Tobacco Control
"Even our most conservative estimate indicates that reductions in lung

cancer, resulting from reductions in tobacco smoking over the last half
century, account for about 40% of the decrease in overall male cancer
death rates and have prevented at least 146 000 lung cancer deaths in
men during the period 1991 to 2003. A more realistic straight line
projection of what lung cancer rates might have become suggests that,
without reductions in smoking, there would have been virtually no
reduction in overall cancer mortality in either men or women since
the early 1990s. The payoff from past investments in tobacco control
has only just begun. The aging of birth cohorts with lower smoking
initiation rates and the anticipated future decrease in lung cancer
mortality in women will help to sustain progress."
Michael Thun, American Cancer Society

Obesity Trends* Among U.S. Adults
BRFSS, 1985
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

BRFSS, 1986
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

BRFSS, 1987
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

BRFSS, 1988
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

BRFSS, 1989
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

BRFSS, 1990
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

BRFSS, 1991
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

BRFSS, 1992
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

BRFSS, 1993
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

BRFSS, 1994
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

BRFSS, 1995
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

BRFSS, 1996
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

BRFSS, 1997
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

BRFSS, 1998
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

BRFSS, 1999
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

BRFSS, 2000
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

BRFSS, 2001
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

BRFSS, 2002
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

BRFSS, 2003
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

BRFSS, 2004
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

BRFSS, 2005
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

BRFSS, 2006
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

Ecological Perspectives on Health
Promotion
 Examine the joint or cumulative effects of personal
and environmental factors in designing health
promotion programs.
 Take into account linkages between various settings

and levels, and how change at one level affects
others.

Individual vs. Social Responsibility
No one would question that, as individuals, we are responsible for
our health. In the final analysis, we are the only ones who can
change our behavior. We are the only ones who lift fork to mouth,
who inhale smoke, who plant feet on sidewalk. And we are the
only ones who can decide to do these things…[But] we don’t live in
a vacuum. Whether we like it or not, our thoughts, ideas, wishes
and behaviors are influenced and conditioned by the people around
us, by the environments in which we find ourselves, and by the
customs, traditions, fads and fashions to which we are continuously
exposed…Effective behavior change therefore requires that we do
our best as individuals, but also that we work together with one
another to create more healthful and supportive social
environments.
S. Leonard Syme

• Theories
• Determining and
measuring
psychosocial
constructs in
theories

What is a theory?
• Definitions
• Characteristics
• Concepts, Constructs, and Variables

Definitions of Theory
 A set of interrelated constructs, definitions, and propositions
that presents a systematic view of phenomena by specifying
relations among variables, with the purpose of explaining and
predicting phenomena. (Kerlinger, 1986, p. 9)
 A systematic explanation for the observed facts and laws that
relate to a particular aspect of life. (Babbie, 1989, p. 46)
 An abstract, symbolic representation of what is conceived to
be reality—a set of abstract statements designed to “fit” some
portion of the real world. (Zimbardo, Ebbesen, & Maslach,
1977, p. 5)

Characteristics of Theory
 General - broad application

 Abstract - not specified in detail
 Testable - you can measure constructs
 Replicable - can be tested again and again

Concepts, constructs, and variables
 Concepts - major components or ideas of a theory

 Constructs - when concepts have been developed for
use in a particular theory, they are called constructs.
 Variables - are the operational form of constructs.
They specify how a construct is to be measured in a
specific situation.

Theories can tell you…
• WHY people are or are not engaging in health-
related behaviors.
• WHAT needs to be evaluated to demonstrate
program or policy effectiveness.
• HOW to shape program strategies to reach people
and organizations.*
*Though most psychosocial theories of health-related

behavior don’t do this.
How do we create, examine, test theories?

Surveying
Observing
From: O’Leary, Z. (2004) The Essential Guide to Doing Research. London: Sage Chapter Eleven.

Survey
 Survey (noun): Information gathered by asking
a range of individuals the same questions
related to their characteristics, attributes,
how they live, or their opinions

 Survey (verb): The process of collecting such
information

Basic Survey Types
 Surveys can also involve populations or samples of
populations:
 Census: This is a survey that does not rely on a
sample. A census surveys every single person in
a defined or target population

 Cross-sectional surveys: This type of survey
uses a sample or cross-section of respondents
selected to represent a target population

Basic Survey Types
 Surveys can capture a moment or map trends:
 Trend surveys: A trend survey asks similar groups
of respondents, or the same cross-section, the
same questions at two or more points in time

 Panel study: A panel study involves asking the
same (not similar) sample of respondents the same
questions at two or more points in time

Basic Survey Types
 Surveys can be administered in lots of ways:
 Face to face
 Telephone
 Self-administered
 Now the Web!

Interview Types
 Interviews can range from fixed to free:
 Structured: Uses pre-established questions, asked in a
predetermined order, using a standard mode of delivery
 Semi-structured: As the name suggests, these interviews

are neither fully fixed nor fully free, and are perhaps best
seen as flexible
 Unstructured: Attempts to draw out information,

attitudes, opinions, and beliefs around particular themes,
ideas, and issues without the aid of predetermined
questions

Response Categories for Closed Questions
 Yes / No - Agree / Disagree:
Do you drink alcohol? Yes/ No
 Fill in the blank:
How much do you weigh? ______________
 Choosing from a list:
What would you drink most often?
Beer Wine Spirits Mixed drinks Cocktails
 Ordering options:
Please place the following drinks in order of preference
Beer Wine Spirits Mixed drinks Cocktails
 Likert type scaling:
It is normal for teenagers to binge drink 1 2 3 4 5

strongly disagree disagree unsure agree strongly agree


Self-efficacy Example:
Please rate how confident you are that you can keep from smoking cigarettes in the following situations:
Not at all Extremely

confident confident
1 2 3 4 5
When I feel stressed O O O O O
After I have just finished a meal O O O O O
While drinking coffee with friends O O O O O
When I feel sad or lonely O O O O O
While talking on the telephone O O O O O
When I am around people who are smoking O O O O O
O O O O O
When I feel angry or frustrated
O O O O O
When I am happy and feel like celebrating
O O O O O
While driving
O O O O O
When I feel nervous or anxious
O O O O O
When I am bored
O O O O O
When at a bar or a party

Motives
 The medication is good for my diabetes.
 I feel guilty if I don’t take my med’s.
 It’s an important choice that I make for myself.
 I’ve seen what diabetes has done for others.
 I like the challenge of taking responsibility for my health.
 My family and/or friends get upset with me if I don’t take my med’s.
 I want to be in charge of my diabetes.
 My physician gets upset with me if I don’t take my med’s.
 It is consistent with my goals of taking control of my diabetes.
 I can avoid or delay getting other health problems if I take my med’s.
 I want to set a good example for others.

Intrinsic Extrinsic
Motives
 The medication is good for my diabetes.
 I feel guilty if I don’t take my med’s.
 It’s an important choice that I make for myself.
 I’ve seen what diabetes has done for others.
 I like the challenge of taking responsibility for my health.
 My family and/or friends get upset with me if I don’t take my med’s.
 I want to be in charge of my diabetes.
 My physician gets upset with me if I don’t take my med’s.
 It is consistent with my goals of taking control of my diabetes.
 I can avoid or delay getting other health problems if I take my med’s.
 I want to set a good example for others.

Validity of self-reported data:
 In some cases validity varies by demographic
characteristics
 More important are:
• Surroundings
• Person or thing asking the question
• How the question is asked
• The questions preceding the question

Surveying
Observing

Types of Observation
 Observational techniques can range from highly
structured to unstructured.
 Structured: Highly systematic and often rely on predetermined

criteria related to the people, events, practices, issues, behaviors,
actions, situations, and phenomena being observed.
 Semi-structured: Observers generally use some manner of

observation schedule or checklist to organize observations, but also
attempt to observe and record the unplanned and/or the unexpected.
 Unstructured: Observers attempt to observe and record data without

predetermined criteria.

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HBHE 600: Psychosocial

Factors in Health-Related Behavior

Victor J. Strecher, PhD

UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH

HBHE 600 provides an overview of the

UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH

By the end of the course, participants

UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH

UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH

In HBHE 600 CourseTools

UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH

• Mid-term exam (40%)

• Final exam (60%)

Content of the examinations will come from

UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH

Students should expect faculty and

Similarly, courtesy, honesty, and respect

UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH

Student academic misconduct refers to

UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH

UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH

UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH

UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH

UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH

"Even our most conservative estimate indicates that reductions in lung

Michael Thun, American Cancer Society

UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH