PU505: Health Behavior Unit 1 Introduction

Question 1

UNIT 1 - INTRODUCTION TO THEORY

Why is understanding and being able to use theories essential?

Answer 1

They provide the foundation for professional practice.

Question 2

What does theories help us accomplish?

Answer 2

Solve problems and formulate programs, interventions, projects, and policies.

Question 3

What type of theory or model can explain, predict, or suggest ways to change behavior by focusing on factors within people that affect their behavior, such as knowledge, skills, attitudes, beliefs, and past experiences?

Answer 3

Intrapersonal theories or models

Question 3

What is a theory from a health promotion and disease prevention perspective?

Answer 3

It represents an interrelated set of propositions that serve to explain health behavior or provide a systemic method of guiding health promotion practice.

“Theory, then, provides a framework for explaining phenomena and may serve as the basis for further research as well as practice application”

Simply put, theories explain behavior and thus can suggest ways to achieve behavior change.

Question 3

What is a a set of assumptions developed to explain why something happens and to predict its occurrence?

Answer 3

A theory

It is “ a set of interrelated concepts, definitions, and propositions that present a systematic view of events or situations by specifying relations among variables in order to explain and predict events or situations.”

Question 4

What is a a composite, a mixture of ideas or concepts taken from any number of theories and used together?

Answer 4

A model.

This can help us understand a specific problem in a particular setting which one theory may not be able to do alone.

Question 4

What theory belongs at the interpersonal level?

Answer 4

Social cognitive theory

Question 4

What type of theory or model can explain, predict, and suggest ways to change behavior by focusing on factors within social systems (communities, organizations, institutions, and public policies) that influence behavior, such as rules, regulations, legislation, norms, and policies?

Answer 4

Community-level theories

Question 4

What are the three different types or levels of influence within theories and models?

Answer 4

Intrapersonal
Interpersonal
Community

Question 4

What theories and models belong in the intrapersonal level? (6)

Answer 4

The health belief model
The theory of reasoned action/planned behavior
The self-efficacy theory
The attribution theory
The protection motivation theory
The transtheoretical model

Question 5

What are theories and models that explain, predict, and suggest ways to change behavior by focusing on factors related to the influence that other people have on a person’s behavior?

These other people can be family, friends, coworkers, healthcare providers, and clergy, influence behavior when they share their thoughts advice, and feelings and when they provide emotional support assistance.

Answer 5

Interpersonal theories and models

Question 5

What is a common theory used at addressing behavior at the interpersonal level?

Answer 5

Social Cognitive Theory

Question 5

What do community-level models and theories attempt to explain, predict, and suggest ways for?

Answer 5

To change behavior by focusing on factors within social systems (communities, organizations, institutions, and public policies) that influence behavior, such as rules, regulations, legislation, norms, and policies.

Changing a social system from one that maintains and supports unhealthy behaviors to on that supports health behaviors ultimately supports individual behavior change.

Question 6

What are some common community-level theories?

Answer 6

Diffusion of Innovation Theory
Social Ecological Model
Social Capital Theory

Question 6

Why are theories even born?

Answer 6

They are born from the need to solve a problem or find an explanation that would account for some repeatedly observed occurence.

Question 7

What is the goal of theory development?

Answer 7

To identify a few principles that can account for (explain) a large range of phenomena.

Scientific inquiry is a cyclical process where theory and data can be regarded as either starting points or endpoints. In a spiral-shaped process of research, inductive and deductive phases of inquiry follow each other. The starting points are ideas, hypotheses, or conceptual frameworks that guide future research. Endpoints are attained when there is a well-substantiated explanation of a particular facet of reality based upon empirical evidence

Question 8

What does the development of theory begin with? (2)

Answer 8

Inductive reasoning and qualitative methods.

Inductive reasoning, if you recall, starts with specific observations or evidence and moves to a conclusion.

For example, using inductive reasoning we observe that COVID-19 is transmitted through respiratory droplets, and we observe that masks and social distancing reduce exposure to respiratory droplets. Therefore, we conclude that masks and social distancing reduce or prevent the spread of COVID-19.

Question 9

What is the difference of deductive reasoning compared to inductive reasoning?

Answer 9

Deductive reasoning starts with the conclusion–masks and social distancing reduce or prevent the transmission of COVID-19–and seek the observations to support the conclusion–masks and social distancing reduce or prevent the spread of disease through droplet transmission.

COVID-19 is spread through droplet transmission.

Question 9

What led to the health belief model?

Answer 9

Observation, Inductive reasoning, and qualitative research methods.

The health belief model was developed by researchers at the U.S. Public Health Service in the late 1950s as a means to understand why so few people were being screened for tuberculosis (TB). Triggered by the observation of poor screening utilization, possible reasons why people might or might not utilize these screenings were identified and research conducted to determine if the reasons proposed did in fact explain the behavior.

They did explain the behavior, and the outcome was the health belief model, one of the most widely used theories in health education and health promotion.

Question 10

What is a theory that was developed when existing ones were revised?

Answer 10

The theory of reasoned action.

The theory is very useful in predicting and explaining behavior that is under a person’s volitional (willful) control, but it is not very useful for behaviors that are not under volitional control.

To make the theory more useful for these types of behaviors, the perception of behavioral control—that is, the perception of ease or difficulty of doing something—was added to the theory of reasoned action and in so doing, the theory of planned behavior was born.

Question 10

What does health behavior include?

Answer 10

It is the things we do that influence our physical, mental, emotional, psychological, and spiritual selves.

Question 10

What are some factors that influence the types of behaviors we engage in?

Answer 10

Factors such as socioeconomic status, skills, culture, beliefs, attitude, values, religion, and gender.

Question 11

What is socioeconomic status (SES)?
How is it typically reflected? (3)
Known risk factor for? At older ages? (9) (6)
Bias associated with low SES?

Answer 11

It is the social standing or social class of a person or group.

It reflects a combination of income, education level, and occupation.

Risk factor for psychiatric disorders, substance abuse, self-harm, and over time is associated with liver and renal diseases, ischemic heart disease, cerebral infarction, chronic obstructive bronchitis, and lung cancer. At older ages, it’s associated with increased risk of premature mortality, coronary heart disease, diabetes, depression, disability and dementia, and accelerated aging.

Low SES people are perceived as being less intelligent, less independent, less responsible, less rational, and less likely to comply with medical advice and follow-up visits.

These perceptions impact clinical decisions, delay diagnostic testing, repress referrals to specialists, and result in prescribing of more generic medication.

Question 11

Consider this—if education and, by extension, knowledge were the driving forces behind health behavior, then physicians, nurses, dentists, and other healthcare professionals wouldn’t smoke. Yet, some do. Why?

Answer 11

Although heath care workers in Florence, Italy, were knowledgeable about vaccine preventable diseases, their behavior did not reflect what they knew. In fact, following a daylong course to update them about these diseases, 72% of those susceptible to mumps, 74% susceptible to measles and pertussis, 79% susceptible to rubella, and 84% at risk of contracting varicella (chicken pox) were not willing to be vaccinated for these diseases.

Question 12

What makes knowledge almost useless?

Answer 12

Without the skills or abilities necessary to use the knowledge, like applying a condom, will render it useless. An example is HIV/AIDS.

Question 13

Even if someone has the knowledge and the ability to use that knowledge, what also influences their health behavior?

And many examples!

Answer 13

Culture.

Culture encompasses the customs, habits, language a group of people share that influence how they perceive themselves, one another, and their place in the world.

For example, in a study of African American men conducted in 2019, the perception of invincibility and immunity to illness risk frequently factored into men’s health decision-making. This stereotype of toughness prevented them from admitting they had a health problem or from seeking care for one (Eley et al., 2019). In rural areas of Ethiopia (as well as in many other areas across the globe), illness is seen as the result of supernatural forces (Kahissay et al., 2017) and, consequently, not under personal control. When people perceive disease causation as being out of their control, it impacts the likelihood of them practicing preventative behaviors such as getting prenatal care, vaccinations, and screening tests.

This perception of disease cause being out of a person’s control not only pertains to physical health, but mental health as well. As an example, in Filipino culture, mental illnesses are attributed to divine retribution for something the person or an ancestor did that was wrong. Consequently, mental illnesses are seen as shameful and result in an unwillingness of older adults to accept a mental illness diagnosis. This naturally leads to an avoidance of mental health services and a reliance on family, friends, healers, and religion (Periyakoil & Della Cruz, 2010) in order to cope with the situation.

In the Traveller (Gypsy) culture, the practice of marrying within the community, often to first and second cousins, increases the risk of recessive genetic diseases (Ahlstrom, 2017). For example, congenital glaucoma, phenylketonuria (PKU), polycystic kidney disease, and oculocutaneous albinism (lack of pigment in the eyes, hair, and skin), to name just a few, are common (Kalaydjieva et al., 2001).

Question 14

Where is beliefs intimately woven? And what are they?

Answer 14

They are intimately woven with culture, and are one’s perception of what is true, although they might not be viewed as such by others.

Such as a wet head causes pneumonia, then the behavior it supports is not going out of the house with a wet head. This seems like a very innocuous behavior on the surface. But take it one step further: people with this belief might not get a pneumonia vaccine, believing instead that staying indoors until their hair is dry is all they need to do to avoid catching it.

In cultures that believe in reincarnation, health behaviors are affected in unexpected ways. For example, the belief in reincarnation in the Chinese culture leads to avoidance of surgery because the body has to remain intact in order for the soul to have a place to live when it comes back in a future reincarnation. In the Hindu and Sikh cultures, the belief in reincarnation reduces the likelihood of adherence to medical protocols because disease is viewed as the result of karma from a previous incarnation or past life.

Similarly, in the Traveller (Gypsy) culture it’s believed that health and illness are given to you, they are predetermined, inevitable, and unchangeable (Dion, 2008). This belief leads to noncompliance with preventative health behaviors and consequently, poor health.

Question 15

How are attitudes formed? And how do these attitudes affect behavior?

Answer 15

They are formed by beliefs, emotions, and past behavior associated with an object, person, issue, or concept. They impact behavior because they represent a person’s thoughts and ideas, likes and dislikes and preferences for or against something.

For instance, in the spring of 2020, early in the COVID-19 pandemic, the CDC conducted a national survey to identify attitudes, behaviors, and beliefs related to the public health recommendations to contain the pandemic. The results showed that overall, 80% of adults in the United States supported (had positive attitudes toward) stay-at-home orders, 67% believed nonessential workers should stay home, and more than 87% supported social distancing guidelines. These positive attitudes translated into more than 77% of adults reporting that they self-isolated, and almost 80% reporting they practiced social distancing (Czeisler et al., 2020).

Positive attitudes toward fruit and vegetable intake—that is, believing they are important for health—liking their taste, and having self-efficacy in the ability to consume them, are associated with greater fruit and vegetable intake in adults (Erinosho et al., 2015). Conversely, negative attitudes toward fruit and vegetable intake are associated with lower consumption. Interestingly, these negative attitudes are also associated with low water intake as well (Goodman et al., 2013). Water intake among middle school students is also impacted by negative attitudes. Students who believe that water fountains are unclean and contaminated, that the water doesn’t taste good, and that it can make them sick, develop negative attitudes toward drinking water from water fountains. As a result, they don’t drink water from the fountains during school hours. While this behavior may seem innocuous, having students drink more water during their school day is an important strategy for reducing their intake of sugary beverages, which would help in controlling childhood obesity (Patel et al., 2014).

Question 15

What are the determinates of attitudes and behavior? And what do they influence?

Answer 15

Values. They influence the type of behaviors they adopt.

They are what people hold in high regard, things that are important to them, such as nature, truth, honesty, beauty, education, integrity, friendship, and family. What people value influences the types of behaviors they adopt. For example, people who value nature might be more likely to recycle, use organic fertilizers, feed the birds, and plant trees. People who value health might be more likely to exercise, maintain a normal weight, drink in moderation or not at all, and not smoke.

The impact of values on health behavior was evident among adolescents when 7th graders in Taiwan were asked to identify their most important personal values from among the following five: family, friends, health, academics, and money. Those who valued health the most were less likely to smoke and drink from 7th to 12th grade than those who valued friends the most. Not only does this show the influence values have on behavior, but also the long-lasting effects of values formed during early adolescence.

Values not only play a role in personal health behavior, they also influence environmental health behaviors. For instance, pro-environmental behavior, or acting in ways to safeguard or avoid harming the environment, is very much related to a person’s biospheric values (Steg, Bolderdijk et al., 2014). People with strong biospheric values base decisions to act in pro-environmental ways on their perception of the cost and benefits to the environment rather than on personal benefit (DeGroot & Steg, 2009). For example, they eat less red meat, take shorter showers (Steg, Perlaviciute et al., 2014), recycle more, and drive in more energy efficient ways.

Question 16

What are other influences of behavior besides knowledge, skills, socioeconomic status, culture, beliefs, attitudes, and values?

Answer 16

Religion, gender.

Question 17

Why do the factors that influence health behavior also form the concepts of the theories we use to explain health behavior?

Answer 17

For example, we saw that beliefs influence health behavior.

Beliefs form the concept (or idea) of the self-efficacy theory and health belief model, while attitudes are the basis of the theory of reasoned action and the theory of planned behavior.

Question 18

What is a variable when talking about concepts?

Answer 18

A variable is an operationalized concept, or how the concept is going to be measured.

Going back to the house analogy, the bricks can be measured (operationalized) by square footage, number, size, or weight.

How the concepts (bricks) are used in each theory (house) are the constructs (steps, walkway), and how they are measured (number, color, size) are the variables.

Question 18

What do you call concepts that are used in each specific theory?

Answer 18

Construct. Constructs are the way concepts are used in theories.

As the concept of a theory develops and evolves, and as it becomes less nebulous and more concrete, constructs emerge.

Each theory, then, has at least one core concept and a series of constructs that indicate how the concept is used in that theory. To use an analogy, if a theory is a house, the concepts are the bricks and the constructs are the way the bricks are used in the house. In one house, the bricks are used for the front steps; in another house, the bricks are used for the façade.