CH. 7 Why Don’t We Do What We Need To? Models of Behavior Change Flashcards
Why Don’t We Do What We Need To?
Why Don’t We Do What We Need To?:
Health Psychologists explain why we don’t do all that we should and why we do some of what we should not. Even though people know that it is important to get physical activity, why do some people not exercise? If smokers know the risks of tobacco addiction, why do they still smoke?
What are Healthy Behaviors?
What are Healthy Behaviors? – Any specific behaviors that maintain and enhance health.
- Many of our daily behaviors influence our health, as well as how long and how happily we live. Many of the most common health problems that plague us today are worsened, and in some cases even caused, by unhealthy behaviors.
- For example, the absence of excess body fat, a result of healthy eating and adequate physical activity, lowers the risks of most cancers
- Wearing a seat belt is a health behavior.
- Smoking, can be tied to a range of negative health outcomes such as lung cancer and heart disease.
HEALTH EDUCATION – Attempts to close the gap between what is known about optimal health practices and what is actually done.
Goal of Health Education – To teach people to limit behaviors detrimental to their health and increase behaviors that are conducive to health.
- Paralleling the biopsychosocial approach, health educators pay attention to a range of factors including the individual, interpersonal relationships, institutions, community, and public policy.
HEALTH PSYCHOLOGISTS essentially follow the same agenda but with more focus on individual factors such as attitudes, beliefs, and personality traits.
Healthy People Programs
HEALTHY PEOPLE PROGRAM:
The most important health behaviors are outlined as Leading Health Indicators** established by the U.S. Department of Health and Human Services’ (DHHS’) **Healthy People 2020 Program.
- The Leading Health Indicators are listed in Table 7.1
HEALTHY PEOPLE 2020 – Guiding a national improvement effort to increase quality of life and to eliminate health disparities.
What Determines Health Behaviors?
What Determines Health Behaviors? – Living a healthy life entails more than just doing the right things on a personal level. Many health behaviors necessitate the help of medical institutions and trained professionals.
- Also important to have medical check-ups, vaccinations, and immunizations.
Biological Factors
Biological Factors – Biologically, we are born with many predispositions that can influence the types of health behaviors that we practice.
- For example, if both your parents are very overweight, there is a good chance that you will be overweight or have a propensity to put on weight.
From Our Parents We Inherit – Metabolic rates, muscle definition.
- Becoming addicted to smoking or drinking has been shown to have a biological basis.
- Dopamine D 2receptor gene plays a role in alcoholism.
- Dopamine is also associated with addiction to gambling and to food addictions.
Psychological Factors
Psychological Factors:
PSYCHOLOGICAL PREDICTORS OF HEALTH BEHAVIORS – Personality traits and characteristics play a large role in determining health behaviors.
- The Big Five personality traits (discussed in Chapter 5) are good indicators of a person’s likelihood to practice specific health behaviors.
- Boys higher in extroversion are more likely to attempt unsafe cliff jumps and practice unsafe water activities.
- Healthiest eaters were those high in conscientiousness and agreeableness.
- Extroverts are more likely to participate in risky behaviors.
- Childhood agreeableness and conscientiousness influenced adult health status mediated by healthy eating habits and smoking.
- The associations implicated the same personality type in different but related behaviors.
- Perhaps health professionals need to design programs that appeal to the unique psychological makeup of persons most at risk for particular behaviors.
Social Factors
Social Factors – The social part of the biopsychosocial model is very important as well.
- Media messages we are exposed to have a strong impact on the types of health behaviors we perform.
- The culture we live in and what we are surrounded by give us a lot of information about what is acceptable and what is not.
- Exposure to smoking in films increased the likelihood of future smoking.
- Individual difference factors and social factors (e.g., church attendance and behaviors of social networks) predicted adolescent health behavior.
- Newer interventions target not only the individual but also interpersonal, environmental, and organizational factors.
Changing Health Behaviors
Changing Health Behaviors:
HEALTH BEHAVIORS FACTORS – Biology, personality, and societal factors.
TJB – To practice Mindful breathing whenever I catch myself ruminating.
A Major Part of Individual-Level Interventions – Involve setting achievable incremental goals, committing to achieving the goals through a behavior contract, monitoring and documenting progress, and reinforcing goal achievements through rewards.
Key Properties of Your Goal Include – Difficulty (e.g., running 10 miles vs. jogging for 1 mile), time frame (e.g., lose 1 pound in a week or 20 pounds in a year), type of goal setting (e.g., self-set, doctor prescribed, or collaborative).
Once You Have a Specific Behavior – take a week or two and closely monitor the behavior that you want to change.
- Write down everything.
- Self-observation or self-monitoring is the first and most important step.
- List all relevant biopsychosocial factors.
- For example, physical activity is influenced by your weight at the biological level, self-efficacy at the psychological level, and support from family and friends at the societal level.
Next, list the barriers that are preventing you from changing:
- These may be practical issues (e.g., no time) or psychological ones (e.g., you do not think you will succeed).
- For each barrier you need a solution. Using this information, you can Develop a Plan to Change in an Organized Manner. Use principles of operant conditioning (reinforcement and punishment) to make sure you keep on track and set achievable goals.
- Your chances of succeeding are low if you do not factor in some key findings from health psychological research.
- What can you use to guide your search for factors thwarting your attempts to change?
- The answer is theory.
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- The answer is theory.
The Importance of Theory
The Importance of Theory – If you want to successfully adopt healthy behaviors, you can rely on theories to identify key factors, of behavior change to help focus on the process.
- There are many available options, so there is no need to begin from scratch or use personal brainstorming.
- Reality is that theoretically informed health behavior change programs are more effective than those without a theoretical basis
Key Theories of Health Behavior Change
KEY THEORIES OF HEALTH BEHAVIOR CHANGE – Health psychologists’ approaches to understanding and changing the extent to which health behaviors are practiced nicely illustrate a full-cycle version of the scientific method.
- Observe a real-world problem.
- Generate hypotheses and a theory of why it occurs.
- Design research to test it.
- Apply successful theory to help intervene and solve the problem.
Most theories draw on SOCIAL COGNITIVE THEORY – A comprehensive theory of behavior change that posits that characteristics of people (i.e., their attitudes and beliefs), their environments, and their health behaviors all interact and determine whether each person performs a health behavior.
SCT suggests that THE MOST CENTRAL DETERMINANT of HEALTH BEHAVIOR CHANGE is SELF EFFICACY:
SELF EFFICACY – Refers to an individual belief in his or her capacity to execute behaviors necessary to produce specific performance outcomes.
- A concept that is now included in numerous theories of health behavior.
Three Theories Dominate The Literature: Transtheoretical Model and Stages of Change, Health Belief Model, and Theory of Planned Behavior:
- These theories all focus on some key predictors of behavior, our attitudes, our intentions, and our readiness to change.
Transtheoretical Model
Transtheoretical Model – We go through different stages as we think about, attempt to, and finally change any specific behavior.
Different psychological traditions had different processes to account for why people changed their behaviors:
- Behaviorists argued that people changed to manipulate the contingency of reward and punishment.
- Humanists believed that helping relationships spurred change.
- Psychodynamic theorists suggested that change came about due to consciousness raising.
- Researchers found that smokers used different processes at different times in their quest to quit smoking and first identified that behavior change unfolds in a series of stages.
TTM Sees Change as a Process Occurring Through a Series of Six Stages.
- If you know what stage a person is in, you will need to tailor your intervention to fit the state of mind that the stage describes.
PRECONTEMPLATION – When people are not aware that they are practicing a behavior that is unhealthy or do not intend to take any action to change a behavior.
- People in this stage avoid reading, thinking, or talking about their unhealthy behaviors. Health promotion programs are often wasted on them because they either do not know they have a problem or do not really care.
- One of the major social factors influencing adolescent smoking is the movies.
CONTEMPLATION – When people recognize they may be doing something unhealthy and then intend to change (within the next month).
- Here they are more aware of the benefits of changing and are also very cognizant of the problems that changing may involve.
- The ambivalence associated with knowing the pros and cons of the behavior change often keeps people in this stage for a long time and calls for unique interventions.
PREPARATION – Is the stage in which the person is ready to take action to change the behavior.
- He or she generates a plan and has specific ideas of how to change.
- In essence, these people make a commitment to spend time and money on changing their behaviors.
- This is the stage people should be in if an intervention is going to have any effect.
ACTION – Once people are actually changing their behavior.
- The change has to have taken place over the past 6 months and should involve active efforts to change the behavior.
- For example, frequent trips to the gym characterize someone who is in the action stage of trying to get in shape.
- Does any attempt to change behavior no matter how small count as being in the action stage? No, it does not. People must reach a criterion that health professionals can agree is sufficient to reduce the risk for disease
- For example, losing enough weight to no longer be classified as obese or abstaining from smoking for a significant period of time.
MAINTENANCE – Is the stage in which people try to not fall back into unhealthy behaviors, or to relapse.
- They may still be changing their behaviors and performing new behaviors, but they are not doing them as often as someone in the action stage.
- Temptation to relapse is reduced, and there is often confidence that the new behavior changes can be continued for a period of time.
TERMINATION – Finally, people may reach a stage in which they are no longer tempted by the unhealthy behavior they have changed.
- Fewer than 20% of former smokers and alcoholics reached this zero-temptation stage.
- For the most part, this part of the model has been loosely interpreted as representing a lifetime of maintenance, and most interventions aim to get participants to the maintenance stage.
- The most helpful contribution of the TTM is that it clearly identifies how interventions can be successful.
- Interventions need to be tailored according to the stage of change that a person is in.
- The most common application involves the tailoring of communications to match the needs of the individual.
- Individuals who are in the precontemplation stage could be given information that would make changing their behavior more of a pro and hence move themselves into the contemplation stage.
- You can use the TTM to see how ready you are to change.
- This suggests that it is not enough just to know what behaviors will efficiently reduce severity and susceptibility, but one has to be confident that one can actually do that behavior.
- Empirical studies have established the utility of the HBM.
PERCEIVED BARRIERS – Are the most powerful component of the model across studies.
- Although perceived susceptibility and benefits are both important.
- Knowing how susceptible one feels is a better predictor of that person’s health prevention behavior.
- Knowing the person’s perceptions of benefits is a better predictor of his or her behaviors when sick.
The Health Belief Model
The Health Belief Model** – The basic contention of the HBM is that our **BELIEFS** – Relating to the **EFFECTIVENESS**, ease, and **CONSEQUENCES of doing (or not doing) a certain behavior will determine whether we do (or do not do) that behavior.
- One of the most widely used frameworks and has been used for both behavior change and maintenance.
- Learning theorists such as Skinner (1938) believed that we learned to do a certain behavior if it was followed by a positive outcome (a reinforcement). Therefore, if exercising made us feel healthy we would be more likely to exercise.
- Cognitive theorists added a focus on the value of an outcome (e.g., health) and the expectation that a particular action (e.g., exercise) will achieve that outcome.
HBM is a VALUE-EXPECTANCY THEORY – Values and expectations were reformulated from abstract concepts into health-related behaviors and concepts.
A big issue in the 1950s was that a large number of eligible adults did not undergo screening for tuberculosis (TB) although TB was a big health problem and the screenings were free. Beginning in 1952, Hochbaum (1958) conducted surveys of more than 1,200 adults to understand why this was the case. He found that 82% of the people who believed they were susceptible and who believed early detection worked had at least one voluntary chest X-ray. Only 21% of the people who had neither belief had an X-ray. TJB** – Action was dependent upon **BELIEF!!
How does the HBM explain health behavior? – The model, suggests that individuals will perform healthy behaviors if they believe they are susceptible to the health issue, if they believe not performing the behavior will have severe consequences, if they believe that their behavior will be beneficial in reducing the severity or susceptibility, if they believe there are benefits to taking action, and if they believe that the anticipated benefits of the behavior outweigh its costs (or barriers). Individuals must also receive a trigger or cue in order to act.
- Another factor that was added to the model with great success was the concept of self-efficacy.
SELF-EFFICACY – Defined as the conviction that one can successfully execute the behavior required to produce the outcome.
This suggests that it is not enough just to know what behaviors will efficiently reduce severity and susceptibility, but one has to be confident that one can actually do that behavior.
Empirical studies have established the utility of the HBM.
PERCEIVED BARRIERS– Are the most powerful component of the model across studies.
- Although perceived susceptibility and benefits are both important, knowing how susceptible one feels is a better predictor of that person’s health prevention behavior.
- Knowing the person’s perceptions of benefits is a better predictor of his or her behaviors when sick.
Culture and the Health Belief Model
Culture and the Health Belief Model:
- Numerous studies have investigated the usefulness of the HBM in multicultural settings.
- Understanding how African American women define concepts such as healthy weight, overweight, and obesity is important because definitions affect perception of weight, body image, and likelihood of developing obesity.
- To explore why Asian Americans underuse mental health services relative to European Americans.
- Perceived benefits partially accounted for differences in help-seeking intentions.
- American Indian women were reluctant to talk openly about their personal health to physicians (a barrier) and so lay health educators presented a screening education program instead.
- Focusing on beliefs is clearly an effective way to change behavior.
Another way to try to predict whether someone is going to do something is to see if he or she intends to do something. – Theory of Planned Behavior.
Theory of Planned Behavior:
- Let’s say we go to dinner together at a restaurant that has great barbeque. If you want to predict whether I am going to get some barbeque, all you have to do is ask. If I intend to get some barbeque, I will probably get some.
INTENTION – A person’s subjective probability that he or she will perform the behavior in question. An estimate of the probability of your doing something.
- If you ask me if I want dessert at the start of a meal when I am hungry, the probability that I will say “yes” will be higher than after a meal when I have stuffed myself.
- Thus, to get a good measure of intentions, they need to be measured with a high degree of specificity regarding the attitude toward the exact action (e.g., eating dessert), the target (e.g., chocolate cake), the context (e.g., on that day), and the time (e.g., right after the meal).
TPB, assumes that people decide to behave a certain way on the basis of their intentions, which are dependent on their attitude toward the behavior and their perceptions of the social norms regarding the behavior.
- Similar to the HBM, attitudes toward the behavior are based on what the person believes are the consequences of the behavior and how important these consequences are (both costs and benefits). Will eating dessert make me gain weight?
- One of the most useful components is the one assessing what you think others think about the behavior or the NORMATIVE BELIEFS.
Do the people you know support eating sweet things?
If you believe that everyone around you thinks that eating dessert is acceptable, you are more likely to want to do it. Of course, you also may not care what people around you think.
MOTIVATION TO COMPLY with others’ preferences is also part of the perception of social norms.
- If you care about the people around you and they support dessert eating, you are more likely to eat dessert.
TPB predicts the likelihood to eat novel foods, and fruits and vegetables, alcohol consumption, texting while driving.
- It even predicts selfie-posting behavior, social networking, and intentions to graduate.
Culture and the Theory of Planned Behavior
Culture and the Theory of Planned Behavior:
- Explored how mothers of different races and ethnicities make decisions to continue exclusive breastfeeding for 6 months after birth.
- Intentions to continue exclusive breastfeeding for 6 months were similar across ethnic groups explained by attitudes, subjective norms, and perceived behavioral control.
- Predictors of intention varied by group.
- Attitude best predicted intention for White mothers, while subjective norm best predicted intention for African American mothers, and perceived behavioral control best predicted intention for Latina mothers
- There was a strong significant correlation between intending to use a condom and actually using one, as measured by self-report. Similarly, in support of the TPB model, subjective norms and attitudes toward condom use and perceived behavioral control were also significant predictors of the behavior.
It is clear that models such as the TPB do not apply in the same way across cultural groups.
- Ethnic differences are seen in the relative effects of peers and parents on adolescents’ substance use or in the components of the model that are significant.
- Peers exert a stronger influence on cigarette use among Whites and Latinos than among African Americans.
- On the other hand, parents have a greater impact on the use of alcohol among African American children than among White children.
- Thus, although the TPB might predict tobacco use among both African American and White children, the relative contribution of the key components differs among cultural groups.
Additional Theories of Health Behavior Change
Additional Theories of Health Behavior Change:
PRECAUTION ADOPTION PROCESS MODEL (PAM) – Identifies seven stages along the path from lack of awareness to action.
HEALTH ACTION PROCESS (HAPA) – Distinguishes between two main phases: when a decision to act is made, and when the action is carried out.
- During the initial phase of the HAPA, people develop an intention to act based on beliefs about the risk and outcomes and their self-efficacy.
- After a goal has been established within this phase, people enter a volition phase in which they plan the details of action, initiate action, and cope with the difficulties of successfully completing the action.
Changing Behaviors: Interventions
Changing Behaviors: Interventions:
INTERVENTIONS – Are specific programs designed to assess levels of behaviors, introduce ways to change them, measure whether change has occurred, and assess the impact of the change.
- The ultimate goal of health psychological interventions is to decrease the number of deaths due to preventable diseases, delay the time of death, and improve quality of life.
Different techniques to get people to do what is healthy.
- Advertisements to change behavior tried to scare the viewer into changing.
- Today fear appeals are still used.
- Most mass media appeals have the benefit of reaching a large number of people relatively easily.
- In one example of using ad campaigns to change behavior none provided
evidence that such methods were effective, and some explicitly questioned their effectiveness.
