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Learning Objectives

Epi 245 Practical Uses of Theory for Understanding and Changing Patient and Public Behavior Margaret Handley, PhD MPH Assistant Adjunct Professor, DEB and Medicine October 16, 2008. Learning Objectives. 1. To apply a theoretical approach to understanding

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Learning Objectives

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  1. Epi 245Practical Uses of Theory for Understanding and Changing Patient and Public BehaviorMargaret Handley, PhD MPHAssistant Adjunct Professor, DEB and MedicineOctober 16, 2008

  2. Learning Objectives 1. To apply a theoretical approach to understanding and changing patient and public behavior 2. To examine theory-based uses of social marketing 3. To think about how ecological models (e.g.PRECEDE-PROCEDE) can help integrate health behavior theories into intervention design and implementation

  3. Talk Outline 1. Describe 2 main theories relevant to individual behavior Health Belief Model and Theory of Planned Behavior *both have strong evidence 2. Provide examples of practical uses of these theories for designing interventions – often linked with social marketing strategies 3. Examples of models/frameworks that can help organize thinking and action steps for implementation/evaluation

  4. Examples used in lecture 1. Uptake of flu vaccination among elderly non-whites 2. Initiation of breast-feeding/solids 3.Medication adherence for TB 4. Community outbreak of lead poisoning in Monterey 5. Evaluation of a self-management support program for patients with diabetes

  5. An Ecological Perspective K Glanz and B Rimmer. Theory at a Glance. NCI, 2005

  6. Practical uses of theories Explanatory Theory: Why? What can be changed? Underlying dynamics? Change Theory: Which strategies? Which messages? Underlying assumptions? Targeted Behavior or Situation

  7. Practical uses of theories Change Theory: Which strategies? Which messages? Underlying assumptions? Explanatory Theory: How true is this? What else can be changed? Targeted Behavior or Situation

  8. 1. Health Belief Model and Theory of Planned Behavior

  9. Health Belief Model

  10. Health Belief Model Strong Health Beliefs translate into MOTIVATION and ACTION to prevent, screen for or control illness

  11. Target Strategies: HBM

  12. Summary- Health Belief Model • Very broad range: modifiable determinants for: screening, ’lifestyle’, risk behaviors, and medication adherence • Very population-specific for many behaviors, which are often dynamic – this is good and bad • Does not address enabling/reinforcing factors • Ignores social context and recognition of this has led to HBM’s use in combination with other constructs and theories that reflect ‘non-self’ factors

  13. Theory of Planned Behavior Strong Planned Behavior translates into INTENTION to ACT to prevent, screen for or control illness

  14. Theory of Planned Behavior Behavioral Beliefs External Factors -Demographics -Personality traits -Environment/Resources Attitude Outcome Expectancy Normative Beliefs Subjective Norms Behavior Intention Behavior Motivation to Comply Control Beliefs Perceived Behavioral Control Perceived Power Ceccato et al, J Cont Educ Health Prof 2007

  15. Target Strategies: TPB

  16. Summary: TPB • Intention may not come to be - the best laid plans…..often go awry. • Assumes non-conscious influences and larger environmental forces work via intention, and recognition of this has led to TPB use in combination with other constructs and theories that reflect ‘non-self’ factors.

  17. 2. Practical uses of these theories

  18. Another view of the toolbox – patient/public behavior K Glanz and B Rimmer. Theory at a Glance. NCI, 2005.

  19. Examples from HBM and TPB • Health Belief Model: • 1. Influenza vaccination disparities • 2. TB medication adherence targets • Theory of Planned Behavior: • 3. Early infant feeding/initiation of breastfeeding • Some of each – broader models: • 4. Reducing exposure to lead-contaminated imported foods • 5. Ecologic framework to interpret influences on engagement in a diabetes self-management support program

  20. Health Belief Model • Example 1:Influenza vaccination behavior - variability among racial/ethnic groups • Vaccination rates in age >65 lower than target • Large disparities evident by race/ethnicity for • African American and Latinos, and also no • disaggregated data on Asian ethnic sub-groups • (e.g. Japanese and Filipino-Americans?) • Q: What are beliefs re susceptibility, severity and barriers to vaccination among diverse ethnic groups ages 50-75? • *Doer and non-doers examined/predictive modeling.

  21. Practical uses of HBM Explanatory Theory: What is relationship with behavior theory components and this behavior? Doer and non-doers? Race/Ethnicity? Targeted Behavior Influenza Vaccination among older ages by ethnicity

  22. Influenza Vaccination Behavior and Beliefs: HBM Chen et al, 2007

  23. Influenza Vaccination Behavior and Beliefs: HBM

  24. Practical uses of HBM Explanatory Theory: What is relationship with behavior theory components and this behavior? Targeted Behavior Adherence to TB Meds.

  25. Health Belief Model Example 2: TB Treatment Adherence Munro et al, 2007. BMC Public Health; Munro et al, 2007. PlosMedicine

  26. TB – Social Marketing and Treatment Adherence Pauwels L. Acta Academia Suppl. 2005: 337-353

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