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Health Psychology

Theories of Health Behavior. What is a scientific theory?Statement about causal relationships among abstract constructs whose validity is not conclusively demonstratedHas application beyond a single situation, event, or thingGoal of theory testing is refutation ? Karl Popper. Theories of Health

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Health Psychology

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    1. Health Psychology Theories of Health Behavior Chapter 3 PY470 - Hudiburg

    2. Theories of Health Behavior What is a scientific theory? Statement about causal relationships among abstract constructs whose validity is not conclusively demonstrated Has application beyond a single situation, event, or thing Goal of theory testing is refutation – Karl Popper

    3. Theories of Health Behavior

    4. Theories of Health Behavior Continuum-models and stage-based models differ in their assumptions regarding the contributions of beliefs across persons situations, and, as a result, the nature of the relationships between beliefs and behavior.

    5. What are continuum theories of health behavior? Identify set of variables combine them to predict likelihood the person will engage in given behavior on a continuum of action likelihood

    6. Health Belief Model

    7. Health Belief Model Likelihood in taking preventive action is a function of: Susceptibility Severity Benefits - Motivational Cues Barriers Self-efficacy Table 3.1, p. 62

    8. Susceptibility & Severity Susceptibility How likely one thinks a bad outcome (e.g., get sick or a disease) is if behavior persists (doesn’t change). Severity The consequence is perceived to be severe as opposed to mild.

    9. Benefits of Behavior The alternative behavior will reduce the likelihood of the negative consequence (e.g., disease). & Benefits are perceived to outweigh costs. Motivational cues – in Janz & Becker (1984) model revision Cues (internal or external) that help convert intentions into behavior Self-efficacy (S-E) – Bandura (1977) -The belief in being able to successfully execute the behavior required to produce the desired outcomes.

    10. Barriers There are not significant psychological, financial, or other costs or barriers to engaging in the behavior.

    11. Roberto is not likely to continue smoking because… He thinks that he might get lung cancer if he continues to smoke (susceptibility). He believes that dying from lung cancer is terrible (severity). Roberto does not find smoking to be very pleasurable (cost/benefits). His friends are supportive of his quitting (absence of barrier) He believes he can do it – (S-E)

    12. Juanita is likely to continue smoking because She agrees with the tobacco industry--smoking doesn’t cause lung cancer (susceptibility). She believes that dying from lung cancer is not any worse than any other way of dying (severity). Juanit feels that smoking relaxes her (cost/benefits). Her friends offer her cigarettes (barrier to quitting) She believes she can’t do it – (S-E)

    13. Theories of Reasoned Action / Planned Behavior

    14. Theories of Reasoned Action / Planned Behavior Intentions Attitudes Beliefs (outcome expectancies) Values Subjective norms Beliefs (about what others think you should do) Motivation to comply Perceived behavioral control See Table 3.2, p. 66

    15. Intentions “Barring unforeseen events, a person will usually act in accordance with his or her intentions” (Ajzen & Fishbein, 1980, p. 5). Intentions to perform a behavior best predictor that he behavior will actually be performed.

    16. Attitudes One’s positive or negative evaluation of performing a behavior (others’ perceptions) Beliefs: about the consequences of performing the behavior (outcome expectancies) Values: appraisal (importance) of the consequences

    17. Subjective Norms One’s perception of the social pressures to perform or not perform a behavior. Beliefs: about whether specific individuals or groups think one should perform the behavior. Motivation to comply with these people.

    18. Someone likely to drink and drive ATTITUDE: Carla feels more at ease with others when she drinks (beliefs about the consequences and values) SUBJECTIVE NORM: Carla feels that her colleagues encourage her to drink after work (belief) and she wants them to like her (motivation to comply) INTENTION: Carla intends (expects) to drink with his colleagues after work and then drive home 1 or more times in the next 30 days (intentions).

    19. Theory of Planned Behavior Past Behavior Always the best predictor of future behavior Behavioral Control Perceived Behavioral Control/Locus of Control/Self-Efficacy Intention -> Behavior Link is problematic when behavior is not fully under the individual’s control.

    20. Learning Theories Assumes that behavior is influenced by learning processes Classical Conditioning unconditioned stimulus (UCS) unconditioned response (UCR) neutral stimulus conditioned stimulus (CS) conditioned response (CR) See Photograph 3.3, p. 71

    21. Learning Theories Classical Conditioning – F 3.3, p. 70

    22. Learning Theories Operant conditioning Differential Reinforcement Positive reinforcement (rewards) Negative reinforcement (avoidance of something bad) Punishments Positive punishment (aversive stimuli) Negative punishment (loss of reward) Positive (present something Negative (take something away) Reinforcement (behavior increases) Punishment (behavior decreases) Can occur through observation – Bandura oberservational learning

    23. Social cognitive theory From Bandura’s social learning theory Direct modeling Symbolic modeling Difference in level of abstraction – gender in elementary school self-efficacy outcome expectancies – evaluative definitions

    24. Imitation of Models We learn behavior by watching and imitating other people. Direct modeling – D’Amico & Fromme (1997) – younger and older siblings and health issues – Box 3.3, p. 73 Symbolic modeling – how people are portrayed by various sources

    25. Self-Efficacy Perceived ability to perform a task. Self-efficacy predicts future behavior if there are adequate incentives and skills. Table 3.3, p.75 – sample scale to measure self-efficacy

    26. Exposure and Adoption of Evaluative Definitions Outcome expectancies The more an individual defines a behavior as good or at least justified rather than bad, the more likely they are to engage in it. Evaluative definitions positive, neutral, negative norms, attitudes, orientations

    27. Social cognitive theory What does it predict? smoking cessation eating nutritious food lowering cholesterol brushing and flossing teeth using condoms exercising regularly Research Focus: Pain during child birth study – Box 3.4, p. 77 Building self-efficacy – Figure 3.4, p. 76 study – Shadel & Mermelstein (1993)

    28. What are stage models of health behavior change? Set of ordered categories or stages that people go through as they attempt to change their behavior Stages of Change “Ordered categories along a continuum of motivational readiness to change a problem behavior” Transtheorectical Precaution adoption process model

    29. Transtheoretical Model Stages of change model – Figure 3.5 precontemplation stage contemplation stage preparation action maintenance Box 3.5, p. 81 – Research Focus – smoking cessation – stages of change model Transtheorectical http://www.uri.edu/research/cprc/transtheoretical.htm

    30. Transtheoretical or stages of change model – Figure 3.5, p. 79

    31. Precontemplation No intention to change behavior in the foreseeable future (next 6 months). Includes people who are unaware of the problem plus those who know about the problem but are not considering change. “I am not thinking about changing my risky sexual behavior within the next 6 months to reduce the risk of getting HIV.”

    32. Contemplation People are aware that a problem exists and are seriously thinking about overcoming it but have not yet made a firm commitment to take action. Intending to change within 6 months; open to feedback and information about how to change. However, ambivalent about the costs and benefits of their behavior. “I am thinking about changing my risky sexual behavior within the next 6 months to reduce the risk of getting HIV.”

    33. Preparation Individual is intending to take action in the next month and has unsuccessfully taken action in the past year (combines intention and behavior criteria). Actively planning change and already taking some steps toward action such as reducing frequency of problem behavior. “I am thinking about changing my risky sexual behavior within the next 30 days to reduce the risk of getting HIV.”

    34. Action Stage in which individuals modify their behavior, experiences, or environment in order to overcome their problems. Involves overt behavioral changes and requires commitment of time and energy. e.g., cessation of smoking has occurred and last cigarette was less than 6 months ago. “In the last few months I have changed my risky sexual behavior to reduce the risk of getting HIV.”

    35. Maintenance People work to prevent relapse and consolidate the gains attained during action. Sustaining change and resisting temptation to relapse. Stage extends from 6 months and beyond the initial behavioral change. “For more than 6 months I have changed my (former) risky sexual behavior to reduce the risk of getting HIV.” After 12 months of continuous abstinence, 43% of former smokers relapse. After 5 years of continuous abstinence, 7% relapse.After 12 months of continuous abstinence, 43% of former smokers relapse. After 5 years of continuous abstinence, 7% relapse.

    36. Transtheoretical Model Box 3.5, p. 81 – Research Focus – smoking cessation – stages of change model Results - Figure 3.6, p. 82 http://www.aafp.org/afp/20000301/1409.html - Stages of Change is another name of the model Model Limitations cognitive processes may be different for stopping a behavior and starting a new one thinking about costs and benefits is not a good predictor of moving forward or not are the stages the right ones?

    37. Precaution adoption process model – Figure 3.7, p. 85

    38. Precaution Adoption Process Model Stage 1: Unaware of issue Stage 2: Unengaged by issue Stage 3: Deciding about acting Stage 4: Decided not to act Stage 5: Decided to act Stage 6: Acting Stage 7: Maintenance Table 3.5, p. 86 – examples of stages Study: http://www.psandman.com/articles/precautn.htm

    39. Precaution Adoption Process Model Do you know what it means to floss your teeth? No -> {stage 1} Yes -> {go to next q} Do you floss your teeth now? Yes -> {Stage 6 or 7} No -> {go to next q} Which of the following best describes you? I’ve never thought about flossing. {Stage 2} I’m undecided about flossing. {Stage 3} I’ve decided I don’t want to floss. {Stage 4} I’ve decided I do want to floss. {Stage 5}

    40. Precaution adoption process model Research Focus – Box 3.6, p. 87 – predicting osteoporosis prevention Implications being at different stages should be influenced by different types of information actually engaing in a behavior should be influenced by obstacles and barriers

    41. Issues for consideration A list of variables is not a model. - Are there other variables that should be included in these models? How models are evaluated - reliability and validity of constructs Context does matter Are all behaviors rational? Behavioral Intention Behavioral Expectation Behavioral Willingness Turning intentions into action

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