chapter 4-Health Behavior Change models/theories

Theories and Models Focusing on Health Behavior Change
-First need to decide on what level to intervene
-Consider the ecological perspective
ecological perspective levels
-Intrapersonal level
-Interpersonal level
-Community levels
-Institutional factors
-Community factors
-Public policy
Change Process Theories – Intrapersonal Level
-Continuum theories
-Stage theories
Continuum theories
– use an approach that identifies variables that influence action & combines them into a prediction equation
Stage theories
– are comprised of an ordered set of categories into which people can be classified, & which identifies factors that could induce movement from one category to the next
Models and theories w/ intrapersonal level
-Health Belief Model
-Theory of Planned Behavior
-Transtheoretical Model
-Precaution Adoption Process Model
-Health Action Process Approach
Health Belief Model (HBM)
-“addresses a person’s perceptions of the threat of a health problem and the accompanying appraisal of a recommended behavior for preventing or managing a problem”
-History – Developed by a group of psychologists in 1950 to help explain why people used or did not use health services
-Theory of Planned behavior subgroup
Constructs of HBM
-Perceived susceptibility
-Perceived seriousness
-Perceived barriers
-Perceived benefits
-Cues to action
Transtheoretical Model (TTM)
-” is an integrative framework for understanding how individuals and populations progress toward adopting and maintaining health behavior change for optimal health”

-has been useful explaining gradual development habitual patterns, e.g., diet & exercise

Has four major constructs -TTM
1) Stages of change (this is why some call it the “Stages of Change Model”),
2) Processes of change,
3) Self-efficacy,
4) Decisional balance
Precaution Adoption Process Model (PAPM)
-explains how people come to the decision to take action, & how they translate that decision to action
-Most useful when a deliberate action is required, e.g., screening or immunization
Stages (7)
1-Unaware of Issue
2-Unengaged by Issue
3-Deciding about Acting 4-Decide not to act
5-Decided to Act
Change Process Theories – Interpersonal Level
-This group of theories is comprised of theories that “assume individuals exist within, and are influenced by, a social environment. The opinions, thoughts, behavior, advice, and support of people surrounding an individual influence his or her feelings and behavior, and the individual has a reciprocal effect on those people”
Social learning, social power, interpersonal communication, social networks, & social support
Type of Change Process Theories – Interpersonal Level
Social Cognitive Theory (SCT)
Social Cognitive Theory (SCT)
– describes learning as a reciprocal interaction among an individual’s environment, cognitive processes, and behavior
-People are thinkers; expectations of consequences
Types of Reinforcement-SCT
-Direct reinforcement
-Vicarious reinforcement (observational learning or social modeling)
Often used constructs
Behavior capability
Locus of control
Reciprocal determinism
Self-control or self-regulation
Emotional coping response
Change Process Theories – Community Level
-This group of theories includes three of the ecological perspective levels- institutional (e.g., rules & regulations), community (e.g., social networks & norms), & public policy (e.g., legislation).
Theories associated with these factors include theories of community organizing and community building
-Diffusion theory
Diffusion Theory
-by Rogers
– it explains the pattern of adoption of the innovations
Diffusion Theory graph-
-bell-shaped curve
Innovators (-2 sd from mean) (2-3%)
Early adopters (-2 to -1 sd from mean) (14%)
Early majority (-1 sd to mean) (34%)
Late majority (mean to +1 sd) (34%)
Laggards (> +1 sd) (16%)
Community Readiness Model
-A stage model for communities
-Like individuals, communities are at various stages of readiness for change
Nine stages-Community Model
1) No awareness, 2) Denial, 3) Vague awareness, 4) Preplanning, 5) Preparation, 6) Initiation, 7) Stabilization, 8) Confirmation/Expansion, and 9) Professionalism