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U14634: Motivating Health Behaviour Mary Gottwald Principal Lecturer Student Experience February 2013 Oxford Brookes University Faculty of Health and Life.

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Presentation on theme: "U14634: Motivating Health Behaviour Mary Gottwald Principal Lecturer Student Experience February 2013 Oxford Brookes University Faculty of Health and Life."— Presentation transcript:

1 U14634: Motivating Health Behaviour Mary Gottwald Principal Lecturer Student Experience February 2013 Oxford Brookes University Faculty of Health and Life Sciences

2 Predicting Health Behaviours – Behavioural change models

3 Learning Outcomes By the end of the module you will be better able to: Understand the factors involved in predicting and explaining behaviour Understand the role of social cognition and stage models in predicting and explaining health behaviour Explore and understand in detail specific models Be able to critique models and apply to case scenarios.

4 Week 2 - overview 09.00 – 10.15am: Lecture 10.15 – 10.45am: Break 10.45 – 12 noon: Seminar

5 Predicting & explaining health behaviour Complete the following: I feel healthy when…….. I feel healthy because….. To stay healthy I need……… I do not feel healthy when……. My health improves when……….

6 Predicting health behaviours So…. How do we account for variability in behaviours? How do we account for variability in health?

7 Predicting and explaining health behaviour Individual differences Locus of control (Rotter 1996) Internal External Multidimensional health locus of control (Wallston and deVellis 1978) Internal External / chance Powerful others Modest predictor of behaviour

8 Health-promoting / risky health behaviours What are risky healthy behaviours? What are health promoting behaviours?

9 Risky health behaviours Global risks: Highest global risks to mortality = tobacco use, physical inactivity, being overweight and obesity (World Health Report 2012). Diet –high fat diet / being underweight Excessive alcohol Unsafe sex Not getting enough sleep Dangerous sports

10 Health-promoting behaviours Alameda-seven 1.Sleeping 7-8 hours a night 2.Not smoking 3.Consuming no more that 1-2 alcoholic drinks per day 4.Getting regular exercise 5.Not eating in between meals 6.Eating breakfast 7.Being no more than 10% overweight (Breslow 1983, cited in Morrison and Bennett 2006:61)

11 Individual differences and health Younger, wealthier, better educated individuals with low stress levels and high social support are more likely to engage in health-enhancing behaviours (exercise, nutrition, non-smoking, low alcohol intake). If a person experiences high stress, fewer social, emotional and economic resources, they are more likely to be engaged in health compromising behaviours (smoking, high alcohol intake, sedentary lifestyle or poor nutrition).

12 Understanding cognition Cognitive factors: Shape health behaviour Predict behaviour through self-regulation Social cognition models describe key cognitions and their interrelationships in the regulation of behaviour.

13 Social Cognition Cognitions: Represent our thoughts, beliefs and knowledge towards a behaviour. Are intrinsic to us. Are modifiable determinants of behaviour. Give rise to social behaviour. Behaviours have an impact on morbidity and mortality.

14 Social Cognition Models Help us to understand and predict health behaviours: Knowledge, perceived social norms, beliefs, attitudes and self-efficacy are linked to behavioural intentions and health related behaviour. Help us to explore the extent to which cognitions predict and explain behaviour. Continuum v stage models

15 Self-efficacy - Bandura The belief that you can carry out a specific behaviour in a specific situation (Bandura 1997 cited in Upton and Thirlaway 2010:21) i.e. if you believe that you can do it then you will! I cant do it I can So, self-efficacy beliefs directly determine behaviour (or action)

16 Enhancing self-efficacy 1.Observational learning / participatory learning. 2.Verbal persuasions 3.Perception of psychological and affective states. (Davis and Macdowell 2006)

17 Continuum v stage models Continuum 1.Health Belief Model 2.Theory of Reasoned Action / Planned behaviour 3.Health Action Model 4.Prototype Willingness Model 5.Dual-Process Models Individuals are likely to perform a (health related) behaviour based on their position on a continuum.

18 Continuum v stage models Stage model Transtheoretical Stages of Change Model (TTM) Individuals move through stages before achieving a change in their (health related) behaviour

19 Behaviour change models Models help us to explain and predict health behaviour. However, the decision we make about whether we decide / dont decide to change our health related behaviour is based on cues and information we have in relation to our social, physical and cultural environment. Motivation also impacts on our decision making. All models have strengths and limitation. (Edberg 2007, Marks et al 2011, Gottwald and Goodman-Brown 2012)

20 Health Belief Model 1950s Hochbaum, Rosenstock, Becker Focuses on understanding an individuals perception of reality rather than how they respond to a situation. Considers a number of factors that may predict the likelihood of changing health related behaviours. Initial research linked to motivation.

21 Health Belief Model (Goodman-Brown and Gottwald 2008) Perceived susceptibility Self efficacy Likelihood of taking action Perceived success Perceived severity Perceived benefits Cues to action

22 Theory of Reasoned Action Ajzen and Fishbein 1980 Behaviour is dependent on two variables: 1.Attitudes – beliefs about the consequences. 2.Subjective norms – how much the individual wants to conform and be like significant others. Attitudes + norms = an intention to change.

23 Theory of Planned Behaviour http://www.youtube.com/watch?v=YfGEbT_RSIE

24 Theory of Reasoned Action Beliefs about the consequences of taking action and judgement of those consequences Beliefs whether Others in their networks would approve and motivation to comply with others Attitude Subjective Norm Behavioural intention Behavioural change

25 Theory of Planned Behaviour Ajzen added another variable: Behaviour is a consequence of perceived control Internal locus of control External locus of control There is some correlation between PBC and intention. Attitudes + PBC + intention = influence behaviour (e.g. uptake of exercise)

26 Theory of Planned Behaviour Beliefs about the consequences of taking action and judgement of those consequences Beliefs whether 0thers in their networks would approve and motivation to comply with others Attitude Subjective Norm Behavioural intention Behavioural change Internal control factors External control factors Perceive behavioural control

27 27 STAGES OF CHANGE (TTM) (Prochaska and DiClemente 1984) Pre-contemplation not thinking of change / not aware of a need to change Contemplation considering change – advice needed Commitment ready to change – practical support and achievable goals needed Action making the change – support and encouragement still needed Maintenance maintaining the change in their lifestyle – developing coping strategies Relapse support needed to return to contemplation

28 28 Contemplation Pre-contemplation Preparation Action Relapse Maintenance Long term change (Adapted from Prochaska and DiClemente, 1984)

29 29 STAGES OF CHANGE (TTM) Exit Action Maintenance Commitment Relapse Contemplation Pre-contemplation ( Gottwald, cited in Davis 2006) Exit

30 30 STAGES OF CHANGE (TTM) Pre-contemplation: denial / low self-efficacy / barriers to change Contemplation: Seek information. Reduced barriers / increased benefits Preparation: Set goals, prioritise, concrete plans (join a gym) Action: Realistic goals essential / social support. Maintenance: Need to self monitor / need positive reinforcement.

31 Health Action Model (Gottwald and Goodman-Brown 2012:79) Translating behavioural intention Action Personality factors: self- concept and self- sentiment Knowledge and skills Barriers, facilitating and environmental factors: social, physical, cultural and socio-economic Belief, motivation and normative systems

32 32 Summary Behavioural models enhance our understanding. Can be used to predict all behaviours. These models focus on individual cognitions – need to remember socio-economic factors, culture, religion and so on. Models help to explain and understand complex situations and suggest approaches to take to ensure effective health promotion.

33 33 Exam question Describe and critically evaluate one Social Cognition Model and its application to predicting and explaining a specific health related behaviour.

34 References - Also see references in module guide Bennett P and Morrison V (2006) An introduction to health psychology London: Prentice Hall Conner M and Norman P (2005) Predicting health behaviour Maidenhead: OUP Edberg M (2007) Essentials of health behaviour. Social and behavioural theory in public health London: Jones and Bartlett Publishers Gottwald M (2006) Health promotion models in S Davis (2006) Rehabilitation. The use of theories and models in practice London: Elsevier Gottwald M and Goodman-Brown J (2008) Public health interventions. In J Mitcheson (2008) Expanding nursing and health care practice Cheltenham: Nelson Thornes Gottwald M and Goodman-Brown J (2012) A guide to practical health promotion Maidenhead: OUP Davies M and Macdowall W (2006) health promotion theory Maidenhead: OUP Rotter J (1966) generalised expectations for internal versus control of reinforcements Psychological Monographs 80:69 Rutter D and Quine L (2010) Changing health behaviour Maidenhead: OUP Upton D and Thirlaway K (2010) Promoting healthy behaviour London: Pearson


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