Seeking Health Care I Modeling Health-Related Behavior

Health-Related Behavior Behavior toward the goal of maximizing health and minimizing disease/disability Behavior toward the goal of maximizing health and minimizing disease/disability Health maintenance behaviors Health maintenance behaviors Seeking medical advice/intervention Seeking medical advice/intervention Risk behaviors and/or lack thereof Risk behaviors and/or lack thereof Theories attempt to explain factors predictive of these myriad behaviors Theories attempt to explain factors predictive of these myriad behaviors

Theories and Models in Psychology Theory – A set of related assumptions from which testable hypotheses are drawn Theory – A set of related assumptions from which testable hypotheses are drawn Model – Theory in progress Model – Theory in progress Uses of Models and Theories Generate Research Organize and explain observations Guide practitioners in predicting and modifying behavior

4 Evaluating Theory Is it comprehensive? Is it logical Is it parsimonious (simple, not too simple)? Does it agrees with empirical research? Does it generate ideas/research? Is is disconfirmable? Part of the evolution controversy This is why most scientists believe that ID is not a science Is it practically useful?

Models of Health Behavior

The Health Belief Model Assumption: People hold certain beliefs about… Assumption: People hold certain beliefs about… personal vulnerability personal vulnerability the severity of the disease the severity of the disease the costs of taking action the costs of taking action benefits of taking action benefits of taking action These beliefs motivate individuals to a greater or lesser degree to modify high- risk behaviors or seek help in doing so. These beliefs motivate individuals to a greater or lesser degree to modify high- risk behaviors or seek help in doing so.

7 Health Belief Model Demographic & PsychosocialFactors PerceivedSeriousness & Susceptibility Cues to Action Perceived Benefits & Barriers Perceived Threat Health-RelatedBehavior

Studying the HBM Support for model: Support for model: Flu shots Flu shots Breast self-examination Breast self-examination Seat belt use Seat belt use Diet Diet Smoking Smoking No support for the model: No support for the model: Exercise Exercise

Critique of the HBM Leaves out emotions, habit, social norms, and other motivations (e.g. appearance) What about context? Does not define how to test relationships between different elements

Is the HBM useful? Comparison of different behaviours and populations Identifies most salient beliefs (i.e. barriers, susceptibility) Interventions: health education, risk appraisal, decisions balance sheets, relapse prevention plans

Theory of Planned Behavior General theory of behavior – Not specific to health behavior General theory of behavior – Not specific to health behavior Assumption: People are reasonable and use information to freely choose behavior. Behavior happens secondary to an INTENTION. Assumption: People are reasonable and use information to freely choose behavior. Behavior happens secondary to an INTENTION. The intention to perform a behavior is an interaction between The intention to perform a behavior is an interaction between Attitude Attitude Subjective Norm – Social Pressure Subjective Norm – Social Pressure Perceived Behavioral Control Perceived Behavioral Control Actual Control Actual Control

12 Theory of Planned Behavior AttitudeTowardBehavior Subjective Norm for Behavior PerceivedBehavioralControl Intention Health-RelatedBehavior

Critique of TPB For some behaviors attitudes, norms and perceived control independently predict intentions In some contexts intentions predict behaviour Attitudes shown to be independently related to perceived control Perceived control independently predicts behaviour Perceived control is the strongest predictor Environmental influences (access to healthcare) Social support Adoption versus maintenance of behaviour Competing behaviours (weight loss versus smoking cessation)

What interventions are related to the TPB? Attitudes: education Norms: public health campaigns Perceived control: relapse prevention planning

The Transtheoretical Model Stage model of general behavior change Stage model of general behavior change Assumption: People utilize a number of processes of change to move through 5 stages of change Assumption: People utilize a number of processes of change to move through 5 stages of change Processes Processes Consciousness Raising, Dramatic Relief, Contingency Management, Stimulus Control, Self-libertation Consciousness Raising, Dramatic Relief, Contingency Management, Stimulus Control, Self-libertation Stages Stages Precontemplation Precontemplation Contemplation Contemplation Preparation Preparation Action Action Maintenance Maintenance

The Behavior Change Spiral Pre-contemplation Contemplation Preparation Action Maintenance Precontemplation: changing a behavior has not been considered; person might not realise that change is possible or that it might be of interest to them Contemplation: something happens to prompt the person to start thinking about change - perhaps hearing that someone has made changes - or something else has changed - resulting in the need for further change Preparation: person prepares to undertake the desired change - requires gathering information, finding out how to achieve the change, ascertaining skills necessary, deciding when change should take place - may include talking with others to see how they feel about the likely change, considering impact change will have and who will be affected Action: people make changes, acting on previous decisions, experience, information, new skills, and motivations for making the change Maintenance: practice required for the new behavior to be consistently maintained, incorporated into the repertoire of behaviors available to a person at any one time

TM People often use different processes during stages and different stages require different interventions People often use different processes during stages and different stages require different interventions Precontemplation – Consciousness Raising Precontemplation – Consciousness Raising Contemplation – Environmental Re-evaluation Contemplation – Environmental Re-evaluation Preparation – Self Re-evaluation, Preparation – Self Re-evaluation, Action – Contingency Management, Stimulus Control Action – Contingency Management, Stimulus Control Maintenance - Contingency Management, Stimulus Control Maintenance - Contingency Management, Stimulus Control

TM – Empirical Findings Quitting Smoking Quitting Smoking Alcohol and Drugs Alcohol and Drugs Exercise Exercise Safe sex Safe sex Mammography Mammography

Critique of Models of Health Behavior All have produced substantial research All have produced substantial research All are predictive of health-related behaviors. Some behaviors more-so than others All are predictive of health-related behaviors. Some behaviors more-so than others Do not explain how people judge thing like susceptibility, or go from stage to stage Do not explain how people judge thing like susceptibility, or go from stage to stage Lack coherence: Lack coherence: Models simply list variables Models simply list variables No overall model of the person No overall model of the person Assessment is and issue Assessment is and issue Adherence is a separate process Adherence is a separate process Barriers are innumerable and not adequately researched Barriers are innumerable and not adequately researched