2. Jump to first page 1 Models of Health Promotion n Stages of Change, Prochaska et al (1982) n Health Belief Model, Rosenstock (1974)

3. 2 Why do people... n do things that are bad for their health such as smoke cigarettes or drink too much alcohol? n not do things that are health- enhancing like exercise or eating low fat foods? n not do things that maximize the likelihood of better outcomes such as wearing seat belts?

4. 3 Stages of Change Model n Prochaska et al (1982) n “Ordered categories along a continuum of motivational readiness to change a problem behavior” n Assumption: most people will pass through these stages, or go back and forth, when adopting a healthy habit http://www.uri.edu/research/cprc/transtheoretical.htm

5. 4 Five Stages of Change n Precontemplation n Contemplation n Preparation n Action n Maintenance

6. 5 Precontemplation n No intention to change behavior in the foreseeable future (next 6 months). n Includes people who are unaware of the problem plus those who know about the problem but are not considering change. n “I am not thinking about changing my risky sexual behavior within the next 6 months to reduce the risk of getting HIV.”

7. 6 Contemplation n 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. n 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. n “I am thinking about changing my risky sexual behavior within the next 6 months to reduce the risk of getting HIV.”

8. 7 Preparation n Individual is intending to take action in the next month and has unsuccessfully taken action in the past year (combines intention and behavior criteria). n Actively planning change and already taking some steps toward action such as reducing frequency of problem behavior. n “I know I should change my behavior, and I think I will soon.”

9. 8 Action n 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. n e.g., cessation of smoking has occurred and last cigarette was less than 6 months ago. n “In the last few months I have changed my risky sexual behavior to reduce the risk of getting HIV.”

10. 9 Maintenance n People work to prevent relapse and consolidate the gains attained during action. n Sustaining change and resisting temptation to relapse. n Stage extends from 6 months and beyond the initial behavioral change. n “For more than 6 months I have changed my (former) risky sexual behavior to reduce the risk of getting HIV.” n Most people take several action attempts before they are able to maintain the behavior

11. 10 Examples of the Stages of Change Model n Do you know what it means to floss your teeth? u No -> {Precontemplation} u Yes -> {go to next q} n Do you floss your teeth now? u Yes, for more than 6 months -> {Maintenance} u Yes, I recently started -> {Action} u No -> {go to next q} n Which of the following best describes you? u I’ve never thought about flossing. {Precontemplation} u I should probably floss. {Contemplation} u I have floss at home, and I know I should floss, but I keep forgetting to actually do it, or I don’t have time. {Preparation}

12. 11 Prochaska et al (1982) n Stages of Change model was developed after studying 872 former smokers n Quitting was a dynamic process; people moved back and forth between the stages

13. 12 Stages of Change Model n Summary: What does this model help us understand? u Where a person is in the process of acquiring a new healthy habit

14. 13 Health Belief Model n Rosenstock (1974) n Predicts the likelihood of healthy behavior n Assumes people are rational

15. 14 Health Belief Model A person evaluates: n The risk - u 1. Vulnerability u 2. Severity u 3. Self-Efficacy n 4. Costs/Benefits n 5. Cues/Motivation n 6. Barriers

16. 15 Vulnerability n How likely one thinks a bad outcome (e.g., get sick or a disease) is if unhealthy behavior persists.

17. 16 Severity n The consequence is perceived to be severe (death) as opposed to mild (yellower teeth).

18. 17 Self Efficacy n Perceived ability to perform a task. n Self efficacy predicts future behavior if there are adequate incentives and skills. n “Can I do it?” “Will I stick to it?” “Will it work?”

19. 18 Costs & Benefits of Behavior n Will it work to reduce the likelihood of the negative consequence (e.g., disease)? n Benefits are perceived to outweigh costs. n Example: I should exercise because it lowers stress and body weight, but if I spend an hour a day exercising I won’t have time to do my homework and I will fail out of school!

20. 19 Motivational cues n Cues (internal or external) that help convert intentions into behavior n Could be good cues (friend started exercising more and looks great now) or bad cues (overweight relative is having chest pains)

21. 20 Barriers n Anything standing in the way from allowing a person to take the decided action u Not enough money or time to perform the behavior you want to u Negative feedback from family and friends

22. 21 First, Risk evaluation (1) Am I vulnerable? (2) How severe is the risk? Second, Modifying Factors (4) Costs (4) Benefits Outcome, Likelihood of Action (5) Cues/Motivations (6) Barriers (3) Will my action be effective?

23. 22 Jane is not likely to continue smoking because… n She thinks that she might get lung cancer if she continues to smoke (susceptibility). n She believes that dying from lung cancer is terrible (severity). n Jane does not find smoking to be very pleasurable (cost/benefits). n Her friends are supportive of her quitting (absence of barrier)

24. 23 Jon is likely to continue smoking because n He agrees with the tobacco industry-- smoking doesn’t cause lung cancer (susceptibility). n He believes that dying from lung cancer is not any worse than any other way of dying (severity). n Jon feels that smoking relaxes him (cost/benefits). n His friends offer him cigarettes (barrier to quitting)