Transcript Seeking Health Care I

Seeking Health Care I
Modeling Health-Related Behavior
Health-Related Behavior
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Behavior toward the goal of maximizing
health and minimizing disease/disability
Health maintenance behaviors
 Seeking medical advice/intervention
 Risk behaviors and/or lack thereof
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Theories attempt to explain factors
predictive of these myriad behaviors
Theories and Models in
Psychology
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Theory – A set of
related assumptions
from which testable
hypotheses are drawn
Model – Theory in
progress
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Uses of Models and
Theories
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Generate Research
Organize and explain
observations
Guide practitioners in
predicting and
modifying behavior
Evaluating Theory
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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
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Is it practically useful?
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Models of Health Behavior
The Health Belief Model
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Assumption: People hold certain beliefs
about…
personal vulnerability
 the severity of the disease
 the costs of taking action
 benefits of taking action
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These beliefs motivate individuals to a
greater or lesser degree to modify highrisk behaviors or seek help in doing so.
Health Belief Model
Demographic &
Psychosocial
Factors
Perceived
Benefits &
Barriers
HealthRelated
Behavior
Perceived
Seriousness
& Susceptibility
Perceived Threat
Cues to Action
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Studying the HBM
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Support for model:
Flu shots
 Breast self-examination
 Seat belt use
 Diet
 Smoking
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No support for the model:
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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
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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.
The intention to perform a behavior is an interaction
between
 Attitude
 Subjective Norm – Social Pressure
 Perceived Behavioral Control
 Actual Control
Theory of Planned Behavior
Attitude
Toward
Behavior
Subjective
Norm for
Behavior
Intention
HealthRelated
Behavior
Perceived
Behavioral
Control
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Critique of TPB
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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
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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
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Stage model of general behavior change
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Assumption: People utilize a number of
processes of change to move through 5
stages of change
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Processes
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Consciousness Raising, Dramatic Relief, Contingency
Management, Stimulus Control, Self-libertation
Stages
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Precontemplation
Contemplation
Preparation
Action
Maintenance
The Behavior Change Spiral
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
Action: people make changes, acting on previous decisions,
Contemplation
Preparation
experience, information, new skills, and motivations for making
the 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
Contemplation: something happens to prompt the person to
Pre-contemplation
start thinking about change - perhaps hearing that someone has made
changes - or something else has changed - resulting in the need for
further change
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
TM
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People often use different processes
during stages and different stages require
different interventions
Precontemplation – Consciousness Raising
 Contemplation – Environmental Re-evaluation
 Preparation – Self Re-evaluation,
 Action – Contingency Management, Stimulus
Control
 Maintenance - Contingency Management,
Stimulus Control
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TM – Empirical Findings
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Quitting Smoking
Alcohol and Drugs
Exercise
Safe sex
Mammography
Critique of Models of Health
Behavior
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All have produced substantial research
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
Lack coherence:
 Models simply list variables
 No overall model of the person
Assessment is and issue
Adherence is a separate process
Barriers are innumerable and not adequately researched