Transcript instructor: norah alsadhan, mph

INSTRUCTOR: NORAH ALSADHAN, MPH
Lecture-2-
 Key concepts
 Multiple levels of influence
 Behavior affect and is affected by multiple determinants at all
level of human life
 Reciprocal causation
 Individual behavior shapes and is shaped by the social
environment.
 52-year old women delays getting a mammogram.
Possible reason for this occur on all levels of influence.
 Socioeconomic status: education, income, occupation
 Skills
 Culture: norms, values, beliefs
 Beliefs: one’s own perception of what is true. Not always
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based on culture.
Attitude: a series of beliefs linked together to form
patterns of behavior
Values: not always valid to assume that health is a strong
value for everyone
Religion: social behavior, practices, social support
Gender: Men eat more fat, less fiber, sleep less, and are
more often heavier than women.
 Knowledge
 Attitudes
 Beliefs
 Personality traits
 Personal history
 Psychodynamic theories:
 Drives and repressed emotion create physical symptom
and anxiety
 Behavioral therapies:
 Behavior is determined by reinforcement
 Cognitive theory
 Behavior is determined by thoughts, feelings,
perceptions, goals, and other mental activity
 Health Belief Model:
 Perceptions of threat, benefit and barrier to action
 Transtheoretical Model:
 Motivation and readiness to change behavior
 Theory of planned behavior:
 Attitudes, intentions, beliefs, and control
 Family, friends, and peers
 Social identity
 Social support
 Social cognitive theory:
 Triadic influences of self, behavior, and the environment
 Social influence:
 Different types of relationships have differing effects on
behavior
 Social support:
 Support of varying types from other people buffers
individuals against the effects of stress.
 Most theories at these levels are based in Cognitive-
behavioral Theory:
 Behavior is mediated by cognitions
 Knowledge is necessary but not sufficient to produce
most behavior change
 Perceptions, motivations, skills, and the social
environment are key influences on behavior
 Community
 Social networks and norms
that are informal or formal
and serve to guide behavior
 Community building:
uniting people around a
common goal using
available resources
 Social networks: the
amount of social dyads
around each individual
 Diffusion of innovations:
 How new ideas, products, and practices spread within a
defined population
 Communication Theory:
 How different modes of communication influence the
behavior of populations and individuals
 Institutional:
 Rules, regulations, policies, that constrain or encourage
recommended behaviors.
 Public policy:
 Multi-level governmental policies and laws that regulate
all aspects of health care.
 No one theory is Adequate
 Every theory and model has a specific goal
 What does it try to explain?
 Is it about how people learn?
 Is it about how people change?
 Is it about how people relate to others?
 Every theory/model is somehow
connected to what came before
 Evolution of understanding
 Increasing complexity and
sophistication
 Every theory/model has a better/best fit:
 For particular problems
 For particular populations
 For particular interventions
 Every theory/ model was developed in a cultural and
social milieu that may be different from present day
 People influence the people and situations around
them
 People are influenced by the people and situations
around them
 Example: 56 year-old man with elevated cholesterolworkplace cafeteria provides only fatty-unhealthy food
choices.
 Multiple types of environmental
influences affect behavior
 Natural environment
 Built environment
 Multiple-level interventions are
usually most effective
 But most interventions still target the
individual
 Sigmund Freud (1856-1939)
 Vienna, Austria
 Studied medicine at university of vienna
 Specialized in Neurology
 Unconscious events influence psychic life
 Unconscious and conscious forces determine:
 Mental events
 Experiences
 Behavior
 Many physical symptoms are caused by psychological
conflicts
 Id, Ego and Superego
 Three aspects of most
internal (neurotic) conflict
 This conflict is almost
always repressed.
 True psychic reality
 Contains instinctual urges
 Sources of desire for
immediate gratification
 No values, ethics, or logic
 Obeys the pleasure principle
 Values and ideals of Society
 As conveyed by parents
 Aims for Perfection.
 The super-ego strives to act in a socially appropriate
manner.
 The super-ego controls our sense of right and wrong
and guilt.
 A type of conscience that punishes misbehavior with
feelings of guilt.
 The executive function
 Organized and rational
 Defers gratification
 Mediates between
 Id
 Superego
 Outer world
 Obeys the reality principle
 Id presents ego with an unacceptable wish
 Ego perceives danger associated with expression of the
wish
 Superego reinforces danger perceptions
 Defenses are mounted against the wish
 Balance is struck between wish and defense
 Sublimation:
 Manifesting an unacceptable impulse in socially
acceptable ways
 Violence-Surgery
 Denial:
 Very commonly used
 Repression:
 Involuntary forgetting of a painful feeling or experience
 Takes many forms:
 Symptoms
 Character trait
 Character style
 Inhibition
 Repression remains prominent as an explanation for
physical and psychological distress
 Repression can lead to active suppression of strong
emotional expression
 Changes in immune function
 Discrepancy between self-reports of distress and
physiological state.
 Type A behavior pattern
 Risk factor for heart disease
 Components:
 Time urgency
 Orderliness
 Hostility
 Irritability with interruptions
 Hyper alertness
 Type A behavior pattern
 Anger and Hostility appear to be most important
 Predictive relationship between hostility and atrial
fibrillation in men (Eaker et al, 2004)
 Scriptotherapy
 Pennebaker,1995; Smyth et al.,1999
 Disclosure relieves the anxiety and physical stress of
repression
 Interventions using writing about traumatic
experiences
 Immune function and symptoms decreased in Asthma
and rheumatoid arthritis.