Transcript Health_behavior_Sirjoosingh_2008

A presentation by
Candace Sirjoosingh
March 26, 2008
We all know the healthy alternative.
What drives us to eat the unhealthy one?
 “...
The motivation required to perform a
particular behaviour” (Armitage & Conner,
2000)
‘The road to hell is paved with
good intentions’
Refer to “basic, applied, and clinical sciences
that contribute to an understanding of
behavior. They naturally include the
behavioral sciences that conduct
experimental analyses of animal and human
conduct. They also include such basic
sciences as neurology, neurochemistry,
endocrinology, and neuroanatomoy, as well
as the fields of psychology, sociology, and
anthropology” (Institute of Medicine, 2001).
Motivational
Behavioural Enaction
Multi-Stage

The objective of most of these models is to
predict behaviour(s) in a certain context, or
point in time.

The definition for the model is in the name – trying to
identify the variables that motivate health behaviours
The models seek to shed light on the variables
that cause or influence health-related decisions
 The models generally consider ‘intention’ the
dependent variable of interest.
 These models have the potential for widespread
application – hand-washing to quitting smoking
to organ donation.

Also known as
Health Motivation
1.
“Perceived Susceptibility”: an individual’s personal perspective on
their likelihood of contracting a disease or health problem
2.
“Perceived Severity”: an individual’s subjective thoughts on the
consequences related to a disease – acquisition of the disease,
treatment, disability, etc.
3.
“Perceived Barriers”: an individual’s perception of the limiting
factors enabling them to take preventative action against a
disease/behaviour. Examples could include costs, time requirement,
convenience, etc.
4.
“Perceived Benefits”: an individual’s conception of the benefits
associated with a health behaviour that is thought to reduce
likelihood of disease contraction.
5.
“Health Motivation/Likelihood of taking preventative health action”:
an individual’s motivation to engage in that health behaviour
6.
“Cues to Action”: external aids to encourage or discourage certain
behaviours. Examples include the media, physicians, peers, etc
 Hailed
as an incredibly influential health
behaviour model, the HBM seeks to explain
why individuals don’t engage in health
prevention activities or programs.
 Arguments have been made that each of the
six elements in the model lack specific
definitions.
 The model also appears somewhat static: it
is not fully clear how each element in the
model is supposed to influence the others.
 An
expansion of the Theory of Reasoned
Action (stated that attitudes and subjective
norms determined intention)
 TPB holds “measures of perceived
behavioural control as a determinant of
intentions and behaviours” (Armitage & Conner,
2000).
 There
1.
2.
3.
are three aspects to the TPB:
Positive or negative attitude
Subjective norms surrounding the behaviour
Degree of perceived behavioural control (this is
said to be proportional to the likelihood of
healthy behaviour adoption)
 Not
all of the behaviours may be subject to a
person’s control
 Armitage & Connor have found other
elements that affect intention, in addition to
the three elements listed in TPB (attitude,
subjective norms and perceived behavioural
control)
1. Self identity: inner/self-reflective attitudes
of oneself that link behaviour and societal
goals
2. Moral norms: an individual’s sense of
obligation to adopt certain behaviours.
 Criticisms
of the Motivational Models led to
the creation of Behavioural Enaction Models
 To ameliorate and expand upon existing
Motivational Models, clearer links were made
between motivational variables and
behaviours.
 The focus of these models is action control,
so there is a move from intention to action.
 Armitage & Conner found that few studies
have used Behavioural Enaction models
(2000).
 Main
difference from other forms of models:
the staged format. This attempts to describe
various behavioural influences at different
stages.
 This type of framework allows for two
pertinent notions:
1.
2.
Acknowledging that individuals may fall into
different stages and thus behave differently
A variety of interventions are needed, and
should be tailored to each stage
Five stages:
1. Precontemplation: Individuals have no plans to
alter their health behaviour in the foreseeable
future
2. Contemplation: Individuals may be thinking
about making changes or adjusting their health
behaviour practices – no action is taken yet
3. Preparation: Individuals prepare to make
appropriate behaviour change
4. Action: The active part of the process; behaviour
change is being made
5. Maintenance: Individuals attempt to sustain their
newly adopted or reformed behaviour(s)

1.
2.
3.
4.
5.
Precontemplation: A couch potato, an individual
who has no motivation to adopt a physically fit
lifestyle
Contemplation: After seeing a variety of workout
commercials, or TV shows such as ‘The Biggest
Loser,’ our couch potato starts to think about
joining a gym
Preparation: Our couch potato leaves the couch and
buys a gym membership and a few sessions with a
personal trainer/dietician
Action: Our couch potato turns into a physically fit
potato, with a healthy diet and exercise regimen
Maintenance: 6 months later, this individual has
forsaken their old habits and is maintaining a
healthy lifestyle
 TTM
seems to be mainly an observational
model; there is little explanation of how one
moves from one stage to another

Granted, a plethora of factors may be involved,
in relativistic terms
 There
is little description of the variables
involved in the model – there are no
operational definitions of set variables.
No.
 We’ve
discussed the flaws in some of the
models.
 Incidentally, some studies have reported that
health behaviour does not explain a great
deal of disease morbidity or even mortality

One study conducted among US adults attributed
12-13% of excess mortality to health behaviours.
 Why
such a little amount? What else is
contributing to mortality?

[What we’ve been studying for the past
semester]
 Individuals
who have a lower socioeconomic
status tend to engage in riskier behaviour, or
health behaviour that may be destructive to
health.
 Why is this so? Reasons include:
 A lack of social support networks and social
relationships
 Self esteem issues, decreased sense of
control over life events
 Chronic/acute stress in life and work (also
related to SES discrimination, racism, etc.)
A
common theory: members of lower
socioeconomic status suffer from higher rates
of mortality due to a higher prevalence of
engagement in “risky” health behaviour
 However, as mentioned in the previous slide,
studies that have controlled for lifestyle risk
factors have still found significant
differences in mortality across levels of SES.
 Marmot’s work has found that lifestyle
behaviours explain < 30% of the social
gradient in mortality.
Source: Lantz
et. al, 1998
Source: Rose G, Marmot M.
1981
“Increasing health promotion and disease
prevention efforts among the disadvantaged
is not a “magic policy bullet” for reducing
persistent socioeconomic disparities in
mortality”
(Lantz et al, 1998)
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Lantz, P. H. (1998). Socioeconomic factors, health behaviors, and mortality:
Results from a nationally representative prospective study of US adults.
Journal of the American Medical Association , 279 (21), 1703-1708.
Marmot, M. (2004). Status Syndrome. New York: Henry Holt and Company.
Prochaska, J. O. (2001). Treating Entire Populations for Behavioural Risks for
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Roden, J. (2004). Revisiting the Health Belief Model: Nurses applying it to
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