Transcript Introduction to Psychology

Behavior Change in Health

Some questions:
What factors predict health behaviors?
e.g., Why do you floss every night? or why not?
How do people change their health
behaviors?
Why don’t people change? What are some of
the barriers?
Theories, Models, and Practicalities…
Behavioral Immunogens
and Pathogens
Behavioral Pathogen
A health-compromising behavior or habit
smoking, excessive eating, substance abuse,
dangerous driving, risky sexual behavior
Behavioral Immunogen
A health-enhancing behavior or habit
exercising regularly, using sunscreen, healthy
eating, practicing safe sex, wearing seatbelts
Behavioral Immunogens
and Death Rate
Preventing Injury and Disease
 Primary Prevention (Efforts to prevent disease or injury
from occurring – e.g., practicing good nutrition, exercising, avoiding
smoking, obtaining regular health screening – these are the
behavioral immunogens)
 Secondary Prevention (Actions taken to identify and treat
an illness or disability early in its occurrence – e.g., monitoring
symptoms, taking medication, following treatment regimens)
 Tertiary Prevention (Actions taken to contain damage once
a disease or disability has progressed beyond its early stages – e.g.,
radiation therapy, chemotherapy)
less cost-effective and less beneficial than primary or secondary
prevention
the most common form of health care in the U.S.
What influences Health Behaviors?
Fig. 6.1, p.177
Barriers to
Healthy Behaviors
Individual Barriers
 Inertia
 Operant conditioning issue – immediate rewards and
punishments are much more effective than delayed ones
 Finances
 Optimistic Bias -- The tendency of most people to believe
that they are less likely to become ill than others
• People who feel vulnerable to specific health problems are
more likely to practice preventive health behaviors
• Invincibility fable (especially in adolescents)
• Within limits, optimism conveys health advantages
Family Barriers
Health habits are often acquired from
parents and others who model healthcompromising behaviors
obese parents are more likely to have obese
children
children of problem drinkers are themselves
at increased risk of abusing alcohol
Health System Barriers
 Medicine tends to focus on treatment rather
than prevention
 A significant percentage of Americans do not
have health insurance
 Unrealistic or confusing recommendations
Community Barriers
 Access to _____ (health care, exercise
facilities, grocery stores)
 Absence of community health promotion
(e.g., no incentives to walk)
 Some environments promote healthcompromising behaviors
e.g., alcohol use and binge drinking in college
Models for
Health Behavior Change
Given all these barriers, why (and how?)
would a person change his or her health
behavior?
Theories and Models (give handout “Changing
Health Behavior Theories” for homework)
Stage Theories
Transtheoretical Model (see Table 6.2)
People pass through 5 stages in altering health
behavior
Stage 1: Precontemplation
Stage 2: Contemplation
Stage 3: Preparation
Stage 4: Action
Stage 5: Maintenance
Stage 6: Termination
Examples -http://www.psychologymatters.org/diclemente.html
Stage Theories
Stage theories provide a “recipe” for ideal
behavior change, but…
 hard to put everyone in a discrete “stage”;
probably a more continuous and non-linear
process
Enable interventions to be matched to the
specific needs of a person who is “stuck”
at a particular stage
Action
Planning
Intention
Coping
Planning
Initiative
Maintenance
Recovery
Risk
Perception
Action
Barriers and Resources
Health Action Process Approach -- A continuum
model http://userpage.fu-berlin.de/~health/hapa.htm
Disengagement
Outcome
Expectancies
Recovery
Self-Efficacy
Coping
Self-Efficacy
Task
Self-Efficacy
The Health Belief Model
(Cognitive model)
Example from text, p. 183
Theory of Planned Behavior
(Social cognition model)
Support for these theories
People’s self-reported attitudes and intentions
predict a variety of health-promoting actions
(weight loss, condom use, smoking behavior,
health screening)
People are more likely to engage in healthprotective behaviors if they feel susceptible to
the hazards of not doing so
Shortcomings of these
theories
People do not always do what they intend (or
claim they intend) to do (“the intention-behavior
gap”)
Attitudes predict some health-related behaviors,
but not others
The predictive power of these theories is greater
for some groups (high-SES, for example) than
for others
The theories ignore past experience with a
specific health-related behavior AND PAST
BEHAVIOR IS OFTEN THE BEST PREDICTOR
Why Aren’t Health Behavior
Theories More Precise?
They say little about how intentions are
translated into action
They are unrealistically complex
Health habits are often unstable over time
For the very young, old, and ill, health
care decisions are often made by other
people
Changing Behaviors
How can we influence people to
change health behaviors? What needs
to be done? What strategies might be
effective?
Changing Behaviors: Interventions
I. Changing Health Beliefs
II. Social Engineering
III. Cognitive-Behavioral Methods
Changing beliefs: Health
Education Campaigns
Health Education ideally…
 identifies specific health problems in a
community
 analyzes background factors that
predispose, enable, and reinforce lifestyle and
environment elements
 implements health education program
How Effective are Health
Education Campaigns?
Mass media appear to be most effective in
alerting people to health risks that they
otherwise wouldn’t know about, but are less
effective in long-term behavior change
(unless the message is presented consistently
over time, e.g., health risks of smoking)
What about fear-based messages (scaretactics)? e.g., Framing the message to stress
the risk of not performing a health behavior
Social Engineering
Changing the environment to change our
behaviors
Automatic seat belts and air bags; lowering speed limit
Design change for baby walkers
Elimination of “Joe Camel” ads
Requiring immunizations for school entry
Worksite wellness programs
• on-the-job health promotion programs
• structuring the environment (on-site gym, banning smoking,
etc.)
Cognitive-Behavioral
Interventions
 Methods are usually used in
combination (a multimodal approach)
 Should be tailored to each person
 Too many interventions can
overwhelm a person
Cognitive-Behavioral
Interventions
Three stages:
Self-observation / monitoring
Implementing change
Maintenance / Relapse prevention
Self-monitoring
 Define target behavior
 Record and chart
 Continual process with revision
Implementing Change
(overview)
Conditioning methods
Modeling
Cognitive change strategies
Etc…
Conditioning methods
Classical (Pavlovian) Conditioning
Interventions
• Antabuse
• Counterconditioning (cancer nausea)
Operant Conditioning Interventions
• Modify consequences of a behavior (e.g., seat
belt buzzer)
• Shaping
• Using rewards (individually or in a group
setting, e.g., token economy)
Modeling
 Observational learning
•
•
•
•
•
Preparing a child for an operation
Taking a yoga class
Watching a video on breast self-examination
Going to A.A.
Most successful when it shows the realistic
difficulties that people encounter in making
changes
Stimulus control
Modifying antecedents of a behavior
Poor health habits often tied to events,
people, places, or things in the environment
(called discriminative stimuli -- DS)
Examples (golden arches, …)
These DS need to be identified and then
reduced
Contingency Contracting
Creating contract with another regarding
consequences of one’s behavior
“Every time I do _____, I instruct my friend
to _____”
Covert Self-control
Cognitive techniques (e.g., cognitive
restructuring)
 Train people to recognize and modify internal
dialogue
“I’m weak, I can’t control my smoking urges…”
This statement would be targeted for modification
Skills Training and
Behavioral Assignments
Learn skills to change behavior





progressive muscle relaxation
assertiveness training
stress management
nutrition education
systematic homework assignments
Relapse
Why do people relapse?
BioPsychoSocial factors (e.g., with smoking)
Bio: Withdrawal, Genetics, Wt. Gain
Psych: Boredom, stress, anger
Social: Conflicts, lack of social support, social cues
(e.g., going to a bar)
Relapse Prevention
Need to control the biopsychosocial factors, especially
developing coping techniques for managing high-risk
situations
Coping with a “slip”
Integrate behavior change into a generally healthy
lifestyle