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Health PsychologyChapter 3:

Seeking Health Care(Health Behavior Models)

Mansfield University

Dr. Craig, Instructor

Understanding/Predicting/Treating Health Behvr.

What measurable factors affect health behavior? Class thoughts

Useful Theories generate research organize & explain observations (research & clinical) guide in predicting behavior (not in book) avenues for behavior change

All models describe processes/or variables leading to INTENTIONAL changes toward healthy behaviors

Health Belief Model (from Hochbaum) Theory of Reasoned Action (Azjen) Social-Cognitive Theory (Self-Regulation, Bandura) Transtheoretical Model (Prochaska & DiClemente)

Well Studied Determinants

1. Characteristics of symptoms• painful?

• Disabling?

• Visible?

2. Perceived Cost/Benefit of seeking help• time, money, pain,

3. Perceived Severity of condition 4. Person’s Intention to Behave & Self-Efficacy 5. Readiness To Change 6. Social & Demographic Characteristics

Rosenstock & Becker’s Health Belief Model

(health seeking behavior)PerceivedPerceivedSusceptibilitySusceptibility

of Disease or Disability

PerceivedPerceivedSeveritySeverity

of the Disease or Disability

PerceivedPerceivedBenefitsBenefits

of HealthImprovingBehavior

PerceivedPerceivedBarriersBarriersto Health

ImprovingBehaviors

HEALTHSEEKING

BEHAVIOR

Evidence for HBM

Mixed evidence, but some impressive results Mammograpy

• Champion- manipulated perceived susceptibility increased rate 4x

• others have manipulated perceived barriers and benefits to increase attendance

Also used in safe-sex, CV screening, AIDS testing, immunization efforts

Large efforts will often manipulate multiple belief systems + other important variables to increase overall intention to behave

Theory of Planned Behavior

Attitude Toward

the Behavior

SubjectiveNorm

Intention toBehave

PerceivedBehavioral

Control

HEALTHBEHAVIOR

AttitudeAttitude-thoughts, feeling, predisposition to act on a topic. One individual beliefs about behavior/condition

Subjective NormSubjective Norm- attitude of the “social group” towardcondition (e.g., what friends think, family says)

Relative ImportanceRelative Importance- the relative influences of ownattitude vs. what subjective norms “say”

Perceived Behavior Control (self efficacy)-Perceived Behavior Control (self efficacy)- one belief in their capacity to exercise behavioral control overevents that affect their lives. Event-specific

RI

Evidence for TPB

An extension of the theory of reasoned action added the self-efficacy component

Measures of intention and perceived behavioral control have been show to be particularly powerful predictors

Stanford 5-city project predicted adolescent smoking

Also predicted : health program attendance breast and testicular self examination dental flossing

Building Self-Efficacy: Socio-Cognitive Models

Self Efficacy- people’s beliefs about the capabilities to exercise control over events that affect their lives.

A/K/A personal control, personal agency Tends to be situation specific It is continually modified by ongoing conditions It can be changed (increased)

How can SE be changed? [class question]

Self Efficacy: Social-Cognitive Model

Performance/Enacting

a Behaviorvicarious experience;

seeing someone w/ similar skillsact successfully

Self-Efficacy

PhysiologicalArousal

HEALTHBEHAVIORVerbal

persuasion or encouragement

fromtrusted other

Goal (Intention)

-

+

+ +

Sense of Personal ControlSense of Personal Control makes increases likelihood of healthy behavior.It is affected by biological, social-biological, social-cognitive & behavioralcognitive & behavioral conditions

Evidence & Info: Self-Efficacy Model Stanford 5 city project

• those with most difficulty changing unhealthy behavior had the lowest efficacy

Other studies• efficacy directly related to smoking cessation and goal

attainment• exercise program adherence• stress management• eating/dietary behavior

Many other models have added SE to greatly improved predictive power.

Clear that SE is related to initiation initiation of behavior, but not clear whether it is related to maintenancemaintenance

SE SE may be more related to behrs requiring “mastery of skills” (learned behaviors e.g condom use) than not (abstinence)

Transtheoretical Model (TTM)

Behavior Changes in Stages:• Precontemplation-Precontemplation- no intention of changing bhvr, and

may not think they have a problem at all• ContemplationContemplation- awareness of problem, some thought of

doing something about it within 6 months• PreparationPreparation- specific behaviors and thoughts involved in

planning to change behavior• ActionAction- overt change in behavior made• MaintenanceMaintenance- sustain behaviors and prevent relapse

Different Stages are affected by different factors, thus requiring different assistance to move to next stage

Relapses part of the model-- to be expected Recognition of importance of decisional balance (pros and cons

of maintaining risky behavior vs. healthy behavior)

Stage Models: Transtheoretical Model

Pre-Contemplation

Contemplation

Preparation

Maintenance

Action

Behavior

No Behavior,but varied

Readiness toReadiness toChangeChange

Measured by Decisional Balance survey (pros & cons)