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).

MotivationalBehavioural 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 asHealth 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 are three aspects to the TPB:1. Positive or negative attitude2. Subjective norms surrounding the

behaviour3. 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. Acknowledging that individuals may fall

into different stages and thus behave differently

2. 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. Precontemplation: A couch potato, an individual who has no motivation to adopt a physically fit lifestyle

2. 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

3. Preparation: Our couch potato leaves the couch and buys a gym membership and a few sessions with a personal trainer/dietician

4. Action: Our couch potato turns into a physically fit potato, with a healthy diet and exercise regimen

5. 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 anotherGranted, 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 mortalityOne 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 relationshipsSelf esteem issues, decreased sense of

control over life eventsChronic/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)

Armitage, C. J., & Conner, M. (2000). Social Cognition Models and Health Behaviour: A Structured Review. Psychology and Health , 15, 173-189.

Jha, P. P. (2006). Social inequalities in male mortality, and in male mortality from smoking: indirect estimation from national death rates in England and Wales, Poland, and North America. The Lancet , 368 (9533), 367-370.

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 Cancer . The Cancer Journal , 7 (5), 360-368.

Roden, J. (2004). Revisiting the Health Belief Model: Nurses applying it to young families and their health promotion needs. Nursing and Health Sciences , 6, 1-10.

Rose G, M. M. (1981). Social class and coronary heart disease. British Heart Journal , 45 (1), 13-19.

Williams, R. B. (2003). Invited Commentary: Socioeconomic Status, Hostility, and Health Behaviors - Does It Matter Which Comes First? American Journal of Epidemiology , 158 (8), 743-746.