U14634: Motivating Health Behaviour

Mary GottwaldPrincipal Lecturer Student Experience

February 2013

Oxford Brookes UniversityFaculty of Health and Life Sciences

Predicting Health Behaviours –

Behavioural change models

Learning Outcomes

By the end of the module you will be better able to:•Understand the factors involved in predicting and explaining behaviour•Understand the role of social cognition and stage models in predicting and explaining health behaviour•Explore and understand in detail specific models•Be able to critique models and apply to case scenarios.

Week 2 - overview

• 09.00 – 10.15am: Lecture

• 10.15 – 10.45am: Break

• 10.45 – 12 noon: Seminar

Predicting & explaining health behaviour

• Complete the following:

I feel healthy when…….. I feel healthy because….. To stay healthy I need……… I do not feel healthy when……. My health improves when……….

Predicting health behaviours

So….

How do we account for variability in behaviours?

How do we account for variability in health?

Predicting and explaining health behaviour

Individual differences

Locus of control (Rotter 1996)

Internal External

Multidimensional health locus of control (Wallston and deVellis 1978)

InternalExternal / chancePowerful others

Modest predictor of behaviour

Health-promoting / risky health behaviours

What are risky healthy behaviours?

What are health promoting behaviours?

Risky health behaviours

Global risks:Highest global risks to mortality = tobacco use, physical inactivity, being overweight and obesity (World Health Report 2012).

Diet –high fat diet / being underweightExcessive alcoholUnsafe sexNot getting enough sleepDangerous sports

Health-promoting behaviours

Alameda-seven

1.Sleeping 7-8 hours a night

2.Not smoking

3.Consuming no more that 1-2 alcoholic drinks per day

4.Getting regular exercise

5.Not eating in between meals

6.Eating breakfast

7.Being no more than 10% overweight(Breslow 1983, cited in Morrison and Bennett 2006:61)

Individual differences and health

Younger, wealthier, better educated individuals with low stress levels and high social support are more likely to engage in health-enhancing behaviours (exercise, nutrition, non-smoking, low alcohol intake).

If a person experiences high stress, fewer social, emotional and economic resources, they are more likely to be engaged in health compromising behaviours (smoking, high alcohol intake, sedentary lifestyle or poor nutrition).

Understanding cognition

Cognitive factors:• Shape health behaviour• Predict behaviour through self-regulationSocial cognition models describe key cognitions and their interrelationships in the regulation of behaviour.

Social Cognition

Cognitions:

Represent our thoughts, beliefs and knowledge towards a behaviour.

Are intrinsic to us. Are modifiable determinants of behaviour. Give rise to social behaviour. Behaviours have an impact on morbidity and

mortality.

Social Cognition Models

Help us to understand and predict health behaviours:

• Knowledge, perceived social norms, beliefs, attitudes and self-efficacy are linked to behavioural intentions and health related behaviour.

• Help us to explore the extent to which cognitions predict and explain behaviour.

• Continuum v stage models

Self-efficacy - Bandura

‘The belief that you can carry out a specific behaviour in a specific situation’ (Bandura 1997 cited in Upton and Thirlaway 2010:21)

i.e. if you believe that you can do it then you will! ‘I can’t do it’ ‘I can’

So, self-efficacy beliefs directly determine behaviour (or action)

Enhancing self-efficacy

1. Observational learning / participatory learning.

2. Verbal persuasions

3. Perception of psychological and affective states.

(Davis and Macdowell 2006)

Continuum v stage models

Continuum

1. Health Belief Model

2. Theory of Reasoned Action / Planned behaviour

3. Health Action Model

4. Prototype Willingness Model

5. Dual-Process Models

Individuals are likely to perform a (health related)

behaviour based on their position on a continuum.

Continuum v stage models

Stage model

Transtheoretical Stages of Change Model (TTM)

Individuals move through ‘stages’ before achieving a change in their (health related) behaviour

Behaviour change models

• Models help us to explain and predict health behaviour.

• However, the decision we make about whether we decide / don’t decide to change our health related behaviour is based on cues and information we have in relation to our social, physical and cultural environment.

• Motivation also impacts on our decision making.• All models have strengths and limitation.

(Edberg 2007, Marks et al 2011, Gottwald and Goodman-Brown 2012)

Health Belief Model

1950sHochbaum, Rosenstock, Becker

Focuses on understanding an individual’s perception of reality rather than how they respond to a situation.Considers a number of factors that may predict the likelihood of changing health related behaviours.Initial research linked to motivation.

Health Belief Model

(Goodman-Brown and Gottwald 2008)

Perceived susceptibility

Self efficacy

Likelihood of taking action

Perceived success

Perceived severity Perceived

benefits

Cues to action

Theory of Reasoned Action

Ajzen and Fishbein 1980 Behaviour is dependent on two variables:

1. Attitudes – beliefs about the consequences.

2. Subjective norms – how much the individual wants to conform and be like ‘significant others’.

Attitudes + norms = an intention to change.

Theory of Planned Behaviour

http://www.youtube.com/watch?v=YfGEbT_RSIE

Theory of Reasoned Action

Beliefs about the consequences of taking action and judgement of those consequences

Beliefs whether Others in their networks would approve and motivation to comply with others

Attitude

SubjectiveNorm

Behavioural intention

Behavioural change

Theory of Planned Behaviour

Ajzen added another variable:

Behaviour is a consequence of perceived control Internal locus of control External locus of control

There is some correlation between PBC and intention.

Attitudes + PBC + intention = influence behaviour

(e.g. uptake of exercise)

Theory of Planned Behaviour

Beliefs about the consequences of taking action and judgement of those consequences

Beliefs whether 0thers in theirnetworks would approve and motivation to comply with others

Attitude

SubjectiveNorm

Behavioural intention

Behavioural change

•Internal control factors•External control factors

Perceivebehavioural control

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STAGES OF CHANGE (TTM)(Prochaska and DiClemente 1984)

Pre-contemplation not thinking of change / not aware of a need to change

Contemplation considering change – advice needed

Commitment ready to change – practical support and achievable goals needed

Action making the change – support and encouragement still needed

Maintenance maintaining the change in their lifestyle – developing coping strategies

Relapse support needed to return to contemplation

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The Stages of Change

Contemplation

Pre-contemplation

Preparation Action

Relapse

Maintenance

Long term change

(Adapted from Prochaska and DiClemente, 1984)

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STAGES OF CHANGE (TTM)

Exit

Action Maintenance

Commitment Relapse

Contemplation

Pre-contemplation

(Gottwald, cited in Davis 2006)

Exit

ExitExit

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STAGES OF CHANGE (TTM)

• Pre-contemplation: denial / low self-efficacy / barriers to change

• Contemplation: Seek information. Reduced barriers / increased benefits

• Preparation: Set goals, prioritise, concrete plans (join a gym)

• Action: Realistic goals essential / social support.

• Maintenance: Need to self monitor / need positive reinforcement.

Health Action Model(Gottwald and Goodman-Brown 2012:79)

Translating behavioural intention

Action

Personality factors: self-

concept and self-sentiment

Knowledge and skills

Barriers, facilitating and environmental factors:

social, physical, cultural and socio-economic

Belief, motivation and normative systems

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Summary

•Behavioural models enhance our understanding.

•Can be used to predict all behaviours.

•These models focus on individual cognitions – need to remember socio-economic factors, culture, religion and so on.

•Models help to explain and understand complex situations and suggest approaches to take to ensure effective health promotion.

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Exam question

•Describe and critically evaluate one Social Cognition Model and its application to predicting and explaining a specific health related behaviour.

References - Also see references in module guide

Bennett P and Morrison V (2006) An introduction to health psychology London: Prentice Hall

Conner M and Norman P (2005) Predicting health behaviour Maidenhead: OUP Edberg M (2007) Essentials of health behaviour. Social and behavioural theory in

public health London: Jones and Bartlett Publishers Gottwald M (2006) Health promotion models in S Davis (2006) Rehabilitation.

The use of theories and models in practice London: Elsevier Gottwald M and Goodman-Brown J (2008) Public health interventions. In J

Mitcheson (2008) Expanding nursing and health care practice Cheltenham: Nelson Thornes

Gottwald M and Goodman-Brown J (2012) A guide to practical health promotion Maidenhead: OUP

Davies M and Macdowall W (2006) health promotion theory Maidenhead: OUP Rotter J (1966) generalised expectations for internal versus control of

reinforcements Psychological Monographs 80:69 Rutter D and Quine L (2010) Changing health behaviour Maidenhead: OUP Upton D and Thirlaway K (2010) Promoting healthy behaviour London: Pearson