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…
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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
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
Health Action Process Approach -- A continuum model http://userpage.fu-berlin.de/~health/hapa.htm
Coping Coping Self-EfficacySelf-Efficacy
RecoveryRecovery Self-EfficacySelf-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 health-protective 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 complexHealth habits are often unstable over
timeFor 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 BeliefsII. Social EngineeringIII. 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 (scare-tactics)? 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 walkersElimination of “Joe Camel” adsRequiring immunizations for school entryWorksite 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)