Unit 5 and 6 Health Behavior

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Course Learning Outcomes for Unit V Upon completion of this unit, students should be able to:

1. Appraise the theoretical models used to define health behavior principles. 1.1 Apply the best theory/model to a chosen health issue. 1.2 Analyze the role of a health professional when identifying theories and models to be applied to

health issues.

Course/Unit Learning Outcomes

Learning Activity

1.1 Unit Lesson Chapter 7 Unit V Assignment

1.2 Unit Lesson Chapter 7 Unit V Assignment

Reading Assignment Chapter 7: Social Cognitive Theory Applied to Health Behavior

Unit Lesson In the previous unit, we took an in-depth look at the transtheoretical model of change (TMC) and the role that it plays in health behavior. The TMC is only one of many models and frameworks that are related to health behavior. The reading in this unit goes in-depth on the social cognitive theory (SCT) which relates individuals and their environment to their health behavior. In additional to the SCT, there is another model and another theory that should be highlighted for their importance in health behavior: the health belief model and the theory of planned behavior. Health Belief Model The health belief model (HBM) focuses on a person’s belief of if he or she is at risk of getting ill or having a health issue. It is also based on how much he or she believes a recommended health behavior will be effective at preventing the illness or health issue. It is those benefits that will predict the likelihood of a person adopting a specific behavior (Glanz, Rimer & Viswanath, 2015). The HBM was developed by social psychologists at the U.S. Public Health Service in the early 1950s (DiClemente, Salazar, & Crosby, 2019). The psychologists were trying to understand why people did not participate in disease prevention strategies or early detection screenings. In a clinical setting, the HBM has been used to understand how patients responded to the health symptoms they were having and why they are or are not compliant with a physician’s treatment orders (DiClemente et al., 2019). The psychological and behavioral theories are at the foundation of the HBM (Carpenter, 2010). There are two main aspects to the model:

1. the desire to not want to get sick or the will to want to get well if already sick, and 2. how much a person believes that taking a specific health-related action will prevent him or her from

getting sick or turning a health issue around that he or she may already have (Carpenter, 2010). In a nutshell, the HBM focuses on the idea that the health behavior a person chooses to engage in depends upon a person’s perception of the benefits and barriers he or she will encounter if a specific health behavior is chosen. The HBM is comprised of six constructs; the first four were a part of the original model when it was

UNIT V STUDY GUIDE

Health Behavior Models and Theories

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developed in the 1950s. These constructs include perceived susceptibility, perceived severity, perceived benefits, and perceived barriers (Carpenter, 2010). After additional research and application of the model, the final two constructs were added: cue to action and self-efficacy (Carpenter, 2010). Below you will find more information about each construct.

Perceived Susceptibility: This phase looks at a person’s view of the likelihood that an illness or health disease is currently, or will in the future, directly affect him or her (Carpenter, 2010). Perceived Severity/Seriousness: This phase is involved with a person’s view of how severely he or she will be affected by an illness or health disease if he or she does not participate in the health-promoting behavior (Carpenter, 2010). For instance, will the health disease or illness kill them, will it cause uncomfortable living for the rest of their life, will it cause them pain for a long time, will it cause them pain for a short period or will it only be an ache? Perceived Benefits: This phase of the model looks at a person’s belief about how effective the actual health promoting behavior will be toward preventing or alleviating the health issue (Carpenter, 2010). This is the idea that one takes into consideration about how effective the health-promoting behavior will be in mitigating health-related problems, as well as if the health issue will be severe enough to warrant action. Perceived Barriers: This phase is involved with a person’s assumption of the barriers he or she will be faced with if they participate in the health-promoting behavior (Carpenter, 2010). A barrier could be physical, social, or psychological. Cues to Action: These are nudges or prompts that a person may need to begin working toward the specific action of participating in the health-promoting behavior (Carpenter, 2010). A nudge could be learning that a close friend or relative was negatively affected by a health condition or it could be seeing a friend or loved one successful at sticking with a health-promoting behavior.

(Laurenhan, 2013)

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Self-Efficacy: This is one’s own belief of his or her ability to follow through with the health-promoting behavior (Carpenter, 2010). If people think that they cannot stick with the health-promoting behavior, that it will be difficult, or they think they will fail, it is less likely that they will begin engaging in the health-promoting behavior. Health Belief Model Limitations Just like with anything, there are limitations to models and theories. When determining which model or theory to apply to health behaviors, it is important to know the limitations. There are a few limitations of the health belief model, which may include that it:

 does not consider determinants of health such as economic, educational, or environmental factors (later in the course we will discuss in more detail about the effects of social determinants);

 does not consider a person’s habitual behaviors and how that relates to their decision-making process to adopt a health behavior;

 does not take into account a person’s attitude or beliefs that affect him or her adopting a specific health behavior;

 does not take into account a persons’ need for social acceptability and the relationship of what is acceptable with a person adopting a health behavior;

 assumes that all people have the amount of knowledge about the health issues;

 assumes the cue to action will encourage most people to change; and

 assumes that the benefits of health are the main goal of a person adopting the health behavior (DiClemente et al., 2019)

Theory of Planned Behavior The theory of planned behavior (TPB) first started as the theory of reasoned action in the early 1980s (DiClemente et al., 2019). The theory of reasoned action predicted a person’s intentions of engaging in a specified behavior at an exact time and place. The original goal of the theory was to explain any behaviors that a person could apply self-control. TPB’s key aspect of this theory is intent; a person’s intended behaviors are influenced by his or her attitude toward the likelihood that the engaged behavior will have the outcome he or she expects. This also includes how the person views the risks and benefits of the outcome. TPB rests on the premise that a person adopting a health behavior is dependent on his or her motivation (intentions) and ability (behavior control) (McEachan, Conner, Taylor, & Lawton, 2011). This theory takes into account three beliefs: behavioral, normative, and control. The TPB has five parts: attitude, subjective norms, perceived behavioral control, intention, and behavior. (McEachan et al., 2011):

(Orzanna, 2015)

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Attitude: This portion of the theory is related to the outlook one has about how enticing or unenticing the end behavior is (McEachan et al., 2011). Subjective norms: This portion of the theory is related to the outlook of approval or disapproval one may have about the given behavior, as well as how they will be viewed by peers if they do or do not engage in the behavior (McEachan et al., 2011). Perceived behavioral control: This portion of the theory refers to one’s view of how easy or difficult it will be to engage in the specific behavior (McEachan et al., 2011). This control can change depending on different situations that a person is in or the specific actions they have taken, leading to them having a magnitude of assumptions about the behavior. This aspect of the theory was not always included, but was later added to the theory. Intention: This portion of theory is related to the intention one have of carrying out a behavior; the stronger ones’ intention, the more likely it is that he or she will follow through to behavior (McEachan et al., 2011). Behavior: This portion of the theory is the end goal/outcome (McEachan et al., 2011). Theory of Planned Behavior Limitations A few limitations that have been noted with TPB. There are limitations in the way the theory.

 It assumes that a person has all the resources needed to be successful in adopting the health behavior whether planning to adopt the health behavior or not.

 It does not consider determinants of health such as economic, educational, or environmental factors that could influence a person’s attitude toward the health behavior; however, it does consider normative influences.

 It assumes that deciding to participate in a specific health behavior results from a linear decision- making process that does not change over time.

 It does not account for time between intending to participate in a specific health behavior and actively participating in the health behavior.

 It does not account for the role emotions play in adopting a health such as a person’s experiences, fears, motivation, or their current mood.

Putting it All Together The theories and models presented in this unit have their pros and cons as well as their own special place depending on the person that needs to adopt a health behavior. As with the information presented on the SCT in the textbook, it is important to note the limitations to theories and models in order to understand the constraints of each as you apply them. It is also essential to point out that the models and theories discussed in this unit evolved from their initial intent by the developer(s). It is important to understand that health behavior theories and models are foundational. As a public health professional, you can use the bases of the models and theories and add additional components that fit your own goal. By doing so, you could come up with the next evolution of a model or theory of your own.

References

Carpenter, C. J. (2010). A meta-analysis of the effectiveness of health belief model variables in predicting behavior. Health Communication, 25(8), 661–669. doi:10.1080/10410236.2010.521906

DiClemente, R. J., Salazar, L. F., & Crosby, R. A. (2019). Health behavior theory for public health: Principles,

foundations, and applications (2nd ed.). Burlington, MA: Jones & Bartlett Learning. Glanz, K., Rimer, B. K., Viswanath, K. (Eds.) (2015). Health behavior: Theory, research, and practice (5th

ed.). Hoboken, NJ: Wiley.

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Laurenhan. (2013). The health belief model [Image]. Retrieved from https://commons.wikimedia.org/wiki/File:The_Health_Belief_Model.pdf

McEachan, R. R. C., Conner, M., Taylor, N. J., & Lawton, R. J. (2011). Prospective prediction of health-

related behaviours with the theory of planned behaviour: a meta-analysis. Health Psychology Review, 5(2), 97–144. https://doi.org/10.1080/17437199.2010.521684

Orzanna, R. (2015). Theory of planned behavior [Image]. Retrieved from

https://commons.wikimedia.org/wiki/File:Theory_of_planned_behavior.png