1Q-587
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whatistheorywhydowelearnthemandhowdoweusethem.pptxHealth behavior and Theory: What and why?
PH 587: Health Behavior
Let’s check in
Initial thoughts on reading?
Why do we use theory?
Questions about sites or readings?
Theory at a Glance
Healthy People 2030
CDC leading causes of death
CBT
County health rankings
WKU health ed and promotion
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But first, health behavior
What is the difference between health education and health promotion?
Examples of each?
Both have a central focus of health behavior
Health ed focuses on changing health behavior through educational interventions
Health promotion is a broader term that encompasses not only educations activities, but also organizational, environmental, and economic interventions that support activities conducive to healthy behavior,
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Leading causes of death (CDC, 2019)
Heart disease: 659,041
Cancer: 599,601
Accidents (unintentional injuries): 173,040
Chronic lower respiratory diseases: 156,979
Stroke (cerebrovascular diseases): 150,005
What social factors are associated with these?
What is ACTUALLY the leading causes of death? (Tobacco 4 of the top 5, poor diet/lack of physical activity, alcohol…)
Social factors:
Low education (245,000 deaths)
Racial segregation (176,000 deaths)
Low social support (162,000 deaths)
Individual-level poverty (133,000 deaths)
Income inequality (119,000 deaths)
Area-level poverty (39,000 deaths)
(Galea, Tracy, Hoggatt, DiMaggio, & Karpati, 2011)
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Changing context
Major causes of death in the U.S.
Chronic vs. Infectious Disease
Greatest gains come from public health advances not medicine
Clean water
Sewage
Food
Etc.
Reemergence of infections disease
Infectious disease e.g., polio, TB, etc.
How do we address these issues?
Emerging issues: access, health care issues. More money spent in US than any other country, yet we rank 37 (WHO, 2020). We are also seeing a DECLINE in life expectancy.
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Health behavior
What “product” are we trying to sell to the public?
What are the challenges involved in selling this “product?”
What is our competition?
Why is changing health behavior so challenging?
Perception
Why is identifying our population and our setting important?
Some topic areas of health ed? Think back to what ACTUALLY causes death.
Some settings to address issues? (schools, work, health dept, communities, etc.).
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Perception versus reality
Perception
Immediate benefits outweigh long term risk
Alcohol use
Diet
Sedentary lifestyle
Unprotected sex
Sun-tanning
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Factors to consider in designing intervention
Health and social characteristics
Beliefs
Attitudes
Values
Skills
Past behavior
Sociodemographic
Life cycle stage
Disease status
Why is it crucial for us to consider these factors? How could not considering them hinder the intervention? Consider the obesity study
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Introducing…THEORY!
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What is a theory?
presents a systematic way of understanding events or situations.
It is a set of concepts, definitions, and propositions that explain or predict these events or situations by illustrating the relationships between variables.
by their nature abstract; that is, they do not have a specified content or topic area.
Models may draw on several theories to help understand a particular problem in a certain setting or context. They are not always as specified as theory.
Many health behavior theories draw from social and behavioral sciences (psychology, sociology, anthropology, and marketing are some examples). This will be obvious as we discuss some of these in greater detail over the course of the semester.
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Some terms to know
Concepts are the primary elements of a theory.
Constructs are concepts developed or adopted for use in a particular theory. The key concepts of a given theory are its constructs.
Variables are the operational forms of constructs. They define the way a construct is to be measured in a specific situation. Match variables to constructs when identifying what needs to be assessed during evaluation of a theory-driven program.
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Theory and health behavior
We can use theory to investigate the “why,” “what,” and “how” health problems should be addressed.
This can help us clarify why people do or do not engage in certain behaviors.
Why do people behave in healthy or unhealthy ways?
Explanatory theory: why a problem exists.
change theory: guides development of health interventions.
True or False?
If people understood the health risks or benefits of engaging in a particular behavior, they would make wise choices.
Many people assume that educating people will resolve the issue.
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consider
Physicians experience some of the highest rates of drug addiction among any profession.
Why?
How many of you floss, use sunscreen, drive safely, eat in moderation consistently, exercise, and use prophylactics?
Why?
Many assume educating is sufficient for resolving health behavior issues.
But don’t we all know better?
How can CBT be used to address health behaviors?
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Theory and health behavior continued
Education is NECESSARY but not SUFFICIENT.
Behaviors may be influenced by other factors and not necessarily health concerns.
Examples?
What is the primary motivation for adolescents to brush their teeth? (kissing)
What could be a factor for drinking responsibly? (don’t want to get “sloppy” or hook up with someone you wouldn’t necessarily want to under sober circumstances)
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Social determinants of health
“Social and health programs generally tend to focus on giving people skills to beat the odds to overcome the structural barriers to successful and healthy lives. In the long run, it makes more sense to change the odds so that more people have a wider and more accessible range of healthy choices.” (Wallack et al., 1993, p.204)
Social, cultural, economic factors may outweigh health concerns
Examples?
Reduce poverty/increase jobs
HPV vaccine
Air bags
Interlock ignition devices for cars
Removing trans-fat
Banning tobacco advertising & use
Safe, convenient, inexpensive places to exercise
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Why use theory?
Increases the chance of program success.
Program planners use theories to shape the stages of planning and to answer:
Why, What and How?
Why are people doing what they are doing?
What information do they need? What should be monitored?
How will the information be received best?
Theories and models explain behavior and suggest ways to achieve behavior change.
It helps us predict what interventions will work best, then to test those predictions to expand, refute, or modify predictions.
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Why use theory continued
Theories can explain and predict virtually all behaviors
Consider survey research
Scientists can predict your ATOD, sexual behavior, diet, exercise, etc. based on how you respond to certain questions
Interventions can and should be designed based on theoretical research
Too often practitioners use their intuition, rather than science to guide their intervention efforts.
What is an “anecdote?”
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Theoretical frameworks
Used to organize thoughts and planning or research, analysis, and intervention.
Theory packages new knowledge into an understandable form related to something.
Assumptions
Concepts
Constructs
Assumptions: what we take for granted
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Create your own need for theory
Get with a partner:
Identify all the reasons you exercised in the last week.
Identify all reasons you didn’t exercise as much as you wanted to:
Did themes emerge?
Possible themes:
Self-efficacy
Habit
Social support
Peer pressure or norm
Expectancies/attitude
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Evaluating a theory
Can it be tested?
Is it logical?
Is it plausible?
Is it useful?
Clarity
Generality
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Empirical validity and rigor
Finding a good fit for a theory is important.
Empirical validity is where you review the literature to assess studies that address or use particular theories.
Evaluate the studies as a whole. Are there enough to warrant the use of this theory?
Rigor. Determine the strength of the studies. Is there empirical support? Does the purpose of study and the theoretical framework fit? Can hypothesis be deduced from the theory?
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How to use theory
Ideas?
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Empirical evidence
Consider WHO you want to help change.
Age group?
Race?
Ethnicity?
Gender?
SES?
Disadvantaged?
Future leaders?
Evaluate
How to use theory continued
What were they addressing? What was their theory?
Why is deciding WHO you want to help important in how you apply theory?
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Let’s recap
Thoughts?
Why do we use theory?
What is our job?
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Glanz, K., & Rimer, B. K. (1997). Theory at a glance: a guide for health promotion practice. Bethesda, Md.: U.S. Dept. of Health and Human Services, Public Health Service, National Institutes of Health, National Cancer Institute.
Glanz, K., Rimer, B. K., & Viswanath, K. (2008). Health behavior and health education: Theory, Research, and Practice 4th edition. San Francisco, CA: Jossey-Bass.
References
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