Post on 03-Apr-2018
7/28/2019 Models of Health Behavior
1/81
Theories of Health Behaviour
Health Psychology
7/28/2019 Models of Health Behavior
2/81
Attribution theory
According to the basic tenets ofattribution theory people attempt to
provide a causal explanation for eventsin their world particularly if those eventsare unexpected and have personal
relevance (Heider, 1958). Thus it is notsurprising that people will generallyseek a causal explanation for an illness,particularly one that is serious.
7/28/2019 Models of Health Behavior
3/81
Attribution theory
Taylor et al. (1984) interviewed asample of women who had been
treated for breast cancer. They foundthat 95% of the women had a causalexplanation for their cancer. These
causes were classified as stress (41%),specific carcinogen (32%), heredity(26%), diet (17%), blow to breast(10%) and other (28%).
7/28/2019 Models of Health Behavior
4/81
Womens causal explanations for breast cancer
7/28/2019 Models of Health Behavior
5/81
Attribution theory
They also asked the women who orwhat they considered responsible for
the disease and found that 41% of thewomen blamed themselves, 10%blamed another person, 28% blamed
the environment and 49% blamedchance. The patients were also askedwhether they felt any control over theircancer and they found 56% felt theyhad some control.
7/28/2019 Models of Health Behavior
6/81
The womens attribution of responsibility
for their cancer
7/28/2019 Models of Health Behavior
7/81
Attribution Theory
Weiner et al. (1972) suggested that wecan classify attributional dimensions
along three dimensions: 1 Locus: the extent to which the cause is
localized inside or outside the person.
2 Controllability: the extent to which theperson has control over the cause.3 Stability: the extent to which the cause isstable or changeable.
7/28/2019 Models of Health Behavior
8/81
Health Locus of control
Health locus of control, likeattribution theory, also emphasises
attributions for causality andcontrol.
7/28/2019 Models of Health Behavior
9/81
Health Locus of control
Wallston and Wallston (1982)developed a measure of the health
locus of control, which evaluateswhether individuals regard their healthas controllable by them or not
controllable by them or they believetheir health is under the control ofpowerful others.
7/28/2019 Models of Health Behavior
10/81
Health Locus of control
Health locus of control is related towhether individuals changed their
behaviour and to the kind ofcommunications style they require fromhealth professionals.
7/28/2019 Models of Health Behavior
11/81
Health Locus of control
There are several problems with theconcept of a health locus of control:
Is health locus of control a fixed traits or a transientstate?
Is it possible to be both external and internal?
Going to the doctor could be seen as external (the
doctor is a powerful other) or internal (I am lookingafter my health).
7/28/2019 Models of Health Behavior
12/81
Unrealistic optimism
Unrealistic optimism focuses onperceptions of susceptibility and
risk. Weinstein (1984) suggested that one of
the reasons why people continued to
practice unhealthy behaviours is due toinaccurate perceptions of risk andsusceptibility - their unrealistic
optimism.
7/28/2019 Models of Health Behavior
13/81
Unrealistic optimism
He asked subjects to examine a list ofhealth problems and displayed what
"compared to other people of your ageand sex, are your chances of gettingthe problem greater than, about the
same, or less than theirs?" Mostsubjects believed they were less likelyto get the health problem.
7/28/2019 Models of Health Behavior
14/81
Unrealistic optimism
Weinstein (1987) described fourcognitive factors that contribute to
unrealistic optimism: 1. Lack of personal experience with the
problem
2. The belief that the problem ispreventable by individual action
7/28/2019 Models of Health Behavior
15/81
Unrealistic optimism
3. The belief that if the problem has notyet appeared, it will not appear in the
future 4. The belief that the problem is
infrequent.
7/28/2019 Models of Health Behavior
16/81
The transtheoretical model ofbehaviour change (stages of
change model) The transtheoretical model of
change emphasises the dynamic
nature of beliefs, time, and costsand benefits.
7/28/2019 Models of Health Behavior
17/81
7/28/2019 Models of Health Behavior
18/81
The transtheoretical model ofbehaviour change (stages of
change model) 1. Precontemplation: not intending to
make any changes
2. Contemplation: considering a change
3. Preparation: making small changes
4. Action: actively engaging in a newbehaviour
5. Maintenance: sustaining change overtime
7/28/2019 Models of Health Behavior
19/81
The transtheoretical model ofbehaviour change (stages of
change model) Individuals would go through these stages in
order but might also go back to earlier
stages. People in the later stages, e.g. maintenance,
would tend to focus on the benefits (I feelhealthier after giving up smoking), whereas
people in the earlier stages tend to focus onthe costs (I will be at a social disadvantage ifI give up smoking).
7/28/2019 Models of Health Behavior
20/81
The transtheoretical model ofbehaviour change (stages of
change model)A relationship has been found between
level of education and the stage of
change reached when contemplatingtaking regular exercise.
7/28/2019 Models of Health Behavior
21/81
The transtheoretical model ofbehaviour change (stages of
change model) Those people with lower levels of
education tended to be at an earlier
stage of change (Booth et al. 1993),and therefore it could be argued thatthe model could be improved by taking
account educational attainment in orderto help predict the length of time aperson is likely to remain at the earlierstages.
7/28/2019 Models of Health Behavior
22/81
7/28/2019 Models of Health Behavior
23/81
Health belief model
Support for individual components ofthe model.
Norman and Fitter (1989) examinedhealth behaviour screening (forexample breast cervical cancer) and
found that perceived barriers (the costsof attending) were the greatestpredictors of whether a person
attended the clinic.
7/28/2019 Models of Health Behavior
24/81
Health belief model
Several studies have examined breastself-examination (BSE) behaviour and
report that barriers (Lashley 1987;Wyper 1990) and perceivedsusceptibility (the likelihood of having
the illness) (Wyper 1990) are the bestpredictors of healthy behaviour.
7/28/2019 Models of Health Behavior
25/81
Health belief model
The role of giving information as a cueto action has been researched.
Information in the form of fear-arousingwarnings may change attitudes andhealth behaviour in such areas as
dental health, safe driving and smoking(e.g. Sutton 1982; Sutton and Hallett1989).
7/28/2019 Models of Health Behavior
26/81
Health belief model
Giving information about the badeffects of smoking is also effective in
preventing smoking and in gettingpeople to give up (e.g. Sutton 1982;Flay 1985). Several studies report a
significant relationship between peopleknowing about an illness and theirtaking precautions.
7/28/2019 Models of Health Behavior
27/81
Health belief model
Rimer et al. (1991) report thatknowledge about breast cancer is
related to having regularmammograms. Several studies havealso indicated a positive correlation
between knowledge about BSE (BreastSelf-examination) and breast cancerand performing BSE (Alagna and Reddy1984; Lashley 1987; Champion 1990).
7/28/2019 Models of Health Behavior
28/81
Health belief model
Showing subjects a video about paptests for cervical cancer was related to
their actually having the pap test(O'Brien and Lee 1990'.)
7/28/2019 Models of Health Behavior
29/81
Evidence Against the HBM
Janz and Becker (1984) found that healthybehavioural intentions are related to low
perceived seriousness - not high as predicted(e.g. healthy adult having a flu injection) -and several studies have suggested anassociation between low susceptibility (not
high) and healthy behaviour (e.g. manystudents recently have agreed to beinoculated against meningitis) (Becker et al.1975; Langlie 1977).
7/28/2019 Models of Health Behavior
30/81
Evidence Against the HBM
Hill et al. (1985) applied the HBM tocervical cancer, to examine which
factors predicted cervical screeningbehaviour. Their results suggested thatbenefits and perceived seriousness
were not related.
7/28/2019 Models of Health Behavior
31/81
Evidence Against the HBM
Janz and Becker (1984) carried out astudy using the HBM and found the
best predictors of health behaviour tobe perceived barriers and perceivedsusceptibility to illness.
7/28/2019 Models of Health Behavior
32/81
Evidence Against the HBM
However, Becker and Rosenstock(1984), in a review of 19 studies using
a meta-analysis that included measuresof the HBM to predict compliance,calculated that the best predictors of
compliance are the costs and benefitsand the perceived seriousness. So thereis lack of agreement over what reallydoes help to predict health behaviour.
7/28/2019 Models of Health Behavior
33/81
CriticismsoftheHBM
Is health behaviour that rational? (Istooth-brushing really determined by
weighing up the pros and cons?). Its emphasis on the individual (HBM
ignores social and economic factors)
The measurement of each component
The absence of a role for emotionalfactors such as fear and denial.
7/28/2019 Models of Health Behavior
34/81
CriticismsoftheHBM
It has been suggested that alternativefactors may predict health behaviour,
such as outcome expectancy (whetherthe person feels they will be healthieras a result of their behaviour) and self-
efficacy (the persons belief in theirability to carry out preventativebehaviour) (Seydel et al. 1990;Schwarzer 1992).
7/28/2019 Models of Health Behavior
35/81
CriticismsoftheHBM
Schwarzer (1992) has further criticizedthe HBM for saying nothing about how
attitudes might change.
7/28/2019 Models of Health Behavior
36/81
CriticismsoftheHBM
Leventhal et al. (1985) have arguedthat health-related behaviour is related
more to the way in which peopleinterpret their symptoms (e.g. if youfeel unwell and you feel it is not going
to cure itself then you would probablydo something about it).
7/28/2019 Models of Health Behavior
37/81
Therevised HBM
Becker and Rosenstock (1987) haverevised the HBM and have described
their new model as consisting of thefollowing factors:
the existence of sufficient motivation;
the belief that one is susceptible or vulnerableto a serious problem;
and the belief that change following a healthrecommendation would be beneficial to the
individual at a level of acceptable cost.
7/28/2019 Models of Health Behavior
38/81
Protection motivationtheory
7/28/2019 Models of Health Behavior
39/81
Protection motivationtheory
Rogers (1975, 1983, 1985) developedprotection motivation theory (PMT)
which expanded the HBM to includeadditional factors.
Componentsof the PMT
Health-related behaviours are a productof five components:
7/28/2019 Models of Health Behavior
40/81
Protection motivationtheory
Coping Appraisal
self-efficacy (e.g. 'I am confident that I canchange my diet');
Response effectiveness (e.g. 'changing mydiet would improve my health');
Threat Appraisal
Severity (e.g. 'bowel cancer is a seriousillness');
Vulnerability (e.g. 'my chances of gettingbowel cancer are high').
Fear
i i i
7/28/2019 Models of Health Behavior
41/81
Protection motivationtheory
According to the PMT, there are two sourcesof information:
1. environmental (e.g. verbal persuasion,observational learning) and
2. intrapersonal (e.g. prior experience).
This information elicits either an 'adaptive'
coping response (i.e. the intention to improveone's health) or a 'maladaptive' copingresponse (e.g. avoidance, denial).
f h
7/28/2019 Models of Health Behavior
42/81
Support for the PMT
Rippetoe and Rogers (1987) gavewomen information about breast cancer
and examined the effect of thisinformation on the components of thePMT and their relationship to the
women's intentions to practise breastself-examination (BSE).
S f h
7/28/2019 Models of Health Behavior
43/81
Support for the PMT
The results showed that the bestpredictors of intentions to practise BSE
were response effectiveness (believingthat BSE would detect the early signs ofcancer), severity (believing that Breastcancer is dangerous and difficult to
treat in it's advanced stages) and self-efficacy (belief in one's ability to carryout BSE effectively).
S f h PMT
7/28/2019 Models of Health Behavior
44/81
Support for the PMT
In a further study, the effects of persuasiveappeals for increasing exercise on intentionsto exercise were evaluated using the
components of the PMT. The results showedthat vulnerability (ill health would result fromlack of exercise) and self-efficacy (believing inone's ability to exercise effectively) predicted
exercise intentions but that none of thevariables were related to self-reports ofactualbehaviour.
S t f th PMT
7/28/2019 Models of Health Behavior
45/81
Support for the PMT
In a further study, Beck and Lund (1981)manipulated dental students' beliefs about
tooth decay using persuasive communication.Their results showed that the informationincreased fear and that severity (tooth decayhas disastrous consequences) and self-
efficacy (I can do something about it) wererelated to behavioural intentions (flossing andbrushing regularly especially after eating).
C iti i f th PMT
7/28/2019 Models of Health Behavior
46/81
Criticisms of the PMT
The PMT has been less widely criticized thanthe HBM; however, many of the criticisms ofthe HBM also relate to the PMT. For example,
the PMT assumes that individuals are rationalinformation processors (although it doesinclude an element of irrationality in its fearcomponent), it does not account for habitual
behaviours, such as brushing teeth, nor doesit include a role for social (what others do)and environmental factors (eg opportunitiesto exercise or eat properly at work).
C iti i f th PMT
7/28/2019 Models of Health Behavior
47/81
Criticisms of the PMT
Schwarzer (1992) has also criticized thePMT for not tackling how attitudes
might change (a problem with the HBMas well).
S i l iti d l
7/28/2019 Models of Health Behavior
48/81
Social cognition models
Social cognition theory was developed byBandura (1977, 1986) and suggests thatexpectancies, incentives and social cognitions
govern behaviour. Expectancies include: Situation outcome expectancies:the
expectancy that a behaviour may bedangerous (e.g. 'smoking can cause lung
cancer'). Outcome expectancies:the expectancy that
behaviour can reduce the harm to health(e.g. 'stopping smoking can reduce the
chances of lung cancer').
S i l iti d l
7/28/2019 Models of Health Behavior
49/81
Social cognition models
Self-efficacy expectancies:the expectancythat the individual is capable of carrying outthe desired behaviour (e.g. 'I can stop
smoking if I want to'). The concept ofincentivessuggests that
behaviour is governed by its consequences.For example, smoking behaviour may be
reinforced by the experience of reducedanxiety, whereas a feeling of reassurancemay reinforce having a cervical smear after anegative result.
S i l iti d l
7/28/2019 Models of Health Behavior
50/81
Social cognition models
Social cognitions involvenormative beliefs(e.g. 'people who are important to me want
me to stop smoking'). Parents have a strong influence over thehealth behaviours of children of the same sexwith regard to Exercise, Smoking, Drinking,
Eating and Sleep (Wickrama, Conger, Wallaceand Elder, Journal of Health and SocialBehaviour, 1999).
S i l iti d l
7/28/2019 Models of Health Behavior
51/81
Social cognition models
S i l iti d l
7/28/2019 Models of Health Behavior
52/81
Social cognition models
Th f l d b h i
7/28/2019 Models of Health Behavior
53/81
Theory of planned behaviour
Theo of planned beha io
7/28/2019 Models of Health Behavior
54/81
Theory of planned behaviour
The TPB emphasizes behavioural intentionsas the outcome of a combination of severalbeliefs.
Intentions - 'plans of action in pursuit ofbehavioural goals' (Ajzen and Madden 1986)and are a result of the following beliefs:
1. Attitude towards a behaviour - positiveor negative -(e.g. 'exercising is fun and willimprove my health').
Theory of planned behaviour
7/28/2019 Models of Health Behavior
55/81
Theory of planned behaviour
2. Subjective norm - social pressureand motivation (e.g. 'people who are
important to me will approve if I loseweight and I want their approval').
3. Perceived behavioural control -
self-efficacy and possible barriers
Support for the TPB
7/28/2019 Models of Health Behavior
56/81
Support for the TPB
Povey et al (2000) studied theintentions of people to eat five portions
of fruit and vegetables per day or tofollow a low-fat diet. The TPB was goodat predicting intentions but not
behaviour. Self-efficacy was found to bea better predictor of behaviour.
Support for the TPB
7/28/2019 Models of Health Behavior
57/81
Support for the TPB
Rutter (2000) studied women andwhether or not they attended two
breast-screening sessions separated bythree years. Intention and first-timeattendance was successfully predictedby the TPB. Attendance at the first
session, however, was the bestpredictor of whether the womanattended three years later.
Support for the TPB
7/28/2019 Models of Health Behavior
58/81
Support for the TPB
Brubaker and Wickersham (1990)examined the role of the theory's
different components in predictingtesticular self-examination and reportedthat attitude towards the behaviour,subjective norm and behavioural control
(measured as self-efficacy) correlatedwith the intention to perform thebehaviour.
Support for the TPB
7/28/2019 Models of Health Behavior
59/81
Support for the TPB
TPB in relation to weight loss (Schifterand Ajzen 1985). The results showed
that weight loss was predicted by thecomponents of the model; in particular,goal attainment (weight loss) was
linked to perceived behavioural control.
Evaluation of the TPB
7/28/2019 Models of Health Behavior
60/81
Evaluationofthe TPB
Good Degree of irrationality
Considers Social and Environmental factors Considers past behaviour within the
measure of perceived behavioural control.
Bad
Schwarzer (1992) Ajzen does not describeeither the order of the different beliefs orsays what causes what (causality).
The health action process
7/28/2019 Models of Health Behavior
61/81
The health action processapproach
The health action process
7/28/2019 Models of Health Behavior
62/81
The health action processapproach
The health action process approach (HAPA)was developed by Schwarzer in 1992.
1. it includes a temporal element in theunderstanding of beliefs and behaviour.
2. it emphasized the importance ofselfefficacy
3.
distinction between a decision-making/motivational stage and an actionmaintenance stage.
Components of the HAPA
7/28/2019 Models of Health Behavior
63/81
Componentsofthe HAPA
According to the HAPA, the motivationstageis made up of the following components: self-efficacy (e.g. 'I am confident that I can stop
smoking'); outcome expectancies (e.g. 'stopping smoking will
improve my health'), and a subset of socialoutcome expectancies (e.g. 'other people want meto stop smoking and if I stop smoking I will gaintheir approval');
threat appraisal, which is composed of beliefsabout the severity of an illness and perceptions ofindividual vulnerability.
Components of the HAPA
7/28/2019 Models of Health Behavior
64/81
Componentsofthe HAPA
The actionstage is composed of:A cognitive factor made up of action plans (e.g. 'if
offered a cigarette when I am trying not to smoke
I will imagine what the tar would do to my lungs')and action control (e.g. 'I can survive beingoffered a cigarette by reminding myself that I ama non-smoker').
The situational factor consists of social support
(e.g. the existence of friends who encourage non-smoking) and the absence of situational barriers(e.g. financial support to join an exercise club).
Support for the HAPA
7/28/2019 Models of Health Behavior
65/81
Support for the HAPA
Schwarzer (1992) claimed that self-efficacywas consistently the best predictor ofbehavioural intentions and behaviour change
for a variety of behaviours, includingfrequency of flossing, effective use ofcontraception self-examination, drug addicts'intentions to use clean needles, intentions to
quit smoking, and intentions to adhere toweight loss programmes and exercise (e.g.Beck and Lund 1981; Seydal et al. 1990).
Criticisms of the HAPA
7/28/2019 Models of Health Behavior
66/81
Criticismsofthe HAPA
Too rational - emotion is neglected
The social and environmental influences arenot considered as directly affectingbehaviour, but rather as cognitions
Do these cognitive states exist or are theysimply created cognitive theorists?
The model attempts to combine componentsof the health belief model, the trans-theoretical model of change and the theory ofplanned behaviour.
Non-Rational processes
7/28/2019 Models of Health Behavior
67/81
Non-Rational processes
The defence mechanism of Denial
Cigarette smokers etc
Lay theories about health
7/28/2019 Models of Health Behavior
68/81
Lay theories about health
Communication between healthprofessional and patient would be
redundant if the patient held beliefsabout their health that were in conflictwith those held by the professional.
Lay theories about health
7/28/2019 Models of Health Behavior
69/81
Lay theories about health
Pill and Stott (1982) reported that working-class mothers were more likely to see illnessas uncontrollable.
In a recent study, Graham (1987) reportedthat although women who smoke are awareof all the health risks of smoking, they report
that smoking is necessary to their well-beingand an essential means for coping withstress.
Lay theories about health
7/28/2019 Models of Health Behavior
70/81
Lay theories about health
Blaxter (1990) analysed the definitions ofhealth provided by over 9000 British adults inthe health and lifestyles survey. She
classified the responses into nine categories: Health as not-ill: the absence of
physical symptoms.
Health despite disease.
Health as reserve: the presence ofpersonal resources.
Health as behaviour: the extent of
healthy behaviour
Lay theories about health
7/28/2019 Models of Health Behavior
71/81
Lay theories about health
Health as physical fitness.
Health as vitality.
Health as social relationships.Health as function.
Lay theories about health
7/28/2019 Models of Health Behavior
72/81
Lay theories about health
It was found that there was considerableagreement in the emphasis on behaviouralfactors as causes of illness. There was
however limited reference to structural orenvironmental factors, especially amongthose from working-class backgrounds.Gender differences were also found. The
women were more likely to define health interms of personal relationships. Murray andMcMillan (1988) also found that working classwomen made repeated reference to their
families when describing cancer.
Lay theories about health
7/28/2019 Models of Health Behavior
73/81
Lay theories about health
Chamberlain (1997) noted a series of socialclass differences in his review of severalstudies of lay peoples perceptions of health.Lower social economic status peopleemphasise the role of health in their ability towork whereas higher social economic status
people referred more to their ability toparticipate in leisure activities. Four differentlay views of health emerged:
Lay theories about health
7/28/2019 Models of Health Behavior
74/81
Lay theories about health
1. Lower social economic statusparticipants only reported a view thatemphasised physical aspects.
2. Both lower and higher social economicstatus participants gave a dualistic view inwhich physical and mental aspects of healthwere combined.
3. Predominantly higher social economicstatus gave a complimentary view of health,which integrated both physical and mentaldimensions.
Lay theories about health
7/28/2019 Models of Health Behavior
75/81
Lay theories about health
4. Higher social economic statusparticipants gave a multiple view of
health, which included physical, mental,emotional, social and spiritualdirections.
Lay theories about health
7/28/2019 Models of Health Behavior
76/81
Lay theories about health
Stainton-Rogers (1991) used Q-sortmethodology to identify the concepts used bya sample of British adults to explain health.She identified eight different accounts ofhealth and illness:
The body as machine account which
considered illness as naturally occurring andreal with biomedicine considered the mainform of treatment.
Lay theories about health
7/28/2019 Models of Health Behavior
77/81
Lay theories about health
The body under siege account which
considered illness as a result of externalinfluences such as germs or stress.
The inequality of access account which
emphasized the unequal access to modernmedicine.
The cultural critique account which wasbased upon a sociological worldview ofexploitation and oppression.
Lay theories about health
7/28/2019 Models of Health Behavior
78/81
Lay theories about health
The health promotion account which
recognized both individual and collectiveresponsibility for ill health.
The robust individualism account which
was concerned with every individuals right toa satisfying life.
The willpower account which definedhealth in terms of the individuals ability toexert control.
Assumptions in Health
7/28/2019 Models of Health Behavior
79/81
Assumptions in Health
psychology
1. Humans are rational in their information
processing. It is the role ofperceived factors(e.g. risk, rewards, costs, etc) rather thanactual risks.
2. Different cognitions are separate from
and perform independently from each other.
Could be because the researchers askquestions relating to each 'type' of cognition.
Assumptions in Health
7/28/2019 Models of Health Behavior
80/81
Assumptions in Health
psychology
3. The types of cognition may not reallyexist nor play a part in the patient's thinkingabout their health; they could just be an
artefact of the way the research was carriedout.
4. Cognitions are not placed within acontext. For example, actual social pressure
and environment are not taken into account,only the individual's interpretation of socialpressure and environmental influences.
The end
7/28/2019 Models of Health Behavior
81/81
The end