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Models of Health Promotion

Stages of Change, Prochaska et al (1982)Health Belief Model, Rosenstock (1974)

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Why do people ...

do things that are bad for their health such as smoke cigarettes or drink too much alcohol?

not do things that are health- enhancing like exercise or eating low fat foods?

not do things that maximize the likelihood of better outcomes such as wearing seat belts?

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Stages of Change Model Prochaska et al (1982) “Ordered categories along a

continuum of motivational readiness to change a problem behavior”

Assumption: most people will pass through these stages, or go back and forth, when adopting a healthy habithttp://www.uri.edu/research/cprc/transtheoretical.htm

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Five Stages of Change

Precontemplation Contemplation Preparation Action Maintenance

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Precontemplation

No intention to change behavior in the foreseeable future (next 6 months).

Includes people who are unaware of the problem plus those who know about the problem but are not considering change.

“I am not thinking about changing my risky sexual behavior within the next 6 months to reduce the risk of getting HIV.”

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Contemplation

People are aware that a problem exists and are seriously thinking about overcoming it but have not yet made a firm commitment to take action.

Intending to change within 6 months; open to feedback and information about how to change. However, ambivalent about the costs and benefits of their behavior.

“I am thinking about changing my risky sexual behavior within the next 6 months to reduce the risk of getting HIV.”

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Preparation

Individual is intending to take action in the next month and has unsuccessfully taken action in the past year (combines intention and behavior criteria).

Actively planning change and already taking some steps toward action such as reducing frequency of problem behavior.

“I know I should change my behavior, and I think I will soon.”

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Action

Stage in which individuals modify their behavior, experiences, or environment in order to overcome their problems. Involves overt behavioral changes and requires commitment of time and energy.

e.g., cessation of smoking has occurred and last cigarette was less than 6 months ago.

“In the last few months I have changed my risky sexual behavior to reduce the risk of getting HIV.”

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Maintenance People work to prevent relapse and

consolidate the gains attained during action.

Sustaining change and resisting temptation to relapse.

Stage extends from 6 months and beyond the initial behavioral change.

“For more than 6 months I have changed my (former) risky sexual behavior to reduce the risk of getting HIV.”

Most people take several action attempts before they are able to maintain the behavior

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Examples of the Stages of Change Model

Do you know what it means to floss your teeth? No -> {Precontemplation} Yes -> {go to next q}

Do you floss your teeth now? Yes, for more than 6 months -> {Maintenance} Yes, I recently started -> {Action} No -> {go to next q}

Which of the following best describes you? I’ve never thought about flossing. {Precontemplation} I should probably floss. {Contemplation} I have floss at home, and I know I should floss, but I keep forgetting

to actually do it, or I don’t have time. {Preparation}

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Prochaska et al (1982)

Stages of Change model was developed after studying 872 former smokers

Quitting was a dynamic process; people moved back and forth between the stages

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Stages of Change Model

Summary: What does this model help us understand? Where a person is in the

process of acquiring a new healthy habit

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Health Belief Model Rosenstock (1974) Predicts the likelihood of

healthy behavior Assumes people are rational

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Health Belief Model

A person evaluates: The risk -

1. Vulnerability 2. Severity 3. Self-Efficacy

4. Costs/Benefits 5. Cues/Motivation 6. Barriers

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Vulnerability How likely one

thinks a bad outcome (e.g., get sick or a disease) is if unhealthy behavior persists.

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Severity

The consequence is perceived to be severe (death) as opposed to mild (yellower teeth).

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Self Efficacy

Perceived ability to perform a task.

Self efficacy predicts future behavior if there are adequate incentives and skills.

“Can I do it?” “Will I stick to it?” “Will it work?”

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Costs & Benefits of Behavior Will it work to reduce the likelihood

of the negative consequence (e.g., disease)?

Benefits are perceived to outweigh costs.

Example: I should exercise because it lowers stress and body weight, but if I spend an hour a day exercising I won’t have time to do my homework and I will fail out of school!

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Motivational cues

Cues (internal or external) that help convert intentions into behavior

Could be good cues (friend started exercising more and looks great now) or bad cues (overweight relative is having chest pains)

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Barriers

Anything standing in the way from allowing a person to take the decided action Not enough money or time to

perform the behavior you want to

Negative feedback from family and friends

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First, Risk evaluation

(1)Am I vulnerable?

(2)How severe is the risk?

(3)Will my action be effective?

Second, Modifying Factors

(4)Costs

(4)Benefits

(5)Cues/Motivations

(6)Barriers

Outcome, Likelihood of Action

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Jane is not likely to continue smoking because… She thinks that she might get lung

cancer if she continues to smoke (susceptibility).

She believes that dying from lung cancer is terrible (severity).

Jane does not find smoking to be very pleasurable (cost/benefits).

Her friends are supportive of her quitting (absence of barrier)

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Jon is likely to continue smoking because He agrees with the tobacco industry--

smoking doesn’t cause lung cancer (susceptibility).

He believes that dying from lung cancer is not any worse than any other way of dying (severity).

Jon feels that smoking relaxes him (cost/benefits).

His friends offer him cigarettes (barrier to quitting)