Presentation5 ch 8 10 handout

Health Behavior

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Session 5MODELS OFINTERPERSONAL HEALTH BEHAVIOR

Sal Sanders, Ph.D.Sal Sanders, Ph.D.

HOW INDIVIDUALS, ENVIRONMENTS, AND HEALTH BEHAVIORS INTERACT: SOCIAL COGNITIVE THEORYSOCIAL NETWORKS AND SOCIAL SUPPORTSTRESS, COPING, AND HEALTH BEHAVIOR

+ObjectivesDefine and describe important concepts and

principles from the Social Cognitive Theory (SCT).

Describe the fundamental emphasis of SCT on the interaction between individuals and their environments and human capacities for learning and adaptation.

+ObjectivesDemonstrate how the social cognitive theory has

been effectively applied for personal and social change to prevent and manage chronic and infectious diseases, and provide useful insight into other problems such as violence and disaster preparedness.

Illustrate the measurement and application of key SCT concepts and principles in case studies on smoking cessation and condom use promotion.

+SOCIAL COGNITIVE THEORYFirst known as social learning theory

(SCT) (Bandura, 1977).

Renamed social cognitive theory (Bandura, 1986).

SCT included concepts from sociology and political science (Bandura, 1997).

Integrated and developed concepts from humanistic psychology.

Glanz, K, Rimmer, B.K. & Viswanath, K. (2008). Health Behavior and Health Education: Theory, Research and Practice. San Francisco: Jossey-Bass.

+SOCIAL COGNITIVE THEORYHumanistic psychology.


+SOCIAL COGNITIVE THEORY

SCT included concepts from sociology and political science (Bandura, 1986).

Emphasizes reciprocal determination in interaction between people and their environments.

Also emphasizes the human capacity for collective action.


+SCT: Key Concepts

Psychological Determinants of Behavior

Observational Learning

Environmental Determinants of Behavior

Self-Regulation

Moral Disengagement

+Psychological Determinants of BehaviorOutcome expectations

Human values and expectations are subjective – not based solely on objective reality – but people’s perceptions of it.

Social Outcome expectationsSimilar to Social Norms in TRA and TPB

Self evaluative outcome expectation – functions like a social outcome.

+Psychological Determinants of Behavior(SE) and Collective efficacy

Collective efficacy- SE extended to how people work in organizations.

+Observational Learning

Capacity for Observational Learning is important to SCT.

4 Processes govern OL (Bandura)Attention – Research on Attention - VideoRetentionProductionMotivation

+Observational Learning of Health BehaviorsStory Telling may be more effective than

directly didactic or persuasive messages (Hinyard and Kreuter, 2007)

+Learning and Literacy

Literacy – Typically refers to the ability to read & write

Recognized need for:

Cultural literacy

Computer literacy

Information literacy

Pettersson, R. (1994). Learning in the information age. Educational Technology Research and Development, 42(1), 91-97.


Recognized need for:

Media literacy

Scientific literacy

Technical literacy

Visual literacy



“In the information age, the competent individual needs a basic knowledge of infology, the science of verbo-visual presentations of information (Pettersson 1989, 1993 a).”



“The various literacies and modes of thinking required in an information society will challenge the capacities of every person.”


+Environmental Determinants of BehaviorSCT posits observational learning will not

lead to behavior change unless the observer’s environment supports the new behaviors (Bandura, 2002).

Consider public policies that influence behavior

Consider unintended effects of these policies.

+Self-Regulation

People have the capacity to endure short-term negative outcomes in anticipation of long-term positive outcomes.

Consider the concept of opportunity costs.

+Self-Regulation

Self-Monitoring

Goal-setting

Feedback

Self-reward

Self-instruction

Enlistment

+Moral Disengagement

People have the potential to learn moral standards for self-regulation.

These moral standards can lead them to avoid violence and cruelty to others.

Can violate these standards through moral disengagement.

+Moral Disengagement: Mechanisms

Euphemistic labeling

Dehumanization and attribution of blame

Diffusion and displacement of responsibility

Perceived moral justification for harmful actions

+SCT: Health Promotion Applications

Community projects to prevent heart diseaseCaliforniaFinland

Community programs to prevent drunk driving http://www.collegedrinkingprevention.gov/supportingresearch/journal/dejong2.aspx

Programs to prevent harm from Alcohol Abuse

+SCT: Health Promotion ApplicationsAmerican Cancer Society Telephone Counseling for Smoking Cessation http://www.cancer.org/Healthy/StayAwayfromTobacco/quit-for-life

American Lung AssociationNOT (Not On Tobacco) http://www.lung.org/associations/states/colorado/tobacco/not-on-tobacco/

The AIDS Community Demonstration Projectshttp://www.cdc.gov/hiv/topics/prev_prog/acdp/index.htm

+SCT

Seeks to provide a comprehensive understanding of both why and how people change individual health behaviors.

Seeks an understanding of the social and physical environments that influence health behaviors.

+Shattered Dreams

School-based intervention aimed at reducingunderage drinkingalcohol-related crashes.

Price, M. A., Salazar, C.I., Villarreal, C. L., Guerra, C. M., Villarreal, R., Stewart, R. M. (2009). APPLYING BEHAVIORAL THEORY TO AN INNOVATIVE SCHOOL-BASED PROGRAM FOR PREVENTING UNDERAGE DRINKING AND IMPAIRED DRIVING. American Journal of Health Studies, 24(1), 223-231.

+Shattered Dreams

Applied Constructs from transtheoretical model and social cognitive theory

To operationalize change among program participants.


+Shattered Dreams

Integrated SCT constructs of:

self-efficacy

behavioral capability

expectations

observational learning


+Shattered Dreams

measured students’ expectancies regarding alcohol (positive and negative consequences)

self-efficacy

knowledge and

self-reported underage drinking and impaired driving


+Shattered Dreams

Participants reported significant decreases in

No. of drinking days in the past 30 days (pre-test mean =1.81; post-test mean = 0.91, p = 0.001)

No. of days having 5 or more drinks (binge drinking) (pretest mean = 1.09; post-test mean = 0.56, p =0.001)


+SOCIAL NETWORKS AND SOCIAL SUPPORT(SE) and Collective efficacy

Collective efficacy- SE extended to how people work in organizations.

+ObjectivesDefine functions and characteristics of social

networks.

Provide a conceptual framework for understanding the relationship between social networks and health.

Briefly review the empirical support for this relationship.

+ObjectivesList and describe types of social network

interventions.

Present two examples of social network interventions for promoting health.

+Definitions

Social Networks – The web of social relationships that surrounds individuals.

Social Integration – The existence of social ties

+Social Support

“The functional content of relationships that can be categorized into four broad types of supportive behaviors or acts:Emotional Support Instrumental Support Informational SupportAppraisal Support” (House, 1981)

+Social Support

+Social Support

Social support approach usually focuses on one relationship at a time.

Social network approach allows the study of how change in one social relationship affects other relationships.

+Social Support

Barnes (1954) – Presented Social network concept.

John Cassel (1976) - Study of social support.

+Social Relationships and Health

Barnes (1954) – Intimate ties and their emotional support increase survival rates for severe cardiovascular disease patients (Berkman and Glass, 2000)

1 strong intimate relationship is a predictor of good health (Michael, Colditz, Coakley and Kiwachi, 1999).

+Social Support - Who

Many types of people can provide social support. What are the differences in the likely type of support provided by a friend, a family member, a health care professional?

+Social Support - What

The perceptions of support recipients not the objective behaviors involved in interactions are most strongly related to the health & wellbeing of the recipients.

+Social Support - When

The types of social networks and social support that enhance health & well-being differ according to age or developmental stage of the recipient of the support (Kahn and Antonucci, 1980).

+Asthma Support

CHW’s provided support and information.

After 1 year, the participants in the high intensity intervention group (5-9 visits over 1 year) showed a larger decrease in the number of days limited by asthma and the number of times urgent health care services were utilized. (Kahn and Antonucci, 1980).

+STRESS, COPING, AND HEALTH BEHAVIOR

+ObjectivesReview major theories, research, and

applications related to stress, coping, and health.

Summarize historical concepts of health, stress, and coping.

Describe an influential theoretical framework—the Transactional Model of Stress and Coping—and key variables, definitions, and research approaches to studying this framework.

+ObjectivesDiscuss theoretical extensions of the

Transactional Model, including information seeking styles, social support, optimism, and psychoneuroimmunology.

Illustrate applications of the Transactional Model to understanding the use of coping strategies and the design and evaluation of health behavior interventions.

+Social Readjustment Rating Scale (SRRS)

http://chipts.ucla.edu/assessment/Assessment_Instruments/Assessment_files_new/assess_srrs.htm

Assessment:1. Death of a spouse 1002. Divorce 733. Marital Separation 654. Jail term 635. Death of a close family member 63Etc.

+STRESS

+STRESS Chronic Stress has an adverse impact on immune

function (Moynihan, 2003)

Transactional model has been applied to public health issues Racism – may indirectly (SES) and directly (acute and chronic

stressor) influence health (Williams, 1999).

Effects of stress may be moderated by coping styles. John Henryism – strong behavioral predisposition to cope

actively with psychosocial and environmental stressors – may result in adverse health effects when coupled with limited

resources.

+Self Assessment

Stress can be positive or negative.

TRUE FALSE

+Self Assessment

The evaluation of an individual’s coping resources is which concept of the Transactional Model of Stress and Coping?

A. A. Primary appraisal

B. Secondary appraisal

C. Coping efforts

D. Outcomes of coping

+Being Poor and Coping With Stress

Individuals may cope with stress through what may be pleasurable but unhealthy behaviors.

…examined whether smoking, alcohol use, and physical inactivity moderate the relationship between perceived stress and the risk of death in the US population as a whole and across socioeconomic strata.

Krueger, P. M. & Chang, V. W. (2008). Being Poor and Coping With Stress: Health Behaviors and the Risk of Death. American Journal of Public Health, 98(5), 889-896.


Data were derived from the 1990 National Health Interview Survey’s Health Promotion and Disease Prevention Supplement

n=40,335

Data linked to prospective National Death Index mortality data through 1997



Unhealthy behaviors moderate the stress–mortality relationship in a nationally representative sample of US adults.

Physical inactivity and former smoking at baseline increased the impact of stress on mortality.



Findings are consistent with “Double Jeopardy”

“Engaging in unhealthy but pleasurable behaviors is a poor strategy for coping with high perceived stress…”



Factors that independently increase risk of death:

Stress

Unhealthy behaviors, and

Low SES



Findings are consistent with “Double Jeopardy”

“Engaging in unhealthy but pleasurable behaviors is a poor strategy for coping with high perceived stress…”


+STRESS MANAGEMENT - VIDEO

http://hdl.handle.net/2374.OX/60014

+The Weight of the Nation - VIDEOS

http://theweightofthenation.hbo.com/films/main-films/Crisis

Presentation5 ch 8 10 handout

Education

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