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Test 3 Study Guide (Chapters 6,7,8,9,11)

by: Grace Stewart

Test 3 Study Guide (Chapters 6,7,8,9,11) HLTH 2400_002

Grace Stewart

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These notes are for the upcoming exam on April 14th, 2016
Determinants of Health Behaviors
Mrs. Amelia Clinkscales
Study Guide
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This 15 page Study Guide was uploaded by Grace Stewart on Tuesday April 12, 2016. The Study Guide belongs to HLTH 2400_002 at 1 MDSS-SGSLM-Langley AFB Advanced Education in General Dentistry 12 Months taught by Mrs. Amelia Clinkscales in Spring 2016. Since its upload, it has received 48 views. For similar materials see Determinants of Health Behaviors in Health Sciences at 1 MDSS-SGSLM-Langley AFB Advanced Education in General Dentistry 12 Months.


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Date Created: 04/12/16
Blue font= Concepts▯ Red Font= Theories▯ Anything underlined= Suggested to put on flashcards ▯ Anything bolded= Important▯ ▯ Health 2400 Test 3 Review - Review of Determinants - Intrapersonal factors - Biological, personality, psychological, knowledge, attitude, beliefs, values, self-esteem, self-efficacy - Interpersonal Factors - social support, social networks - Environmental factors - Built, Natural - Policy - Public/private; Health Policy - Different ways of classifying/organizing determinants - predisposing - enabling - reinforcing - Predisposing - “determinants the individual brings with him/her into a situation which provide motivation/reason for a behavior” - cognitive variables - awareness/knowledge - attitudes - beliefs - genetic predisposition - conviction (sometimes linked with fear) - Values - self-efficacy - behavioral intention - interventions addressing predisposing determinants - the individual experiences direct communication with 1) strengthening factors and 2) creating cognitive dissonance - Enabling - Determinants that allow for motivation to be acted upon and can influence opportunity, convenience or barriers to behavior - ex. resources, accessibility, affordability, supportive policies, assistances, services, and skills - enablers - “power players” (ex. parents, teachers, business leaders…) - community organizing, political interventions, trainings - new participatory approaches are lead by people intended for behavior change ▯ ▯ - reinforcing - determinants that come into play once a behavior has begun which contribute to the behavior becoming long term or internalized - ex. praise - can be positive or negative (ex. benefits/punishments) - Decision Matrix - Phase 3: Behavioral and Environmental Diagnosis - Health and environmental factors that are identified are the ones that the intervention will be tailored to affect - Each of these environmental factors are rated in terms of its importance to the health issue as well as its changeability - Decision Matrix: Less Important More Important More Changeable Low priority except to High propriety for program focus demonstrate change for political purposes Less Changeable No program Priority for innovative program; evaluation crucial - By narrowing the scope, researchers can focus on what makes the largest contribution to behavior change - Once the behaviors and conditions are laid out, objectives can be write. - SPECIFICITY IS VITAL ▯ - Behavior Change Strategies: Learning, Teaching, and Counseling - Learning Theory - Main focus: cognitive learning - concerns: how people learn and change - Learning theory is more focused on knowledge than attitudes whereas all behavioral theories focus on attitudes - Behavior change strategies - Teaching - groups, students, and teachers - Training - “train-the trainer”- teaching skills to prepare others to instruct - Counseling - one-to-one - dynamic interaction - Effective instructions - effective instructors - 1) relationships - 2) expectations - 3) engagement - 4) knowledgeable- teachers as change agents - effective instructional units - 1) best practices/Evidence Based Programs - 2) Importance/Relevance - Effective Instructional Strategies - 1) Goals - 2) Expectations - 3) Monitor progress and provide feedback - 4) Reinforcement - 5) Communication and Information Processing - 6)Assimilation - 7)Accommodation - 8) Problem Solving- “ICAN” approach: Identify problem; Consider and Choose option;Act carefully; Note what happens - Sentence to remember: Goats Eat Many Rice CakesAfterAPoop - Managing the instructional environment - eliminate poor behaviors quickly in the beginning - separate when necessary - Counseling - Motivational Interviewing - Carl Rogers- developed a client centered counseling method - focus: ambivalence- the state of wanting to change, but at the same time, not wanting to change. Creates the feeling of being “stuck” - common human condition - typical of many health behaviors - Counselor Role - Inform - Advise - Encourage - Honor,Accept - Semi-directive - Extrinsic motivation helps people to get “unstuck” - Reinforcement - Encouragement - Support - “RES”=Extrinsic - Intrinsic is more powerful and sustaining - ambivalence= indicates some intrinsic motivation needs to be changed - Motivational interviewing helps to activate internal motivation to get out of being “stuck” - Effective MI Counseling - Making suggestions= direct - Counselor is only interested in the individual and not their success, it is up to the client to change - The counselor uses questions to help the client to find intrinsic motivation in himself or herself. Methods include: - Open-ended questions (ex. “tell me about…” - Reflective listening (ex. restating what the client has communicated) - Affirmation (ex. “That seems like a good idea”) - Summarizing (ex. “what i heard you say…”) - Change talk (ex. “what would you like to be your next step?”) - Motivational Interviewing Phases of Change - 1) Overcome ambivalence - counselor: “so you want to…” - client: “I plan, I want, I will…” - 2) Commitment and action - the client identifies everything that he/she needs to change and his/her intrinsic motivation - the only thing the counselor does is suggests strategies for change - Cognitive Behavior Therapy - Emphasis on cognitive strategies - Our own thoughts influence our behavior - ex. instead of telling yourself “I cannot do that”, tell yourself “I could learn to do that but it will take some effort”. This will more likely lead to the change you want to see in yourself. - Assumptions - “The content and process of thinking is knowable”- The content you think about when you want to change a behavior is achievable - “Thoughts mediate emotion and behavioral response” - your thoughts provoke action - “Emotional responses and behavior can be controlled through cognitive strategies that alter thought processes.”- If you change the way you think for the benefit of the behavior you want to change, your responses will also change for the better - Thoughts are independent of knowledge, beliefs, perceptions and attitudes - Cognitive Behavior Therapy: Strategy - Assessment: What does the client think and feel? - problem? - nature, characteristics and dimensions of the problem? - what would help with the problem? - Treatment plan and problem list - includes variety and severity of problems - identifies referral needs - order problems for attention (what should be focused on more) - facilitates the action plan - Cognitive Behavior Therapy: Counseling Strategies - 1) Goals: should be difficult and agreed upon by the client. These goals should also be measurable and the goals should include short, intermediate and long-term goals - 2) Counselor Relationship: Should be warm, supportive, empathetic, and respectful - 3) Persuasion: counselor should be confident in the client and should prove encouragement and suggestions - 4) Clear Instructions - 5) High Expectations - Cognitive Behavior: Counseling Methods - Problem solving - Behavior activation: counselor assigns “baby steps” that the client can manage independently and successfully - Skills training: clients should be given skills instruction on how to communicate, deal with pressure and avoiding negative situations - Environmental control: controlling your own environment through operant/self- management methods - Cognitive restructuring: positive self-talk- the idea is to instill positive thoughts (“CBT method”) - Modify core beliefs: Identify and modify beliefs that underly the change wanting to be achieved - Self-Determination Theory - Grounded in humanistic perspective - growth occurs through challenge, discovering new perspectives, pushing capacity - this growth will be integrated into self-concept, identity and self-esteem - Basic psychological needs - a meta-theory - Self-determinism theory: elements - extrinsic and intrinsic motivation - psychological needs - AUTONOMY!- the independence or freedom of one’s actions - competence - relatedness- success of meeting those needs - autonomy is not independence - individual differences - energy and related concepts - aspiration and life goals - Extrinsic motivation - Contingencies shape motivation and behavior - extrinsic motivation= “controlled motivation” - people respond differently to extrinsic motivation - Intrinsic motivation - contingencies are eventually internalized - behavior is then guided by internalized motivation - external reinforcement eventually becomes self-regulated as people become socialized - Self-Determinism: Three Basic Psychological Needs - Autonomy - Control over one’s own behavior - Rotter- locus of control - ability to act in one’s own interests - Competence - Ability to manage one’s own behavior tasks - Relatedness - Family, friends, mate - Individual Differences: competence, autonomy, and relatedness - Extrinsic foci vs. intrinsic foci - extrinsic: wealth, fame, popularity - intrinsic: personal development, generatively, affiliation about… - people vary according to - aspirations and life goals - energy - mindfulness and presence - Motivational Interviewing:Ambivalence - People often want to change and want not to change - Ambivalence can only be overcome by the person experiencing it - competing goals, needs, and contingencies - Motivational Interviewing Methods - Detachment: it is not up to the counselor but up to the client to change - Empathy: provides the basis for the counselor-person/client relationship - Listening - Developing discrepancy: Get the person to see the discrepancies between their goals and behavior - Rolling with resistance: Rather than overcoming resistance, roll with it - Empowerment: Get person to explore change; encourage their ideas of change ▯ - Personal Trainer Study - Children and adolescents with Type 1 diabetes - Applied behavioral analyses - Personal trainers with motivational interviewing skills - home delivery of the intervention - six sessions - youth select possible changes using the results of theABA - Personal Trainers: - detached- allowed the youth to select change goal and try their own ideas for change - empathy - encouragement - identified discrepancies - suggested possible strategies - Results - Significant treatment group difference in hemoglobinA1c, the measure of glycemic control - Better effects of adolescents than pre-adolescents - Social Influence and Social Network - Social Influence - Definition: The effect on thought and behavior of information shared among group members leading to common social norms - Information: knowledge, beliefs, norms, behavior-input from all available sources about a particular thought or behavior - Social forces: context and culture; social networks and social capital - Influences processes: socialization and selection - Cognitive processes: social norms - Social Norms - reflect upon accepted/prevalent thought and action - People tend to conform to prevalent and acceptable - Norms are measured as cognitions-beliefs, perceptions, attitudes, values - there may be sub-groups norms, each being unique to its members - Group Membership - Provides support for shared norms and enforces normative views and behavior among group members through rewards and punishments - Membership is conforming - often a condition of membership - status in group may depend on it - “information” shared, approved - Culture and ContextAffect Norms - general and pervasive - nationality - race, ethnicity - religion - neighborhood - time period (age and time-related conditions) - culture and context are pervasive- most often, we are not aware - consider the differing world views: obesity, breastfeeding, etc. - Social influence processes - Selection: The tendency of people with similar thoughts and behaviors to affiliate - elective affiliation- we choose like-minded friends; we choose people with whom we can engage in similar behaviors - like interests attract; unlike interests repel - Socialization - Others influence our behavior - usually this is conformity - Sometimes due to pressure - Social Capital - The connections between and within social networks - Very similar concept to social network - more specifically focused on the degree of connectedness- breadth and depth of relationships - measured in terms of being able to get help or advice when needed - social networks have value - Obesity inAmerica: Christakis and Fowler - Those who became obese were twice as likely as those who did not know others who became obese - an effect of social network? - Do obese people persuade others to become obese? - Is one more likely to become obese because it is acceptable? - Maybe this is simply a matter of obese people sharing similar social contexts ▯ - Social Support and Social Network - Social Support and Health - Health Impacts - Decrease stress - Increase recovery time - Decrease complications associated with pregnancy and child birth - Decrease herpes outbreak - Decrease risk of MI, CAD,Angina - Decrease mortality rates - Social Support - Social Support and Health - There are different forms of social support - informational - increase knowledge, awareness, advice, suggestions, and information - instrumental/tangible - Assistance, resources, advise - emotional - empathy, understanding, care, listening - appraisal - Information that is useful for self-evaluation (understand better) - Social support can be: - Information- ex. that you are loved, cared for, valued - Assistance- coping with stressors - Goal furthering- from the supporter - Aid andAssistance- exchanged through social relationships and interpersonal transactions - Types and Characteristics of Social Support Network Concepts Definitions Social Network A person-centered web of social relationships Reciprocity Extent to which resources and support are both given and received in a relationship Intensity Extent to which social relationships offer emotional closeness Complexity Extent to which network members know and interact with each other Density Extent to which network members know and interact with each other ▯ - Enhancing Social Support - Encourage people to recognize potential sources of support - Teach people how to draw on support - Teach people how to develop support resources - Teach family and significant others how to provide support - Social Networks -Definition: everyone with whom we have contact in anyway -information shared within networks -larger networks share more information - diverse networks share diverse information -Greater influence is exerted by strength, immediacy and frequency of contact; we are influenced by those we spent time with ▯ ▯ ▯ - Pathway 1: - social support/networks ave a direct affect on health through helping to meet an individual’s most basic needs - Pathway 2 and 4: - Buffering effect: social support influences coping processes and buffer the effect(s) of a stressor at many different levels - Pathway 5 - We are influenced and supported in the behaviors we choose to do or not do (ex. girls with more physically active friends are also more active) - Pathway 3 - Social support and social networks influence the frequency and duration of exposure to a stressor (ex. a supportive boss will make sure his/her employee is not given too much work) - Communication Theory - Communication: production and exchange of information by use of signs and symbols - process of creating shared meaning. It is related to persuasion and attitude change. - Factors affecting communication: context, relationship between sender and receiver, meaning attached, process of encoding and decoding - Communication as a code - when information is communicated, it is put into a code that will make sense to the audience - the audience will then decode the information to interpret the meaning - Communication channel - the medium through which you transmit the information - channels can be specific to region, language, religion, etc. - communication in public health aims to provide information, influence behavior change, and impact theAGENDAof what people are concerned about in order to create the “stage” for action - Health Communication - concerned with understanding and applying human communication processes at multiple levels in order to promote health in the most beneficial manner - Communication Process - communication isALSO about breaking through to understanding and applying - Basic process model- Lasswell’s summary: “who says what to whom through what channel and with what effect?” - Models of Communication - Action Model - One way communication from sender to receiver - sender- the source of information - encoding- the way the information is packaged - message- the package of info being communicated - channel- the medium used to transmit the “package” - decoding- the way the message is “unpackaged” - receiver- the person or target audience - noise- any type of interference at any point of the process - Interaction Model - 2-step transmission of communication from sender to receiver and receives feedback from the receiver to the sender - Transaction Model - includes conscious feedback loops between sender and receiver - Intermediary Model - one-way communication model from the sender through an intermediary to the receiver(s) (ex. the press) - Importance of Context - Advances in technology has changed the way we communicate - ecological perspective: reflexive creators and consumers rather than senders and receivers - influential factors: social structures, history, and politics - Persuasion - communication strategies are used to persuade and effect attitude change, based on the assumption that attitudes underlie behavior choices ▯ ▯ ▯ ▯ ▯ - - Communication-Persuasion Matrix Elaboration Likelihood Model - (ELM): illustrates factors that influence what type and how much information will actually attend to, and the processes by which that information results in persuasion (or not). - Key Concepts: - Central route processing: the scrutiny of information to determine the quality of the information and what, if any, action should be taken - Peripheral route processing: The passive consideration of information that relies on external cues to determine the necessary response - Both routes are often used simultaneously - Cognitive Dissonance Theory - (CDT) describes the process of persuasion in terms of what individuals do when confronted with information that does not agree with their current beliefs, attitudes, or values - Key concepts: - Selective exposure: a mechanism people use to reduce their own likelihood of encountering information that may indicate their having made a poor choice - Induced compliance: the idea that the less justification one has having engaged in a behavior that is dissonant with their existing attitude, the more likely they are to change their attitude to justify the behavior - Post-decision dissonance: dissonance experienced specifically following an important decision (ex. buyer’s remorse) - Inoculation Theory - Concerned with preventing persuasion rather than causing it - Repeatedly exposing an individual to a weakened counterargument builds their resistance to persuasion and their ability to retain their original attitude. In other words, an individual will be more resistant if you try to persuade them with a “weakened counterargument” - Diffusion Theory - “the effect of communication about the characteristics of an innovation on adoption” - How innovation spreads through communication - rate and extent of adoption depends on the characteristics of the innovation, communication, social system, and the innovation-decision process - Elements of Diffusion Theory - Innovation - Communication Channels - Social System - Time and adopter categories - Innovation-decision process - Communication about Innovation - Innovation Knowledge - Awareness-knowledge: how many people know about the innovation - Subjective evaluation: the opinions regarding the innovation of those who know about it - Channels of communication - Formal: media - Informal: word of mouth among acquaintances, or within one’s social network - Social System - Social system is very similar to social network - Both characterized by shared Beliefs and Norms - System: Structures that enable information sharing - Network: Those who share information - System Structures - formal and informal structures (appointments vs. unplanned discussions- ex. a lunch or Q&A-) - Physical, cyber, vicarious - Dimensions/boundaries - families - communities - workplaces/school - groups - acquaintances - Properties - Contact affords communication opportunities - Determine what is discussed - “information” shared, approved - Source of new information - Opinion Leaders - The opinions of some members of social system are more important and influential than others - Opinion Leaders - Trusted sources of information - Know more than others - Often have opinions - Two stages of Communication - Directed at opinion leaders/influential individuals - The spread of information about innovation: opinion leaders—>potential adopters - Persuade opinion leaders of the advantage of the innovation - Innovation-decision process - Adopter categories ▯ ▯ ▯ ▯ ▯ ▯ ▯ ▯ ▯ ▯ ▯ - Characteristics of Innovations - Health Literacy - Healthy People 2010 definition: “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions - includes both literacy and numeracy (statistics) - -thics in Health Communication Ethical questions to ask when applying health communication strategies: - Who gets to define health issues and their causes? - Who benefits from the intended behavior change? - Who pays for the intended behavior change? - Are certain marketing strategies using fear or those that provoke emotions, ethical in health promotion? - What is the role of the federal government in influencing personal behavior, health- related or not?


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