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HSC 464 Exam 4 Study Guide

by: Chelsea Ross

HSC 464 Exam 4 Study Guide HSC 464

Chelsea Ross
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HSC 464 Exam 4 Study Guide- Theories
Health Education in the Clinical Setting
Study Guide
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This 24 page Study Guide was uploaded by Chelsea Ross on Sunday December 13, 2015. The Study Guide belongs to HSC 464 at Ball State University taught by Otiam in Fall 2015. Since its upload, it has received 52 views. For similar materials see Health Education in the Clinical Setting in Nursing and Health Sciences at Ball State University.

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Date Created: 12/13/15
HSC 464 Study Guide Exam 4 Guest Lectures Transtheorectical Model  Transtheorectical Model  This is a stage model that was reinvented in the late 70’s and early 80’s by Prochaska and Diclementi. The majority of the work using this model has been conducted with smoking cessation. Applications of the model to other behaviors has rarely resulted in a clear 5 stage model.  Overview  The fundamental concepts with the theory are that people go through a variety of predictable stages when attempting a behavior change. Therefore behavior can be modified by assisting individuals to accelerate through the stages more efficiently. These assisting factors are referred to as processes.  Transtheorectical Model (Stages of Change)  Precontemplation  Contemplation  Preparation  Action  Maintenance  The Behavior of Change Spiral  Precontemplation: changing a behavior has not been considered; person might not realize that change is possible or that it might be of interest to them  Contemplation: something happens to prompt the person to start thinking about change - perhaps hearing that someone has made changes - or something else has changed - resulting in the need for further change  Preparation: person prepares to undertake the desired change- requires gathering information, finding out how to achieve the change, ascertaining skills necessary, deciding when change should take place- may include talking with others to see how they feel about the likely change, considering impact change will have and who will be affected  Action: people make changes, acting on previous decisions, experience, information, new skills, and motivations for making the change  Maintenance: practice required for the new behavior to be consistently maintained, incorpoated into the repertoire of behaviors available to a person at any one time  Progress  Key Concept:  Moving through the stages is not unidirectional. Some people make progress and then regress while others may go through the stages very quickly.  Precontemplation  Criteria :  The individual has not given serious thought to participating in this activity in the next 6 months.  Note:  Person may not wish to change  Person may feel incapable of changing.  Contemplation  Criteria:  The individual has given serious thought to changing a particular behavior during the next six months. Thinks about it weekly - has talked to individuals about it.  Note:  Lacking sufficient motivation or  Opportunity to feel capable of changing.  Preparation  Criteria:  The individual has collected resources in some manner to assist with the anticipated behavior change.  The individual plans to take action in the next 30 days.  Example: cook books for weight loss, pamphlets on fitness club etc.  Note:  Has identified strategies but needs motivation, opportunity, or incentives to begin the change.  Action  Criteria:  Initiates a behavior change.  Weight loss, fitness, smoking cessation etc.  Can clearly define when the behavior change was voluntarily initiated  Changes in behavior for less than 6 months.  Note:  Individual has started performing the new behavior - still has not adopted new routines to make the behavior part of regular lifestyle.  The new behavior is easily displaced.  Maintenance  Has maintained the behavior change for six months. Now feels that this is part of their normal lifestyle.  Termination  No temptation to relapse and 100 % confidence  Decisional Balance?  “Pros and cons”  Self-efficacy?  “Situational specific confidence”  How does the practitioner use the theory?  Research has continued to assist in the refinement of the model. Various processes have been identified to fit the various stages more effectively.  Consciousness-Raising  Increases the level of intellectual awareness about the behavior or issue.  Strategies that challenge denial or defense mechanisms, surveys, Heath Risk Appraisals.  Examples:  Questionnaires, professional counseling,  Personal recognition of the need for changing - personal responsibility for doing so.  Dramatic Relief  Experiencing the negative emotions (fear, anxiety) that go along with unhealthy behavioral risks.  Initially produces increased emotional experiences, followed by reduced affect or anticipated relief if appropriate action is taken.  Examples:  Increased emotional awareness - i.e. Friend with heart attack motivates you to exercise  Role playing, media campaign, health risk feedback  Social Liberation  Creating more alternatives and choices for individuals, providing more information about problem behaviors, and offering public support to assist.  Realizing that social norms are changing in the direction of supporting healthy behavior change  Example:  No smoking zones, non-drinking alternatives, self-help groups, tapes, posters, newsletters, gay health promotion  Environmental Reevaluation  Realizing the impact of behavior (+ or -) on one’s social and physical environment.  Person can be a role model?  Examples:  Empathy Training, documentaries, family intervention  Self-Reevaluation  Realizing that the behavior change is an important part of one’s identity  This is done in conjunction with emotional arousal.  Examples:  Imagery of what the new behavior does for the person, activities that define the pros and cons of given behaviors.  Devices that provide insight into why the destructive behavior deteriorates the quality of life.  Self-Liberation  Making a firm commitment to change.  It is both the belief that one can change and the commitment and re- commitment to act on that belief  Examples:  Did you buy new shoes on 1 January?  Counterconditioning  Requires learning healthier behaviors that can substitute for problem behaviors.  Finding positive responses to the stimuli that formally had the person engaging in negative behavior.  Work on assertiveness? Self-talk?  Relaxation? nicotine replacement?  Examples:  Weight loss - I know it will be hard to go to the x-mas party without eating, but I can do it!  As soon as I get hungry I’ll...  Stimulus Control  Removes cues for unhealthy habits and add prompts for healthier choices  Examples:  Avoidance and Environmental re-engineering  Reminders - do list, calendar, etc.  Contingency or Reinforcement Management  Provides consequences for taking action in a particular direction:  Increase Rewards  Decrease Rewards  Why not punishment? Prochaska’s research on self-changers!  Examples:  You think? Can you?  Helping Relationships  Combines caring, trust, openness, acceptance and support for healthy behavior change?  Examples:  Let others know that you’re changing a behavior.  Buddy up when possible.  Have others also rearrange things  Write contracts with others.  Get stroked  Keep it positive  No guilt trips from others when you relapse.  Critical Assumptions  No single theory can account for behavior change!  Behavior change is a process  Stages are both stable and open to change!  Just like chronic behavioral risk factors  The majority of at-risk populations are not prepared for action!  Specific processes and principles of change should be emphasized at specific stages to maximize efficacy!  Health Promotion Program  How does this theory relate to:  Needs assessment  Conceptualization  Implementation  Evaluation  Needs Assessment  Individuals need to be staged.  The practitioners should have a set of questions that assist them to identify which stage an individual is in  Additional information should be collected at this time to gain insight on the processes and which ones are a better fit for the individual.  There is no set strategy for this – it can be done by a questionnaire you develop or through some interview process.  Conceptualization  There is no need to set goals and objectives for this type of program. Hopefully the main goal will be to progress through the stages.  It should be a very structured program  Examine the word file on the processes and you’ll see that using this theory is much like using a recipe to bake something.  Implementation  Once the stage is identified and you have a sense of the individual’s resources, you can fit the processes to assist change  This requires considerable preparation before working with the individual.  A lot of structure and preparation before you get to this point.  Evaluation- Two Things to Focus on  Is the individual making progress through stages?  You will need to make adjustments each time the person gets to another stage.  Is the goal to progress all the way through the stages or just make progress?  Summary  This is a cookbook approach to behavior change. It has been successful with smoking cessation.  Planning to use the theory is extensive and individuals usually progress better when they are grouped with individuals in the same stage as they are in. Health Belief Model  The Health Belief Model  The Health Belief Model (HBM) is a psychological model that attempts to explain and predict health behaviors by focusing on the attitudes and beliefs of individuals.  Since development the HBM has been adapted to explore a variety of long- and short-term health behaviors, including sexual risk behaviors and the transmission of HIV/AIDS.  This model emerged during the 1950’s and is one of the most frequently used models in practice.  Generally only some of the constructs are used. Three main concepts drive this theory with two concepts having multiple constructs.  1950’s Hochbaum and Rosenstock (USPHS) - work with tuberculosis. They primarily used two concepts perceived susceptibility and beliefs. Original work examine the constructs as discriminators regarding x- rays.  1970’s Haefner & Kirscht worked with physician checkups, adherence, medical regimens, and added perceived severity and anticipated benefits.  Health Belief- Original Model  Threat Perception  Perceived susceptibility  Anticipated severity of consequences  Behavioral Evaluation  Benefits of behavior  Barriers to enactment  Cues to action – triggers  Health Motivation  Concern about health  1970s- Model Refinement  Focus on:  Threat perception  Behavioral evaluation  Threat Perceptions  Threat perception constructs:  Perceived susceptibility to illness  Anticipated severity of the consequences of illness  Behavioral Evaluation Beliefs  Constructs:  Benefits of a recommended behavior  Barriers to enacting the behavior  Cues to action -- factors that trigger health behavior  Later constructs  Health motivation  Self-efficacy  Overview of HBM  Demographic Variables  Psychological Characteristics  Both impact on susceptibility, severity, motivation, benefits, and barriers.  These impact on action.  Cues to action act independently of other constructs.  Program Planning  Needs Assessment  Conceptualization  Implementation  Evaluation  Uses of HBM  Depends on the situation  Excellent for needs assessment  Good for conceptualizing the programs  Evaluation tool for impact is questionable due to evaluation issues.  Best for medical compliance and related treatment issues.  My recommendations (prof Khubchandani):  Best for:  Needs assessments  Focus groups  Conceptualizing a program  General Consensus  The basic constructs are very good for conceptualizing, but no consistency in how they should be used.  Recommend standard formula:  Use the approach adopted by Champion (1984)  Problems - she did not do motivation or self-efficacy  Research on HBM  All constructs generally have modest significance.  Harrison (1992) - meta-analysis  Order of significance in research:  Barriers -.21  Susceptibility .15  Benefits .13  Severity .08  Poor research on cues to action and health motivation.  Problems/Issues with HBM  Value expectancy model - - need to measure value of health behavior  Cognitive based and not emotion based  No clear operationalization instructions  No formulas for creating instrumentation  A lot of variability in interpretation and research  HBM- Application  Larson et al (1979).  Postcard reminders re: flu shots.  Neutral Card - focus - reminder of availability of vaccine. (25%)  Personal Card- signed by physician referred to them by name. (41%)  HBM card - emphasized risk & seriousness of flu, effectiveness of vaccine, low risk of negative side effects. (51%)  Control (no cards -20%)  Clearly tailoring the postcards with key concepts from HBM improved the response rates.  Health Belief Model Constructs  Perceived susceptibility  An individual’s assessment of his or her chances of getting the disease  Perceived benefits  An individual’s conclusion as to whether the new behavior is better than what he or she is already doing  Perceived barriers  An individual’s opinion as to what will stop him or her from adopting their new behavior  Perceived seriousness  An individual’s judgement as to the severity of the disease  Modifying Variables  An individual’s personal factors that affect whether the new behavior is adopted  Cues to action  Those factors that will start a person on the way to changing behavior  Self-efficacy  Personal belief in one’s own ability to do something  General limitations of HBM  Most HBM-based research has incorporated only selected components of the HBM, thereby not testing the model as a whole  As a psychological model it does not take into consideration other factors, such as environmental or economic factors, that may influence health behaviors  The model does not incorporate the influence of social norms and peer influences on people's decisions regarding their health behaviors (a point to consider especially when working with adolescents on HIV/AIDS issues). Theory of Reasoned Action  Theory of Reasoned Action  Develops numeric outcomes that allow individuals to determine the magnitude of effect.  This theory was designed to predict behavior.  “An individual is more motivated to perform a behavior that will result in an outcome that is highly valued.”  “When an individual does not believe that an act will lead to a specific outcome or, the outcome is not valued, the individual will be less motivated to perform a particular behavior.”  Belief about the behavior and/or evaluation of the behavior → attitude about the behavior → intention → behavior  Opinions of referent others and/or motivation to comply → subjective norm → intention → behavior  Behavior is best predicted by intent.  Intent is predicted by:  Attitude toward the behavior  Subjective norms toward the behavior  Attitude toward the behavior ↓  Intention → Behavior ↑  Person’s perception of relevant others  TRA- Specificity  The theory works differently for different behaviors.  For some behaviors, attitude will have greater ability to determine intentions  For some behaviors, subjective norms will have greater ability to determine intentions.  Influencing factors vary according to ethnicity, age, etc. - difficult to generalize  Purpose  TRA was designed to predict behavior.  True use requires measurement of behaviors and a repeat measurement no sooner than 6 months later.  Attitude Toward the Behavior  Key considerations:  Ability  Effort  Task difficulty  Antecedent Considerations  Two attitude constructs  Attitude - cognitive belief of:  Carrying out a behavior leads to a specific outcome  An evaluation of the outcome  need to measure both of these to determine attitude  Subjective Norm- person’s perceived expectation that:  One or more significant others think one should or should not perform the behavior  Motivation to comply with the behavior  Subjective Norms  Two subjective norm constructs  Determined by:  Normative beliefs  Motivation to comply with behavior  Issues of Control  Locus of Control  Beliefs regarding causation  Self-Efficacy  Confidence re: personal ability  These were not accounted for in the original model. This led to revisions and a new name.  Theory of Planned Behavior  This theory incorporated TRA and included a new concept with two constructs.  Perceived Behavioral Control:  Especially important in situations where the individual has incomplete volitional control  Can impact on behaviors through intentions or directly on behavior  TRA + Perceived Behavioral Control  Perceived Behavioral Control :  Control beliefs re: facilitating and/or obstructing factors  Perceived power relative to control factors that facilitate or inhibit performance of the behavior.  Perceived Behavioral Control  Composed of:  Control Beliefs  Perceived Power  Application  Steps:  Elicitation Studies - interviews and focus groups to clarify beliefs  Instrument Development - six groups of questions  Question Development  Use a 7 point Likert scale.  Group 1:  6-12 items whether actions will lead toward a specific outcome  Group 2:  6-12 items - how important is this outcome?  Group 3:  6-12 items -how others are perceived to feel about the behavior  Group 4:  6-12 items - is the individual motivated to comply with the behavior  Group 5:  6-12 items about control beliefs about performing the behavior  Group 6:  6-12 items about perceived power of being able to initiate the behavior  Application of TPB  Montano, et al. 1996 - Journal of Applied Social Psychology - Prediction of Condom Use Among High Sexually Transmitted Disease Risk Group  Groups at Risk  Those who use inject drugs  Men who have sex with men  Female commercial sex workers  Multipartnered heterosexuals  Instrumentation  Questionnaire Development  Structured around the main constructs within TPB  Semi-structured open-ended interviews  Open-ended questions re: factors that might affect condom use  Questions for questionnaire development  Attitude Construct - beliefs about outcomes or attributes of using condoms  Subjective Norms - people or groups the participant listened to about condom use  Perceived Behavioral Control - factors that made it easier or more difficult to use condoms The 5 A’s Model How Belief interventions can help?  The 5A Approach  Ask about patient’s habits.  Advise of consequence of smoking.  Assess willingness to quit.  Assist with cessation plan development.  Arrange for follow-up  The Approach for 5 A’s  Ask  Identify and document tobacco use status for every patient at every visit.  Advise  In a clear, strong, and personalized manner, urge every tobacco user to quit.  Assess  Is the tobacco user willing to make a quit attempt at this time?  Assist  For the patient willing to make a quit attempt, use counseling and pharmacotherapy to help him or her quit.  Arrange  Schedule follow up contact, in person or by telephone, preferably within the first week after the quit date.  Research  Brief cessation counseling session can improve cessation rates as compared to simple advice to quit  More intensive counseling has not been documented to increase cessation rates  Benefits of brief counseling effective in light to moderate smokers (less than a pack per day  Ask  Goal: Find out if the patient smokes and Systematically identify all tobacco users at every visit  Advise  Strongly urge all tobacco users to quit  Goal is to either:  Present compelling evidence about the importance of quitting  Encourage recent quitters to continue abstinence  Examples:  Appropriate:  “Ms. Smith, it is important for you to quit smoking. As your nurse, I need you to know that quitting smoking increases your chances of having a healthy baby. Your health will also improve...”  Inappropriate:  “Ms. Smith, you need to quit smoking.”  Create an Advise Statement  Maria is 19-year old woman with two children. She has smoked since she was 16 years old. She has indicated that she smoked with her first two children and “they are fine.”  Three Patient Types  Current smoker who wants to quit.  Recent non-smoker  Current smoker who does not want to quit.  Dealing With the Resistant Patient  Find out why patient doesn’t want to quit.  Emphasize risks of smoking.  Point out the rewards of quitting.  Discuss roadblocks and ways to overcome them.  Smoking Cessation Plan  Step 1. Identify why, common triggers, and major roadblocks.  Step 2. Identify rewards.  Step 3. Establish a quit date.  Step 4. Identify cessation method and coping strategies.  Step 5. Provide resources.  Arrange for Follow-up  For patient who has remained smoke-free, offer congratulations.  For patient who has relapsed, return to assist step in 5A approach.  Relapse Questions  What was the trigger?  When did the relapse occur?  What was going on in your life at the time of relapse?  Did you have a support person there?  What techniques did you try to help you work through the craving?  Would you like to set another quit date? Application of the SCM  Review: Behavior Models  The HBM, SCT, and the Trans Theoretical Model of change emphasize individual characteristics, skills, and proximal social influences such as family and friends, but do not explicitly consider the broader community, organizational and policy influences on an individual’s health behaviors.  The SCM goes a step ahead to explain individual behaviors not only based on individual characteristics, but also in terms of the broader community, cultural and public policy influences.  Review: Components of the HBM  Perceived Susceptibility: how likely do you think you are to have this health issue?  Perceived Severity: how serious a problem do you believe this health issue is?  Perceived Benefits: how well does the recommended behavior reduce the risk(s) associated with this health issue?  Perceived Barriers: what are the potential negative aspects of doing this recommended behavior?  Cues to Action: factors which cause you to change, or want to change (advertisements, warning labels, billboards)  Self-Efficacy: one’s “conviction that one can successfully execute the behavior required to produce the outcomes” (Bandura, 1977).  As the health concerns of the nation have shifted to lifestyle-related conditions, self-efficacy has taken on greater importance, both as an independent construct, and as a component of HBM  Example: Educating a Patient About Flu Vaccination  Questions that have influence on whether a patient will take your health advice or not:  How likely is it I’ll get the flu? (Perceived susceptibility)  How bad would it be? (Perceived severity)  How often do I hear warnings? (Cue to action)  How much will it cost and do I have time? (Perceived barriers)  How will vaccination influence my health? (Perceived benefits)  Ecological Models  Ecological Models, as they have evolved in behavioral sciences and public health, focus on the nature of people’s transactions with their physical and socio-cultural surroundings, that is, environments.  Ecological models can incorporate constructs from models that focus on psychological, social, and organizational levels of influences to provide a comprehensive framework for integrating multiple theories, along with consideration of environments and policy in the broader community.  Ecological Perspective  Core concept:  Behavior has multiple levels of influences, often including intrapersonal (biological, psychological), interpersonal (social, cultural), organizational, community, physical environment, and policy.  Four core principles of ecological models include:  That there are multiple influences on specific health behaviors (think of the levels).  That those influences on behaviors interact across these different levels.  That Ecological models should be behavior-specific, identifying the most relevant potential influences at each level.  That Multi-level interventions should be most effective in changing behavior.  In this model, individual level and many external influences are integrated in a single framework, making it clear that causation of behavior is widely distributed; not lodged in one or another source.  A central conclusion of ecological models is that it usually takes a combination of both individual-level and environmental/policy-level interventions to achieve substantial changes in health behaviors.  Ecological Model: Individual Responsibility & Human Dignity  Reframe behavior (Example: smoking and addiction)  Result of influences across diverse ecological layers rather than the responsibility of individuals  Raises interesting issues about the role of individual responsibility for change  One could view EM as “robbing the individual of dignity” by attributing their behaviors to a range of forces  One could also view the ecological perspective as removing an unreasonable attribution of responsibility to the individual—a sort of victim blaming—by recognizing that many forces shape human behavior  Ecological models can enhance human dignity by moving beyond explanations that hold individuals responsible for, and even blame them for, harmful behaviors.  Summary Points on Ecological Models  Ecological models help us to understand how people interact with their environments.  Can be used to develop effective multi-level approaches to improve health behaviors.  Basic Premise: Providing individuals with motivation and skills to change behavior cannot be effective if environments and policies make it difficult or impossible to choose healthful behaviors.  We should create environments and policies that make it convenient, attractive, and economical to make healthful choices, and then motivate and educate people about those choices.  How Ecological Model Makes Patient Education Challenging  Methodological challenges  Logistical challenges of conducting research and interventions based on EMs  There is a need to be creative and persistent in using ecological models to generate evidence on:  The roles of behavior influences at multiple levels;  On the effectiveness of multi-level interventions on health behaviors;  And to translate that evidence into behavior change and maintenance for improved health.  Operant Conditioning  Operant conditioning  Behavior is the product of experience with potential for reinforcement  Reinforced behavior tends to recur and unreinforced behavior tends not to recur.  Stimuli ( antecedent events)alert an individual to the potential for reinforcement  Stimuli elicit behavior to be undertaken to gain reinforcement  Unlike animals, people employ cognitive processes in evaluating stimuli and consequences  The goal of operant conditioning is self-regulation of goal-directed behavior  SCT integrates elements of cognitive and operant theories.  Reciprocal determinism is the dynamic feedback system for the self- regulation of goal directed behavior.  “Learned” helplessness—people quit trying for lack of reinforcement  Addiction—the addict enters a spiral of use that creates need that can only be satisfied by need  Depression—a person’s negative thoughts and affect can be debilitating and self-defeating.  Self-Regulation  Self-regulation is the process by which people manage their own goal- directed behavior; reconciling immediate with long term goals  Self-regulation is about behaviors that are under one’s control and directed towards achieving personal goals  To understand human behavior, we need to know the goal behind the behavior  Self-regulation means self-management and self-control  Lack of self-regulatory skills renders individuals susceptible to external environmental conditions, and to self-destructive impulses  Social Cognitive Theory (SCT)  SCT suggests that the variability in response to stimuli is partially due to individualized goals  That people are self-directed according to their goals and manage their behavior and their environment accordingly  Therefore people interpret and respond to stimuli according to their individual goals or values  Health professionals need to know:  How behavior is influenced by reinforcement;  How stimuli elicit behavior responses  Self-regulatory processes are cognitive  SCT extends operant conditioning theory to the important individual and social influences on goal-directed and self-regulatory behavior.  The goal of SCT is to explain how people learn from experience and regulate their own behaviors  SCT provides a comprehensive conceptual framework that describes the dynamic interrelationship of self-regulatory processes involved in goal-directed behavior  This theory is at the core of maintaining behavior change as the goal of health promotion for individuals and communities—from the perspective of self-regulatory behavior  The central concept of the SCT is reciprocal determinism—the person, behavior and environment interact  Reciprocal Determinism  Posits that the person, behavior and the environment interact  That each influences the other in a dynamic, reciprocal fashion  That such influences facilitate self-regulation and goal directed behavior  That cognitive and environmental constructs govern self-regulatory behaviors  Cognitive Processing of the Environment  The environment and behavior interact, but there is substantial individual variability in how individuals react to the environment  The environment provides opportunity for behavior and feedback when behavior occurs.  Behavior alters the environment  Individuals evaluate their environment for possible stimuli and evaluate the consequences of their behavior based on past experience  Individuals react uniquely based on individual preferences, and process information quickly to make decisions  Bandura suggests that generalized expectations are a primary cognitive mechanism by which stimuli are evaluated and by which self- regulation occurs  People are ever thinking about general ideas or expectation about the potentials for reinforcement  General ideas are based on memories of past experience, and these quickly determine how it fits into the current situation with potential reinforcement  The concept of generalized expectancies provide an explanation for how people cognitively evaluate reinforcement potential of stimuli. Expectancy Theories  Fishbein & Ajzen’s TRA  What is the main idea of this theory?  Behavior is not only dependent upon knowledge and beliefs, but also specific attitudes.  Emphasizes that attitudes people hold toward a behavior (object) predicts whether a person intends to do a behavior.  Thus, TRA, is really a modification of HBM and Field Theory.  What are the theory constructs?  Attitude toward the behavior—that doing a behavior results in a certain outcome (behavioral beliefs), and that there is a value in that outcome (evaluation)  Subjective norms—that people approve or disapprove of the behavior (normative beliefs), and that it is important to the person to conform to the norm (motivation to comply)  Ajzen’s TPB  Theory of Planned Behavior is simply TRA with another construct:  Perceived Behavioral Control: Belief that one has, and can exercise, control over performing the behavior.  Other key definitions:  Inhibiting factors—factors that may inhibit performance of the behavior.  Facilitating factors—any actual or perceived external factor that increases the likelihood of the occurrence of the behavior in question.  Perceived power—pertains to the strength of the facilitating and inhibiting factors.  Fisher & Fisher’s IMB  Information-Motivation-Behavioral Skills Model (IMB)  What are the key constructs?  Information  Motivation—embodies a range of perceptions related to the behavior in question  Behavioral skills—(think of self-efficacy*); an integration of both actual skill and self-efficacy  One’s confidence in one’s ability to take action or to change a health- related behavior; a task-specific self-perception of one’s personal ability  General Thoughts  What’s the most important thing to look at across all of these theories and why?  Knowledge  Do the theories presume that people act “rationally” based upon this knowledge?  Do these theories presume that behavior is rational once you understand an individual’s valences (i.e., beliefs, attitudes, etc)?  What kinds of behaviors are best predicted by these theories?  Behaviors that are under strong voluntary control  What kinds of behaviors are not as well predicted by these theories?  Behaviors that are not under an individual’s volition, because people may want to do a behavior, but other factors besides benefits/barriers may be an influence. Social Cognitive Theory  Introduction  Behaviorism  Behavior is a result of stimulus  A stimulus can be conditioned  Pavlov (Classical Conditioning)  Form of learning in which one stimulus, the conditioned stimulus, comes to signal the occurrence of a second stimulus, the unconditioned stimulus (US). The US is usually a biologically significant stimulus such as food or pain that elicits a response from the start; this response is called the unconditioned response (UR). The CS usually produces no particular response at first, but after conditioning it elicits the conditioned response or CR.  B.F. Skinner  Behavior=Consequences for response  Operant Conditioning  Form of learning in which an individual's behavior is modified by its consequences  Albert Bandura  SLT  SCT  Social Learning Theory (SLT, Bandura 1977)  Social learning relies on observation, and observational learning governed by 4 processes:  Attentional—determines what is selectively observed  Retentional—determines what is remembered  Motor reproductive—converting symbolic representations into appropriate actions  Motivational—relates which observationally learned responses will be perfected  Reinforcement influences observational/social learning through anticipation rather than just antecedent reward (Skinner).  Social Cognitive Theory (SCT, Bandura, 1986)  Based upon social learning theory  Introduced cognitive psychology regarding learning from observation, experience and communication  What is the main idea of SCT?  Reciprocal determinism (Reciprocal Triadic Causation) between people and their environments—specifically—personal, behavioral, and environmental influences.  Back to Reciprocal Determinism  A change in any one can produce change in other  How is this so?  Strengths vs. Limitations  SCT is very broad and ambitious, in that it seeks to provide explanations for all human phenomena  Because it is so broad, it has not been tested comprehensively in the way that other HB theories have been  Self-efficacy: has been repeatedly validated  Work that is informed by other theories and conceptual models may be enhanced by incorporating SCT concepts and principles  SCT: Key Concepts  Reciprocal determinism  Environmental factors influence individuals and groups, but individuals and groups can also influence their environments and regulate their own behavior  Outcome expectations  Beliefs about the likelihood and value of the consequences of behavior choices  Self-efficacy  Beliefs about personal ability to perform behaviors that bring desired outcomes  Collective efficacy  Beliefs about the ability of a group to perform concerted actions that bring desired outcomes  Observational learning  Learning to perform new behaviors by exposure if interpersonal or media displays of them, particularly through peer modeling  Incentive motivation  The use and misuse of rewards and punishments to modify behavior  Facilitation  Providing tools, resources, or environmental changes that make new behaviors easier to perform  Self-regulation  Controlling oneself through self-monitoring, goal-setting, feedback, self-reward, self-instruction, and enlistment of social support  Moral disengagement  Ways of thinking about harmful behaviors and the people who are harmed that make infliction of suffering acceptable by disengaging self-regulatory moral standards Social Support and Social Networks  Social Support  Lots of considerations to be made as you explore patient needs:  Who is giving the support?  What kind of support is provided?  To whom is support provided?  For what kind of problem?  For how long?  How does social support affect your health?  Main effect: support enhances your health overall, irrespective of stress because it increases self-esteem, stability, control over your environment, availability of resources, et cetera.  Buffering effect: support protects people from harm in the presence of stress by either increasing coping or reducing the perception of stress.  Social Networks & Social Support  Structural support = social networks  Social networks: looks at the quantitative characteristics of interactions with people in the social environment  How many people are available to you?  What do they have to offer?  Reciprocity: resources that are given and received between people  Intensity: emotional closeness between people  Complexity: number of functions served by relationship  Formality: extent to which social relationships exist in the context of the organizational or institutional roles  Density: number of people within network  Homogeneity: similarity of people in network  Geographic dispersion: proximity of people in network  Directionality: members share equal power and influence  Social support: also looks at the qualitative (emotional, instrumental, informational, and appraisal) aspects of interactions with people in the social environment  Emotional  Instrumental  Informational  Appraisal


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