Health Psychology Chapter 4
Health Psychology Chapter 4 Psyc 3128
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This 12 page Class Notes was uploaded by Maya Blair on Saturday February 6, 2016. The Class Notes belongs to Psyc 3128 at George Washington University taught by Thomas Nassif in Winter 2016. Since its upload, it has received 146 views. For similar materials see Health Psychology in Psychlogy at George Washington University.
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Date Created: 02/06/16
CH 4: THEORIES AND MODELS OF HEALTH BEHAVIOR CHANGE SECTION I: THEORIES AND MODELS OF HEALTH BEHAVIOR CHANGE Expectancy Value Theory (EVT) Originally developed to explain human behaviors Health psychologists adapted it to explain health behaviors A cognitive process whereby an individual assesses behaviors and evaluates consequences (1975) Individuals assigned a positive or negative value to the outcomes → based on past experiences 2 Forces Motivate Behavior 1. Anticipated/expected outcome of behavior 2. Value assigned to the outcome (consequence) Example ● Eddie enjoys smoking, especially “social smoking” ● Therefore he assigned a positive value to smoking ● EVT might predict that Eddie would continue smoking Author Defining Features Limitations Fishbein & Ajzen, 1975 Two forces motivate behavior: Cannot explain effects of multiple factors on behavior (ex. social 1. Anticipated/expected outcomes of influences like Eddie’s friends) the behavior 2. Value assigned to the outcome The matching law proposed to address the EVT’s inability to account for more than 1 factor Decisions to engage in specific behaviors are influenced, in part, by reinforcements for the intended behavior as well asreinforcements for alternate behaviors If the reinforcement for an alternate behavior is greater than the reinforcement for the intended behavior, then the likelihood is greater that an individual will perform the alternate behavior In essence: researchers question whether EVT with matching law adequately explains behaviors. BUT they accept that some concepts included in EVT are important determinants and should be integrated into other theories Social Cognitive Theory (SCT) Learning Processes Learned behavior consequences Individuals learn from the consequences of their behaviors Cognitive processes are critical to the acquisition and regulation of behaviors Consequences communicated through “response information” cues that are acquired in one of four ways 1.)Direct Experience ➢ Individual engage in a behavior that results in a specific behavioral outcome ➢ Ex. Touching a hot stove → negative outcome conveys info to the person about their behavior ➢ Pairing occurs as a conscious effort by the actor. NOT automatic 1 2.) Vicarious Experiences ➢ Learning can occur as a result of observing the outcomes of another individual ➢ Ex. Witnessing someone else touch a hot stove → learn from their experience that a hot stove causes pain 3.) Persuasory Learning ➢ Learning that occurs from the judgements expressed by others about specific behaviors ➢ Requires no action on anyone’s part ➢ Wholly cognitive learning process ➢ Ex. We may never experience lung cancer that resulted from longterm smoking, but we credit the judgement of the experts who tell us that lung cancer is a possible outcome from smoking 4.) Inferred learning ➢ Learning derived from a person’s own knowledge ➢ Application of logic or rules allows individuals to posit an outcome w/o having to engage in the act ➢ No action is required ➢ Cognitive processes of deduction allows us to derive a set of probable behaviors and their corresponding outcomes based on our knowledge of both the behaviors and our application of rules Mirror Neurons Neurons in the frontal lobe that fire when performing certain actions or observing others perform those actions Enable imitation and empathy Underlie humans’ social nature Albert Bandura’s Bobo Doll Experiment (1961) Kids saw adults punching an inflated doll while narrating their aggressive behaviors such as “kick him” These kids were then put in a toydeprived situation...and acted out the same behaviors they had seen SelfEfficacy 5th critical component of Bandura’s theory Defined as a person’s conviction that his or her actions will produce the expected outcomes Will we be able to perform this task? A strong belief in our ability to perform a behavior will increase the probability of performing the behavior Serious doubts about the ability to perform a specific behavior will almost certainly result in the behavior not occurring 2 3 Dimensions of selfefficacy 1. Magnitude : referring to the level of difficulty 2. Generality : the level of mastery needed to accomplish a specific task 3. Strength : meaning the strength of the expectation (weak or strong) Selfefficacy concept is compelling and appears to be an important factor in determining behaviors. Strong correlations between selfefficacy and behavioral outcomes Limitations: Reciprocal Determinism Principle problem with SCT is the inability to test the concept of reciprocal determinism Reciprocal determinism states that behavior must be viewed in the context of environmental events (E) and personal factors (P) that influence behaviors (B) Bandura proposes that each of these variables interact significantly with the other 2 E influences P; P influence E P influence B; B influence P B influence E; E influence B Because of the simultaneous interaction of all 3 variablesdifficult to isolate one (ex. environment and test its effect on the other two) Bandura, 1977 Individuals learn from cognitive assessment and Reciprocal determinism (RD): consequences of behavior using 4 cues: Behavior viewed in context of environmental 1. Direct experience factors, personal factors, and behaviors 2. Vicarious experiences 3. Persuasory learning No way to test RD 4. Inferred learning Selfefficacy is critical to learning In essence: SCT of behavior is compelling conceptually but difficult to test. However, selfefficacy supported/included in other theories/models of health behaviors, & can be tested. Theory of Planned Behavior (TPB) Builds on an earlier theory known as the theory of reasoned action (TRA) Theory of Reasoned Action States that an individual’s behavior is determined by his or her intentions Behavior/intention and expected outcome determined by: 1. Attitudes about the behavior (positive/negative) 2. Subjective norms (normative behavior of peer group) Does not suggest that attitudes influence subjective norms or viseversa 3 Rather attitudes and subjective norms appear to independently influence behavioral intentions, which then influence actual behaviors Ex: Intention to text & drive influenced by 1. Attitude: if texting while driving, behavior is influenced by expected outcome (no accident) and positive attitude behavior 2. Subjective norms : behavior influenced by what other influential members of social group think of the behavior Limitations of TRA ● Intended to predict only volitional or intentional behavior ● Cannot explain addictive, habitual, or involuntary behaviors ○ Unable to explain large percentage of frequently occurring behaviors ● Studies testing explanatory power of TRA produced Similarities between Expectancy Value Theory and Theory of Reasoned Action EVT identifies anticipated outcomes and values as determinants of human behaviors TRA identifies attitudes and subjective norms as the principal factors influence behaviors Yet attitudes and behaviors reflect values and values are influenced by subjective norms Support for the TRA is mixed: most research supporting TRA focuses on the ability of the theory to predict the intention to act but not the actual behavior Criticism: If according to the TRA, intentions determine behaviors, then the theory cannot explain addictive, habitual, or involuntary behaviors Spontaneous behaviors (brushing teeth w/o though) cannot be explained b/c intent assumes some level of thought and purposefulness Theory of Planned Behavior Includes the concept of perceived behavioral control to account for nonvolitional actions Suggests that peoples’ belief that they possess the resources and the opportunities needed to perform a behavior is directly related to their perceived control over their behavior The greater the perceived behavior control, the greater the likelihood that the behavior will be performed Behavioral intention/behavior influenced by: 1. Attitudes 2. Subjective norms 3. Perceived behavioral control Once again, all independently influence behavioral intentions and ultimately influence one’s actual behavior 4 TRA Behaviors determined by intentions Cannot explain spontaneous, involuntary, habitual behaviors Ajzen & Fishbein, 1980 Intentions influenced by: 1. Attitudes about behavior 2. Subjective norms TPB Behaviors determined by intentions Proposed to account for nonvolitional acts, a correction of Ajzen (1985) Intentions influenced by: TRA 1. Attitudes about behavior Maintains that attitudes and subjective norms remain 2. Subjective norms influential factors in determining behavior 3. Perceived behavioral control Cannot account for spontaneous, habitual, or unplanned behaviors Perceived behavioral control very similar in concept to selfefficacy Not a limitation, but an adaptation In essence: TRA and TPB identify 2 constructs that contribute to explaining human behavior. Also rely heavily on selfefficacy as a determinant of behavior. To explain spontaneous, habitual, or unplanned behaviors, we must turn to other models and theories Health Belief Model (HBM) Examines the motivational factors specifically associated with health behaviors Introduced to understand why and under what conditions a person uses preventative health services Model seeks to explain the preventive health behaviors of persons who believe they are healthy and who attempt to maintain that stage by preventing disease or by detecting and treating a disease in its earliest, asymptomatic stages Goal coincides with the public health goals of prevention, early detection, and disease control Attempts to explain and predict an individual’s health behavior using the individual’s own subjective frame of reference → considered a p sychosocial model Subjective focus in 5 key concepts used to explain health behaviors 1. Perceived susceptibility → Both to the perceived threat of a disease 2. Perceived severity → 3. Perceived benefits → Both directly affect the likelihood that a person will take action 4. Perceived barriers → against the disease 5. Cues to action 5 Perceived Susceptibility and Perceived Severity Perceived susceptibility degree to which an individual feels at risk for catching a disease or illness Perceived severity perception of the seriousness of a disease also varies by person; subjective value Refers to more than just the impact of the disease on a person (ex. loss of eyesight isn’t just no vision, it most likely will also impact your daily activities, functions, and responsibilities) Shaped by 2 factors: emotional response to the illness and perceived impact on the person’s life ***When combined, a perceived high susceptibility to and a perceived high severity to the disease should result in a strong perceived threat of the disease, perception that should lead to action Perceived Benefits and Perceived Barriers Help individuals transition from potential to actual behavior change Perceived Benefits Perceived physical benefits of performing health behavior Perceived psychological benefits of preventing onset of illness Perceived Barriers As any impediment, real or perceived, that prevents an individual from performing activities that would be beneficial to their health Includes tangible factors such as money, time, and effort Includes psychological factors such as stigma or a negative response from peers Cues to Action Prompts an individual to act when several conditions are met: Person perceives that they are susceptible to a disease Person views the disease as serious Person positively views the benefits to action Identifies few if any barriers to action Cue can be tangible or visible (physiological reaction or symptom of illness) Cue can be environmental (advertisement or other stimulus external to the individual that may evoke action) SelfEfficacy A person’s conviction that his/her actions will produce the expected outcomes Our strong belief in our ability to perform a behavior will increase the probability of performing it Efficacy expectations vary on 3 dimensions 1. Magnitude (level of difficulty) 2. Generality (level of mastery needed to accomplish a task) 3. Strength (weak or strong expectation) Rosenstock, Strecher, & Motivational factors that influence Limited ability of some concepts to explain behavior Becker (1988) health behaviors and health care Perceived barriers strongest in explaining preventative seeking sare behaviors and health care seeking behaviors 1. Perceived severity Perceived suceptibility explained only preventive health 2. Perceived susceptibility behaviors 3. Perceived benefits Perceived benefits explain only health care seeking 4. Perceived barriers behaviors Selfefficacy added as fifth factor Perceived severity explained little in terms of health behaviors Selfefficacy remains strongest concept in explaining behaviors 6 Transtheoretical Model of Behavioral Change (TTM) Explains change as a process, not an event (IMPORTANT DISTINCTION) Change takes place over time Stage model → each stage of change is completed before moving to the next or more advanced level Person must be READY for change...successful behavioral outcomes are more likely when people, and programs, carefully consider a person’s level of readiness for change 5 stages 1. Precontemplative Stage Characterized as the “notreadyforchange” stage Not thinking about change 2. Contemplative Stage Signals the beginning of the change process Person is thinking about change but no action is involved Weight the benefits of the changed behavior against the barriers to change 3. Preparation for Action Signals a readiness to change behaviors Plans the activities needed for change 4. Action Stage Time to enact the plan and perform the new health behavior Highly active stagemust work to adhere to the new behaviors Constant monitoring and attention to the new behavior Active resistance against old behaviors Usually lasts about 6 months in order to solidify the behavior 5. Maintenance Stage Requires less active monitoring and attention By this time, individual has adopted the new behavior Regressing back to old behavior is called recidivism 6. Recidivism (NOT a formal stage) Part of the process of change, although not a formal stage 6th stage: recidivism is included to reflect the process of failure to maintain the new behavior Individuals may revert to the action stage, the preparation for action stage, the contemplative stage, and finally the precontemplative stage People approach the process of change from different starting points 7 Decisional Balance and Situational SelfEfficacy Decisional balance pros and cons Situational selfefficacy influences the likelihood that an individual will be effective in planning and performing the new behavior Prochaska & DiClemente (1983) Change is a process that includes: Fails to weigh effects of factors other than 1. Precontemplation individual in process of change 2. Contemplation 3. Preparation for action 4. Action 5. Maintenance Recidivism explains setbacks To recap 1. Expectancy Value Theory (EVT) *13 explain general human behavior but have 2. The Theory of Planned Behavior (TBH) been adapted to explain health behaviors 3. Social Cognitive Theory (SCT) *4 & 5 were developed specifically as health 4. The Health Belief Model (HBM) behavior models 5. Transtheoretical Model of Behavior *Selfefficacy, in addition to attitude toward the Change (TTM) behavior, subjective norms, barriers to action, and readiness for change seem to be strong predictors of behavior change SECTION II: SOCIAL MARKETING: A TECHNIQUE TO PROMOTE BEHAVIOR CHANGE Using commercial marketing techniques to change behaviors for a social good Encourage an audience to adopt an intangible idea or a belief that will lead to behavior change Goal to produce social change by causing outcomes that will benefit the individual, and by extension, the society Social Marketing ➢ Social marketing is the use of marketing techniques to solve social and health problems ➢ Develop promotional efforts designed to get individuals to change highrisk health behaviors ➢ Health products need to be attractive, reasonably priced, and readily available The Marketing Exchange ➢ Marketing : a series of steps that are directed at need and want satisfaction by consumers ○ Need: a condition where there is a deficiency of something ○ Want: requires a wish or desire for something useful ➢ As long as a need is being satisfied in exchange for something of value, the marketing process has occurred The Four P’s of Marketing Promotion Product Place Price Select target audience No tangible product to sell Location for gaining access to the tools needed to Tangible Appeal to specific Product = desired outcome perform the new behavior costs (price, demographics or behavior Includes modifying behaviors Should be sustainable, creative, & compete w/ distance, time) (ex. dietary habits) campaigns marketing bad behaviors 8 characteristics of that specific Includes new behaviors (ex. Once motivated to adopt a new behavior, the target Intangible audience exercising) audience needs to know where to obtain the product, costs Will attract and retain their To reinforce behaviors, social materials, or services to assist them in performing (emotional or attention marketers must associate an the new behavior social price) Will motivate them to intangible concept with a initiate tangible symbol that evokes the Distribution channel place that distributes the the intended behavior concept → symbol will serve as product. A good channel would minimize barriers to Market segmentation a reminder performing behavior (ex. not out in the open) Ex. logos or slogans Blended Models Integrating or combining two models or approaches to achieve a desired behavior change Allows for psychologists to put forth a compelling combination of a theory and an implementation strategy that could lead to successful and longterm behavior change Social market includes a message and a program Social advertising includes a message but no program 3 Reasons Why Social Marketing Approaches are Less Successful Than Commercial Marketing Campaigns 1. Immediate gratification a. Commercial marketers = immediate gratification (ex. buying a cellphone) b. Social marketing = delay gratification (must wait for positive outcomes) 2. Tangible item 3. Impulse a. Commercial marketers = an attractive, wellpromoted garment or jewelry that can be acquired easily may lead to an impulsive purchase b. Social marketers = cannot rely on impulse SECTION III: THE ECOLOGICAL APPROACH TO HEALTH: FACTORS THAT INFLUENCE HEALTH BEHAVIORS Factors that influence individual health outcomes, including the individual, culture/social networks, the environment, health systems, and health policy Brand ➢ Give the public health product a personality that is acceptable to the consumer ➢ Build a relationship with the target market ➢ The image is the visual symbol of the product that aids in the needs satisfaction of the target audience Individual Factors Focusing here on the characteristics that are beyond our control or difficult to change Ex. Gender, age, ethnic or cultural group Gender and HealthSeeking Behaviors Gender norms shaped by society and may vary by family, cultural heritage, and country of origin HOWEVER, some similarities with respect to gender roles and health behaviors across cultures, as demonstrated by research 9 Healthseeking behaviors actions taken to obtain guidance or assistance with healthrelated issues Have a direct impact on the quality of an individual’s health status Boys less likely to seek out health care services than girls Reasons: Men ignore health symptoms, thinking they will go away if ignored Not recognizing the symptoms Believing a man would appear weak or non masculine if seeking medical care Some studies attribute the difference to gender socialization which subtly discourage health seeking behaviors among men (social norms) Multiple Influences on HealthSeeking Behaviors Ex. looking at culture & gender as contributing to the lower rate of healthseeking behaviors among men One study found that gender, age, and ethnicity all interact and contribute to healthseeking behaviors Knowledge and HealthSeeking Behaviors Individuals need accurate information about the health risks associated with their behaviors to adopt healthy actions Ex. If you think smoking “light” cigarettes are better for you, you may be less likely to seek help Information (knowledge) alone does not always result in changed behaviors Ex. Individuals often override knowledge to continue engaging in unhealthy behaviors Ex. Individuals would not consistently use nutritional information on restaurant menus even though they indicate an interest in having the information In some instances, knowledge about a health issue may be secondary to practical social, socioeconomic, or cultural barriers Cultural and Social Networks Different perceptions of illness, alternative forms of treatment, and alternate sources of care among some cultural groups will influence a person’s likelihood of seeking health care Peer Groups and HealthSeeking Behaviors Much work focuses on the effects of peer groups on encouraging or discouraging substance use as well as risky sexual behavior Acculturation the adoption of behaviors and values of a majority group Studies suggest that individuals who are influenced by the norms and behaviors of the dominant culture group in their communities attempt to imitate the same behaviors The greater the attempt to acculturate to the dominant culture, the greater the likelihood of experimenting with substances Media and HealthSeeking Behaviors Massmedia advertisements can effectively shape behavior Can shape both positive and negative health behaviors Positive found older women responded more positively than young women to mass media appeals for breast cancer screening Negative 10year campaign by cigarette manufacturers to promote cigarette smoking in the military 10 Physical Environment Environmental contamination → health consequences to individuals Environmental contaminants caused by human behaviors that changed or altered the environment Clean Air and Water Acts Efforts to correct harmful effects on the environment due, in part, to humans Clean Air Act of 1970 established National Ambient Air Quality Standards (NAAQS) designed to protect both the environment and the health of the public Clean Water Act of 1977 Both regulate the quality, type, and frequency of pollutants that can be released by industry into the air and water, respectively Both administered by the US Environmental Protection Agency (EPA) Goal: to protect valuable environmental resources, they also ensure clean water and air for human consumption Kyoto Protocol agreement among nations to reduce greenhouse gas emissions (37 developed nations, NOT including the US) Superfunds Superfund a program administered by the federal government to clean up hazardous waste sites Superfund sites identify areas where there is toxic waste from various industries Toxic waste is not only an environmental pollutant but is also causing human health problems Health Systems Health systems regulate the type of services available to their members Limited access to care is one of the factors contributing to the current crisis in the US healthcare system Access to care = the means to afford health care or having a person responsible for one’s medical care needs Underinsured health care insurance not adequately covering medical needs Socioeconomic status and ethnicity also likely to contribute to limited access to care Problems in US health system which have been shown to inhibit healthseeking behaviors 1. Inability to pay for needed medical care at the time of service ➢ Causes people to postpone care for otherwise treatable illness → more health problems ➢ 3x more likely to experience adverse health outcomes ➢ 4x more likely to experience p reventable hospitalizations 2. Access to medical care provider ➢ People w/o primary care provider are likely to delay needed treatment ➢ May end up seeking treatment from emergency service centers (more costly & less effective) When care is unavailable (may take weeks to schedule an appointment) or inconvenient (clinics only open during working business hours), people often choose one of two options: Find alternative sources of care (ex. hospital emergency departments) Forego care entirely 11 Health Policy Health policy involves another form of regulation: government regulations intended to improve the overall health of a community, region, or nation Smoking and Health Policy 1998 US federal gov. ban on smoking on all domestic airline flights 2000 extended ban to include international travel on US carriers Some states regulate or restrict smoking in restaurants, movie theaters, workplace, and even in bars Studies linking secondhand smoke as a health hazard to the public has lead to health policy aimed at improving the outcomes, the primary goal of health policy initiatives Nutrition and Health Policy From 2002 2013, NYC banned soda, candy, and sugary snacks from vending machines in schools This health policy was developed to reduce negative health outcomes among schoolchildren and other urban areas SECTION IV: CHALLENGES TO SUSTAINING HEALTH BEHAVIOR CHANGE Short versus LongTerm Adherence Average duration for new health regimens is about 6 months Challenges to longterm change include: Selfefficacy needed to perform behavior Temptation from environment Emotional or psychological dependence on old behaviors Change in lifestyle is needed for long term adherence The Appeal of Unhealthy Behaviors Advertising agency craft marketing messages that are very persuasive Candy bars at checkout line are there for a reason! 12
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