KNES 400: Foundations of Public Health
KNES 400: Foundations of Public Health HLTH 377
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This 5 page Class Notes was uploaded by Victoria Dassing on Sunday October 2, 2016. The Class Notes belongs to HLTH 377 at University of Maryland taught by Jenna Beckwith in Fall 2016. Since its upload, it has received 39 views. For similar materials see Human Sexuality in Health Sciences at University of Maryland.
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Date Created: 10/02/16
Behavioral Models and PA: T argeting the Individual Monday, August 29, 2016 11:20 AM I Theoretical Frameworks a What are they for? i Help predict specific outcomes ii Help us interpret or understand a situation or problem iii Help us answer why and what can be changed b Often abstract and applicable to a broad range of situations c There are also theories that help explain behavior at specific levels i Cognitive-behavioral theories ii Political economy theories iii Social/cultural theories II Psychological behavior changing theory a Behavior change due to conditioning through a process of reinforcement and punishment i Does not include free-will ii Humans are not robots II Dominant Theories: "Cognitive-Behavioral" a Behavior is mediated by cognitions i What people know and think affects how they act ii Knowledge is necessary for, but not sufficient to produce, most behavior changes iii Perceptions, motivations, skills and the social environment are key influences on behavior II Key Cognitive Behavioral Theories a Health Belief Model (HBM) i Used to explain individual decision-making 1 Question: why aren't more people making use of our preventive programs? 2 Ex. Free tuberculosis testing at home (by service truck) that many people did not use ii 6 Main Constructs 1 Perceived susceptibility 2 Perceived severity 3 Perceived benefits a Is the screening effective? 2 Perceived barriers 3 Cue to action 4 Self-efficacy (later added) ii Central Focus: Health Motivation: why people take action to prevent, screen for or control illness conditions iii HBM Components and Linkages 1 Individual perceptions: perceived susceptibility and severity of disease ii Example: Hypertension -risk for stroke 1 People don’t get screened because there are not many symptoms 2 Individual perceptions: a Do people understand hypertension could lead to stroke? 2 Likelihood of Action a Perceived benefits of PA a Perceived barriers to PA b Likelihood of taking preventative health action c Perceived self-efficacy 1 Modifying Factors a Demographic: i Age ii Gender iii Social iv Psychological b Cues to action i Mass media campaigns ii Advice from others iii Illness of family member iv Physician's explanation a Theory of Planned Behavior i Behavior intention: viewed as most immediate determinant of behavior 1 Attitude toward behavior a Belief about what behavior entails and if it leads to certain outcomes b Evaluation of behavior outcome 2 Subjective norm a Normative beliefs b Motivation to comply 2 Perceived behavioral control a Control beliefs b Perceived facilitation ii Example: physical activity in pregnancy 1 Dominant advice a Engage in moderate physical activity - if low risk pregnancy 2 Very low compliance to advice to engage in physical activity throughout pregnancy 3 How might TPB explain intensions to exercise in pregnancy, as well as intentions to rest in pregnancy a Women's attitudes towards PA DECREASED b Women's attitude toward rest INCREASED c In all groups : i Subjective norm ii Perceived behavioral control iii Intention ii Example: Concussions 1 Found all the athletes were educated on the dangers of concussions, along with the symptoms 2 Athletes attitudes wouldn't report their concussions due to SUBJECTIVE NORMS a Don’t want to let teammates down b Cultural norm c Coaches response i If they knew they wouldn’t be punishment, they were more likely to report concussions Behavioral Models and PA (II): Adding Complexity - Habitus & Concerted Cultivation Wednesday, September 28, 2016 11:01 AM I Models do not change behavior a It can change individuals' intentions, but does not carry into actions b Helps shape people's II Critiques of Cognitive Behavioral Theories a Place undue emphasis on rationality and conscious weighing up costs and benefits in decision making i We are not always rational individuals ii What about emotional and spontaneous aspects of decision making? 1 Mood disturbance 2 Pleasure seeking behavior a Avoiding pain of exercise b Thrills of seeking through risky b Dual Process Models i Reflective System: rational, thinking side 1 Reasoning: weighing personal knowledge 2 Intention: decide to follow through on something 3 Start behavior: begin decision 4 Happens when you have more time ii Impulsive System 1 Positive a Positive valence: "runners high" b Joy : enjoying 2 Negative a Exhaustion : not b Pain 2 More distracted -- no time to reflect II Example: Nudging a Organ Donation i Nudging includes intending to sway individuals' minds, but they still have the option to make a CHOICE ii The countries with high level of organ donation 1 Have a big uppercase, boldprint box with YES 2 Have a little, lowercase, box with no b Nudging in HS i If you participate in physical activity class, you get 3 points added onto KNES360 b Nudging and Stairwalking i When cool stickers with pictures b Nudging in Physical Activity i Workplace wellness programs 1 Participation based a Incentives to participate in health fairs b Reimbursement for gym membership 2 Standards-based a Waive annual deductible for employees who have BMI within certain range b Premium discount for those who meet exercise targets II Critiques of Cognitive Behavioral Theories a Reductionist i Tend to describe behavior in isolation of social and cultural context ii Not enough attention to processes of socialization through which habits and predispositions to act developed iii Ex. Women smoking 1 Single, lower class women smoke while knowing it is unhealthy because it is something in their life they have control over -- it is an opportunity to take a break b Working Class Men i Short-termism 1 Strong present time orientation 2 Reluctance to plan for the future ii Health is a matter of luck 1 messages but base assessment on personal experiences and life circumstances, viewing health as something not in their control ii Health is release 1 Relaxing control/escaping from discipline of work and everyday life a Alcohol, smoking, drugs, fatty foods b Social capital linked to consumption of these leisure pursuits II Critiques of Cognitive Behavioral Theories a Based on middle class norms and sensibilities especially with regards to "agency" i The dominant view of agency is one of independence, control, and acting on the environment b Ex. Hurricane Katrine - Why did they "choose" to stay? i Interviewers with survivors: found that leavers and stayers relied on divergent models of agency 1 Leavers emphasized independence, choice, and control a Predominantly middle class b "Disjoint model of agency" = good action are those that emanate from within individual and act upon environment 2 Stayers emphasized interdependence, strength, and faith a Predominantly lower income b "Conjoint model of agency" = good actions are those that adjust to the environment and promote independence with others b Models helps limit health disparities II In-Class Video: Subway Stairs a Made stairs a fraction of an inch higher than the rest of stairs b People tripped while walking up the stairs c The stair structure is embodied within us d Relates to socialism, which is embodied within us, and oftentimes unconsciously II Habitus - Embodied Social Knowledge a "Functions as a collection of perception, tastes, preferences, appreciations, and actions; forming a way to perceiving the world and distinguishing between appropriate and inappropriate activities" manifested in lifestyle "choices" b Reflects where and how we grow up c Ex. Wine, budweiser, and kraft beer --> boater, ATV, bikers i Our "tastes" or preferences that are the basis for our lifestyle are shaped by habitus and provide system of differentiation through which class differences expressed 1 An individual's upbringing, family, education has large influence on tastes and leisure time consumption choices b Capitals: forms of capital are dependent and conditional on each other; different forms can be converted one into another; can be accumulated; can be transmitted i Cultural Capital: skills and knowledge 1 Incorporated a Ex. Knowing how to sail, play tennis, ski 2 Objectivized a Ex. Books, tools bicycle 2 Institutionalized a Ex. Educational degrees, vocational certificates ii Social Capital: 1 Inter-individual level 2 Actual or potential resources: material of non-material linked to durable network of mutual acquaintance ii Economic Capital: money, material assets iii Unequal distribution of capitals is part of fundamental system of inequality in a given society 1 All passed generation from generation 2 Ex. May have the money for yacht club, but you II Transmission of Capital: Concerted Cultivation of Middle Class Kids a Observed actions, family, interactions, etc. i Middle class: involved in a lot of sports ii Working class: involved in some basic sports iii Poor : little amount of sports, have a lot of free time b Social class had more of an impact c Family i Concerted cultivation 1 Institutions: teach children how to talk to older individuals