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Theory-based Education

Theory-based Education. COMT 492-02. Overview . Why we need theories How to select a theory Pros & cons of theories Common theories Example Lessons learned. Types of theories?. Linguistic How we word messages determines whether people will pay attention & respond

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Theory-based Education

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  1. Theory-based Education COMT 492-02

  2. Overview • Why we need theories • How to select a theory • Pros & cons of theories • Common theories • Example • Lessons learned

  3. Types of theories? Linguistic How we word messages determines whether people will pay attention & respond Behavioral Decision-making Behavior change is complex & involves a series of stages Affective or framing theories Fear appeals and positive framing affect how people respond to messages

  4. Why do we need theories? • Guides practice • Leads to more effective interventions • May save costs • Help develop models of change Freudenberg, N., Eng, E., Flay, B., et al. (1995). Strengthening individual and community capacity to prevent disease and promote health: In search of relevant theories and principles. Health Education Quarterly, 22 (3) : 290-306.

  5. Why do we need theories? • Understanding “antecedents” to health behavior • Promotes better understanding of causes of behavior… • leading to more effective programs • Helps identify groups who are at risk… • helping target programs

  6. How to select a theory?

  7. Numerous theories exist • Sociological • Psychosocial • Biological

  8. Numerous theories exist • Sociological theories • poverty, ethnicity, disorganization, structural causes • Psychosocial theories • beliefs, personal values, perceived norms, intentions • family education, parenting, stability • Biological theories • genetics, hormones, and psychological (proximal) determinants of behavior

  9. How to select a theory? • Theories must answer: • What are primary causes of the health problem? • What are links between interventions & outcomes? • How do community, individual and societal factors interact? • What’s role of health educator?

  10. Links between activities & outcomes • Understanding how and why interventions work enables us to replicate effective change. • Evaluation research can test whether an intervention worked in the way(s) a theory predicts.

  11. Role of health educator • An effective intervention should have a coherent rationale – or a theoretical basis – for goals, intervention activities, and role of the educator.

  12. Weaknesses of theories

  13. Not readily available to practitioners Emphasize individual change at expense of societal factors Static or unidirectional Not very participatory Don’t explain big picture -- how problems emerge and how interventions work Weaknesses of health education theories

  14. Common health education theories

  15. Psychosocial Theories • Elaboration Likelihood Model • Health belief model • Social cognitive theory • Theory of reasoned action • Theory of self-regulation & control • Stages of Behavior Change • Agenda-setting

  16. Elaboration likelihood model:Motivation to attend to health messages • Before you get people to change their behavior, you need to get them to attend to a message. • Mindless/passive vs. Active/mindful • Peripheral vs. Cognitive (central processing) • An audience involved with a topic will actively seek, attend and process messages about that topic. • Uninvolved audiences will process info in a passive fashion.

  17. Switching cognitive gears • How do you prompt active thought (Louis & Sutton, 1991) • Mode of presentation • Unusual, novel or unfamiliar • Positive affect appeals for topics usually associated with fear (e.g., skin cancer) • Entertainment (e.g., Amazing Spiderman Comics) • Parasocial relationships • Behavior modeling

  18. Switching cognitive gears (cont’d) • Content represents discrepancy • When a message is inconsistent w/ what’s expected, it prompts active thought • External or internal request for paying attention • Verbal immediacy • Denotative specificity • Personalizes & simplifies a message • “You should wear sunscreen” vs. “People should…” • Spatial immediacy • “This, these, here” vs. “those, that and there” • Temporal immediacy • Present tense verbs • Avoid qualifiers

  19. Health Belief Model:Factors influencing behavior • Intention to engage in the behavior • Environmental constraints • Skills or ability to engage in the behavior

  20. Factors influencing behavior • Intention • Perceived net benefits • Perceived social norms • Self-efficacy • Consistency with self-standards • Emotional reactions

  21. Example: Teen Pregnancy • A person is more likely to intend to use contraception if they believe: • Benefits outweigh costs • Others have positive beliefs about contraception • They can readily obtain contraception • Using contraception is consistent with their self image

  22. Antecedents of teen pregnancy & childbearing • No one antecedent explains all variance in behavior • Many antecedents weakly or moderately related • Results can paint picture of youths most at risk

  23. Antecedents (cont’d) • Youths at greatest risk are more likely to: • Live in communities w/ high turnover; low education, high poverty, high divorce, high rates of adolescent births • Have parents w/ low education, poor, history of divorce, history of teen pregnancy • Have parents w/ poor childrearing practices, less supervision • Have friends who are sexually active

  24. Implications for teen pregnancy programs • Difficult to reduce teen pregnancy markedly • Many factors • Many of the factors are structural, biological or distal • Programs should not focus on any one factor alone • Programs should focus on: • Sexual beliefs, attitudes, perceived norms, self-efficacy, skills & intentions • Environmental constraints • Structural inequities

  25. Theories of Behavior Change • Social Learning Theory (Bandura, 1977) • Empowerment Education (Freire, 1973) • Agenda Setting (McCombs, 1978) • Theory of Reasoned Action (Azjen & Fisbein, 1980) • Stages of Behavior Change (Prochaska & DiClemente, 1986)

  26. Health Belief Model

  27. Health Belief Model • One’s attitudes, social norms and beliefs about outcomes of a behavior determine their behavior • Hell-raiser may expect pregnancy or HIV, and therefore use condoms more • Romantic Idealist may expect loss of love if she insists on condom use Becker, M., 1974

  28. Social Learning Theory& Social Cognitive Theory

  29. Social Learning & Cognitive Theories • People learn by observing role models being rewarded or punished for a behavior • Learning is increased if: • Role model is: • Likeable • Similar to target audience • Credible • Skills are clearly demonstrated • Behavior appears easy to do Bandura, A., 1977, 1986

  30. Empowerment Education

  31. Empowerment Education • Learning occurs when people are involved in the process of education or change • Learning is increased if: • People participate more • People are involved with every step of the process • People agree on end goal Freire, P., 1973

  32. Agenda-setting

  33. Agenda-setting • Media sets the agenda for what people think is important • When media gives high salience to an issue, it is reflected by popular opinion Shaw, D. & McCombs, M., 1978

  34. Stages of Behavior Change

  35. Stages of Behavior Change • Behavior change is not a one-step process • Different messages are needed for each stage • Stages of Behavior Change Model: • Pre-contemplation: No intention of condom use • Contemplation: Intends to use condoms in next 6 months • Ready-for-action: Intends to use condoms from now on • Action: Continual condom use for less than 6 months • Maintenance: Condoms used every time for at least 6 months Prochaska J, et al. The transtheoretical model of change and HIV prevention: A review. Hth Ed Quart use of condoms using the stages of change model. Public Health Reports 1996;111(suppl 1):59-68.

  36. Pre-contemplation to Contemplation • Consciousness-raising: Increasing information about oneself in relation to a particular problem • Dimensional models and risk comparisons • Cumulative and one-shot probability • Qualitative & quantitative probability terms • Framing effect

  37. Dimensional models & risk comparison • Only risks with similar dimensional profiles should be compared. • Health communication can encourage people to move from PC to C by increasing perceived risk associated w. a particular behavior and by making comparisons with activities widely regarded by society as risky. • Inappropriate comparisons will fail.

  38. Cumulative & one-shot probabilities • People underestimate cumulative risk. • Emphasizing cumulative might move people from PC to C more effectively than talking about the risks of a single incident.

  39. Qual. & Quant. Terms • People associate specific numbers with specific terms. • Communication designers should consult qualitative probability literature to find the rage of quantitative equivalents (Bryant & Norman, 1980). • “virtually always” = .99 • “unlikely” “low probability” = .20

  40. Segmenting by Stage of Behavior Change • Campaigns that target audience by risk level are more effective than non-targeted campaigns • in smoking cessation, exercise adoption, dietary fat reduction & mammography screening -- why not HIV? Prochaska JO, et al. In search of how people change. American Psychologist 1992;47(9):1102-14.

  41. CDC Role Models Campaign

  42. CDC Uses Stages of Change Theory • Campaign • CDC’s Role Model Stories in San Francisco, 1993-96 • Goal • To change women’s HIV risk behavior & community norms • Media • Narrative pamphlets • Target audience • Welfare mothers ages 17-54 Kinght K, et al. This is my story: A descriptive analysis of a peer education HIV/STD risk reduction program. Presented at American Public Health Association, New York City, November, 1996.

  43. Stages of Change Campaign • Different stories were developed for each stage of behavior change: • Contemplation: • Kizzy says she’ll “seriously try” to use condoms • Ready-for Action: • Mayeisha decides to use condoms with her next man • Action: • Champagne uses condoms, but not every time

  44. Campaign Results • People who progress from one stage to next early in campaign are more likely to change behavior • 3% pre-contemplators quit smoking • 7% pre-contemplators who moved to contemplation in 1st month quit smoking • 20% contemplators took action • 41% contemplators who moved to ready-for-action in 1st month took action

  45. ASHA Teen Web Site • www.iwannaknow.org

  46. ASHA Teen Web Site Employs Theories • Social Cognitive Theory • Role model similar to target audience moderates message board • a young adult with extensive STD prevention counseling experience • Topics teens can relate to • frequently asked questions from other teenagers • Tone of voice appropriate to teenagers

  47. ASHA Teen Web Site Employs Theories (cont’d) • Stages of Behavior Change • Each component of Web site addresses different stage of readiness to protect against STD/HIV • Question-and-answer format gives knowledge (contemplation) • Internet games build safe sex negotiation skills (ready-for-action) • Message boards provide confidence and social support (maintenance) • Teens can click on topics most appropriate

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