Seeking Health Care I

1. Seeking Health Care I Modeling Health-Related Behavior

2. Health-Related Behavior • Behavior toward the goal of maximizing health and minimizing disease/disability • Health maintenance behaviors • Seeking medical advice/intervention • Risk behaviors and/or lack thereof • Theories attempt to explain factors predictive of these myriad behaviors

3. Theory – A set of related assumptions from which testable hypotheses are drawn Model – Theory in progress Uses of Models and Theories Generate Research Organize and explain observations Guide practitioners in predicting and modifying behavior Theories and Models in Psychology

4. Evaluating Theory • Is it comprehensive? • Is it logical • Is it parsimonious (simple, not too simple)? • Does it agrees with empirical research? • Does it generate ideas/research? • Is is disconfirmable? • Part of the evolution controversy • This is why most scientists believe that ID is not a science • Is it practically useful?

5. Models of Health Behavior

6. The Health Belief Model • Assumption: People hold certain beliefs about… • personal vulnerability • the severity of the disease • the costs of taking action • benefits of taking action • These beliefs motivate individuals to a greater or lesser degree to modify high-risk behaviors or seek help in doing so.

7. Health Belief Model Demographic & Psychosocial Factors Perceived Benefits & Barriers Health- Related Behavior Perceived Seriousness & Susceptibility Perceived Threat Cues to Action

8. Studying the HBM • Support for model: • Flu shots • Breast self-examination • Seat belt use • Diet • Smoking • No support for the model: • Exercise

9. Critique of the HBM • Leaves out emotions, habit, social norms, • and other motivations (e.g. appearance) • What about context? • Does not define how to test relationships • between different elements

10. Is the HBM useful? • Comparison of different behaviours • and populations • Identifies most salient beliefs (i.e. barriers, • susceptibility) • Interventions: health education, risk appraisal, decisions balance sheets, relapse prevention plans

11. Theory of Planned Behavior • General theory of behavior – Not specific to health behavior • Assumption: People are reasonable and use information to freely choose behavior. Behavior happens secondary to an INTENTION. • The intention to perform a behavior is an interaction between • Attitude • Subjective Norm – Social Pressure • Perceived Behavioral Control • Actual Control

12. Attitude Toward Behavior Health- Related Behavior Subjective Norm for Behavior Intention Perceived Behavioral Control Theory of Planned Behavior

13. For some behaviors attitudes, norms and perceived control independently predict intentions In some contexts intentions predict behaviour Attitudes shown to be independently related to perceived control Perceived control independently predicts behaviour Perceived control is the strongest predictor Environmental influences (access to healthcare) Social support Adoption versus maintenance of behaviour Competing behaviours (weight loss versus smoking cessation) Critique of TPB

14. What interventions are related to the TPB? • Attitudes: education • Norms: public health campaigns • Perceived control: relapse prevention planning

15. The Transtheoretical Model • Stage model of general behavior change • Assumption: People utilize a number of processes of change to move through 5 stages of change • Processes • Consciousness Raising, Dramatic Relief, Contingency Management, Stimulus Control, Self-libertation • Stages • Precontemplation • Contemplation • Preparation • Action • Maintenance

16. The Behavior Change Spiral Maintenance: practice required for the new behavior to be consistently maintained, incorporated into the repertoire of behaviors available to a person at any one time Maintenance Action: people make changes, acting on previous decisions, experience, information, new skills, and motivations for making the change Action 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 Preparation 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 Contemplation Precontemplation: changing a behavior has not been considered; person might not realise that change is possible or that it might be of interest to them Pre-contemplation

17. TM • People often use different processes during stages and different stages require different interventions • Precontemplation – Consciousness Raising • Contemplation – Environmental Re-evaluation • Preparation – Self Re-evaluation, • Action – Contingency Management, Stimulus Control • Maintenance - Contingency Management, Stimulus Control

18. TM – Empirical Findings • Quitting Smoking • Alcohol and Drugs • Exercise • Safe sex • Mammography

19. Critique of Models of Health Behavior • All have produced substantial research • All are predictive of health-related behaviors. Some behaviors more-so than others • Do not explain how people judge thing like susceptibility, or go from stage to stage • Lack coherence: • Models simply list variables • No overall model of the person • Assessment is and issue • Adherence is a separate process • Barriers are innumerable and not adequately researched