Application of Health Behavior Theories Toward Survey Development

1. Application of Health Behavior Theories Toward Survey Development

2. Purpose of Notes • Provide students with knowledge on specific theories and develop survey questionnaire’s using theories as a framework.

3. Learning Objectives • By the end of the special topic seminar students will be able to: 1. Understand the importance of using theories when designing survey questionnaire’s on human behavior 2. Name three human behavior theories and the major components of each theory.

4. Learning Objectives (cont.) 3.Design a survey scale based upon Bandura’s self-efficacy scale. • Develop survey questions from several human behavior theories. • Teach one of the theories to colleagues. • Conduct an observational survey. • Develop a behavior modification program based on theory.

5. Key Definitions • Theory • “a set of interrelated concepts, definitions, and propositions that presents a systematic view of events or situations by specifying relations among variables in order to explain and predict the events of the situations” (Glanz, Lewis, & Rimer, 1997, p. 21) • Concepts • the primary elements of theories (Glanz, Lewis, & Rimer, 1997)

6. Key Definitions (cont’d) • Construct • a concept that has been developed, created, or adopted for use with a specific theory (Kerlinger, 1986) • Variable • “specify how a construct is to be measured in a specific situation” (Glanz & Rimer, 1995, p. 11)

7. Key Definitions (cont’d) • Model • “a subclass of a theory” (McKenzie & Smeltzer, 2001, p. 138); draws “on a number of theories to help people understand a specific problem in a particular setting or context” (Glanz, Lewis, & Rimer, 1997, p. 24)

8. How can theory be used? • Describe (event, behavior, etc.) • Explain • Predict • Prescribe

9. Concept Construct Variable Model Theory Personal beliefs Perceived benefit Rank order incentives Health Belief Model Social Cognitive Theory Examples

10. Why use theory? • Help guide the practice of health educators • “…provides direction and justification for program activities…” (Cowdery et al., 1995, p. 248)

11. Behavior Change Theories / Models • First need to decide on what level to intervene • Consider the ecological perspective (McLeroy et al., 1988) • Intrapersonal, or individual, factors • Interpersonal factors • Institutional, or organizational, factors • Community factors • Public policy factors

12. Behavior Change Theories / Models • Health Belief Model (HBM) • Self-efficacy • Theory of Reasoned Action • Transtheoretical Model (TTM) • aka-Stages of Change • Diffusion Theory • Social Cognitive Theory

13. Assumptions of Behavior Change Models • Cognitive Ability/Inability is primary reason for behavior change. • N/A for children • Health is highly valued part of life. • Behavioral is intentional. • Behavior is rationale. • People want to change behavior. • Stages of Change • Self Efficacy

14. Health Belief Model • Four major components • Threat Components: • Perceived severity • Perceived susceptibility • Action Components • Benefits • Barriers • Mediating factors (Cues to Action) • Social, environmental, media, others

15. Health Belief Model Benefits Barriers Perceived Severity Perceived Susceptibility Perceived Threat Outcome Modifying Factors -Media -People -Other factors Self-Efficacy

16. 5 Criticisms of HBM • Belief-Behavior connection has not yet been established • Why we don’t want to get vaccinated and reason we don’t. • Attempts to modify or change beliefs are often unsuccessful. • Family or religious beliefs prevent us from doing this change.

17. 5 Criticisms of HBM cont. • Individual and Social Factors should be included in behavior change intervention. • Mental health issues (sometimes you just don’t want to change) • Parents or Friends • Lack of quantification of HBM in past research. • Not enough evidence

18. 5 Criticisms of HBM cont. • Focus on individual determinants for health behavior may lead to victim blaming. • Person gets cancer so we as a society may blame them for not exercising, eating right, and using protection. • Where it could be environmental or public policy to blame instead.

19. Self-Efficacy (Albert Bandura) • Definition: person’s confidence to perform a specific task.

20. Self Efficacy Theory Person Behavior Outcome Efficacy Expectation Outcome Expectations Response Efficacy (Does it work?) Can I Do Activity? If I Do It, What Will Happen?

21. Sources of Self-Efficacy Behavior Performance attainment Decision to perform Vicarious learning Perceived Self-Efficacy Effort expended Verbal persuasion Persistence Physiological monitoring

22. Self-Efficacy • Development of scale to determine efficacy level: • Examples: • Likert Scale Items • How confident are you in….

23. Theory of Reasoned ActionakaTheory of Planned Behavior • Intentions predict behaviors • “Do you intend to…..” • Three factors that affect a person’s intention to do a specific behavior: • Personal attitudes • Social norm (what others think) • Good to use in assessment bc you ask about social norms. • “Do your friends….” • Perceived behavioral control

24. Theory of Planned Behavior Attitudes Attitudes Social Norm Inentions Behavior Intentions Behavior Social Norm Perceived Control

25. Stages of Change Theory(Prochaska and DiClemente) Best to use for Behavior Change • 6 stages of behavior change • Precontemplation • Contemplation • Preparation • Action • Maintenance • Termination

26. Stages of Change Theory • Precontemplation • Person is not aware that they have a problem and does not see how unhealthy behavior is effecting their life or health. • Process of change: • Consciousness raising- media report • Social liberation- no smoking signs • Helping relationships • Identify on survey-not ready for change in next 6 months.

27. Stages of Change Theory • Contemplation • Person knows that change would be good, but does not have the confidence to change and needs more information. • Process of change: • Self-reevaluation- Self liberation • Does this behavior fit in with your current lifestyle? • Dramatic relief (emotional arousal) • Helping relationships • Identify-will change in next 6 months

28. Stages of Change Theory • Preparation • Person begins preparing for changing unhealthy behavior for new healthy behavior. • Process of change • Self-liberation (commitment) • Helping relationships • Identify-Ready for change in next month

29. Stages of Change Theory • Action • Person begins the new healthy behavior. • Process of change • Reinforcement management (Reward) • Stop smoking and get some taste back • Helping relationships • Stimulus control • Controlling your environment • Example- Limit activity where behavior is prevalent • Counter conditioning • Chew gum instead of smoking • Identify-currently changing

30. Stages of Change Theory • Maintenance • Person is practicing healthy behavior but may need feedback and a booster to avoid obstacles and temptations. • Process of change • Helping Relationships • Identify-have made change in past 6 months.

31. Stages of Change Theory • Termination • Persons feels that new behavior is a part of their life and they never look back and think about the unhealthy behavior. • Helping Relationships • Example: • You feel “naked” with out your Seat Belt now…

32. Diffusion Theory(Everett Rogers) • Definition: spread of ideas (tangible or intangible) and innovations over time through communication channels( interpersonal most important) among members of a social system. • Fast Diffusers- IPOD • Slow Diffusers- Helmet with Bicycle • Used to predict best channels to communicate health information in hopes of behavior change.

33. Diffusion Theory • Adopter categories • Innovators (1.3%)- developers • Early adopters (16%)- Mass Media • Early majority (33%)- Word of Mouth • Late majority (33%)- Word of Mouth • Laggards (16%)- Late Bloomers • Think your grandparents and computers! • Never get 100% compliance rate

34. Diffusion Theory • Innovation- Decision Process: • Knowledge • Persuasion • Decision • Implementation • Confirmation • Decide to Adopt or Reject Product

35. Diffusion Theory • Example: • Knowledge • Gain information of new product or idea • Persuasion • Marketing Campaign to persuade you to change over • Decision • Make the decision to use the product or idea • Implementation • Actually using the product • Confirmation • Use product and Like it

36. Diffusion Theory • Types of Innovation- Decisions • Optional- individual choice • Collective- group • Authority- powerful group • Contingent- combination

37. Diffusion Theory • Characteristics of Innovations • Relative Advantage • Ipod vs. Radio • Compatibility • How compatible are helmets with hair? • Complexity • Is it to hard or difficult to make the change?

38. Diffusion Theory • Characteristics of Innovations • Try-ability- • Try it before you buy it • Observability- • Want to see other people doing the behaviors

39. Diffusion Theory • Diffusion Curve Percent adoption at 20% adoption, Innovation takes off! Time

40. Social Cognitive TheoryAKASocial Learning Theory(Albert Bandura) • Based on premise that an interaction exists between behavior, individual, and the environment. • Reciprocal Determinism Environment Behavior Individual

41. Social Cognitive Theory • Behavior change occurs in 4 phases: • Pre-Training • Assessment on the first day of basketball tryouts • Training- • Learning to dance example • Initial Testing- • Building up confidence to perform task • Continual Performance- • Practicing (really learning the skill) • Learning a new language example

42. Social Cognitive Theory • Pre-Training Phase • Reciprocal Determinism • Behavioral Capability • Is person capable of performing task? • Example: • If you are afraid of water there is a possibility you will not be able to learn to swim.

43. Social Cognitive Theory • Training Phase • Trying to build of confidence to perform task. • Expectations • What will the likely outcome be? • What do you consider the outcome or goal? • Expectancies • Value placed on expected outcomes • Fitness Program Example: • What do you consider goal? • Weight loss- benefit • Soreness- barrier

44. Social Cognitive Theory • Training Phase • Self-Efficacy • Doesn’t kick in until you are motivated and want to make a change. • Emotional coping response • How will person deal with change? • Emotions on giving up things we need: • Example: Giving up driving when you are older • Example: Wilson the volleyball on Castaway

45. Social Cognitive Theory • Initial Testing Phase • Observational learning • Game like conditions, think scrimmage • Observing others perform task/activity • Taking a tour of a fitness facility before actually joining the gym. • Self-control or self-regulation • Self commitment • Monitoring self progress

46. Social Cognitive Theory • Continual Performance Phase • Reinforcement • Reward for continuing performance/activity • Son put on helmet with out being told , so he got a candy bar treat. • Locus of control • Internal--self reward • You reward yourself • Exercise and lose weight • External--other reward • Needs others to help make them feel good • Verbal reinforcement from peers, coaches, friends

47. Social Marketing Theory

48. What is it? • Social Marketing Theory- • Applies the concept of traditional marketing to the “sale” or promotion of healthy behaviors. • Elements • market plan • carefully designed messages • employment of mass media • consensus building • appropriate packaging

49. SMT continued • SMT emphasizes the importance of specific target audiences and segmentation of the population when designing programs. • Gender, race, age, religion, education, etc.

50. Components • The eight components include but are not limited to: • consumer orientation • exchange theory • audience analysis and segmentation • formative research • channel analysis • marketing mix • process tracking • marketing management