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Behavior Change in Health. Some questions: What factors predict health behaviors? e.g., Why do you floss every night? or why not? How do people change their health behaviors? Why don’t people change? What are some of the barriers? Theories, Models, and Practicalities….

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behavior change in health
Behavior Change in Health
  • Some questions:
    • What factors predict health behaviors?
      • e.g., Why do you floss every night? or why not?
    • How do people change their health behaviors?
    • Why don’t people change? What are some of the barriers?
    • Theories, Models, and Practicalities…
behavioral immunogens and pathogens
Behavioral Immunogens and Pathogens
  • Behavioral Pathogen
    • A health-compromising behavior or habit
      • smoking, excessive eating, substance abuse, dangerous driving, risky sexual behavior
  • Behavioral Immunogen
    • A health-enhancing behavior or habit
      • exercising regularly, using sunscreen, healthy eating, practicing safe sex, wearing seatbelts
preventing injury and disease
Preventing Injury and Disease
  • Primary Prevention(Efforts to prevent disease or injury from occurring – e.g., practicing good nutrition, exercising, avoiding smoking, obtaining regular health screening – these are the behavioral immunogens)
  • Secondary Prevention(Actions taken to identify and treat an illness or disability early in its occurrence – e.g., monitoring symptoms, taking medication, following treatment regimens)
  • Tertiary Prevention(Actions taken to contain damage once a disease or disability has progressed beyond its early stages – e.g., radiation therapy, chemotherapy)
      • less cost-effective and less beneficial than primary or secondary prevention
      • the most common form of health care in the U.S.
barriers to healthy behaviors
Barriers to Healthy Behaviors
  • Individual Barriers
    • Inertia
    • Operant conditioning issue – immediate rewards and punishments are much more effective than delayed ones
    • Finances
    • Optimistic Bias --The tendency of most people to believe that they are less likely to become ill than others
        • People who feel vulnerable to specific health problems are more likely to practice preventive health behaviors
        • Invincibility fable (especially in adolescents)
        • Within limits, optimism conveys health advantages
family barriers
Family Barriers
  • Health habits are often acquired from parents and others who model health-compromising behaviors
    • obese parents are more likely to have obese children
    • children of problem drinkers are themselves at increased risk of abusing alcohol
health system barriers
Health System Barriers
  • Medicine tends to focus on treatment rather than prevention
  • A significant percentage of Americans do not have health insurance
  • Unrealistic or confusing recommendations
community barriers
Community Barriers
  • Access to _____ (health care, exercise facilities, grocery stores)
  • Absence of community health promotion (e.g., no incentives to walk)
  • Some environments promote health-compromising behaviors
    • e.g., alcohol use and binge drinking in college
models for health behavior change
Models for Health Behavior Change
  • Given all these barriers, why (and how?) would a person change his or her health behavior?
    • Theories and Models (give handout “Changing Health Behavior Theories” for homework)
stage theories
Stage Theories
  • Transtheoretical Model (see Table 6.2)
    • People pass through 5 stages in altering health behavior
      • Stage 1: Precontemplation
      • Stage 2: Contemplation
      • Stage 3: Preparation
      • Stage 4: Action
      • Stage 5: Maintenance
      • Stage 6: Termination
    • Examples --
stage theories12
Stage Theories
  • Stage theories provide a “recipe” for ideal behavior change, but…
    • hard to put everyone in a discrete “stage”; probably a more continuous and non-linear process
  • Enable interventions to be matched to the specific needs of a person who is “stuck” at a particular stage


Coping Self-Efficacy

Task Self-Efficacy















Barriers and Resources

Health Action Process Approach -- A continuum model

support for these theories
Support for these theories
  • People’s self-reported attitudes and intentions predict a variety of health-promoting actions (weight loss, condom use, smoking behavior, health screening)
  • People are more likely to engage in health-protective behaviors if they feel susceptible to the hazards of not doing so
shortcomings of these theories
Shortcomings of these theories
  • People do not always do what they intend (or claim they intend) to do (“the intention-behavior gap”)
  • Attitudes predict some health-related behaviors, but not others
  • The predictive power of these theories is greater for some groups (high-SES, for example) than for others
  • The theories ignore past experience with a specific health-related behavior AND PAST BEHAVIOR IS OFTEN THE BEST PREDICTOR
why aren t health behavior theories more precise
Why Aren’t Health Behavior Theories More Precise?
  • They say little about how intentions are translated into action
  • They are unrealistically complex
  • Health habits are often unstable over time
  • For the very young, old, and ill, health care decisions are often made by other people
changing behaviors
Changing Behaviors
  • How can we influence people to change health behaviors? What needs to be done? What strategies might be effective?
changing behaviors interventions
Changing Behaviors: Interventions
  • I. Changing Health Beliefs
  • II. Social Engineering
  • III. Cognitive-Behavioral Methods
changing beliefs health education campaigns
Changing beliefs: Health Education Campaigns
  • Health Education ideally…
    • identifies specific health problems in a community
    • analyzes background factors that predispose, enable, and reinforce lifestyle and environment elements
    • implements health education program
how effective are health education campaigns
How Effective are Health Education Campaigns?
  • Mass media appear to be most effective in alerting people to health risks that they otherwise wouldn’t know about, but are less effective in long-term behavior change (unless the message is presented consistently over time, e.g., health risks of smoking)
  • What about fear-based messages (scare-tactics)? e.g., Framing the message to stress the risk of not performing a health behavior
social engineering
Social Engineering
  • Changing the environment to change our behaviors
      • Automatic seat belts and air bags; lowering speed limit
      • Design change for baby walkers
      • Elimination of “Joe Camel” ads
      • Requiring immunizations for school entry
      • Worksite wellness programs
        • on-the-job health promotion programs
        • structuring the environment (on-site gym, banning smoking, etc.)
cognitive behavioral interventions
Cognitive-Behavioral Interventions
  • Methods are usually used in combination (a multimodal approach)
  • Should be tailored to each person
  • Too many interventions can overwhelm a person
cognitive behavioral interventions25
Cognitive-Behavioral Interventions
  • Three stages:
    • Self-observation / monitoring
    • Implementing change
    • Maintenance / Relapse prevention
self monitoring
  • Define target behavior
  • Record and chart
  • Continual process with revision
implementing change overview
Implementing Change (overview)
  • Conditioning methods
  • Modeling
  • Cognitive change strategies
  • Etc…
conditioning methods
Conditioning methods
  • Classical (Pavlovian) Conditioning Interventions
    • Antabuse
    • Counterconditioning (cancer nausea)
  • Operant Conditioning Interventions
    • Modify consequences of a behavior (e.g., seat belt buzzer)
    • Shaping
    • Using rewards (individually or in a group setting, e.g., token economy)
  • Observational learning
    • Preparing a child for an operation
    • Taking a yoga class
    • Watching a video on breast self-examination
    • Going to A.A.
    • Most successful when it shows the realistic difficulties that people encounter in making changes
stimulus control
Stimulus control
  • Modifying antecedents of a behavior
    • Poor health habits often tied to events, people, places, or things in the environment (called discriminative stimuli -- DS)
    • Examples (golden arches, …)
    • These DS need to be identified and then reduced
contingency contracting
Contingency Contracting
  • Creating contract with another regarding consequences of one’s behavior
    • “Every time I do _____, I instruct my friend to _____”
covert self control
Covert Self-control
  • Cognitive techniques (e.g., cognitive restructuring)
    • Train people to recognize and modify internal dialogue
      • “I’m weak, I can’t control my smoking urges…”
      • This statement would be targeted for modification
skills training and behavioral assignments
Skills Training and Behavioral Assignments
  • Learn skills to change behavior
    • progressive muscle relaxation
    • assertiveness training
    • stress management
    • nutrition education
    • systematic homework assignments
  • Why do people relapse?
  • BioPsychoSocial factors (e.g., with smoking)
    • Bio: Withdrawal, Genetics, Wt. Gain
    • Psych: Boredom, stress, anger
    • Social: Conflicts, lack of social support, social cues (e.g., going to a bar)
  • Relapse Prevention
    • Need to control the biopsychosocial factors, especially developing coping techniques for managing high-risk situations
    • Coping with a “slip”
    • Integrate behavior change into a generally healthy lifestyle