PSY333H1F L3 Sept 26, 2013 vs. ,avoidance-oriented ppl (use loss-framed;
Theories and Models Used for Understanding Health tend to be in denial)
Behaviour Change
1. Attitudinal Approaches to Health Bhvr Change Montana Meth Project
2. Social Cognition Models Montana.methproject.org
a large-scale prevention program aimed at reducing Meth use
3. Stage-Based Theories & Models
thru public service messaging, public policy, and community
1. Attitude Change & Health Bhvr outreach
central to the integrated, research-based campaign is
Assumes that if we give people correct info about the possible
effects of their poor health bhvrs, they may be motivated to Methproject.org – a definitive source for info about Meth for
change in a healthy direction teen – supported by hard-hitting radio, print, online, mobile,
Educational Appeals: make the assumption that correct info and social media campaigns that communicate the risk of
will lead to change Meth use
Persuasion: the attempt to change people’s attitudes & beliefs The Problem:
Attitude: a cognition in which a person evaluates some object o As of September 2005 Montana was overwhelmed by
methamphetamine abuse
or idea
2 routes thru which attitudes are influenced o Ranked #5 in the nation for Meth abuse
1. Central route: use of logic, facts, and reason Campaign (2007):
o 88 400 TV ads, 82 600 Radio ads, 140 000 Print
o statistics about something or medical info
o ex. facts about why smoking leads to lung cancer impressions, 2 510 Billboards, 112 125 003 online
2. Peripheral route: appealing to emotion & general impressions
o Large scope of issue
impression
o ex. graphic images of what lung cancer looks like Ex:
o Celebrity endorsement o Photos: “Will meth change the way I look?”, “Will meth
change the way I am?
Reaction: denial in meth addicts, fear in non-
Effective Communications are:
o Colorful & vivid, avoid stats & jargon users who at at risk for starting
o Messenger should have credibility, likable, trustworthy For some ppl this might be too fearful
defensive, denial
(similar)
o Beginning & end should have strongest argument Those at risk for starting starting to question
Primacy & recency effect if they should use it or not
o Short, clear, direct, explicit Loss-framed
o Video:
o Explicit conclusions
o Extreme but not too extreme Results (2012):
o Emphasize potential risks (illness detection bhvrs) or o Montana ranks #39 in the nation for Meth abuse
o Teen Meth use has declined by 63%
potential benefits (health promotion bhvrs)
Receptive to change: give only favourable pts o Adult Meth use has declined by 72%
Not receptive to change: discuss both sides of the issue o Meth-related crime has decreased by 62%
o Meth use declined by 65% in Arizona
o Since they would become defensive
o Meth use declined by 52% in Idaho
Fear Appeals: assumes that if ppl are fearful that a particular Be cautious examining these #s:
o There could’ve been a natural decline, decline in
habit is hurting their health, they will change the bhvr availability of Meth
Drive-reduction theory: we are driven to reduce the tension
brought about by deprivation or other (-)ve states o Look for other variables
o Mechanisms driving it unknown – don’t know which
Criticisms: ads worked best, and which populations were affected
o Too much fear may not work
o Fear alone may not be enough (recommendations for the most
action may be needed) o The results are still good
Might become defensive, be in denial
2. Social Cognition Models of Health Bhvr Change
Message Framing: the phrasing of a msg (+ve or -ve)
Social Cognition Models
o Prospect theory: dif presentations of risk info will o Propose that the beliefs that ppl hold about a health
change ppl’s perspectives & actions
o high risk health bhvrs (uncertain outcomes): emphasize bhvr will motivate their decision to change (or not
potential losses (ex. condom use loss of relationship) change) the bhvr
Expectancy Value theory
promoting detection bhvrs
o low risk health bhvrs (certain outcomes): stress o Ppl will choose to engage in bhvrs they believe they will
benefits or gains of changing the bhvr (ex. disease succeed in & have outcomes they value
Important to them, believe they can succeed
prevention thru gains from exercise)
promoting prevention bhvrs
o One’s motivation: Health Belief Model (HBM)
approach-oriented ppl (use gain framed; Formerly, one of the most influential theories of why ppl
practice health bhvrs
motivated to learn) Health bhvr determined by:
Perception of threat Self-efficacy:
o Am I at Risk? o Component of the person factor
o Influenced by 3 Factors Believe you can do something about the bhvr
1.Values: Interest & concern about health o Situation specific
o Ex. I’m concerned about my cardiovascular Depends on the activity they’re engaging in
2.Perceived susceptibility: Beliefs about personal o Strong connection btwn self-efficacy & health bhvr
vulnerability change, and longer term maintenance of that change
o Ex. How they perceive themselves being
likely or unlikely to get lung cancer Self-efficacy theory assumes that ppl’s beliefs concerning their
3.Perceived severity: Beliefs about the conseqs of the ability to initiate difficult bhvrs will predict their likelihood of
disorder accomplishing these bhvrs
o Ex. Belief that current hypertension won’t get
Outcome expectations: ppl’s beliefs that those bhvrs will
in the way of their life produce valuable outcomes
Perceived threat reduction o Value the outcomes of the change increase likelihood
o Influenced by 2 Factors of making the change
1. Perceived benefits: Will the change in bhvr be Combo of self-efficacy & outcome expectations predicts
effective (ie. reduce the threat to health)? bhvr
2. Perceived costs: Will the costs of performing the
new bhvr out weight the benefits?
Bandura suggested self-efficacy can be acquired, enhanced, or
Want the benefits to outweigh the costs decreased by:
engage in the bhvr 1. Performance or enacting a bhvr
i. seeing that you can do it
The HBM Applied to the Health Bhvr of Stopping Smoking 2. Vicarious experience or seeing another person w
similar skills perform a bhvr
i. If they can do it, I can do it
3. Verbal persuasion (listening to) encouraging
words of a trusted person
i. You can do it, you can do it!
4. Physiological arousal states, such as feeling
anxiety or stress, which would ordinarily
decrease self-efficacy
I can’t do this
Self-efficacy predicts:
o Adherence to health recommendations &
If at any stage if someone has a dif belief continue smoking medication regimens
o Response to relapse
o Maintenance of exercise regime
Support o Better management of diabetes
Predicts:
o Dental care, breast self-exams, dieting, high risk sexual Ex. Iannotti et al., 2006 – among adolescents,
self-efficacy predicted better self-management &
bhvrs, and drinking & smoking intentions optimal blood sugar levels
Criticisms
Theory of Planned Bhvr
Does not predict adherence/maintenance well (Ajzen & Madden; Fishbein & Ajzen)
Fails to include emotional responses
Health beliefs alone are typically a modest determinant of Assumes that health bhvr is the direct result of bhvr’al
intentions
ppl’s intentions
o Having a belief doesn’t mean you’ll make a bhvr change 3 factors determine one’s intention:
Perceived benefits & barriers are the predictors of bhvr
1. Attitudes toward the action
Perceived susceptibility & severity are weak predictors a. Personal evaluation of the bhvr
Fails to include the perception that one will be able to change b. Belief that the bhvr will lead to (+)vely or (-)vely
the bhvr (self-efficacy)
valued outcomes
2. Subjective Norms (social influence)
a. What we think important others think that we should
Self-Efficacy do & how important their opinions are to us
Albert Bandura proposed a social cognitive model that
3. Perceived Behavioural Control (PBC)
assumes that humans have some capacity to exercise limited a. Ease or difficulty one has in achieving desired bhvr
control over their lives b. Perceived ability to overcome obstacles
o use their cognitive processes for self-regulation
c. We feel that the bhvr will have the intended effect
Reciprocal determinism: interactive triadic model (triangle) d. aka self-efficacy – takes it into consideration
o human action results from an interaction of bhvr, envt, &
person factors (cognition) TPB & Dieting o Dedicates considerable time & energy
o Make changes
o Develop strategies to overcome barriers
5. Maintenance: work to prevent relapse & adapt change
o Ex. Smoking: Still feel like fighting urges
6. Termination: bhvr eliminated; treatment terminated
o Ex. Smoking: No more urges
A Spiral Model of the Stage of Change Model
Strength: identifies beliefs that shape bhvr
Evidence
o Predicts bhvrs such as condom use, sunscreen use, oral
contraceptive use, soft drink consumption, breast
cancer screening, exercise, AIDS related risk bhvrs
Criticisms of Attitude-Behaviour change models
o Not successful at explaining sudden changes
o Do not predict long-term change
o Does not provide people w skills
o Most useful to predict when ppl are already motivated
Ppl can move up & down the spiral
o Subjective norms more strongly predict bhvr for o Ex. change techniques
adolescents compared w adults o Ex. relapse action phase, preparation, or
Ex. Self-report responses of Korean university students on contemplation stage; then can slowly move back up
premarital sex Best for understanding smoking cessation
o 320 male & female unmarried college students aged 18-
25 Important to understand what stage a person is already at
o Structure treatment to match this level
o Results: subjective norms were predictors for males & Longitudinal study of adopting a low-fat diet (Armitage et al.,
females
Dif factors affected males & females 2004)
o Ppl’s attitudes and bhvr fall into the various stages &
Subjective norms was biggest predictor, progress and regress like the model predicts
largest effect
o Perceived behavioural control was a factor only for o Interventions that moved ppl from 1 stage to another
varied by stage
males (because virginity may be a more deliberate o Moving ppl from the preparation to the action stage
choice for men) was more difficult than other transitions
o Females: Attitudes about the bhvr was a stronger
predictor of bhvr change
Precaution Adoption Process
The Precaution Adoption Process Model (Weinstein, 2000):
3. Stages of Behaviour Change Models
o Assumes that when ppl begin new & complex bhvrs
aimed at protecting themselves from harm, they go thru
Transtheoretical Model of Bhvr Change several stages of belief about their personal
Transtheoretical Model of Bhvr Change (aka, Stages of
Change, Prochaska et al., 1992, 1994) susceptibility
o Do not move inevitably from 1-7; may move backward
o A model that analyzes the stages & processes ppl go Ex. could go 1-3, then back to 1
thru, in attempting to bring about a change in bhvr, and
suggested treatment goals & interventions for each
1. Ppl have not heard of the hazard & unaware of personal
stage risk
o Effective for smoking bhvr 2. Hold an optimistic bias regarding own risk
1. Pre-contemplation: no intention of changing bhvr o Believe that other are at risk but they themselves
are not at risk
o Unaware of problem or in denial 3. Acknowledge their personal susceptibility & accept that
2. Contemplation: realize problem
o Not ready to commit to changing precaution would be effective but have not decided to take
action
3. Preparation: intentions to change & to take action 4. Decide to take action
o Small changes & set goals & priorities
o But have not taken action o Goes w stage 5
5. Decide that action is unnecessary
o Ex. Tell family, set a date for starting bhvr change 6. Already taken the precautions to reduce risk
4. Action: commitment to chance bhvr 7. Maintaining the precaution Techniques/Learning
Can see similarities to Transtheoretical model
SMART Goals
Ex. Encouraged home owners to test their homes for the Specific
presence of radon o “I’m going to exercise more” – how & when?
o Classified participants into a) undecided about radon
Measurable
testing (stage 3) & b) those who had decided to act o Can measure & show if they’ve reached their goal
(stage 4) Attainable
o Homeowners received either: a) risk awareness
o Realistic, able to reach the goal
intervention or b) a low-effort (how-to-test) Relevant
intervention o Important to them
o Results: homeowners who were undecided were more
likely to decide to test after receiving a risk awareness Timely
o Long-term goals are hard to maintain& keep in mind
intervention compared to a how-to-test intervention o Keep goals in shorter time periods (ex. week, month)
Need the risk info to move to the next stage Make a goal public more likely to maintain, reach goal
o Homeowners who decided to act were more likely to
order a radon testing kit after receiving the how-to-teHow are Cognitive Bhvr’al Approaches Used to Change Health
intervention compared w the risk awareness Bhvr?
o Example of the Matching Hypothesis
Important to match where ppl are at before Cognitive Bhvr’al Therapy: focus on the way ppl think (how
cognitions, bhvr, emotions interact)
giving feedback or advice o Changing one aspect will change the others
Health Action Process Approach o Usually focus on changing cognition (thoughts, beliefs)
or bhvr
Most recent model Focus on the target health bhvr & the conditions that elicit
Incorporates the most important aspects of other models and maintain that bhvr, & the factors that reinforce the
Simplified stage model w 2 general stages
bhvr
o Working on the beliefs ppl have about their health
Stage 1: Motivational phase habits; change in internal monologues
Intention to either adopt a preventive measure or to change a
o Control over bhvr change shifts from the therapist
risk bhvr is formed to the client.
3 beliefs are necessary for an intention to form:
1. Perceive a personal risk Cognitive Behavioural Strategies
2. Favorable outcome expectations Self-Observation & Monitoring:
Believe changes will be beneficial o A person must understand the dimensions of a target
3. Sense of self-efficacy bhvr before change can be initiated
Action self-efficacy: confidence in one’s ability to
o Assess frequency of a target bhvr
make the change (most important) o The antecedents
What happens before the bhvr
Stage 2: Volitional phase (action)
o The consequences of that bhvr
Person attempts to make the change to bhvr as well as persist What happens after the bhvr is performed
in those changes over time
A dif set of beliefs & strategies are important: Modeling: Learning that occurs by virtue of witnessing another
o Planning (ex. weight loss, exercise) person perform a bhvr
o Implementational intentions: specific plans that o Can be an important long-term bhvr-change
identify what they intend to do, where, when, and how technique
to do it
o Used in reducing anxiety (ex. Children & vaccinations)
o Self-efficacy also important o Exposes an indiv to other ppl who have successfully
Ex. maintenance self-efficacy: confidence in their modified the health habit (ex. AA)
ability to keep up the bhvr; esp if obstacles o Similarity is an important principle
appear Ppl are more likely to imitate someone similar to
Ex. relapse self-efficacy: confidence in their them
ability to resume the bhvr after relapse
Stimulus Control
The Intention-Bhvr Gap Successful modification of health bhvr involves understanding
Even our best intentions did not always translate into bhvr the antecedents as well as the conseqs of a target bhvr
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