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Lecture

PSY333H1 Lecture 3

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Department
Psychology
Course
PSY333H1
Professor
Lisa Lipschitz
Semester
Fall

Description
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  So
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