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Lecture

Health Sciences 2801A/B Lecture Notes - Health Belief Model, Transtheoretical Model, Doorbell


Department
Health Sciences
Course Code
HS 2801A/B
Professor
Terry Biggs

Page:
of 3
Intro to unit 2 - HP models & theories
What they are & why they're important
Foundations in Operant & Classical Conditioning
Look at some models & theories
Application work in groups
Planning Models & Intervention Models
Understanding similarities & differences among models (Precede-Proceed &
MATCH - know in detail!)
We'll deal w/ SMART in unit 4
Ch 2 - models for HP programming
Ch 7 - models & theories for HP interventions
Behavioural change theories & models
Lots of specific theories & models in Ch 7 -
Know the similarities & differences of models
All are often used in HP programs
Thus all are important! (will be on exam! Know which components belong to which
theories; don't need to know names or dates) know all except SMART, ELM & PAPM
Importance of Models & Theories
Similar to narrowing the focus of a research paper -
gives direction about INTENT of paper
Models & theories enable program planners to give
structure & organization & understanding to the
program process & purpose
Difference b/w models & theories
Help us to understand what influences health
Why are people (not) engaging in certain health behaviours
How are peoples behaviours influenced?
What factors should be considered when evaluating program's focus?
Models in HP provide a vehicle for applying the theories -
framework/map
How models & theories work together for successful HP programs
Eg: students & readings (students read textbook b/c it's testable)
Theories provide insights & directions
Eg: dog trainer = "model" (when & how they give the treat)
Models then give steps to actually initiate change
A model not grounded in theory is generally unsuccessful
Need to know why people do what they do (theory) in order to make a
model
Psychological basis for beh change
Combo theories
Stimulus response (SR) therapy
Social cognitive theory/social learning theory
Theory of reasoned action (TRA)
Theory of planned behaviour (TPB)
Theory of freeing (TF)
Problem behaviour theory
Combo models
Based on a variety of theories & combos of the combos
Health Belief Model
Transtheoretical Model (Stages of Change)
Most often used...
2 well known & often used are:
Precede - Proceed
8-step framework for HP programming
Evaluation processes start in step ONE!
Pre-pro work in tandem, providing continuous series of steps in planning,
implementation, & evaluation of HP programs
Working thru p-p like solving mystery
Led to think 1st inductively (start w/ focus of what you want to accomplish in
the end) then deductively (look at the initial problem; narrow things down) -
start w/ desired ends & work back to original causes
P-P Phase 3: Educational & Ecological Assessment
3.
ID specific health-related beh, enviro & genetic factors that
could be inked to health problem chosen in phase 2 (risk factors
& conditions)
Enviro factors - Outside person, 'can' be modified (smoking &
non-smoking areas)
Enviro eg: counselling services (indicator) & accessibility
(dimension)
Beh eg: compliance (indicator; take pill) & frequency
(dimension)
Genetics eg: breast cancer (indicator: genetic
predisposition for some) & high-fat diet (dimension: risk
factor) interaction of indicators & dimensions
Consider enviro, beh, & genetic indicators & dimensions:
Prioritization Matrix - ranking & matrix
Use quadrant 3 in order to show that "we can change," political
purpose.
P-P Phase 3: Education & Original Assessment
3.
On basis of cumulative research on health & soc beh & on
Theories = ?
Models = map
Condition "natural" response to occur w/ stimuli that wouldn't normally produce
that response
Thru "shaping" we learn to modify our beh
Focus on the +ives & not the -ives of peoples' beh b/c people are more
responsive to the +ive consequences
Eg: target beh = teach children to use seatbelts
Consequences shape the continuation/termination of beh (+ive consequence =
continuation of beh)
Operant Conditioning - Modify beh by manipulating consequences of beh
Many combo theories & models using op & classical cond are used
Operant conditioning principles are WIDLEY used in beh strategies for health beh
change b/c these behs are conscious, not like CC which are unconscious responses to
stimuli
Eg: natural stimulus = smell of fries w/ door bell & eventually we'll salivate
when we hear the door bell
All responses are reflexes - elicited
Classical/Pavlovian conditioning - Pair new stimulus w/ natural stimulus to produce
natural response
Theories & Models
September-27-11
1:27 PM
HP Units 1 & 2 Page 1
SCT Constructs
Eg: aerobic exerciser
What & how
Behavioural capacity - "knowing" of behaviour
Working thru p-p like solving mystery
Eg: heart disease. Inductive - we want people to have better hearts.
Deductive - what causes people to have bad hearts? Chemicals,
pollution, fast food, where do people work? Challenges to change this
Led to think 1st inductively (start w/ focus of what you want to accomplish in
the end) then deductively (look at the initial problem; narrow things down) -
start w/ desired ends & work back to original causes
P-P Phase 1: Social Assessment (& Situational Analysis)
1.
Begin w/ consideration of QOL - what's happening w/ the people in the
community
Involve people who will be targeted so they feel like they OWN the program, &
you get to understand the people from their own perspective. This makes the
program useful!
Acquire subjectively defined problems & priorities of individs or communities
Social problems of community offer practical & often accurate barometer of
its QOL
Indicators include: absenteeism, aesthetics, crime, unemployment, SE, etc
What's the biggest need in your community?!
P-P Phase 2: Epidemiological Assessment
2.
Essential for program planning
Eg: sick building syndrome - buildings that are buildings w/ bad air
filtration systems which then cause illness in the people that work in
them
Task is to match info in Phase 1 & 2 & to match info to contributing factors to
main concerns/problems
Use both subjective & objectively measured info
Rank them by importance, while keeping reality in mind
Consider "vital indicators" (morbidity, fertility, mortality) & their "dimensions"
(strength of problem/need)
Incidence - new cases in a group at a certain time period
Prevalence - existing cases in a group at a designated time period
To what extent is a population having more incidence/prevalence of a problem
Use quadrant 3 in order to show that "we can change," political
purpose.
P-P Phase 3: Education & Original Assessment
3.
On basis of cumulative research on health & soc beh & on
ecological relationships b/w enviro & beh, 100s of factors have
potential to influence health beh
Precede groups factor according to their educational &
ecological approaches
Genetics, EC experiences
Predisposing factors - knowledge, attitudes, beliefs,
values, perceptions
1.
Created by society forces or systems
Time, free access to facilities, support,
equipment
Factors that make possible a change
Enabling factors - skills, resources, barriers
2.
Encourage or discourage beh continuation
Produce lifestyles which influence enviro (via
consumer demand, cumulative actions, political
advocacy)
Reinforcing factors - rewards & feedback (reward must
match the behaviour we want to continue) reinforcement
3.
3 broad groupings:
P4 sorting & categorizing factors via 3 classes
P, E, & R helps re prioritizing for intervention
Decision based on importance & evidence of possible
change & cost
Phase 3 summary:
P-P Phase 4: Admin & Policy Assessment (& Intervention
Alignment)
4.
Assess of organizational & administrative capabilities &
resources for program intervention
Assess limitations
P-P Phases 5-8: Implementation & Evaluations:
5.
Make up PROCEED portion
Evaluation is integral & continuous throughout all phases
of implementation
Evaluation as last phase is misleading
Precede-Proceed final thoughts: Obvious need for
interdisciplinary work in field & multidisciplinary professionals
Why are we looking at a variety of theories & models?
No perfect theory or model for all occasions
The health behs, problems, populations, cultures & context are broad &
varied
Determines what model & theory should be used
Unit of change must be considered: indivds vs groups
Stimulus Response Theory (SR Theory)
Combo theory (of what?)
Beh is based on stimulus, response & reinforcement
Learning: events which decrease phys. drives that activate beh
Which part represents classical conditioning? - physiological drive that activates beh
Behaviour frequency determined by consequences
Type of conditioning? Operant conditioning
Consequences either reinforcement or punishment
Reinforcer - a consequence that strengthens a beh
+ive reinforcer - a consequence that strengthens/maintains beh by its added
pleasure (eg. flowers/studying)
-ive reinforcer - a consequence that strengthens beh by removing an unpleasant
stimulus (eg. Advil)
Reinforcement - rewarded beh tends to be repeated
Eg: aversive smoking cess program, bad tasting nail polish, speeding ticket
+ive punishment - adding something unpleasant to decrease beh
Eg: non-exercisers & health insurance, eating in class (garbage = removal of
privilege)
-ive punishment - removing a +ive reinforcer
Eg: don't always get speeding tickets when we speed
Effects are usually temporary (when punishment ceases following beh, the
undesirable beh will continue again)
Punishment - stimulus that decreases the strength of beh
Consequences (reinforcement/punishment)
Eg: dog-pillow-greeting, fat loss programs
In order for consequences to be effective, they need to be: Immediate & Frequent
Social Cognitive Theory (SCT)
Formerly known as Social Learning Theory
Candy + will get candy = answer question
Consequence + belief about consequence =
behaviour
It different from Stimulus Response theory b/c it uses
this equation: Reinforcement + expectation = behaviour
Consequences of behaviour & beliefs re consequences
important
Eg: partner-forgiveness: give Jamie flowers so she
will forgive
"Expectancy" & "incentives"
Considered the most complete theory currently applied
to HP b/c it addresses both underlying determinants of
health beh & methods of promoting change
Built on an understanding of the interaction b/w people
& their enviro... dynamic, subtle & complex (referred to
as reciprocal determinism)
Learning & behaving explained thru "constructs"
We will consider, w/ application, those most pertinent to
HP
Reinforcement is essential. Reinforcer must match goal! May have difference
reinforcers for different levels of success
Self control/self regulation: control over beh thru monitoring & adjusting
Reinforcement in 3 ways:
HP Units 1 & 2 Page 2
SCT Constructs
Eg: aerobic exerciser
What & how
Behavioural capacity - "knowing" of behaviour
Eg: exerciser & advice; smoking & bad breath
I expect that if I exercise, I will gain more muscle
Expectations: think & expect situation-specific outcomes
Eg: value athletic/svelt body; value good breath
for kissing
Increase values = increase likelihood of beh
Understand people's values in order to make a model
for their beh change. Why do they or don't value
these expectations
Values is where beh change happens!!!!!!!
Expectancies: values
Situation specific
Task mastery
1.
Vicarious experiences
2.
Verbal persuasion
3.
Emotional arousal
4.
4 ways to increase self efficacy:
Self Efficacy: perceived competence
SCT Constructs Summary
Behavioural capacity
Expectations
Expectancies
Self efficacy (4 ways to enhance)
Self control/regulation
Reinforcement (3)
Reciprocal determinism
Reinforcement is essential. Reinforcer must match goal! May have difference
reinforcers for different levels of success
Self control/self regulation: control over beh thru monitoring & adjusting
Direct reinforcement
1.
Vicarious reinforcement - see someone answer the question right & got praise
& you knew the answer too, so now you want to answer the question so you
can be told you're smart too
2.
Self-management - keep track of yourself
3.
Reinforcement in 3 ways:
Seeking to modify social norms re smoking is considered among the
most powerful way to promote cessation among adults
Enviro, person & beh all influence each other
Eg: uni students & nutrition on campus; smoking
Dynamic relations
Reciprocal determinism: interaction among person, beh, & enviro - INTERACTIVE
HP Units 1 & 2 Page 3