Health Beliefs: Ogden (2023) Chapter 2

• Health beliefs are covered in Chapter 2 of Ogden (2023).

Health Behaviors

• Health behavior aims at preventing disease, such as eating a healthy diet.
• Illness behavior aims to seek remedies, like going to the doctor.
• Sick role behavior includes activities aimed at getting well, such as taking medication and resting.

Role of Health Beliefs

• Health beliefs are explained through attribution theory, risk perception, motivation, self-determination theory, and self-efficacy.

Attribution Theory

• Attributions about causality are structured by distinctiveness, consensus, consistency over time, and consistency over modality.
• Distinctiveness entails whether the cause of a behavior is specific to the individual.
• Consensus addresses whether the cause of a behavior is shared by others.
• Consistency over time relates to whether the same attribution about causality is made at any time.
• Consistency over modality determines if the same attribution is made in different situations.
• Attribution can be described as internal vs. external, stable vs. unstable, global vs. specific, and controllable vs. uncontrollable.
• Internal versus external attribution considers whether failure is due to poor performance or interviewer prejudice.
• Stable versus unstable attribution relates to whether failure is specific to an event.
• Global versus specific attribution questions if failure influences other areas of life or only a specific situation.
• Controllable versus uncontrollable attribution considers whether the cause of failure is controllable by the individual.
• Internal vs. external locus of control relates to the extent to which health is seen as controllable by someone.

Risk Perception

• Three dimensions of risk perception include unrealistic optimism, risk compensation, and self-affirmation theory.
• Unrealistic optimism is the tendency to believe one is less likely to experience illness than others.
• Risk compensation involves neutralizing risky behaviors with others.
• Self-affirmation theory suggests motivation to protect self-integrity and self-concept when facing threatening experiences or information.
• Individuals may process risk information in ways that enable them to continue unhealthy behavior.

Motivation and Self-Determination Theory

• This theory focuses on reasons/motives regulating behavior, like autonomous/intrinsic vs. controlled/extrinsic motivation.
• Intrinsic motivations satisfy needs for autonomy, competence, and relatedness.
• Autonomy means someone can manage their own behavior.
• Competence means someone can master their environment.
• Relatedness means someone can develop close relationships.

Self-Efficacy

• Self-efficacy relates to the belief in one's ability to execute actions.
• Self-efficacy also relates to confidence in one’s ability to engage or not engage in certain behaviors.

Stage Models

• Stage models share properties such as a classification system defining stages, an ordering of stages, similar barriers within stages, and different barriers between stages.

Stage of Change Model (SOC)

• Components involve pre-contemplation, contemplation, preparation, action, and maintenance.
• Pre-contemplation is not intending to make changes.
• Contemplation is considering a change.
• Preparation is making small changes.
• Action is actively engaging in a new behavior.
• Maintenance is sustaining the change over time.
• Problems associated with the SOC model include difficulty proving change occurs according to stages, absence of qualitative differences between stages, quick changes between stages, change due to perceived special attention, and a focus on conscious decision-making.

Health Action Process Approach (HAPA)

• The two main stages are decision-making/motivational and action/maintenance.
• Components of the motivational stage include self-efficacy, outcome expectancy, and threat appraisal.
• Self-efficacy comes from the belief that one is confident.
• Outcome expectancy stems from the belief that improved behavior will improve health.
• Threat appraisal is beliefs about the severity of illness & perception of personal vulnerability.
• Components of the action stage are cognitive (volitional) factors, situational factors, and behavioral factors.
• Cognitive factors are action plan & action control.
• Situational factors include social support & absence of situational barriers.
• Behavioral factors relate to the action itself.

Social Cognition Models

• Social cognitive theory suggests that behavior is governed by expectancies, incentives, and social cognitions.
• These models examine subjective predictors and precursors to health behavior.
• Three types of expectancies include situation outcome, outcome, and self-efficacy expectancies.
• Situation outcome expectancy is the expectancy that situational factors may affect the outcome.
• Outcome expectancy is that a behavior can reduce or increase harm.
• Self-efficacy expectancy is that one is capable of carrying out the desired behavior.

Health Belief Model (HBM)

• HBM is the most used theory in health promotion and education.
• Constructs of HBM include perceived seriousness, perceived susceptibility, perceived benefits, perceived barriers (cost of action), and cues to action.
• Cues to action are people, events, or things that move people to change their behavior.
• Problems associated with HBM include a focus on conscious processing of information, emphasis on the individual rather than social or environmental factors, unacknowledged interrelationship between different stages, no role for emotional factors in change, other factors, health behavior due to perception of symptoms, and a static approach.

Protection Motivation Theory (PMT)

• The inclusion of fear is the main contribution of PMT over the HBM in understanding health behaviors.
• Five components of PMT are severity, susceptibility, response effectiveness, self-efficacy, and fear.
• Severity is the perception that something is a serious illness.
• Susceptibility is the perception that one's chances of getting a disease are high.
• Response effectiveness is the belief that changed behavior would improve health.
• Self-efficacy is the belief that one can change their behavior.
• Fear is an emotional response.

Theory of Reasoned Action (TRA)

• TRA emphasizes the role of social cognitions in the form of subjective norms, values, and beliefs;
• TRA focuses on the relationship between attitude and behavior.

Theory of Planned Behavior (TPB)

• TPB components are attitudes toward a behavior, subjective norms, and perceived behavioral control.
• Attitudes are the positive/negative evaluation of a behavior & beliefs about its outcomes.
• Subjective norms are perceptions of social norms & pressure to perform behavior & evaluation of motivation to comply.
• Perceived behavioral control relates to beliefs about the ability to carry out a behavior based on internal/external control factors.

Problems with Social Cognition Models

• TPB, TRA, and HBM often use cross-sectional designs, and resulting associations do not imply causality.
• More fine-grained analysis, such as structural equation modeling, is needed.
• Studies should use power and sample size calculation.
• Research participants may not always interpret questions in ways researchers intend.
• The models are not very successful at predicting behavioral intentions and actual behavior.

Expanding Models by Adding New Cognitions

• Expanded norms are needed to include ethical/moral norms.
• Affective beliefs such as beliefs that a behavior is enjoyable or worrying are needed.
• Anticipated regret includes anticipated feeling of regret or guilt if the person carries out/ not carries about a behavior.
• Self-identity relates to individuals carrying out behavior that fits with their self-image.
• Ambivalence relates to approach-avoidance conflict.
• Personality’s role is needed in predicting health and health-related behaviors.

Intention-Behavior Gap

• Research shows that past behavior predicts future behavior.
• Past behavior may influence future behavior indirectly through a conscious change in cognitions.
• Habits may cause behavior to occur more automatically and less consciously.
• Intentions may influence behavior through other variables, such as action plans.
• Encouraging individuals to implement intentions increases correlation between intentions and behaviors.