Individual Health Behaviour PDF

Individual Health Behaviour POH705 School of Occupational and Public Health Toronto Metropolitan University Week 8 1 Why do we care about behaviour change in health promotion?...

Individual Health Behaviour POH705 School of Occupational and Public Health Toronto Metropolitan University Week 8 1 Why do we care about behaviour change in health promotion? 2 Lesson Objectives Recognize variables that impact behaviour change Develop an in-depth understanding of three behaviour change theories Identify tools that can be used to facilitate change 3  Learning and Behaviour Learning is generally defined as a change in behaviour as a result of experience S-R Theory: Learning results from events that activate a response (i.e., behaviour) S O R Stimuli Organism Response If a behaviour is followed by a reward → behaviour likely to be repeated 4  However, in learning there are also __cognitive_________ variables Learning is a cognitive process – not just stimuli pushing our response or behaviour Cognitive theorists emphasize the role of subjective beliefs or expectations held by individuals Mental processes including thinking, reasoning, hypothesizing, or expecting 5  Major Cognitive Variables 1. Knowledge – An intellectual awareness of _facts_____, truth or principles gained by sight, experience or report 2. Skills – The ability to do something well, arising from talent, training or practice 3. Beliefs – Acceptance of or confidence in an alleged fact or body of facts as true or right without positive knowledge or proof (perception is reality) 6  Major Cognitive Variables 1. Knowledge – You have knowledge about the number of cases of yellow fever in the area you are Example: visiting (fact) You are planning a trip 2. Skills to India – how would – You are able to do research on these cognitive factors the risks of yellow fever (ability to search for credible play into whether or not information) you get a yellow fever 3. Beliefs vaccine? – You believe that getting yellow fever on your vacation is possible, and that getting vaccine can prevent it 7  Major Cognitive Variables 4. Attitudes Attitudes can be difficult to – Manner, disposition, feeling change or position toward a person Potential to influence by or thing providing more knowledge and increasing skills 5. Values Personal, religious or political – Ideas, ideals, customs that values may influence whether arouse an emotional response you get a vaccine for yellow for or against them fever 8  Cognitive Variables Knowledge is ___necessary_________ to produce behaviour change, but not __sufficient_________. What does this mean? Cognitive variables impact peoples’ perceptions and willingness (i.e., motivation) to improve health Individual knowledge of health plays a role (e.g., health literacy) There is an important role for health educators here! – To increase health literacy, knowledge, and shift beliefs 9  What are health risks? “The chance or likelihood that something will harm or otherwise affect your health.” - Does not mean that you definitely will be affected by this risk factor or illness - Reflects a possibility that you could be affected 10 https://newsinhealth.nih.gov/2016/10/understanding-health-risks Source: https://youtu.be/vyku4EuVUXU?si=fv1Or_5I7OFCf6KM 11  How people view health risks varies What factors do you think influence this? – Social situation and status – Role models – Immediate vs long term risk – Expectations of peer group – Others.. 12  Health risks are affected by: - Personal characteristics, i.e., age, sex, family history of disease, lifestyle - Health behaviours, i.e., diet, physical activity, wearing a seatbelt, flossing - Social determinants of health, i.e., access to healthcare services, resources to manage health Perception of risk is further influenced by: - Frequency of messaging related to a disease/threat in the media - Individual values or beliefs - Group dynamics 13 https://newsinhealth.nih.gov/2016/10/understanding-health-risks  Push and Pull Discussion Should Ontario move from universal to private healthcare? What factors come into your argument? – FOR – AGAINST Which cognitive variables are relevant? – Attitudes, beliefs, values, knowledge What are the associated health risks? Source: https://www.cbc.ca/news/canada/british- Source: https://www.cbc.ca/news/health/canada- columbia/angus-reid-health-care-privatization-1.6762099 healthcare-privatization-debate-second-opinion- 1.6554073 15  Recall: Theory is used to… Indicate why people are behaving in unhealthy ways Identify information we need before developing an intervention Provide a conceptual framework Determine how best an intervention should be developed Identify measurements needed to evaluate the impact Allow for comparisons across studies 16  Different levels of theories https://cancercontrol.cancer.gov/sites/default/files/2020-06/theory.pdf Theory selection depends on the level at which we plan to implement a program or intervention  The Health Belief Model Most widely used framework Used to explain why individuals take part in health behaviour ___change______ as well as ____maintenance_________ of health behaviours Initially was used to understand screening and immunization program participation People will take action to improve health based on 5 key constructs 19  The Health Belief Model 1. Perceived Susceptibility: Perceive themselves to be susceptible to a problem or condition E.g., an individual must believe there is a ____possibility of getting__ colon cancer before being interested in screening 2. Perceived Severity: Feelings about the ___seriousness________ of contracting an illness or leaving it untreated Medical/Clinical and social consequences 3. Perceived Threat: = Combination of Susceptibility & Severity 20  The Health Belief Model 4. Perceived Benefits: Even if there is a perceived threat, behaviour change will be influenced to individual belief regarding ___benefits_____ of the ___actions________ to reduce threat E.g,. Financial savings from quitting smoking, family benefit 5. Perceived Barriers: Negative aspects of a health action could act as impediments to undertaking recommended behaviours Typically an unconscious ____cost benefit analysis________________ occurs where individuals weigh potential costs (i.e., side effects, inconvenience, etc.) with benefits 21  The Health Belief Model Modifying factors Cues to action: __external factors______________ that could trigger action Individual variables: age, sex, sociodemographic status, etc. Mass media campaigns, advice from others, reminders from a healthcare professional, illness of a family member/friend, online information Self Efficacy ___Confidence___________ in one’s own ability to perform a certain task Not originally included in the model, new addition 22 Health Belief Model: Smoking Cessation Example https://youtu.be/fXI1BKpe4fA?si=YP_eQn4C9_fMOCU5 23  Diagram of the Health Belief Model Perceived Susceptibility Perceived Threat Perceived Seriousness Self-efficacy Perceived Benefits Outcome Expectations Perceived Barriers Research supports that for behaviour change to succeed, individuals must: 1) Feel threatened by their current behavioural patterns 2) Believe behaviour change will result in a valued outcome at an acceptable cost 3) Must feel competent to overcome perceived barriers to take action 24 With other modifying factors taken into account. Chart available in your readings (Glanz, 2008) Theory of Reasoned Action (TRA) and of Planned Behaviour (TPB) Most important determinant of behaviour here is ____intention__________ People's intention to perform a behaviour depends on: – __Attitude__________ towards the behaviour – Belief of what others think they should do – TRB adds the element of perceived control over the behaviour, i.e., ease/difficulty of performing the behaviour 26 Attitude towards the behaviour Subjective norms Intention Behaviour Perceived behavioural control Theory of reasoned Action (TRA) takes all the green boxes into account. Theory of planned behaviour (TPB) considers yellow box 27 Theory of Reasoned Action (TRA) and of Planned Behaviour (TPB) 28 https://youtu.be/iiWKnqKdbHk?si=JxQta7Wu2knhRlot  Transtheoretical Model (TTM) Uses __stages of change___ to understand how people modify their behaviour Helps to identify the factors that contribute to successful behaviour change – Smoking cessation program – Also applied to anxiety disorders, substance abuse, bullying, HIV/AIDS prevention 29  Stages of Change Model Behaviour change is a process not an event Five stages of change Process is __circular__, not ___linear______ Speed of movement varies Can be impacted by individual confidence 30 31  Stages of Change Model 1. Pre contemplation Those not considering change and those who consciously intend not to change 2. Contemplation A person considers making a change to their behaviour 3. Preparation Person makes a commitment to change 32  Stages of Change Model 4. Action Behaviour change is ___initiated______ 5. Maintenance __Sustaining_________ change 6. Termination (optional 6th step) Will not return to unhealthy behaviour 33  Transtheoretical Model (TTM) 34 https://youtu.be/IwxyyE--AjU?si=1TIeBNHNAuS1yCGA Source: www.emro.who.int/dsaf/EMRPUB_2012_EN_1362.pdf  Stages of Change Model Useful for selecting appropriate interventions for population groups (i.e., patients) By identifying a patient's position in the change process, physicians can tailor an intervention, often with skills they already possess Thus, the focus of the visit is not to convince the patient to change behavior, but to help the patient move along the stages of change 36  Discussion Use the Stages of Change Theory to develop a plan for promoting a fitness program among factory workers: Suggested Action Pre-contemplation Promote awareness, increase knowledge Contemplation Motivate people to begin a program, promote benefits Determination Also the preparation stage, assist with developing goals Action Provide feedback and supports Maintenance Help people cope, have reminders 37  Interpersonal-Level Theories Social Learning Theory Social Cognitive Theory Recall, interpersonal processes include family, friends, and peers that contribute to our social identity 38  Social Learning Theory Based on the idea that people not only self-regulate their environments and actions, they are also acted upon by their environments. – I.e., They create and are influenced by their surroundings “The opinions, thoughts, behaviour, advice, and support of the people surrounding an individual influence his or her feelings and behaviour, and the individual has a _________________________ on those people” – Also termed “reciprocal determinism” 39  Social Learning Theory Behaviour Personal Environmental factors factors 40  Social Cognitive Theory Incorporates basic parts of social learning theory but adds… – Observational learning – Vicarious reinforcement Refers to watching and learning from the actions of others E.g., watching parents driving fast and not wearing a seat belt (role models this behaviour to children) Positive or negative ____reinforcement_________ will determine if that behaviour is ____repeated_________ Three main factors for behaviour change: – self-efficacy – goals – outcome expectancies 41  Social Cognitive Theory Three main factors for behaviour change: 1. Self-efficacy – With self-efficacy, can change behaviour even when faced with obstacles 2. Goals – Setting specific health-related goals, e.g., exercising for 10 minutes/day, drinking 1L of water, etc. 3. ___Outcome expectancies_________________________ – Belief that when a certain behaviour is performed, it will lead to an anticipated outcome – E.g., If I do yoga for 10 mins/day, I will become more flexible 42 www.emro.who.int/dsaf/EMRPUB_2012_EN_1362.pdf Example: Improving Sun Safety in Children *Symbolic modeling is another term for observational learning. www.emro.who.int/dsaf/EMRPUB_2012_EN_1362.pdf  Which theory applies? __No single_________ theory dominates Addressing a health problem will likely require __more than one theory_____________________________________ Think about: – Does the theory include all relevant variables or issues? – Does it exclude redundant variables? – Does its use make logical sense in the particular situation? – Has it been used by others for similar purposes? – Are there any published studies that use the theory for similar purposes? – Is it consistent with the values integral to the work? 45  Some Considerations There are no ‘right’ or ‘wrong’ theories Theories should be viewed as guidlines for understanding change and developing appropriate programs Many of the theories are based on very narrow assumptions about individual behaviour change Theories should never be applied without a thorough understanding of your population 46  Factors to improve success for all behaviour changes __Personalize_ the health information – Make it about them! Communicate the risks/benefits that are important to that person/group Stress short term consequences – Short-term risk initiates more change than long-term Make information _____relevant___ to individuals – Make it matter to them! This includes not using too much jargon and giving practical information 47 Who is your audience/ target population? Life phases impact our acceptance of change initiatives – E.g., parenting tips would be of greater interest to an adult population, vs. avoiding falls for elderly Understanding aspects of life phases can assist in targeting health education techniques where it is most needed 48 Life Stages Infant Toddler Preschooler School child Adolescence and youth Young adult Middle-aged person Later Adulthood 49 How do health messages change over life stages? 1. Who is the target audience here? 2. What is the message, and what behaviour are we trying to change? 3. Would this be effective? - Personalized - Highlights short term consequences - Targets young people in their 20s - Message – get tested for STDs - Relevant 1. Who is the target audience here? 2. What is the message, and what behaviour are we trying to change? 3. Would this be effective? - Targets mothers, but also patrons of that particular establishment - Intends to improve health of both child and mother by minimizing any stress they may experience when breastfeeding in public Benefits of a Health Education approach: Empowers people to take control over their own health Works directly with people and tailors the message 52 Limitations of a Health Education approach Doesn’t take into consideration the social and _environmental context Are most likely to be acted on by those better off in society Assumes a direct link between behaviour, attitudes and knowledge ‘Victim blaming’ 53  Next Week – Adult Learning Styles and Health Literacy 54