14. Complexity of Health Behaviors.pdf

Understanding the Complexity of Health Behaviors Meghan L. Wilson, PhD Assistant Professor Bluefield College: VCOM-VA Campus, Edward Via Virginia College of Osteopathic Medicine, 1691 Innovation Dr. Suite 1100, Blacksburg, Virginia 24060 (office) Telephone: 540-231-7761 Fax: 540-231-5338 Meghan.wil...

Understanding the Complexity of Health Behaviors Meghan L. Wilson, PhD Assistant Professor Bluefield College: VCOM-VA Campus, Edward Via Virginia College of Osteopathic Medicine, 1691 Innovation Dr. Suite 1100, Blacksburg, Virginia 24060 (office) Telephone: 540-231-7761 Fax: 540-231-5338 [email protected] Learning Objectives a) b) c) d) e) f) g) h) i) j) k) l) Define important terminology (i.e., lifestyle, customs, traditions, culture) Describe the variations of cultures (e.g., shared, learned, adaptive) Define health behavior and health behavior change Identify types of behaviors that promote health and prevent disease Identify appropriate settings and audiences for health behavior change Categorize audiences most in need of health behavior change interventions Define health literacy and determine the impact it has on health behavior change Identify appropriate and inclusive strategies to address health behaviors with patients Define theory, model, and framework and distinguish between the three Identify the commonly used theories for health behavior change (e.g., social cognitive theory, health belief model, transtheoretical model) Select appropriate theories that are best suited for various settings and audiences Describe why theory can effectively change health behaviors of selected audiences Important Terminology • Lifestyle: the collection of behaviors that make up a person’s way of life (e.g., diet, family life, house, work, physical activity, etc.) • Customs: a pattern of actions shared by some members of a community (i.e., represent that groups behavior) • Traditions: behaviors that have been carried out over time and handed down through generations Terminology Cont’d • Culture: a system of various knowledge, attitudes, norms, beliefs, values, habits, customs, traditions, and all other capabilities/skills that have been acquired by a community – Culture is: • Shared (e.g., language, style, etc.) • Learned (e.g., speaking, manners, cooking, etc.) • Adaptive (e.g., diet, exercise, traditions, etc.) What is a Health Behavior • “The actions of individuals, groups, and organizations as well as those actions’ determinants, correlates, and consequences, including social change, policy development and implementation, improved coping skills, and enhanced quality of life” (Parkerson et al., 1993) • “Personal attributes such as beliefs, expectations, motives, values, perceptions, and other cognitive elements; personality characteristics, including affective and emotional states and traits; and overt behavior patterns, actions, and habits that relate to health maintenance, to health restoration, and to health improvement” (Gochman, 1982, 1997) Behavior, Cont’d • Behavior is an action that has a specific frequency, duration, and purpose regardless of being conscious or unconscious • A result of action or behavior = staying healthy or becoming ill Health Behavior Change • Positive, informed changes in health behaviors Examples of Behaviors that Promote Health and Prevent Disease Behaviors Examples Utilization Immunizations Family planning Mindfulness Self-referral of illness Symptom recognition Compliance Immunization sequence Following a course of prescribed drugs/diet Prevention/ Rehabilitation Physical therapy Structural modification (e.g., wheelchair ramp) Community action Ramps, specialty stores, street lighting, accessibility Where and/or what settings are most in need of behavior change? • • • • • • • Schools Communities Worksites Health care settings Homes Consumer marketplace Communication environment Who and which audiences are most in need of behavior change? • • • • • • • • • • • • Health professionals Clients Those at risk of disease Patients Ethnic/racial minorities People of various life cycle stages Individuals Groups Organizations Communities Sociopolitical entities Etc. Barriers to Behavior Change • ….there are many – Self-efficacy – Lack of immediate consequences – Social influences – Lack of support – Knowledge, beliefs, attitudes, & values – Health literacy* Health Literacy • “the degree to which individuals have the capacity to obtain, communicate, process, and understand basic health information and services needed to make appropriate health decisions” • Which subgroups of the populations are most impacted by low health literacy? – Racial and ethnic minorities; older adults, children (in some cases) Health Literacy • Most adults read at an 8th grade level • 20% of the population reads at or below a 5th grade level • Most health care materials are written at a 10th grade level Health Literacy Measurement Tools • Short Assessment of Health Literacy- Spanish and English • Rapid Estimate of Adult Literacy in MedicineShort Form • Short Assessment of Health Literacy for Spanish Adults The Result of Low Health Literacy • • • • Reduced use of preventive healthcare services Greater chance of being hospitalized More suffering from worse health outcomes Difficulty: – accessing health care – Following physician instruction – Taking medicines appropriately mHealth and Health Literacy • Can be an innovative way to overcome health literacy barriers because of its reach: mobile phone ownership is ubiquitous across race, ethnicity, education, and income levels • Conveniently delivers relevant health information that could improve patientphysician communication mHealth • Mobile Health: the use of mobile phone and other wireless technology in medical care to educate consumers about preventive health care services. • “Opening new lines of communication between patients and their physicians” • An innovative strategy to engage traditionally hard-to-reach populations such as racial and ethnic minority communities How to effectively achieve health behavior change in patients… • Use evidence-based theories, models, or frameworks to effectively propose or initiate necessary behavior changes Theory, Model, Framework • Theory- a set of principles or statements that structure our observation, understanding, and explanation of the world – Provides clear explanation of specific relationships or events • Model- a deliberate simplification of a phenomenon or a specific aspect of a phenomenon – Not always completely accurate; more descriptive than explanatory • Framework- outline, system or plan for the relationship between descriptive variables and how they may lead to a phenomenon Concepts, Constructs, and Variables • Concepts: paints a vivid picture on something that helps to understand the diversity of a related phenomenon – (e.g., body build relative to weight) • When concepts are adopted for use in a particular theory, they are called constructs – A focused abstract idea on something inferred from an observable phenomenon For Example: Theory of Planned Behavior Concepts, Constructs, and Variables • Concepts: paints a vivid picture on something that helps to understand the diversity of a related phenomenon • When concepts are adopted for use in a particular theory, they are called constructs – A focused abstract idea on something inferred from an observable phenomenon • Variable: the factor or aspect of an issue that can be measured – Based on values – Varies from study to study – (e.g., demographics, geographic, etc.) How does the use of theory effectively change health behaviors? • It depends… • Different theories are best suited to different units of practice, such as individuals, groups, and organizations. Commonly used Theories for Behavior Change • Social Cognitive Theory • Transtheoretical Model • Health Belief Model Social Cognitive Theory Five Stages of Behavior Change (Transtheoretical Model) Decisional Balance: weighing the pros and cons Self-efficacy: degree of confidence in ones ability to make and maintain a change Processes of Change: cognitive and affective experiential processes and behavioral processes Example: Transtheoretical Model • Often used by health care providers to initiate a conversation about health behaviors – E.g., Smoking cessation, Substance abuse, Addictive behaviors, Physical activity, Weight management, Stress management Example: Health Belief Model Example: Health Belief Model • Overcoming personal barriers; beliefs about susceptibility and severity of a health concern and beliefs about the utility of possible preventive action predict the likelihood of action – E.g., obtaining a mammogram – Immunizations – Taking medication Example: Health Belief Model Questions?