NURS 2011 Health Behavior Change Theories & Model 2024 PDF

NURS 2011 Health Behavior Change Theories & Model Dr. P. Siewdass 2024 Objectives Define the difference between a model and theory Describe the role of models and theories in changing health behavior Identify the constructs of behavior change theories and models Activity #1- Review of HP What is the...

NURS 2011 Health Behavior Change Theories & Model Dr. P. Siewdass 2024 Objectives Define the difference between a model and theory Describe the role of models and theories in changing health behavior Identify the constructs of behavior change theories and models Activity #1- Review of HP What is the goal of HP? What are chronic disease, risk factors & the levels of prevention? Role of HP Health promotion improves the health status of individuals, families, communities, and the nation. Health promotion enhances the quality of life for all people. Health promotion reduces premature deaths. Prevention- health promotion reduces the costs for health care. Health Behaviour Change Models & Theories Primary focus of HP – to help people limit unhealthy behaviours and replace them with healthy ones A Theory is an explanation intended to account for the actions that people take or not take to promote health Models : theory –based planning framework that helps guide program creation and evaluation Importance of theories Theories can guide the search to: - Understand why people do or do not practice health promoting behaviours; - Help identify what information is needed to design an effective intervention strategy; and - Provide insight into how to design a program so it is successful Health behaviour theories The Health Belief Model (HBM) The Transtheoretical Model/Stages of Change (TTM) Social Cognitive Theory (SCT) Theory of planned behaviour Health behavior theories and models used in health promotion : Intrapersonal –the Health Belief Models, Theory of Planned Behavior, Trans-theoretical Model. Interpersonal – Social Cognitive Theory, Social Learning Theory Community-Diffusion of Innovation Intrapersonal : Health Belief Model HBM -is a theoretical model which explain that behaviours is influenced by values and expectations Focused on the attitudes and beliefs of individuals Developed in the 1950s by social psychologists Hochbaum, Rosenstock and Kegels Adapted to explore a variety of long- and short-term health behaviors Core assumption The HBM is based on the understanding that a person will take a health-related action if that person:✓ Feels that a negative health condition can be avoided (i.e., HIV) ✓Has a positive expectation that by taking a recommended action, he/she will avoid a negative health condition HBM HBM Perceived susceptibility – - This refers to a person's subjective perception of the risk of acquiring an illness or disease. - There is wide variation in a person's feelings of personal vulnerability to an illness or disease. Perceived severity This refers to a person's feelings on the seriousness of contracting an illness or disease (or leaving the illness or disease untreated). There is wide variation in a person's feelings of severity, and often a person considers the medical consequences (e.g., death, disability) and social consequences (e.g., family life, social relationships) when evaluating the severity. 3.Perceived benefits This refers to a person's perception of the effectiveness of various actions available to reduce the threat of illness or disease (or to cure illness or disease). The course of action a person takes in preventing (or curing) illness or disease relies on consideration and evaluation of both perceived susceptibility and perceived benefit, such that the person would accept the recommended health action if it was perceived as beneficial 4.Perceived barriers This refers to a person's feelings on the obstacles to performing a recommended health action. The person weighs the effectiveness of the actions against the perceptions that it may be expensive, dangerous (e.g., side effects), unpleasant (e.g., painful), time-consuming, or inconvenient HBM Cue to action - This is the stimulus needed to trigger the decisionmaking process to accept a recommended health action. These cues can be internal (e.g., chest pains, wheezing, etc.) or external (e.g., advice from others, illness of family member, newspaper article, etc.) Self-efficacy - This refers to the level of a person's confidence in his or her ability to successfully perform a behavior. HBM HBM has been applied to a broad range of health behaviors and subject populations: - Preventive health behaviors- health-promoting (e.g. diet, exercise) and healthrisk behaviors (e.g. smoking) and vaccination and contraceptive practices - Sick role behaviors, compliance with recommended medical regimens, following professional diagnosis of illness. - Clinic use. Concept 1. Perceived Susceptibility 2. Perceived Severity 3. Perceived Benefits 4. Perceived Barriers Definition Application One's belief of the chances of getting a Define population(s) at risk and their risk levels condition Personalize risk based on a person's traits or behaviors Heighten perceived susceptibility if too low One's belief of how serious a condition Specify and describe consequences of the risk and and its consequences are the condition One's belief in the efficacy of the Define action to take — how, where, when advised action to reduce risk or Clarify the positive effects to expected seriousness of impact Describe evidence of effectiveness One's belief in the tangible and psychological costs of the advised behavior 5. Cues to Action Strategies to activate "readiness“ 6. Self -Efficacy Confidence in one's ability to take action Identify and reduce barriers through reassurance, incentives, and assistance Provide how-to information Promote awareness Provide reminders Provide training, guidance, and positive reinforcement Concept Condom Use Education Example STI Screening or HIV Testing 1. Perceived Susceptibility Youth believe they can get STIs or HIV or create a pregnancy. Youth believe they may have been exposed to STIs or HIV. 2. Perceived Severity Youth believe that the consequences of getting STIs or HIV or creating a pregnancy are significant enough to try to avoid. Youth believe the consequences of having STIs or HIV without knowledge or treatment are significant enough to try to avoid. 3. Perceived Benefits Youth believe that the recommended action of using condoms would protect them from getting STIs or HIV or creating a pregnancy. Youth believe that the recommended action of getting tested for STIs and HIV would benefit them — possibly by allowing them to get early treatment or preventing them from infecting others. 4. Perceived Barriers Youth identify their personal barriers to using condoms (i.e., condoms limit the feeling or they are too embarrassed to talk to their partner about it) and explore ways to eliminate or reduce these barriers (i.e., teach them to put lubricant inside the condom to increase sensation for the male and have them practice condom communication skills to decrease their embarrassment level). Youth identify their personal barriers to getting tested (i.e., getting to the clinic or being seen at the clinic by someone they know) and explore ways to eliminate or reduce these barriers (i.e., brainstorm transportation and disguise options). 5. Cues to Action Youth receive reminder cues for action in the form of incentives (such as pencils with the printed message "no glove, no love") or reminder messages (such as messages in the school newsletter). Youth receive reminder cues for action in the form of incentives (such as a key chain that says, "Got sex? Get tested!") or reminder messages (such as posters that say, "25% of sexually active teens contract an STI. Are you one of them? Find out now"). 6. Self-Efficacy Youth confident in using a condom correctly in all circumstances. Youth receive guidance (such as information on where to get tested) or training (such as practice in making an appointment). The Transtheoretical Model: Behavior change is a process that unfolds over time through a sequence of stages. Health population programs need to assist people as they progress over time. Each stages are both stable and open to change, eg chronic behavior risk factors are both stable and open to change Population health initiatives can motivate change by enhancing the understanding of the pros and diminishing the value of the cons. Helping people set realistic goals, like progressing to the next stage, will facilitate the change process Stages of The Transtheoretical Model Prochaska, DiClemente, & Norcross, (1992) 1.Precontemplation In this stage, people do not intend to take action in the foreseeable future (defined as within the next 6 months). People are often unaware that their behavior is problematic or produces negative consequences. People in this stage often underestimate the pros of changing behavior and place too much emphasis on the cons of changing behavior 2. Contemplation In this stage, people are intending to start the healthy behavior in the foreseeable future (defined as within the next 6 months). People recognize that their behavior may be problematic, and a more thoughtful and practical consideration of the pros and cons of changing the behavior takes place, with equal emphasis placed on both. Even with this recognition, people may still feel ambivalent toward changing their behavior. 3.Preparation (Determination) In this stage, people are ready to take action within the next 30 days. People start to take small steps toward the behavior change, and they believe changing their behavior can lead to a healthier life. 4. Action - In this stage, people have recently changed their behavior (defined as within the last 6 months) and intend to keep moving forward with that behavior change. People may exhibit this by modifying their problem behavior or acquiring new healthy behaviors. 5. Maintenance In this stage, people have sustained their behavior change for a while (defined as more than 6 months) and intend to maintain the behavior change going forward. People in this stage work to prevent relapse to earlier stages. 6. Termination - In this stage, people have no desire to return to their unhealthy behaviors and are sure they will not relapse. - Since this is rarely reached, and people tend to stay in the maintenance stage, - this stage is often not considered in health promotion programs Regression However, people can regress from any stage to an earlier stage. Regression occurs when individuals revert to an earlier stage of change. The vast majority regress to Contemplating or Preparation. Social Cognitive Theory – By Bandura (1986) Social Cognitive Theory (SCT) describes the influence of individual experiences, the actions of others, and environmental factors on individual health behaviors SCT Key constructs of social cognitive theory that are relevant to health behavior change interventions include: Observational learning Reinforcement Self-control Self-efficacy Key components of the SCT Self-efficacy: The belief that an individual has control over and is able to execute a behavior. Behavioral capability: Understanding and having the skill to perform a behavior. Expectations: Determining the outcomes of behavior change. Expectancies: Assigning a value to the outcomes of behavior change. Self-control: Regulating and monitoring individual behavior. Observational learning: Watching and observing outcomes of others performing or modeling the desired behavior. Reinforcements: Promoting incentives and rewards that encourage behavior change. Theory of Planned Behavior (TPB) Behavioural intentions are influenced by the attitude about the likelihood that the behavior will have the expected outcome and the subjective evaluation of the risks and benefits of that outcome Used successfully to predict and explain a wide range of health behaviors and intentions eg. smoking, drinking, health services utilization, breastfeeding, and substance use etc 6 constructs of TPB 1.Attitudes - This refers to the degree to which a person has a favourable or unfavourable evaluation of the behavior of interest. - It entails a consideration of the outcomes of performing the behavior. 2.Behavioral intention - This refers to the motivational factors that influence a given behavior where the stronger the intention to perform the behavior, the more likely the behavior will be performed. TPB 3. Subjective norms - This refers to the belief about whether most people approve or disapprove of the behavior. - It relates to a person's beliefs about whether peers and people of importance to the person think he or she should engage in the behavior. 4. Social norms - This refers to the customary codes of behavior in a group or people or larger cultural context. - Social norms are considered normative, or standard, in a group of people. TPB 5. Perceived power - This refers to the perceived presence of factors that may facilitate or impede performance of a behavior. 6. Perceived behavioural control - This refers to a person's perception of the ease or difficulty of performing the behavior of interest. - Perceived behavioural control varies across situations and actions, which results in a person having varying perceptions of behavioural control depending on the situation. Theory of Planned Behaviour Criticism of the behaviour change approach to HP It is unable to target the major causes of ill health. The choice of which behaviour to target lies with ‘experts’ whose task it is to communicate and justify this choice to the public. The behaviour change paradigm does not address the many variables other than cognitions that influence human actions. Reference Bezner, J. R. (2015). Promoting health and wellness: Implications for physical therapist practice. Physical Therapy, 95(10), 1433–1444, https://doi.org/10.2522/ptj.20140271 Snelling, A. (2014). Introduction to health promotion. Wiley JoseyBass. Chapter 2 Walker, J. R. (2014). Wellness Promotion: School Nurses as Models of Health. NASN School Nurse, 29(3), 128–129. https://doi.org/10.1177/1942602X14522831