1 Health Psychology n Health Promotion Models

2 Today’s Question n Why do people behave in health- compromising ways?

3 Why do people... n do things that are bad for their health such as smoke cigarettes or drink too much alcohol? n not do things that are health- enhancing like exercise or eating low fat foods? n not do things that maximize the likelihood of better outcomes such as wearing seat belts?

4 Why do people…? n smoke cigarettes? n drink too much alcohol? n overeat? n fail to follow their doctor’s recommendations?

5 Stages of Change Model n Stages of Change u “Ordered categories along a continuum of motivational readiness to change a problem behavior”

6 Five Stages of Change n Precontemplation n Contemplation n Preparation* n Action n Maintenance

7 1. Precontemplation n No intention to change behavior in the foreseeable future (next 6 months). n Includes people who are unaware of the problem plus those who know about the problem but are not considering change. n “I am not thinking about changing my risky sexual behavior within the next 6 months to reduce the risk of getting HIV.”

8 2. Contemplation n People are aware that a problem exists and are seriously thinking about overcoming it but have not yet made a firm commitment to take action. n Intending to change within 6 months; open to feedback and information about how to change. However, ambivalent about the costs and benefits of their behavior. n “I am thinking about changing my risky sexual behavior within the next 6 months to reduce the risk of getting HIV.”

9 3. Preparation n Individual is intending to take action in the next month and has unsuccessfully taken action in the past year (combines intention and behavior criteria). n Actively planning change and already taking some steps toward action such as reducing frequency of problem behavior. n “I am thinking about changing my risky sexual behavior within the next 30 days to reduce the risk of getting HIV.”

10 4. Action n Stage in which individuals modify their behavior, experiences, or environment in order to overcome their problems. Involves overt behavioral changes and requires commitment of time and energy. n e.g., cessation of smoking has occurred and last cigarette was less than 6 months ago. n “In the last few months I have changed my risky sexual behavior to reduce the risk of getting HIV.”

11 5. Maintenance n People work to prevent relapse and consolidate the gains attained during action. n Sustaining change and resisting temptation to relapse. n Stage extends from 6 months and beyond the initial behavioral change. n “For more than 6 months I have changed my (former) risky sexual behavior to reduce the risk of getting HIV.”

12 Health Belief Model n Susceptibility n Severity n Costs/Benefits n Cues/Motivation n Barriers

13 Susceptibility n How likely one thinks a bad outcome (e.g., get sick or a disease) is if behavior persists (doesn’t change).

14 Severity n The consequence is perceived to be severe as opposed to mild.

15 Benefits of Behavior n The alternative behavior will reduce the likelihood of the negative consequence (e.g., disease). & n Benefits are perceived to outweigh costs.

16 Motivational cues n Cues (internal or external) that help convert intentions into behavior

17 Barriers n There are not significant psychological, financial, or other costs or barriers to engaging in the behavior.

18 Jane is not likely to continue smoking because… n She thinks that she might get lung cancer if she continues to smoke (susceptibility). n She believes that dying from lung cancer is terrible (severity). n Jane does not find smoking to be very pleasurable (cost/benefits). n Her friends are supportive of her quitting (absence of barrier)

19 Jon is likely to continue smoking because n He agrees with the tobacco industry-- smoking doesn’t cause lung cancer (susceptibility). n He believes that dying from lung cancer is not any worse than any other way of dying (severity). n Jon feels that smoking relaxes him (cost/benefits). n His friends offer him cigarettes (barrier to quitting)

20 Imitation of Models n We learn behavior by watching and imitating other people.

21 Differential Reinforcement n Positive reinforcement (rewards) n Negative reinforcement (avoidance of something bad) n Positive punishment (aversive stimuli) n Negative punishment (loss of reward) u Positive (present something) u Negative (take something away) u Reinforcement (behavior increases) u Punishment (behavior decreases)

22 Exposure and Adoption of Evaluative Definitions n The more an individual defines a behavior as good or at least justified rather than bad, the more likely they are to engage in it. u Evaluative definitions F positive, neutral, negative F norms, attitudes, orientations

23 Behavioral Consequences n What happened after the behavior was performed?

24 Jerry is likely to overeat n Jerry’s parents are big eaters (imitation of models) n Jerry’s family serves big meal portions and encourages him to “clean your plate or you won’t get dessert” (negative reinforcement) n Jerry feels that thin people are unhealthy (evaluative definitions). n Jerry’s family praises him for finishing his meals (behavioral consequences).

25 Concluding Thoughts -evaluate these models of health promotion