Theories and Models of Behavioral Change Mr. Lema, Isaac Clinical Psychologist (MSc) 11 th January 2016

Learning Objectives Understand the parameters required for health model Be able to apply those parameters on models 11 January 2016Theories and Models of Behavioral Change2

Outline Introduction What influences health behaviors? Health promotion Individual level models Communities level models Communication level models Organisational level models Social level models 11 January 2016Theories and Models of Behavioral Change3

Introduction Health is a state of complete physical, psychological, and social well-being and not simply the absence of disease or infirmity (World Health Organization, 1948) Behavior is a key factor in determining health Maternal and child underweight Smoking and alcohol abuse Unsafe sex Unsafe water and lack of adequate sanitation 11 January 20164Theories and Models of Behavioral Change

Introduction … Theory is a set of interrelated concepts, definitions and propositions that present a systematic view of events or situations by specifying relations among variables, in order to explain and predict the events or situations (Kerlinger, 1986) Models draw on a number of theories to help understand a specific problem in a particular setting or context (Glanz et al., 2008) 11 January 2016Theories and Models of Behavioral Change5

Introduction … A fully developed theory explains Major factors that influence the phenomenon of interest Relationship between these factors Condition under which these relationships do or do not occur or the how, when and why of the hypothesized relationships 11 January 20166Theories and Models of Behavioral Change

Introduction … Theory can help in the planning and delivery of programs in several ways Better understand the nature of the problem being addressed Used evidence informed methods and measures to monitor the problem and program Explain or make propositions concerning how to change health status, related behaviors and their determinants 11 January 20167Theories and Models of Behavioral Change

What influences Health Behaviors? 11 January 2016Theories and Models of Behavioral Change8 Biological Gene Physiology Age Gender Fitness Weight Psychological Personality Reward / Punishment Cognitive biases Emotion / Motivation Social Support Relationship Status Health Behaviors e.g. eating well, getting physical activity, not smoking, sleep well © 2006 Wardsworth – Thomson

Health Promotion Health promotion means changing behavior at multiple levels Individual, interpersonal, institutional or organizational, community and public policy factors Four theories or models that have been influential in health promoting practice 1. Health beliefs model 2. Reasoned action and planned behaviors 3. Trans theoretical model 4. Social cognitive theory 11 January 20169Theories and Models of Behavioral Change

Health Promotion … Planning Cycle 11 January Theories and Models of Behavioral Change 1. Problem definition [Redefinition] 2. Solution generation 3. Resource mobilization 4. Implementation 5. Impact assessment 6. Intermediate outcome assessment 7. Outcome assessment

Individual Level Models Most basic unit of health promotion Components of broader level theories and approaches Theories which explain health behavior change by focusing on individual characteristics 11 January 2016Theories and Models of Behavioral Change11

Individual Level Models Explain health behavior change by focusing on individual characteristics 1. Health Belief Model 2. Theory of Reasoned Action 3. Theory of Planned Behaviour 4. Transtheoretical Model 5. Social Cognitive Theory 6. Information Motivation Behavioural Skills* 7. AIDS Risk Reduction Model* 11 January 2016Theories and Models of Behavioral Change12

1. Health Belief Model One of the most widely recognized conceptual frameworks of health behavior Understand individual beliefs about health Individuals conduct an internal assessment of the net benefits of changing their behavior, and then decide whether to act 11 January 2016Theories and Models of Behavioral Change13

1. Health Belief Model … The likelihood of an individual taking action related to a given health problem is based on the interaction between four different types of beliefs 1. They suspect themselves to be susceptible to a condition or problem 2. They believe it would have potentially serious consequences 11 January 2016Theories and Models of Behavioral Change14

1. Health Belief Model … 3. They believe a course of action is available that will reduce their susceptibility or minimize the consequences and 4. They believe that the benefits of taking action outweigh the costs or barriers 11 January 2016Theories and Models of Behavioral Change15

11 January 2016Theories and Models of Behavioral Change16 Perceived susceptibility to problem Perceived seriousness of consequences of problem Perceived benefits of specified action Perceived barriers to taking action Perceived threat Outcome expectations Self efficacy [Perceived ability to carry out recommended action

1. Health Belief Model … Self efficacy is the belief in ones own ability to successfully perform a behavior Health promotion messages Mass media, peer education, and other interventions Act as cues to action, translating that readiness into overt behavior 11 January 2016Theories and Models of Behavioral Change17

1. Health Belief Model … Often necessary to overcome habitual unhealthy behaviors such as not wearing seat belts, eating primarily high-fat foods, or smoking Factors in an individual’s sense of self-efficacy or confidence in one’s ability to make the desired change 11 January 2016Theories and Models of Behavioral Change18

1. Health Belief Model … Limited to accounting for as much of the variance in an individual’s health behaviors as can be explained by their attitudes and beliefs Taking little account of social, economical and environmental influence on behavior 11 January 2016Theories and Models of Behavioral Change19

2,3. Theories of Reasoned Action and Planned Developed by Ajzen and Fishbein to explain human behavior that is under “voluntary” control People are usually rational and will make predictable decisions in well defined circumstances 11 January 2016Theories and Models of Behavioral Change20

2,3. Theories of Reasoned Action and Planned … Intention to act is the most immediate determinant of behavior and that all other factors influencing behavior will be mediated through behavior intention 11 January 2016Theories and Models of Behavioral Change21

11 January 2016Theories and Models of Behavioral Change22 Behavioral beliefs Evaluation of behavioral outcome Normative beliefs Motivational to comply Control beliefs Perceived power Attitude towards behavior Subjective norm Perceived behavioral control Behavior al intention Behavior

2,3. Theories of Reasoned Action and Planned … Useful in identifying what information a person might need to collect from a target group before developing a program In depth interview 11 January 2016Theories and Models of Behavioral Change23

4. Transtheoretical Model Developed by Prochaska and DiClemente to describe and explain the different stages of change that appear to be common to most behavior change processes Describe both stages of change and the process of change relevant to the different stages 11 January 2016Theories and Models of Behavioral Change24

4. Transtheoretical Model … Behavioral change is a process rather than an event 1. Pre contemplation – not ready for change 2. Contemplation – thought of change 3. Preparation or determination - commitment to change 4. Action – behavioral change initiated 5. Maintenance – staining change 11 January 2016Theories and Models of Behavioral Change25

4. Transtheoretical Model ….) Pre contemplation ActionPreparation MaintenanceContemplation 11 January 2016Theories and Models of Behavioral Change26

3. Transtheoretical Model … Model is circular as people can enter or exit at any point Stage of change model 11 January 2016Theories and Models of Behavioral Change27

5. Social Cognitive Model Interaction that occurs between an individual and their environment Bandura refer it as “reciprocal determinism” Range of personal cognitive factors form a third part of this relationship – individual and environment 11 January 2016Theories and Models of Behavioral Change28

5. Social Cognitive Model … 1. Capacity to learn by observing both the behavior of others and the rewards received for different behaviors 2. Capacity to anticipate and place value on the outcomes of different behaviors patterns – expectations 3. Concept of self efficacy 11 January 2016Theories and Models of Behavioral Change29

Community Level Models Theories on change in communities for health 1. Diffusion on innovation theory 2. Community organisation and community building 11 January 2016Theories and Models of Behavioral Change30

1. Diffusion of Innovation Model Diffusion process by which an innovation is communicate through certain channel is over time among members of a social system Innovation an idea, practice or object perceived as a new by an individual 11 January 2016Theories and Models of Behavioral Change31

1. Diffusion of Innovation Model … Rogers identify five general factors that influence the success and speed with which new ideas are adopted in communities 1. Characteristics of the potential adopters 2. Rate of adoption 3. Nature of the social system 4. Characteristics of the innovation 5. Characteristics of change agents 11 January 2016Theories and Models of Behavioral Change32

1. Diffusion of Innovation Model … This theory provide an excellent diagnostic tool for anal sing how and why population respond to the introduction of new ideas It can also be adopted in relation to organizations where the adopters may be employees or professional groups and the change agent my be managers and professional leaders 11 January 2016Theories and Models of Behavioral Change33

2. Community Organizational and Building Model Working with local communities or community in interest has been a central strategy for health promotion workers Framework developed by Rothman Why, how and in what way local communities may be involved in health promotion 11 January 2016Theories and Models of Behavioral Change34

Communication Level Models Modeling which guide communication to bring about behavior change Provide insight and guidance on the strengths and weakness of education and communication for health promotion 11 January 2016Theories and Models of Behavioral Change35

Communication Level Models 1. Healthy literacy 2. Communication behavior change model 3. Social marketing 11 January 2016Theories and Models of Behavioral Change36

Organisational Level Models Model for change in organisations and creation of supportive organisational practices 1. Theories of organisational change 2. Models of interpectoral action 11 January 2016Theories and Models of Behavioral Change37

Social Level Models of Change 1. Diffusion Theory 2. Leadership Models 3. Social Movement Theory 11 January 2016Theories and Models of Behavioral Change38

Conclusion Theory would guide research, the findings of research would inform theory and each would influence and be influenced by clinical practice More often than not, however the interplay among theory, empirical research and practice remains an ideal not a reality January 2016 Theories and Models of Behavioral Change

References Gross, R. (2010) Psychology the Science of Mind and Behaviors 6 th edition; Macmillan Company Kerlinger, EN (1986). Foundations of Behavioral Research (3d ed.). Mew York: Holt, Rinehart and Winston. Glanz, KM, Rimer, BK & Viswanath, K. (Eds.),(2008). Health behavior and health education: Theory, research and practice 4th Edition, San Francisco, California: Jossey-Bass. 11 January Theories and Models of Behavioral Change