1. THEORY, PRINCIPLE AND PERSPECTIVES MENTAL HEALTH THEORY FOR HEALTH PROMOTION PRACTICE PSYC 377

2. Model Subclass of theory Describe what happens in a practice in a general way Applicable to a wide range of situations Has structured format Prescribes what should be done Generalizable E.g. Recovery model – People can begin to recover not only just through individual therapy or medication or self- help but by learning skills that apply to all aspects of their lives

3. Perspective Particular way of viewing an issue or a situation Relating to activities or broad categories rather than description Not too concerned with scientific proof or validity of intervention e.g. Strengths Perspective – identifies, uses, builds and reinforces strengths and abilities that people have in contrast to problem-oriented perspective which focuses on client’s deficiencies or inabilities

4. Theory Interrelated concepts, definitions, and propositions that present a systematic view of events and situations Focuses on factors and variables in order to understand, predict and control events Concepts are building blocks of theories E.g. Explanatory theory – focuses on the theory of the problem describing factors (knowledge, attitudes, self- efficacy, social support, lack of resources ) that influence behavior or a situation and identifies why a problem exists

5. Theory Theories are made up of concepts which are easily translated into actions Translating theories into actions allows you to evaluate your program See: http://cancercontrol.cancer.gov/brp/constructs/theory.html

6. Discussion: Why do we need a theory to start with? Who do you want to change?

7. Change Theories (1) Individual Change Theories: Assumption: Individual behavior is rational, determined by attitudes and beliefs and perceptions of what causes disease and whether or not these causes could be overcome Example 1: Health Belief Model (HBM): Explains and predicts health-related behavior from belief patterns Belief: Is object real or not? (Cigarettes are bad for me) Components: (1)Perceived severity or seriousness, (2)perceived susceptibility, (3) Perceived benefits and barriers, (4) Cues to action and (5) Self-efficacy

8. Individual Change Theories: Example 2 : Theory of Reasoned Action: Before action takes place, the formulation of behavioral intervention should take place Components: (1)Attitude and facilitating components (2) Used widely for tobacco control, alcohol and drug abuse

9. Individual Change Theories: Example 3 : Value Expectancy or Valance Theory: A particular level of effort will be followed by a particular level of performance – Taking certain actions for future well-being and health Components: (1)perception is the motivational key to doing something different (2) positive change is brought about with gentle persuasion

10. Individual Change Theories: Example 4 : Stages of Change Theory/Transtheoretical Model: This theory recognizes that with issues such as addiction or other problems, recurrence is the rule not the exception simply because issues could be perceived as ‘ cyclical’. Treatment programs that have ‘zero tolerance’ is detrimental for clients. This theory focuses on persons readiness to change or attempt to change to health behaviors. Components/Stages: (1)precontemplation (2) contemplation (3) Preparation (4) Action (5) Maintenance and (6) Recurrance

11. Dr Hibbert Now, a little death anxiety is normal. You can expect to go through five stages. The first is denial. Homer: No way! Because I’m not dying! Dr Hibbert : The second is anger. Homer: Why you little! [Steps towards Dr Hibbert] Dr Hibbert: After that comes fear. Homer: What’s after fear? What’s after fear? [In frightened voice] Dr Hibbert : Bargaining. Homer: Doc, you gotta get me out of this! I’ll make it worth your while! Dr Hibbert: Finally, acceptance. Homer: Well, we all gotta go sometime. Dr Hibbert: Mr Simpson, your progress astounds me.

12. Change Theories (2) Interpersonal Change Theories: Assumption: Importance of relationships individuals have with friends, family and others in their environment Example 1: Cognitive Behavioral Theory: Emphasizes the influence of thoughts and beliefs about the self and the world on behavior and emotional states. Human functioning can be changed by altering cognition, behavior, affect or interpersonal or social situations. Components: (1)Emphasis on visible behavior causing problems or absence of adaptive behavior, (2) attributions by persons towards meaning of stimuli, (3) Present behavior and thoughts and feelings that goes with behavior, (4) Target sequence of behaviors (5) Identify controlling situations or conditions (6) Identify people’s labels (7) flexibility in listening and guiding client to a clear hypothesis of behavior

13. Interpersonal Change Theories: Example 3: Social Cognitive Learning Theory: Emphasizes observational learning and in-vivo (real life) experiences Components: (1)Reciprocal determinism – environment determines cognition, individual’s behavior and cognition affects environment, (2)Role modeling – observation and identification with ‘others’

14. Interpersonal Change Theories: Example 4: Empowerment Theory: Gaining of the power by an individual, family, group of persons, or community Assumption: All individuals are potentially competent even in extremely challenging situations and all human beings are subject to various degrees of powerlessness Concepts: Strengths orientation, reduction of barriers and promotion of individual growth Components: (1) Creation of consumer boards for participatory management, (2) Consumers are able to make independent decisions about services (3) establish communication (4) opportunities of skill and personal development by collaborative relationships, capacity building among family members and using family and non-kin networks

15. Change Theories (3) Organizational-Level Change Theories: Assumption: Interactions of individuals within systems or organizations Example 1: Chronic Care Model: Quality improvement for strategies for working with chronic health and mental health conditions Assumptions: (1)Untreated chronic disease affects mortality and morbidity, (2) prevalence of such diseases are increasing, (3) application of best treatments to informed patients leads to reduction in suffering Components: (1)Organization of health care, (2)delivery system design, (3)client self-management, (4) decision support (5) Clinical information systems

16. Change Theories (4) Community-Level Change Theories: Assumption: Association between morbidity and community factors (unemployment, isolation, inadequate housing) are very important Example 1: Community Empowerment Theory: Focuses on both individual and community change Components: (1) Individuals and organizations apply their skills jointly (2) Support each other, (3) Address conflicts in community (4) Gain influence and control over quality of life (5) Participation, caring, sharing and responsibility (6) Power as an expanding commodity