1. 1 Models of prevention

2. MODELS OF PREVENTION 2

3. 3 Watch video 5 mins 34 secs Changing or preventing risky or unhealthy behaviour has become a major concern of health professionals and governments alike. Social psychologists have focused on the cognitions underlying problem behaviours, and have concentrated on understanding how these contribute to actual behaviour. The key to changing such behaviours is to understand what factors contribute to a person’s intention to change an unhealthy behaviour, and then how that intention might be transformed into an actual behaviour.

4. In order to help us understand cognitive factors in the addictive behaviour psychologists have developed models of health behaviour.. 4

5. 5 Models of health behaviour YOU need to know; 1. Theory of Planned Behaviour (TPB) 2. The Health Belief Model (HBM) Referred to collectively, as “Cognitive Models” All Answering the question: ‘why do people adopt – or don’t adopt particular health-related behaviours’

6. 6 TPB

7. 1. Theory of Planned Behaviour (TPB) Model Main assumptions of TPB The TRA model emphasises the belief that behaviour is under the conscious control of the individual. For example it would assume that if a person intended to give up smoking then they would be able to do so. Perceived behavioural control (PBC).. 7

8. DRAWING TIME.. 8

9. 9 Theory of Planned Behaviour (TPB) Model Evaluation of these outcomes Beliefs about significant others’ attitudes t o the behaviour Motivation to comply with others’ expectations Attitude towards specific behaviour Subjective norm Behavioural intention Behaviour Beliefs about outcome of action Internal control factors (e.g. skills abilities) External control factors (e.g. Obstacles, opportunities) Perceived behaviour control Activity: A2 textbooks page 423 Ajzen (1989)

10. Perceived behavioural control (PBC).. This is about feeling confident that our current skills and resources will enable us to achieve the desired behaviour and overcome any external barriers. This is crucial to understanding motivation: e.g. if you think you are unable to quit smoking, you probably won’t even try. PBC can have a direct effect on behaviour because; the more control people believe themselves to have over the behaviour in question, the stronger will be their intention to actually perform that behaviour an individual with higher PBC is likely to try harder and to persevere for longer than someone with low PBC 10

11. Smoking and the TPB Conner et al (2006) investigated the role of planned behaviour in smoking initiation in 11-12 year olds. They tested 675 non-smoking adolescents with various baseline measures including TBA, and nine months later they checked whether any of the adolescents had taken up smoking. They used a carbon-monoxide breath monitor to assess this to avoid subjective judgement and found that behavioural intentions were generally a good predictor of later smoking behaviour. 11

12. Application to addictive and risky behaviour Intention to change unhealthy behaviour The TPB has been successfully applied in the prediction of a wide range of social behaviours, including stopping smoking, eating a healthy diet etc. For example Rise et al (2008) found that affective attitude (how someone feels about the behaviour in question) and descriptive norms(what others are actually doing)played a more crucial role than other aspects of the TPB in predicting whether smokers would actually quit. When is perceived control important? Perceived behavioural control (PBC) is more important when issues of control are associated with the performance of the task. Thus control contributes little to the prediction of intentions to consume convenience food, but a lot to the prediction of outcome to lose weight, etc (Netemeyer et al 1991) 12

13. 13 Activity: Using your A2 textbooks (pages 424 and 425) complete the TPB evaluation 1.Influential model - Walker et al (2004) currently most popular and widely used social cognition model in health psychology 2.Substantial empirical support – assessment of variety of health-related behaviours Brubaker and Wickersham (1990) examined components re testicular self examination: attitude, subjective norm, behavioural control (self-efficacy measured) All correlated with the behavioural intention 3.Need for additional non-cognitive components: need to consider variables e.g. ‘anticipated regret’ – strength of emotional disappointment if behavior not achieved 4.Doesn’t take other variables into account: includes irrationality (advantage over HBM) doesn’t address social and environmental factors Evaluation of TPB

14. 14 1.Supported by research evidence - Penny (1996): P TRB successfully predicted a wide range of behaviours – E blood donation, smoking marijuana, dental hygiene and family planning. However… P Correlation evidence is weak – lack of cause and effect – i.e. intention vs actual behaviour E people don’t always do what they say they intend to 2. P REDUCTIONIST- Penny (1996) E Fails to take past behaviour into account: E TPB doesn’t consider past behaviour However… Evidence a good predictor of future behaviour 3.Irrational and involuntary behaviour? P RELIABILITY- Fails to account for irrational decisions (Penny 1996) E Maes and van Elderen argue ‘The assumption that behaviour is a function of intentions....... limits the applicability....... of the model to volitional behaviour – E behaviours that are perceived to be under personal control’ Evaluation of TPB

15. 15 HBM

16. 16 Belief in personal health threat Belief in the effectiveness of a health behaviour Health Behaviour ( stop smoking) Health Belief Model (Stroebe 2000) Perceived Susceptibility (because I often engage in smoking, I could get lung cancer) Perceived Severity (practically all people who smoke get cancer eventually) Perceived Benefits (if I give up smoking now the risk of getting cancer will reduce) Perceived Barriers ( I like smoking) Cues to action Internal (e.g. Health problems External ( e.g. Information in health education leaflets)

17. CLIP 17

18. 2. Health Belief Model (HBM) This was developed by Becker 1974; Janz and Becker 1984: social psychologists working in the US Public Health Service. They wanted to understand why; 1.People failed to make use of disease prevention and screening tests for early detection of diseases, not associated with clear-cut symptoms such as tuberculosis. 2.Later it was applied to patients’ responses to symptoms and compliance with/adherence to prescribed medication among acutely and chronically ill patients. 3. Recently it has been used to predict a wide range of health-related behaviours (Ogden 2004) 18

19. Main assumptions of HBM (see diagram below) People will engage in a particular health behaviour as a function of: The extent to which they believe they are susceptible to the associated disease Their perception of the severity of the consequences of getting the disease Together these determine the perceived threat of the disease. Given the threat, people then consider whether or not the action will bring benefits that outweigh the costs associated with the action. In addition, cues to action increase the likelihood that the action will be adopted: these might include advice from others, a health problem or mass-media campaigns. Other important concepts include general health motivation (the individual’s readiness to be concerned about health matters), and perceived control e.g. I’m confident I can give up smoking – (Becker and Rosenstock 1987). 19

20. 20 EVALUATION - two strengths and two weaknesses Strengths 1. Takes demographic variables and psychological characteristics into account e.g. Age and gender Coping with stress (Forshaw 2002) 2. Supporting evidence: re dietary compliance, safe sex, vaccinations Related to perception of susceptibility to related health problems belief problem severe, perception that benefits outweigh costs (Becker 1977) Includes one off behaviours – short periods, longer term (dieting ) Weaknesses 1.Conflicting evidence: Janz and Becker (1984) – healthy behavioural intentions related to low perceived seriousness (not high) Studies suggest association between low susceptibility (not high) and healthy beh aviour 2.Importance of intention: no reference to intention but central beliefs and perceptions act directly on likelihood of behaviour When included increases HMB model level of predictability

21. 21 The Health Belief Model in relation to Habitual Behaviours Addictive behaviours are reinforcing. – they are habitual. Not all habitual behaviours are addictive (or bad for your health). Habitual behaviour is performed frequently and regularly under stable environmental conditions. – habitual means that it is no longer guided by conscious deliberation. Two aspects of these health models distinguished by Strobe (2000) is; Process & Prediction Strobe argued that responses are guided by conscious intentions – reflect attitudes, norms and PBC. Then attitudes, norms and perceptions are linked to behaviour because they influence Behavioural intentions (Eagly and Chaiken 1993). This action process does not apply to habitual behaviours which are instigated by recurring features of the environment.

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23. Timed essay – exam question a) Outline two models of the prevention of addiction (10 marks) b) Evaluate the models you described in part a) (14 marks) 23..30 minutes

24. Plan a) Define addiction Describe basis of two models (i.e. Cognitive approach ) + Describe TPB or HBM b) Evaluate – use research evidence to compare the models Debate = free will vs determinism Strengths & weaknesses of both Relate some of your points to the underlying debate 24