1. 1 Health Psychology Chapter 3: Seeking Health Care (Health Behavior Models) Mansfield University Dr. Craig, Instructor

2. Understanding/Predicting/Treating Health Behvr. §What measurable factors affect health behavior? l Class thoughts §Useful Theories  generate research  organize & explain observations (research & clinical)  guide in predicting behavior  (not in book) avenues for behavior change §All models describe processes/or variables leading to INTENTIONAL changes toward healthy behaviors l Health Belief Model (from Hochbaum) l Theory of Reasoned Action (Azjen) l Social-Cognitive Theory (Self-Regulation, Bandura) l Transtheoretical Model (Prochaska & DiClemente)

3. Well Studied Determinants §1. Characteristics of symptoms painful? Disabling? Visible? §2.Perceived Cost/Benefit of seeking help time, money, pain, §3.Perceived Severity of condition §4.Person’s Intention to Behave & Self-Efficacy §5.Readiness To Change §6.Social & Demographic Characteristics

4. Rosenstock & Becker’s Health Belief Model (health seeking behavior) PerceivedSusceptibility of Disease or Disability PerceivedSeverity of the Disease or Disability PerceivedBenefits of Health Improving Behavior PerceivedBarriers to Health Improving Behaviors HEALTH SEEKING BEHAVIOR

5. Evidence for HBM §Mixed evidence, but some impressive results l Mammograpy Champion- manipulated perceived susceptibility  increased rate 4x others have manipulated perceived barriers and benefits to increase attendance l Also used in safe-sex, CV screening, AIDS testing, immunization efforts § Large efforts will often manipulate multiple belief systems + other important variables to increase overall intention to behave

6. Theory of Planned Behavior Attitude Toward the Behavior Subjective Norm Intention to Behave Perceived Behavioral Control HEALTH BEHAVIOR Attitude Attitude-thoughts, feeling, predisposition to act on a topic. One individual beliefs about behavior/condition Subjective Norm Subjective Norm- attitude of the “social group” toward condition (e.g., what friends think, family says) Relative Importance Relative Importance- the relative influences of own attitude vs. what subjective norms “say” Perceived Behavior Control (self efficacy)- Perceived Behavior Control (self efficacy)- one belief in their capacity to exercise behavioral control over events that affect their lives. Event-specific RI

7. Evidence for TPB §An extension of the theory of reasoned action l added the self-efficacy component §Measures of intention and perceived behavioral control have been show to be particularly powerful predictors §Stanford 5-city project l predicted adolescent smoking §Also predicted : l health program attendance l breast and testicular self examination l dental flossing

8. Building Self-Efficacy: Socio-Cognitive Models §Self Efficacy- people’s beliefs about the capabilities to exercise control over events that affect their lives. l A/K/A personal control, personal agency l Tends to be situation specific l It is continually modified by ongoing conditions l It can be changed (increased) §How can SE be changed? [class question]

9. Self Efficacy: Social-Cognitive Model Performance/ Enacting a Behavior vicarious experience; seeing someone w/ similar skills act successfully Self-Efficacy Physiological Arousal HEALTH BEHAVIOR Verbal persuasion or encouragement from trusted other Goal (Intention) - + + + Sense of Personal Control Sense of Personal Control makes increases likelihood of healthy behavior. biological, social- It is affected by biological, social- cognitive & behavioral cognitive & behavioral conditions

10. Evidence & Info: Self-Efficacy Model §Stanford 5 city project those with most difficulty changing unhealthy behavior had the lowest efficacy §Other studies efficacy directly related to smoking cessation and goal attainment exercise program adherence stress management eating/dietary behavior §Many other models have added SE to greatly improved predictive power. initiation maintenance §Clear that SE is related to initiation of behavior, but not clear whether it is related to maintenance §SE §SE may be more related to behrs requiring “mastery of skills” (learned behaviors e.g condom use) than not (abstinence)

11. Transtheoretical Model (TTM) §Behavior Changes in Stages: Precontemplation- Precontemplation- no intention of changing bhvr, and may not think they have a problem at all Contemplation Contemplation- awareness of problem, some thought of doing something about it within 6 months Preparation Preparation- specific behaviors and thoughts involved in planning to change behavior Action Action- overt change in behavior made Maintenance Maintenance- sustain behaviors and prevent relapse §Different Stages are affected by different factors, thus requiring different assistance to move to next stage §Relapses part of the model-- to be expected §Recognition of importance of decisional balance (pros and cons of maintaining risky behavior vs. healthy behavior)

12. Stage Models: Transtheoretical Model Pre-Contemplation Contemplation Preparation Maintenance Action Behavior No Behavior, but varied Readiness to Change Measured by Decisional Balance survey (pros & cons)