Chapter 6-Stage Models of health

Self-efficacy should be favorable in translating into

action, as well as interventions and perceptions. Example: How to use a condom correctly to avoid HIV.

Processes of change

actions that help you achieve change in behavior

In terms of systematic relationship between the stages, health-promotion interventions need to include

all stages of change readiness according to change. Example: practitioners need dramatic relief and consciousness raising to help overcome behaviors.

task-specific self-efficacy

an individual's internal expectancy to perform a specific task effectively. Example: A woman who wants to lose weight knows how to cook healthy food, but does not know about exercise programs.

Attributes of effective health communication

Accuracy Availability Balance Consistency Cultural competence Evidence based Reach Reliability Repetition Timeliness Understandability

Knowledge is a precondition for what kind of change?

Behavior change, which is fundamental for all health promotion programs. Example: People avoiding foods with additives which can cause cancer.

message tailoring

any combination of information and behavior change strategies intended to reach one specific person, based on characteristics that are unique to that person, related to the outcome of interest, and derived from an individual assessment. Example: Amazon, making movie recommendations.

The elaboration Likelihood Model is used to describe

attitudes toward a given behavior.

Formative research uses target

audience. Example: Teens and "See It and Stop It"

To understand theories, you should know that they are like

puzzles, as they are key to understanding the pieces that fit and how they interact through theory.

The reception yielding model can be important for

reception and adoption of health protective behaviors.

contingency management undesirable behavior is not

reinforced, while desirable behavior is reinforced. Example: Smoking money can be used for vacation.

The behavior may be important for

relapse, as the person changing the behavior may need to increase the capacity to learn and improve their readiness of behavior change.

Health promotion programs should accomodate differences in

self efficacy levels. Example: Variance in Alcohol levels during a college campus.

In the health-promotion, there is a multitude of

self help books, printed materials, etc. Example: mHealth study of sedentary type 2 diabetic patients.

Failure connects with

self-efficacy as it affects experiences. Example: La Leche league.

self-reevaluation

self-seeing without healthrisk behavior. Example: obese person without obesity.

In terms of the evaluation stage, changing behaviors are a

slow progression, which lead to long lasting behaviors.

successive approximations

small steps in behavior, one after the other, that lead to a particular goal behavior. Example: a mile, 3 miles, and running three miles.

content knowledge

understanding the ins and outs of health

Peripheral Route Procssing

using emotion. Example: The use of seductive women on a beer advertisement.

Factors intervene in completing

health behaviors. Example: No handwashing when clean water is not avaliable.

Environment reevaluation-realizing the negative

impact (unhealthy) & positive impact (healthy) has on proximal social/ physical environment. Example: children of obese parents seeing their parents bad behaviors.

When making a TMC intervention, what is taken into account?

information based on the stages and change of steps for a behavior problem.

A marketing mix is

interconnected. Example: Women over 40 who are going to get their mammograms have had a negative experience.

Stage targeted intervention the theory that explains

intervention can facilitate behavior change.

Doubts about self-efficacy and weak Outcome Expectations includes multiple

intervention needs to behavior change and may include social outcomes.

The level of motivation

is needed for self efficacy and outcome expectations. Example: Maintaining a low sodium diet.

In the PAPM, how is the issue of rejection and attempts of change handled?

label it, "decides not to act."

Intervention materials have been made to help people meet their

level of readiness to change. Example: Smoking cessation. Sun protection. etc.

McGuire's input/put model was used to test

messages and their attractiveness, encouragement, level of infromation and relevance to one's life (early steps) and self-efficacy, application with output steps.

Long term maintainence behaviors are better than

nothing and that movement through the stages is important.

Psychological state

our experience, expectations, motivation, and alertness. Example: learning to overcome fear of seeing the dentist.

Expectancies are attatched to the personal

outcome

negative reinforcement

people classify as something undesirable. Example: contraception and reproductive age.

The social environment is important for shaping

perception and outcome expectations. Examples: 10 points down in terms of cholesterol levels.

Self-efficacy is connected to

perceptions. Example: A man cuts down on sodium because he has high BP.

Outcome expectations include negative

perceptions. Example: Vaccines may have an allergic reaction.

Extreme utility of the

peripheral route. Example: Jimmy Carter getting his flu shot.

Behavior back to the

person. Example: To lose weight, switch to a low fat diet.

A program will not work, unless it helps the whole

population

Five Stages of the Transtheoretical Model

precontemplation, contemplation, preparation, action, maintenance and termination (addiction only)

maintenance (Transtheoretical Model of Change) is when relapse is

prevented.

audience segmentation

producers and distributors try to reach different types of people with content tailored specifically for them. Example: Male and female audience.

SCT is a combination of principles to design a health promotion

program for optimal effectiveness for specific behaviors.

TIPSS

Tailored Information Program For Safer Sex. Example: Uses attitudes (positive/negative) social influences (descriptive norms) self-efficacy (determinants/confidence in one's abities.)

An example of how place was not considered adequately in the marketing mix?

The 5 a day Campaign.

There is a downside to peripheral attitudes

The attitudes are not counter resulting and are far less enduring.

Optimism Bias

The belief that bad things happen to other people but not to us. Example: Doctors performing heart surgery on someone else, but eat steak and potatoes with lots of butter and sour cream.

Collective cognitions

The community is influenced by the ideas. Example: Gay people who view HIV as normal.

perceived self-efficacy

The most widely known theory, meaning someone knows how to complete a behavioral task.

Diffusion Theory

The spread of ideas and technology through human contacts: -Triability (minimal cost) -compatibility (stability of cultural values) -relative advantage (perception)

Threefold Stepwise Implementation Model

Three steps: 1. High Self-Efficacy and strong Outcome Expectations 2. Doubts about self-efficacy and weak Outcome Expectations. 3. Personal Control over behavior is lacking.

Computer technology based interventions

Using technology to help overcome a problem. Example: HIV prevention among African Americans.

Attitudes and counterpersuasion example:

Vaccine vs. Autism.

Self-efficacy can be learned by what type of learning?

Vicarious and establishing long term behaviors. Examples: Quitting smoking.

shaping approximations

conditioning a target behavior by progressively reinforcing behaviors that come closer and closer to the target. Example running a 10k.

vicarious experience

conditions that allow us to learn by watching what happens to others. Example: A college program that shows how to prevent drunk driving, sexual negotiations, condom application.

Weak Principle

cons change from 1 Standard deviation.

Stage Theories are a subset of value

expectancy theories.

Health outcomes can be based on positive

experiences. Example: saying no to food.

verbal persuasion (self efficacy)

feedback, encouragement, motivation to overcome high risk health behaviors. Example: Resist high calorie foods.

Self-liberation is making a

firm commitment to change. Example: Changing a diet.

From an SCT perspective, low self-efficacy gnerates what?

fleeting or no efforts through adoption.

Behavioral capacity

knowledge and skill to perform a given behavior.

The reciprocal triad includes changes to what three environments?

social, political and economic

The precaution adoption process model (PAPM) is the second major

stage theory in the field of health promotion.

Behavior change comes in different

stages for different stages.

Determining a change of behavior is dependent on the______________algorithm.

staging

The implementation of TMC of constructs varies by

study and behavior. Example: North Queensland among Australians.

Reinforcement

the final aspect of outcome expectations and it can add something good or something bad, which takes the form of a good or bad behavior, regardless of the reinforcement.

Place

the point of contact with the target audience. Example: Media, Health Clinic, Mall.

Health Communication

the study and use of communication strategies to inform and influence individual and community decisions that enhance health: 1. Patient to health professional relations 2. Health information use 3. Clinical recommendations 4. Dissemination of health risk info 5. Mass media of public health/culture 6. Education of consumers for public health systems

Future social marketers should take the social marketing to

the upstream in order to achieve better results.

Social Marketing

the use of commercial marketing concepts and tools in programs designed to influence individuals' behavior to improve their well-being and that of society. Example: using it to developing health determinants, as it is used among Public health professionals.

McGuire's Reception Yielding Model was split into

two steps: reception probability with yielding probability, with the cue of an expert.

central route processing

type of information processing that involves attending to the content of the message itself. Example: HPV vaccine for men receiving Anal/oral sex.

Attention is important to

understand a message, then it will tell the person to resonate with the message, catch their attention and understand it.

Action (Transtheoretical Model of Change)

Changes to specific behavior have been made. Example: Smoking cessation and consuming 5+ servings of fruits and veggies.

Procedural knowledge

How to engage in a health behavior. Example: How to cook a food low in saturated or trans fat.

Stage theories should include

1. A classification system to define stages 2. Order of stages 3. Common barriers 4. stages that are defined by different barriers to change.

Key questions of tailoring messages are consisted of two means:

1. Assessment 2. Feedback.

Two theories of social marketing?

1. Diffusion theory 2. Stages of change

SCT health promotion programs include

1. Environmental/Personal levels 2. Five key constructs 3. different degrees of readiness.

Five key constructs of Social Cognitive Theory

1. Knowledge 2. Perceived self-efficacy 3. Outcome expectations 4. Goal Formation 5. Sociostructural factors.

PAPM assumption of barriers to change:

1. Not being personally aware 2. not being personally engaged 3. Rejection of behavior after behavior.

Assumptions of Transtheoretical model of change

1. One theory doesn't fit all 2. Behavior change comes in different stages. 3. Behavior is open to change and stability 4. Planned interventions are important for behavior change 5. At risk populations are not prepared for action. 6. Specific stages=specific behaviors. 7. No random behaviors 8. Behavior change is consisted of progress, backslide, cycle and recycle.

2). Dramatic relief

Increase emotional reactions to behavior. Example: Showing pictures of sun damaged skin to decrease the effect of skin cancer.

Observability and immediacy

(long term) and (short term) behaviors are effective and challenging for behavior change.

Research on TMC is focused on countries such as

-Australia (smoking cessation/secondhandsmoke) -Taiwan (smoking cessation/secondhandsmoke) -Turkey (smoking cessation/secondhandsmoke) -France (Physical activity)

Public Health programs are designed to

-Change attitudes -Raise awareness -Teach Healthy behavioral skills, but often fail give into entire populations

Subgoals for behavior change can do what three things?

-Increase a person's self-efficacy -increase expectancies -motivate people to increase in behavioral change overall.

Price

-Monetary, social or psychological value of a product. Example: Ostricized because friends continue to smoke, A young man going to an STD clinic, etc, as they do a cost benefit analysis.

10 processes of change

1). Conscious Raising. 2). Dramatic relief 3). Self Reevaluation. 4). Environmental Reevaluation. 5). Self Liberation. 6). Helping Relationships. 7). Counter Conditioning. 8). Reenforcement Management. 9). Stimulus Control. 10). Social Liberation.

Marketing Mix strategy example

1. Product: sexual assault 2. Price: Cons (violent encounter) vs. Pros (getting someone home) 3. Place: Social media and around off/on campus locations. 4. Promotion: Social media posts, stickers, campus bus ads, restaurants, and community outreach.

Two stages of PAPM

1. unaware of the issue 2. unengaged by the issue.

Promotion

Communication by marketers that informs, persuades, and reminds potential buyers of a product in order to influence an opinion or elicit a response. Examples: Media events, DVDs, swag.

TMC example

Computer delivered system for contraceptions. TMC computers and contraceptives for 30 minutes to test efficacy of condom use.

Two levels of self-efficacy:

Confidence and Temptation.

Confidence

Coping in high risk situations without relapsing.

Two important concepts in the TMC:

Decisional Balance and self-efficacy.

Temptation

Engaging in a specific behavior when challenging situations come up. Example: Emily eating a low fat diet, but during the holidays, it is tempting to eat lavishly.

Health behaviors can be affected by what two factors?

Examples: -gender=Men who are overweight (not a big deal) vs. women who are overweight (a big deal) -Socioeconomic status=People living in poor areas (overweight) and urban areas (not overweight.)

1). Conscious Raising.

Increasing the awareness of a bad behavior Example: Sunscreen for blocking harmful UV rays.

McGuire's input output matrix

Inputs: 1. Source 2. Message 3. Channel 4. Receiver 5. Context Outputs: 6. Exposure to communication message 7. Attention 8. Enjoys and maintains interest in message 9. Contents of Message 10. Cognitions of message 11. Relevant skills 12. Communication position and attitude changes. 13. Memory storage 14. Retrival new attitude from memory 15. Decisions on actions 16. Action 17. Integration of congnition 18. Encourage others to change their behavior

High Self-Efficacy and strong Outcome Expectations

Interventions before adoptions of health behavior combined with health behaviors and self efficacy. Example: eating a low sodium diet.

Personal Control over behavior is lacking

Involves personal agency which is the larger perception of controlling the behavior.

Intrinsic reinforcement

No socially constructed. Example: Runner's high (losing weight) increased body image statisfaction.

Is the five stage Transtheoretical Model of Change a linear path?

No, as recycling/relapse may occur through the stages.

Precontemplation

Not intending to make changes within the next 6 months. Example: Not thinking, reading or talking about their behavior.

Perception self-efficacy

One health behavior may or may not mirror reality. Examples: vaccine forms can be filled out orally. and Birth control methods

Decisional balance

One of the four components of the transtheoretical model; refers to the numbers of pros and cons an individual perceives regarding adopting and/or maintaining an activity program, it involves two implications: enhancing perceptions of the advantages of changing behaviorand minimizing perceptions of the barriets to changes in behavior. Example: Joe wants quit smoking, by weighing pros (helps decrease stress) and cons (adverse side affects.)

yielding (public health)

Other solutions to the problem. Example: Young guys getting the vaccine.

Transtheoretical model of behavior change

People go through stages of behavior changes through methods of behavior. Example: Therapy is used to overcome smoking.

enactive attainment to what kind experiences

Personal experiences of mastery. Example: how to apply a condom.

Information processing chain of responses

Presentation-Attention-Comprehension-Yielding-Retention-Behavior

Social Cognitive Theory connects to

Public Health through changing people's behaviors.

Example of PAPM

Radon Testing.

Social liberation

Realizing that the social norms are changing in the direction of supporting the healthy behavior change. Example: Non-Smoke cities.

Promotion of family planning

Women may not have faith in family planning.

stage matching

-People can be determined to be at a particular stage of change for a specific behavior -Allows interventions to be designed with greater specificity, and is dependent on the willingness and readiness of behavior change.

Interactive marketing theories

-Product -Price -Promotion -Place -Positioning

Key features of the Elaboration Likelihood model

-Public health messages -Change attitudes of behavior -Evaluation of a person, object, or issue -Specificity -Persuastion research -Discrepancies -cerebral, as it is drives emotions by attitudes -Personal confidence with attitudes -motivation -central and peripheral -Attitudes -Mental shortcuts -Equal contributions -process of messages -susceptibility and severity -counterpersuasion -Negative feelings -Efficacy of elm to changing behavior.

TIPSS program procedure

-Questions about sexual preferences -Tailored feedback -Interactive exercises on a particular stage. -Above or below constructs -effect sizes

Health communication includes what two things?

-Scientific principles/research -appealing to the audience

Social Cognitive theory includes aspects of

-Social -Physical -Economic -Legal/policy -Personal characteristics

Three goals of health communication

-The Use of Theory -Channels and technologies for various health communication tools -Being Creative

Social marketing benefits

-The greater good -cost effective -audience -wide range of communication -change of social norms -environmental change -health range behaviors -empowering communities.

Health communication theories

-The reception yielding tool -elaboration likelihood -Social marketing -Tailored communications

The two theories that predominate health promotion research and practice:

-Transtheoretical Model of Change (TMC) and Precaution Adoption Process Model (PAPM)

Movement from one stage to the next eventually leads to a number of what type of steps?

-involvement steps, as they are different from person to person.

Social learning theory is connected to what kind of factors

-social context theories -environmental factors -the individual -the individual's behavior Example: Obesity.

Four methods of learn

1. Psychological state 2. Verbal persuasion 3. Vicarious experience 4. Enactive attainment

Stages of PAPM

1. unaware of issue-never heard about the issue 2. unengaged by issue-Opinions 3. undecided about acting-Thinking about acting and those who act 4. decided not to act-considered avaliable information; no action 5. decided to act-Considered the avaliable the information and take action 6. acting-Information influences action. 7. maintenance-Behavior change has occurred.

Middle East Syndrome study

77% of the study participants used the internet, Physicians, and healthcare providers because they are trustworth for MERS information.

Yale Communication Model

A model of the persuasion process that stresses the role of the communicator (source of a message), the nature of the message, the audience, and the channel of communication. Example: Attention-comprehension-learning-acceptance-retention

Stimulus control

A situation in which the frequency, latency, duration, or amplitude of a behavior is altered by the presence or absence of an antecedent stimulus. Example: Keep your gym bag in your office or car to use them.

message targeting

A specific message that is geared toward a specific audience. Example: Safe sex.

Product

A tangible good, service, idea, or some combination of these that satisfies consumer or business customer needs through the exchange process; a bundle of attributes including features, functions, benefits, and uses, as it has an audience through surveys, interviews, focus interviews with a target audience. Example: Smoking cessation programs.

Example of sct to prevent morbidity and mortality

Hispanic women and mammography, women who are 40 and over, have Spanish speaking coworkers.

Collective self-efficacy

Shared belief of members of a group that they can be successful when they work together on a task. Example: Tabacco ETS laws

The social learning theory is predicted based on what kind of environment?

Social environment, which has an influence on behaviors.

Preparation

Steps to change their behavior. Example: Life coach, talking with doctor, consulting a counselor.

Expectancies vs expectations

Y will follow x, with either a positive or negative value will be attatched to it.

High intelligence favors reception, but does it work against yielding?

Yes, but it should be working on a foundation of knowledge.

Counterconditioning

a behavior therapy procedure that uses classical conditioning to evoke new responses to stimuli that are triggering unwanted behaviors; includes exposure therapies and aversive conditioning. Example: Yoga, meditation, or Physical activities.

Precaution Adoption Process Model (PAPM)

a model dealing with change that occurs in stages and over time.

Elaboration Likelihood Model (ELM)

a model of persuasion maintaining that there are two different routes to persuasion: the central route (facts) and the peripheral (feelings) route

Outcome expectancies

a person's assumptions about the likely consequences of a future behavior

outcome expectations

a person's assumptions about the likely consequences of a future behavior. Example: If I wear a condom, then I will avoid getting HIV.

What limits goals on health behaviors?

a person's environment. Example: Living in a rural area of the USA vs. living in a suburban California area.

reception yielding model

a persuasive message should be scary enough to be convincing but not so scary that people tune out

Social marketing done correctly should have

a systematic exploring method filled with ecological factors, which mix in with healthy behaviors.

Overall self-efficacy breaks down into finer gradients of

behavior. Example: 1. Charting menstrual cycles 2. Using math to determine ovulation 3. Thickness of cervical mucus. 4. measuring and recording body temp. 5. Non-intercourse days. 6. communication with partner.

resilient self-efficacy

belief that one can perform a task successfully even after experiencing setbacks

Health behaviors can be either

challenging (eating healthy) or easy (exercising a few weeks.)

In behavior change, stage theories are used to help people find the perfect fit for behavior

change.

We should mix in the process of change with enhancement

changes, as the concepts are not equal.

Environment shapes

cognition. Example: Defensible space.

Contemplation is engaging in_____________processess about_______________ _________________.

cognitive processes about behavior change.

Extrinsic reinforcement is socially

constructed reward Example: applause for smoking cessation.

stage-matched interventions

designed to move the person toward the action, maintenance, and termination stages. Example: Precontemplation-Contemplation Contemplation-preparation Preparation-Action Action-maintenance.

Social Cognitive theory was

developed by Albert Bandura, which is composed of learning via observation, imitating their behavior, and reinforcement. It evolved from the social learning Theory. Example: Teens who watch violent tv are more likely to be violent.

Stage models of behavior change shows the

development, implementation, and evaluation of health promotion across a multitude of health behaviors.

Each stage come with its own list of different challenges, which therefore begs to use

different changes processes. Example: cognitive, affective, and evaluative processes in early stages and evaluative processes through late stages, and commitments, conditioning, and contingencies, environmental controls and support.

Being "unaware" and "unengaged" stages are important because the barriers are

different.

Program effect sizes depend on

dissemination and resource level.

Termination (Transtheoretical Model of Change) is when the unhealthy behavior has

ended.

Outputs may be used for Public health

engagement. Example: Social media for exposure and paying attention.

Reciprocal Triadic Causation includes three factors

environment, person, behavior

A person can be affected by the

environment. Example: The Netherlands has female birth control pills, eating a vegetarian diet.

In TMC, behavior change is

evolutionary, not revolutionary.

helping relationship

exists among people who provide and receive assistance in meeting a behavior change. Example: Joe wants to workout and he needs people (personal trainer or workout body.)

Strong Principle of Progress is progression from

from Precontemplation to Action is a function of approximately one standard deviation increase in the Pros of a healthy behavior change.