Theory

compression of morbidity hypothesis (green check)

James Fries (1980) "The idea behind compression of morbidity is to squeeze or compress the time horizon between the onset of chronic illness or disability and the time in which a person dies" -postponement of age of onset of morbidity -average illness burden is reduced -period of adult vigor is prolonged -quality of life is improved -need for medical care and associated costs may be reduced

DALY

disability-adjusted life years DALY=YLL+YLD YLL=years of life lost YLD=years lived with disability

variables

empirical counterparts, or operational forms, of constructs; they specify how a construct is to be measured

social liberation

increase in healthy social opportunities or alternatives

cognitive constructs of SCT

self-efficacy collective efficacy outcome expectations knowledge

Why Theory? (green check)

1) It improves our understanding of: determinants of conditions/health behaviors, process of behavior change, and critical constructs 2) it makes underlying/implicit assumptions explicit 3) it facilitates focus on what is changeable 4) it guides the development, testing, and refinement of behavior change interventions 5) funders prefer/require it

principles of ecological models

1) behavior is influenced by factors at multiple levels 2) environment is a determinant of behavior 3) variables interact with and influence each other across levels 4) ecological models should be behavior-specific and tailored to a specific behavior 5) multilevel interventions should be most effective in changing behavior

TPB underlying assumptions

1) factors outside of individual's control may affect behavioral intention and thus behavior 2) individual will expend more effort to perform a behavior when they have a high perception of behavioral control 3) perceived behavioral control is a realistic proxy for actual control 4) control can be measured

adequacy of a theory

1) its logic, or internal consistency, in not yielding mutually contradictory deviations 2) the extent to which it is parsimonious, or broadly relevant 3) its plausibility in fitting with prevailing theories in the field

challenges of using theory in public health

1) there is a dominance of interpersonal level theories and models, and a focus on psychological determinants 2) there is a lack of comparison among numerous health behavior theories that exist 3) tests of theory often occur in more controlled settings rather than real life, which decreases generalizability 4) most theories do not specify how the relationship between constructs, or the relative importance of a construct changes between contexts

limitations of SCT

1)maybe too comprehensive 2) temporality and interrelationships between constructs not well defined 3) inconsistent measurement of constructs

theory continuum

4 categories 1) informed by theory 2) applied theory 3) tested theory 4) building/creating theory

reciprocal determinism

Bandura; model of causation in which behavior, personal cognitive factors, and socioenvironmental influences all interact

Ecological models

Focus on the nature of people's interactions with their physical and sociocultural environment Ecological frameworks/models do not specify constructs or variables that generalize across behaviors, which makes them different from a theory they do not specify causation or processes

efficacy expectations

HBM added to the HBM years after it was first developed outcome efficacy: belief about the extent to which a particular behavior will lead to a certain outcome (similar to perceived benefits) self-efficacy: belief that one can successfully execute a behavior potential change strategies: provide training and guidance; use progressive goal setting; give verbal reinforcement; demonstrate desired behaviors; reduce anxiety about action

perceived susceptibility

HBM belief about the likelihood of getting a disease or condition potential change strategies: personalize risk information based on person's characteristics or behavior; make an individual's perceptions more consistent with his or her actual risk

perceived severity

HBM belief about the seriousness of contracting an illness or condition or of leaving it untreated, including physical consequences potential change strategies: specify the consequences of conditions; trigger emotions like distress and regret with images least powerful construct in predicting behavior

perceived benefits

HBM beliefs about positive features or advantages of a recommended action to reduce threat, such as reduced threat of disease or its consequences potential change strategies: shift an individual's perspective by highlighting others' beliefs about a behavior and its effects; provide knowledge and arguments in favor of the behavior

perceived threat

HBM combination (multiplication) of susceptibility and severity

perceived barriers

HBM possible obstacles to taking action, including negative consequences resulting from an action; such as inconvenience, cost, or fear of a screening procedure potential change strategies: identify and reduce perceived barriers through reassurance, correction of misinformation, incentives, and assistance reviews have found this is the most powerful single construct in the HBM in predicting behavior

cues to action

HBM; not well defined or systematically studied; factors that trigger the behavior can be internal (feeling a symptom) or external (media, recommendation from a physician, friend's diagnosis; placement of sunscreen near the cash register) potential change strategies: promote awareness; use appropriate reminder and recall systems (e.g., text message reminders, post cards)

commonly used theories

Health Belief Model Social Cognitive Theory Theory of Planned Behavior Social Support Diffusion of Innovations Social Ecological Model

social ecological framework (SEF)

NOT a theory ; does not give specific constructs or variables; different theories can be applied to different levels intrapersonal, interpersonal, institutional/organizational, community, policy

stimulus-response theory

Skinner, Watson behavior is an automatic response to a stimulus; no reasoning or thinking involved

conceptual model

a diagram of proposed causal linkages among a set of concepts believed to be related to a particular public health problem; may draw on more than one theory; are specific to one health problem; may not include all variables related to the health problem not the same as a logic model

self-efficacy

a person's confidence in their ability to perform a behavior that leads to an outcome explanation/strategies: mastery experience, social modeling, verbal persuasion, practice under stress-free conditions

helping relationships

action to maintenance caring, trust, openness, and acceptance as well as support from others for healthy behavior change; e.g., a positive social network

counterconditioning

action to maintenance learning healthy behaviors that can substitute for problem behaviors

stimulus control

action to maintenance removing cues for unhealthy habits and adding prompts for healthier alternatives

reinforcement management

action to maintenance rewarding oneself or being rewarded by others for making progress

Theory of Planned Behavior

added perceived behavioral control to the Theory of Reasoned Action; key constructs are perceived behavioral control, which is influenced by control beliefs and perceived power constructs of TRA are behavioral intention, which is influenced by attitude (behavioral beliefs and evaluation of behavioral outcomes) and subjective norms (normative beliefs and motivation to comply)

barriers & opportunities

attributes of the social or physical environment that make behaviors harder or easier to perform explanation/strategies: increase opportunities to engage in and master behaviors, or remove impediments to developing the behavior

paradigm

basic schema that organizes our broadly based view of something in health behavior: logical positivism or logical empiricism an example of a paradigm shift is when we shifted from pushing people to change their behavior to focus on reducing obstacles to change

reinforcement and punishment

behavior can be increased or attenuated through provision or removal of rewards or punishment explanation/strategies: tangible (money, goods, physical attributes, illnesses) or social (praise, approval, attention, exclusion)

behavioral constructs of SCT

behavioral skills intentions reinforcement and punishment

collective efficacy

belief in the ability of a group of individuals to perform concerted actions to achieve an outcome explanations/strategies: shared goals, communication, teamwork, prior success

principles

broader than theories; general guidelines for action; may be based on precedent or history or research; hunches

building/creating theory

category on the theory continuum; new or revised theory was developed using constructs analyzed in a study

tested theory

category on the theory continuum; theory is identified and more than half the theoretical constructs measured and explicitly tested, OR 2 or more theories were compared to each other

informed by theory

category on the theory continuum; theory is identified but not applied in specific study components

applied theory

category on the theory continuum; theory is specified and several constructs were applied in study components

value-expectancy theory

cognitive theory; reinforcements operate by influencing expectations rather than behavior directly; behavior is influenced by expectation of an outcome and how much that outcome is valued

TTM processes of change

consciousness raising dramatic relief (e.g., fear) self-reevaluation environmental reevaluation self-liberation helping relationships social liberation stimulus control reinforcement management

perceived control

construct of TPB influenced by control beliefs and perceived power belief that one can exercise control over performing the behavior

control beliefs

construct of TPB that influences perceived behavioral control beliefs concerning the presence or absence of facilitators and barriers to behavioral performance

perceived power

construct of TPB that influences perceived behavioral control impact of each control factor to facilitate or inhibit the behavior

self-reevaluation

contemplation to preparation cognitive and affective reassessment of one's self-image, with or without an unhealthy behavior; e.g., values clarification

normative beliefs

cultural norms and beliefs about the social acceptability and perceived prevalence of a behavior explanations/strategies: discussions about perceptions of others' behavior versus others' actual behavior

injunctive norms

define what is commonly approved of or disapproved of in a situation (e.g., going 5 mph over a speed limit) most effective messaging is when descriptive norm matches desired injunctive norm

descriptive norms

define what is commonly done in a situation; how people are actually behaving, whether or not their behavior is approved of

logical positivism

dominant paradigm in health behavior 1) emphasis on induction, or sensory experience, feelings, and personal judgments as the source of knowledge 2) deduction is standard; theories must be tested through empirical methods and systematic observation researcher should begin with a hypothesis deduced from a theory and then test it; quantitative

models

draw on multiple theories to help understand a specific problem in a particular setting; such as the PRECEDE-PROCEED model

social proof

element of social influence one way that people decide what to believe or how to act is based on what they believe other people are believing or doing there -compliance increases with a request that shows other people are complying this is most influential when people are unsure and the situation is ambiguous, or the people already complying are similar to the people to be persuaded tip jar example (empty vs full, more likely to give to full)

scarcity

element of social influence people assign more value to opportunities or information when they are less available information that is limited causes individuals to want to receive it and be more favorable to it most important when scarce items have high value or items are newly scarce

reciprocity rule

element of social influence that obligates a recipient to a future act of repayment features -overwhelming and powerful -rule applies even to uninvited first favors -can spur unequal exchanges, uncomfortable feelings of indebtedness, exploitation of the first recipient

ecological validity

extent to which a theory conforms to observable reality when empirically tested

determinants

factors that are observed to influence or cause behavior

intentions

goals of adding new behaviors or modifying existing behaviors, both proximal and distal explanations/strategies: writing or verbalizing goals, setting target dates and activities, monitoring progress

punishment

incentive motivation; consequences of a behavior that reduce the likelihood of it occurring can be direct or vicarious

reinforcement

incentive motivation; responses to a person's behavior that increase the likelihood of a behavior positive: positive stimulus added negative: negative stimulus removed can be direct or vicarious

policy SEF level

intervention: E/T/S of general community beyond target population and immediate contacts specific to policy change; creation or modification of public policies targets changes in: capacity for policy advocacy; social norms; perception/attitudes of policy makers; public policy (creation or enforcement)

community SEF level

intervention: E/T/S of general community beyond target population and immediate contacts, including community leaders; modifications to community environments or services targets changes in: delivery of community services; community physical environment; community capacity

organization SEF level

intervention: ETS of institution members beyond target population and immediate contacts, including institutional leaders; modifications to institutional environments, policies or services targets change in: perception/attitudes of institution leaders; institutional culture; institutional policies; institutional physical environment; institutional capacity

interpersonal SEF level

intervention: education/training/skills (E/T/S) of people who interact with targeted population; modifications to home/family environments targets change in: perception/attitudes of social networks; behavior of social networks, including provision of social support; makeup of social networks

intrapersonal SEF level

intervention: education/training/skills enhancement (E/T/S) of target population targets change in: participants' knowledge, perception, attitudes, stages of change, behavioral intentions, self-efficacy

outcome expectations

judgments about the likely consequences of action explanation/strategies: consider physical, social, and self-evaluative consequences

Health Belief Model

key components -perceived susceptibility -perceived severity -perceived benefits -perceived barriers -cues to action -self-efficacy (from SCT) -"other variables" include demographics, social, psychological, structural and other factors it is common for researchers to combine constructs from the HBM with constructs from other theories rather than using HBM on its own many studies did not rigorously test for reliability and content and construct validity because of variance in relationships among constructs (e.g., moderation, mediation) poor and inconsistent measurement of constructs; relationship among constructs inconsistent

Health Impact Pyramid

levels: 1) counseling and education 2) clinical interventions 3) long-lasting protective interventions 4) changing the context to make individuals' default decisions healthy 5) socioeconomic factors as #s go up, increase in population impact and decrease in individual effort needed the pyramid supports use of multilevel interventions

concepts

major components of a theory

methods for increasing self-efficacy

mastery experiences social modeling improving physical and emotional states verbal persuasion

mastery experiences

method of increasing self-efficacy; break down complex behavior to small parts and create "small wins" application: skills training, disaster preparedness training

improving physical and emotional states

method of increasing self-efficacy; making sure people are relaxed before attempting a new behavior application: providing low-anxiety environment for skills building

verbal persuasion

method of increasing self-efficacy; telling the person that he/she can do it application: give positive feedback and encouragement (e.g., through a smoking quit line)

social modeling

method of increasing self-efficacy; vicarious experience, observational learning; showing that others like themselves can perform the behavior application: peer modeling in media campaigns

environmental constructs of SCT

observational learning normative beliefs social support barriers and opportunities

constructivist paradigm

organization and explanation of events should be revealed through a process of discovery rather than before the study begins; qualitative

socioeconomic factors

part of Health Impact Pyramid -greatest impact on population health -examples: reduce poverty, improve education -challenges: how to achieve "fundamental societal transformation"

changing the context

part of Health Impact Pyramid -healthy options are the default choice -individuals would need to expend effort NOT to benefit -example: trans fat elimination

counseling & education intervention

part of Health Impact Pyramid -least effective, but sometimes needed -results in failure to make healthy options default choice

social support

perception of encouragement and support a person receives from his/her social network explanations/strategies: provision of informational, instrumental, or emotional support

environmental reevaluation

precontemplation to contemplation cognitive and affective assessment of how the presence or absence of a behavior affects one's social environment, such as the impact of one's smoking on others

consciousness raising

precontemplation to contemplation increasing awareness about the causes, consequences, and cures for a problem behavior

dramatic relief

precontemplation to contemplation increasing negative or positive emotions (e.g., fear or inspiration) to motivate taking appropriate action

self-liberation

preparation to action belief that one can change and the commitment and recommitment to act on that belief

importance of primary prevention

preventive lifestyle changes and health improvements are key to delaying onset of morbidity (Fries)

social norms

rules that a group uses for appropriate and inappropriate values, beliefs, attitudes, and behaviors -may be explicit or implicit -transgressions result in social sanctions -vary and evolve through time, among groups, and across cultures descriptive and injunctive norms

theory

set of interrelated concepts, definitions, and propositions that present a systematic view of events or situations by specifying relations among variables; they can be broadly applied, tested, and are abstract theories and models explain behaviors and suggest ways to achieve behavior change

TTM

stages of change -precontemplation: no intention over next 6 months -contemplation: intention to change in next 6 months -preparation: intend to take action in next month -action: have made changes for less than 6 months -maintenance: working to prevent relapse; 6 months-5 years -termination: zero temptation to return

strengths and limitations of ecological models

strength: focus on multiple levels of influence; can help identify different types of interventions; interdisciplinary; helps place responsibility on society and environment rather than on individual weakness: lack of specificity about hypothesized influences; difficult to identify critical factors for each behavioral application; lack of information about how constructs interact across levels; expensive and sometimes impractical to intervene on multiple levels; more difficult to evaluate

behavioral skills

the abilities needed to successfully perform a behavior explanations/strategies: development of specific skills depending on the targeted behavior (knowledge + skills = behavioral capability)

change theory

theory of action; guide the development of interventions; form the basis for evaluation implementation theories are change theories that link theory specifically to a given problem, audience, and context

explanatory theory

theory of the problem; help to identify why a problem exists; predict behaviors under defined conditions

constructs

these are concepts that have been developed or adopted for use in a particular theory

Lewin's meta-theory

this theory stipulates the rules to be followed for building good theory analysis starts with the situation as a whole and includes contemporaneity, a dynamic approach, a constructive method, a mathematical representation of constructs and variables, and a psychological approach that explains individual behavior

causes of death (green check)

tobacco; poor diet, physical inactivity; alcohol consumption top three causes of death are mostly preventable

observational learning

type of learning in which a person learns new information and behaviors by observing the behavior of others and the consequences of their behavior explanation/strategies: observation of peer-led education, mass media, behavioral journalism, dramatic performances

knowledge

understanding of the health risks and benefits of different health practices and the information necessary to perform a behavior explanation/strategies: information necessary to perform a certain behavior, such as recipes for healthy meals, where to buy healthy food, and how to prepare it

mixed methods

uses both constructivist and logical paradigms; start with constructivist and then shift towards logical positivist paradigm

decisional balance

weighing the pros and cons of changing in precontemplation, increase the benefits of changing in contemplation, decrease costs of changing