Chapter 7: Theories and Models Commonly Used for Health Promotion Interventions

laggards

not interested in innovation and would be the last to be involved; they are traditional and suspicious and have limited communication

Behavior Change Theories

- Used to help specialists to plan programs. - Some wok better than others.

threat appraisals

- Addressed first because a threat to one's health must be received or identified before there can be an assessment of the coping options. Focuses on maladaptive behaviors (assessment includes review of intrinsic and extrinsic rewards, review of perceived severity and vulnerability to the threat. - Rewards increase selecting maladaptive behaviors and threats decreases selecting such behaviors (rewards - threat)

coping appraisals

- Addresses adaptive behaviors or health enhancing behavior. Assessment includes a review of response efficacy and self-efficacy and a review of the response costs. - Response efficacy and self-efficacy increases the probability of selecting adaptive reposes, where response cost decreases it. (response + self - response cost).

Interpersonal Level Theories

- Assumes that individuals exist within, and are influenced by, a social environment. Reciprocal effect. - Theories to explain the concepts of social learning, social power, social integration, social networks, social support, social capital, and interpersonal communication. - Social network and social social capital theories are more in the model stage.

Types of Theories and Models

- Categorizing the theories and models by dividing them into two groups. - Theories and models used for planning, implementing, and evaluating health promotion programs = planning models. - Theories and models used to help explain how change takes place = behavior change theories.

community readiness model (CRM)

- Communities are in different levels of readiness for change. The CRM is a stage theory for communities. - Communities may have similar problem, but the dynamics in each community did not mean that the starting point for dealing with the problem could be the same. - Communities are fluid, always changing, adapting, growing, and like individuals communities are in various stages of readiness for change. - Stage of readiness in a community have to deal with group processes and group organizations, characteristics that are not relevant to personal readiness. - Nine stages. - Community readiness for addressing an issues can be assessed through a process in which interviews are conducted and scored with key informants. Interviews are based on five dimensions of community readiness (community knowledge efforts, leadership, community climate, community knowledge of the issue, and resources). - Once stage of readiness is known, there are suffused processes for moving a community from one stage to the next.

Community Level Theories

- Community level theories are any theory that would apply to the last five levels of the ecological perspective- institutional, community, public policy, environmental, and culture. - Explores how social systems function and cage and how to mobilize community members and organizations.

model

- Composite, a mixture of ideas or concepts taken from theories and used together. Draw on theories to help understand a problem in a particular setting or content. - Not as specific as theories; do not attempt to explain the processes underlying learning, by to represent them.

locus of control

- Construct that grew out of the social learning theory. Posited that a person's history of positive or negative reinforcement across a variety of situation shapes a belief as to whether or not a person's own actions lead to those reinforcement. - Internal and external locus of control. - Internal perceived that reinforcement was under their control, external through that reinforcement was to be under the control of smoother external force. - Internal locus of control are more likely to engage in health-enhancing behaviors. - Watson and colleagues developed Multidimensional Health Locus of Control. Concluded that locus of control accounts for a small amount of variability in health behavior. Internal locus of control was necessary but not sufficient determinate of health-enhancing behavior. Feels that self-efficacy is a stronger predictor of health-promoting behavior than locus of control.

The Transtheoretical Model (TTM)

- Core concepts include stages of change, process go change, decisional balance, self-efficacy, and temptation. - Stage construct, precontemplation stage, contemplation, preparation, action stage, maintenance stage, termination. Process of change, decisional balance, self-efficacy, and temptation. - Transtheoretical Model Constructs Table 7.3 169. - Five critical assumptions of the TTM.

Information-Motivation-Beahvioral (IMB) Skills Model

- Created for a theoretical basis for HIV/AIDS prevention efforts. - Constructs of information, motivation, and behavioral skills are determinants of preventive behavior. - Information provided the needs to be relevant, easily enacted based on the specific circumstances, and serve as a guide to personal preventive behavior (makes facts east to translate into behavior). - Recognized additional cognitive process and content categories that influence behavior. - Prevention motivation include personal motivation to act and social motivation to act (both needed for action to happen). - Behavioral skills includes individual's objective ability and his or her perceived self-efficacy to perform the behavior. - Conceptually-based, empirically-targeted, population-specific.

collective efficacy

- Defined as the people's shared belief in their collective ability to act to produce specific changes. - Situation specific. Construct that has application when people seek to alter social systems and application in health promotion with regards to health policy. This can influence what people choose to do as a group, how much effort they put into it, and their staying power when group efforts fail to produce results.

socio-ecological approach

- Developed by Brofenbrenner. 1980s with the movement toward using a systems-approach for interventions. - Underlying concept (ecological perspective) is that human behavior shapes and is shaped by multiple levels of influences. Individual influence and are influenced by their families, social networks, organizations that they participate in, communities, and society. - Health behavior is shaped by the social context: sociocultural factors that shape people experiences and affects their health and behavior. Central conclusion is that interventions must be aimed at multiple level of influence to achieve health behavior change. - Five levels: intrapersonal or individual, interpersonal, institutional or organizational, community, public policy. Added the physical environment and culture. Total of seven levels. An Ecological Perspective: Levels of Influence (156). - Certain theories are more useful in developing programs aimed at a specific levels of influences. - Community level requires taking into consideration institutional and public policy factors and social networks and norms > aded physical environment and culture. - Theories are placed based on the level influence and categorized by approach- continuum theories and stage theories.

diffusion theory

- Explanation for the spread of innovations or an explanation for the pattern of adoption of the innovations. - Adoption is situation specific and it results from people going through a series of stages. - Five stages. If an individual thinks a health promotion program as an innovation, the theory describes a pattern the PP will follow in adopting the program. - Prevalence of adopters represented through S-curve. - Useful when marketing because the distinguishing characteristics of the people who fall into each category of adopters. - Key subgroups are the early adopters and early majority. Important to identify the early adopters because as soon as they adopt the innovation the sooner the rest of the population will follow. - Used to conceptualize the transference of health promotion programs from. one locale to another.

Theory of Planned Behavior (TPB)

- First of several value expectancy theories, which are used to explain how behaviors were influenced by beliefs and attitudes. Tendency to perform an act Is a function of the expectancy that the act will be followed by certain consequences. - Foundation in the TRA, which was developed to explain volitional behaviors (behaviors that are performed at will). Realized that complications were that behavior was not all under control. - TPB was an extension to address the incomplete volitional control. - Intention, attitude toward the behavior (this is determined if a person has strong beliefs about positive attributes or outcomes performing the behavior will have a positive attitude toward behavior; beliefs linking the behavior to outcomes and other attributes), subjective norm, perceived behavior control (separates the TPB from TRA). - Perceived behavioral control has motivational implications for intentions; without perceived control intentions could be minimal even if attitudes toward the behavior and subjective norm were strong. May be a direct link between perceived behavioral control and behavior, which means that behavior depends not only on motivation but control. Gives a good prediction of behaviors behavior.

Elaboration Likelihood Model of Persuasion (ELM)

- Initially used to help explain inconsistencies in the results from research dealing with the study of attitudes. The model helped to explain how persuasion messages (communication) aimed at changing attitudes were received and processed by people. 1. Proposes that modifying attitudes or other judgments can be formed as a result of high degree of through (central) or low degree of thought (peripheral and processing). Elaboration continuum ranges from low to high. The place on the continuum depends on elaboration. 2. Numerous of specific processes of change that operation along the elaboration continuum. Stretches from processes that require no thinking (classical conditioning), to process requiring some effortful thinking like inferences on one's experiences, and to processes requiring careful considerations (value expectancy theories). Distinction between central and peripheral is the amount of consideration five to the information and how the information is processed (not just the information itself) 3. When comparing consequences of the two routes there are times when results are similar. Two routes lead to attitudes with different consequences. 4. Organizes the process by which variables can affect attitudes into a finite set that operate at different points along the continuum. Variables have an impact on how a message is processed - content, messages recipient. - Tailoring messages: matched to the needs, interests, and circumstances of the intended recipient.

social cognitive theory

- Reinforcement is an integral part of learning, but emphasize the role of subjective hypotheses or expectations held by the individuals. - Reinforcement contributes to learning, but reinforcement along with an individual's expectations the consequences of behavior determine the behavior. - Behavior is a function of the subjective value of an outcome and the subjective probability (expectation) that a particular action will achieve that outcome. Value expectancy theory. - Reciprocal causality: internal personal factors of cognitive, affective, and biological events, behavioral patterns, and environmental influences operate as interacting determinants that influence one another bidirectionally. - Direct reinforcement, vicarious reinforcement, self-reinforcement, behavioral capability, expectations, expectancies, self-regulation or self-control. Efficacy expectations, outcome expectations, collective efficacy, emotional-cping response, reciprocal determinism, locus of control. - Vicarious reinforcement referred to as observational learning or social modeling. - Self-efficacy is the construct that has a special emphasis in programs. - Four ways to become more self-efficacious: through performance attainments (personal mastery of a task), through vicarious experience (observing the performance of others), as a result of verbal persuasion (receiving suggestions from others), and through emotional arousal (interpreting one's emotional state).

Cognitive-Behavioral Model of the Relapse Process

- Relapse, lapse, recidivism, relapse prevention

theory

- Set of interrelated concepts, definitions, and propositions that presents a systemic view of events or situations by specifying relations among variables in order to explain and predict the events of the situation. - Presents a systematic way of understanding events, behaviors, and situations and they help education specialists to develop an organized, systematic, and efficient approach to investigating health behaviors. - Findings can be used to inform the design of theory-based intervention programs. - Theory characterized by three elements: (1) the major factors that influence the phenomena of interest (2) relationship between these factors (3) the conditions under which these relationships do or do not occur; the how, when, and why of the hypothesized relationships.

Precaution Adoption Process Model (PAPM)

- Seven stages.

social capital theory

- Social capital. - Three types of social capital.

Intrapersonal Level Theories

- The most basic. Planners have to explain and influence the behavior of individuals. Focuses on factors within. Assists individuals with behavior change. Does not account for social context. - SR Theory, TPB, HBM, PMT, ELM, IMB / TTM, PAPM.

social capital

- The relationships and structures within a community, such as civici participation, networks, norms of reciprocity, and trust, that promise cooperation of mutual benefit. Degree of social connectedness. - Feature of communities rather than a property of individuals (individuals do not own it). - A cause and effect relationship has not been established between social capital and better health. Social capital is an important descriptor of community wellness, but it is not a strategy and requires community organizing and capacity building in order to be strengthened. - This is a concept not a intervention.

Introduction

- The word theory is used in a general way to mean wither theory or model. - Explanation between the discrepancy between theory and models page 152-153. - Concepts, constructs, and variables on page 153. - Reasons for theories (153): identify why people behave the way that they do, identify the information needed before an intervention, provides a conceptual framework, providing direction and justifications, providing insights, helping to guide research. Emphasizes on evidence-based interventions. Without direction can lead to wasting valuable resources. - There is no best theory. The best theory is a function of how well it serves the objective that must be met to achieve sustainable protective behaviors among a specified population. - Theories have to be the most appropriate, feasible, and practical for a particular setting or population. No single theory or conceptual framework dominates research or practice in health promotion and education.

Stimulus Response (SR) Theory

- Used to explain and modify behavior is the stimulus response. Reflect combination of classical conditioning and instrumental conditioning. - Conditioning theories explain learning based on the associations among stimulus, response, and reinforcements. - Learning results from events (reinforcements) that reduce physiological drives that activate behavior. B.F. Skinner. Frequency of behavior determined by the reinforcements that followed that behavior. - Operants. Operant behaviors are behaviors that act n the environment to produce consequences that wither reinforce or do not reinforce the behavior that preceded. - Environmental consequences > reinforcement and punishment. - Reinforcement, positive reinforcement, negative reinforcement, punishment positive punishment, stimulus, negative punishment. - When behavior is reinforced it tends to recur. Smaller steps towards the desired goal. Useful in changing complex health behavior. Reinforcement will increase the frequency of a behavior, punishment will decrease the frequency of a behavior. - Positive means adding something (effects of the stimulus) and negative means taking something away (removal or eduction of the effects of the stimulus) from the situation.

Protection Motivation Theory (PMT)

- Value expectancy theory. Originally created to explain the effects of fear appeals on health attitudes and behavior. - Theory of persuasive communication that included reward and self-efficacy components. Similarities to the HBM because has cost-benefit analysis and emphasis on cognitive processes mediating attitude and behavior change. - Inputs come from environmental sources of information (verbal persuasion and observational learning) and intrapersonal resources (personality and feedback). Based on inputs, people make a cognitive assessment of whether there is a threat to their health. Information about the threat arouses two cognitive mediating process: threat and coping appraisals. - When results fo threat and coping appraisals are combined, it is the protective motivation. The output of the threat and coping is the decision or intention to initiate, continue, or inhibit the applicable adaptive responses or coping modes. The PMT measures behavioral intentions. - Assumers that protection motivation is maximized when the threat to health is severe, individuals feel vulnerable, adaptive response can avert the threat, person is confident in his or her abilities to complete successfully the adaptive response, the rewards associated with the maladaptive behavior are small and the costs associated with the adaptive response are small = produce protection motivation and the enactment of adaptive or coping, response.

Health Belief Model (HBM)

- Value expectancy theory. Used to explain a variety of health behaviors. - Health action depends on: the existence of motivation or health concern, belief that one is susceptible or to the sequelae of that illness or condition (perceived threat), and the belief that following a health recommendation would beneficial in reducing the perceived threat and at a low cost (perceived barriers). - Emphasis on self-efficacy. - Perceived susceptibility, severity, benefits, self-efficacy, likelihood of taking recommended preventive health action.

social network theory (SNT)

- Web of social relationships that surround people and the structural characteristics of that web. - Researcher that studied Norwegian villages. - Created because researchers were dissatisfied with many other theories; theories that show attitude toward a behavior are associated with the behavior often do no help to understand how to change those attitudes. - Felt that social network and concept of social support are concepts that describe the structure, processes, and functions of social relationships. Known that people who are part of social networks are as a whole healthier than those who are not involved in networks. - Edberg, different types of social networks: ego centered networks and full relational networks. Indicated that the key components to SNT are the relationship between and among individuals and how the nature of those relationship influences beliefs and behaviors. - Things to consider: centrality versus marginality, reciprocity of relationships, complexity or intensity of relationships in the network, homogeneity or diversity of people in the network, subgroups/cliques/linkages, and communication patterns in the network. - Specific of who is most impacted and how best to set up and use social networks are unknown.

early majority and late majority

- early are interested in the program but they need external motivation and deliberate for some time before making a decision - late means they need more work and they are skeptical and will not adopt until most of the social system has; need to get them in a peer monitoring program or through constant exposure

efficacy expectations

- people's competency feelings - they must believe that they are capable of quitting (efficacy expectations)

Limitations of Theory

187-188

reinforcement

Any event that follows a behavior, which in turn increases the probability that the same behavior will be repeated in the future. Strengthening effect. Behavior has greater probability of occurring in the future (1) reinforcement is frequent (2) reinforcement is provided soon after the desired behavior. Immediacy.

continuum theories

Behavior change theories that identify variables that influence actions and combine them into a single equation that predicts the likelihood of action (beliefs and attitudes) and combine them into an equation that predicts the likelihood of action. Theories acknowledge quantitative differences among people in their positions on different variables. Each person is placed along a continuum of action likelihood.

negative reinforcement

Behaviors that avoids punishment because it reduces the tension that precedes the punishment. Response or behavior is strengthen by the removal of something from the situation. The something is called the negative reinforcer or aversive stimulus. Not a form of punishment. Increases the likelihood that the behavior will be repeated.

stage theory

Comprised of ordered set of categories into which people can be classified and identifies factors that could induce movement from one category to the next. Four elements: category system to define the stages, ordering of stages, common barriers to change facing people in the same stage, different barriers to change facing people in different states. Qualitative differences among people and question whether change in behaviors can be described by a single prediction.

positive punishment

Deceases the frequency of a behavior by adding or presenting a negative reinforcer or aversive stimulus.

negative punishment

Removing a positive reinforcer.

punishment

Suppresses behavior. Removing a positive reinforced or presenting a negative reinforcer as a consequence of response. Linked to some uncomfortable experience and decreases the frequency of a behavior.

relapse preventuon

The process of trying to prevent slipping back as relapse prevention, Based on the social cognitive theory, common skill-training proceeds, cognitive therapy, and lifestyle rebalancing. A self-control program designed to help individuals to anticipate and cope with the problem of relapse in the habit-changing process. Relapse is triggered by high-risk situations. People who have coping skills to deal with high-risk situations have greater chance of preventing relapse than those who do not. Developed both global and specific self-control strategies for relapse intervention. Self-control are designed to help participants anticipate and cope with relapse episode itself, global intervention procedures are designed to body the early antecedents of relapse, including restructuring of the participant's general style of life.

positive reinforcement

When individuals act in a certain way to produce a consequence that makes them feel good or that is enjoyable. Reward. Pleasant experiences that occur right after the behavior that increased the changes that the frequency of the behavior will increase.

lapse

a single slip or mistake - first drink or smoke following a period of abstinence is a lapse

response efficacy

belief that the coping action will avert the threat

high risk situation

defined broadly as any situation that poses a threat to the individual's sense of control and increases the risk of potential relapse falls into two major categories: interpersonal and interpersonal determinants - Found that 56% of relapse situations were caused by intrapersonal determinants like negative emotional states, negative physical states, positive emotional states, testing personal control, and urges and temptations. 44% represented by interpersonal determinants like interpersonal conflicts, social pressure, and positive emotional states. Determinants are referred to as covert antecedents of relapse. - High risk situations do not just happen, they are created through lifestyle imbalances.

extinction

if the behavior is ignored the behavior will be less frequent and will not be repeated

behavioral capability

in order for individuals to perform specific behaviors, they must know what the behaviors are and then how to perform them

peripheral route process

involves minimal thought and rely on superficial cues or mental short cuts

early adopters

people are interested din the innovation but they are not the first to sign up; wait until innovators are involved; respected by others in the social systems and are opinion leaders

bonding social capital

referred to as exclusive social capital is defined as the type that brings closer together people who already know each other; encompasses people who are similar or people who are members of the same group

bridging social capital

referred to as inclusive social capital and was defined as the type that brings together people or groups who previously did not know each other; seen more as the resources that people obtain from their interaction with people from outside their group, oftentimes from people with different demographic characteristics

expectations

refers to the ability of human beings to think and thus anticipate certain things to happen in certain situations hedonic principle

elaboration

refers to the amount of cognitive processing (thought) that a person puts into receiving messages

relapse

refers to the breakdown or failure in a person's attempts to change or modify a particular habit pattern, such as stopping bad habits or developing new, optimal health behaviors indication of total failure

actual behavioral control

refers to the extent to which people have the skills, resources, and other prefers needed to perform a given behavior

recidivism

slipping back to an old behavior after attempting a behavior change

emotional-coping response

states that for people to learn, they must be able to deal with the sources of anxiety that may surround the behavior - fear

self-control or self-regulation

states that individuals may gain control of their own behavior through monitoring and adjusting it - Six methods for achieving self-regulation: self monitoring (self-observation), setting both incremental and long-term goals, obtaining feedback on the quality of a behavior and how it can be improved, rewarding self (or self-reinforcement) for meeting goals, self-instructing both before and as the behavior is being performed, and gaining social support for the behavior.

outcome expectations

the feeling that the rewards of the performing the behavior is great enough for them - belief that the cessation will benefit their health

linking social capital

the most recognized and weakest of the network sources; social capital comes from relationships between/among individuals with institutions and individuals who have relative power over them

reciprocal determinism

there is an interaction among the person, behavior, and environment, and that the person can shape the environment as well as the environment shape the person

central route process

thoughtful consideration or effortful cognitive elaboration of issue-relevant information and one's own cognitive responses as primary bases for attitude change - for this to occur: the recipient of the message must be both motivated and able to think carefully

innovators

want to be involved because they hear about it and wanted to be first; venturesome, independent, and daring; they want to be the first to do things and people may not really respect them