HLT 3301
Perceived suseptibility
Perceived susceptibility or personal risk is one of the more powerful perceptions prompting people to adopt healthier behaviors. • When an intervention increases the perception of risk, that is, the chances of contacting or developing a disease is believed to be greater, health behavior changes. • When people believe they are not at risk or have a low risk of susceptibility, unhealthy behaviors tend to result. • People change their behavior based on the perception of threat of a fatal disease.
Perceived benefits
The construct of perceived benefits is a person's opinion of the value or usefulness of a new behavior in decreasing the risk of developing a disease. In order for a new behavior to be adopted, the perceived benefits of the new behavior have to be seen as outweighing the consequences of continuing the old behavior and that the new behavior will decrease the chance of developing a disease.
Personal Seriousness
The construct of perceived seriousness speaks to an individual's belief about the seriousness or severity of a disease. • While the perception of seriousness is often based on medical information or knowledge, it may also come from beliefs a person has about the consequences an illness might personally have on him or her. • Perception of seriousness can also be influenced by past influence.
Perceived barriers
The most significant construct in behavior change. These are an individual's perception of the obstacles in the way of adopting a new behavior
Attitude
A series of beliefs about something that affects the way we think and behave.
What is the Health Belief Model?
As individuals take greater investment in their health they are more likely to make relevant and meaningful behavior changes. Must feel that the risks outweigh the benefits.
The Theory of Planned Behavior
Builds on TRA(The theory of reasoned action): • Attention to motivation to comply with subjective norms • Adds perceived control if we believe we can make a change then that will strengthen our determination and the likelihood of actually making the change
Cues to action
Cues to action: Factors that start a person on the way to changing behavior
How was the theory was reasoned action created
Fishbein and Ajzen (1975) conducted a review of studies done on attitude and behavior and, once again, found little evidence supporting a relationship between the two, further confirming the assumption was false. They proposed instead that it was the intention to perform rather than the attitude toward a behavior that determined behavior (Theory of Reasoned Action).
What is the Health Belief Model in a nutshell?
If I believe-> I will do
What are some limitations to the Theory of Planned Behavior and the Theory of Reasoned Action
In general, attitude is a better predictor of behavioral intent than social norms (O'Keefe, 1990) • TRA/TPB don't take into account personality variables or demographic variables (unless they are included as indirect predictors) • Measurement problems due to disagreement on how to measure "perceived behavioral control" • Behavior intent predicts proximal behavior better than distal behavior (but not always the case) • Interventions may not work because the wrong beliefs (ones not very related to behavioral intention) are targeted or too few beliefs are targeted
What was the consensus in the 60s and 70s in regards to attitude and behavior.
In the 1960s and 1970s, it was believed that attitude and behavior were strongly connected in that attitude affected behavior, despite the fact that many of the statistical evidence of the day did not arrive at that conclusion
Theory of Planned Behavior (TPB)
Included in revised TRA, behavior is also based on the person's perceived control over the behavior (is it easy or difficult).
Perceived seriousness
Individual's belief about the seriousness or severity of a disease. - Medical information or knowledge - Belief of the consequences an illness might have - Past exp
What influences the intention of the Theory of Reasoned Action and Theory of Planned Behavior?
Intention in the TRA/TBP is influenced by attitudes, subjective norms, and, volitional control in the TRA and behavioral control in the TPB.
The TRA (Theory of Reasoned Action) and the TBP (Theory of Planned Behavior) propose that behavior is based on the concept of intention.
Intention is the extent to which someone is ready to engage in a certain behavior or the likelihood that someone will engage in a particular behavior' o People are more likely to do something if they have the intention to do something with a plan or aim to do it, as opposed if they do not.
Modifying variable
Modifying variable: An individual's personal factors that affect whether the new behavior is adopted
Modifying variables
Modifying variables are factors that alter or affect a person's perceived benefit of a prevention behavior. They are grouped into three categories: o Demographic, such as age, gender, martial status and ethnicity o Sociopsychological, such as peer group, social class, and personality o Structural such as knowledge and past experience.
Health Belief Model
Our beliefs regarding the effectiveness, ease, consequence, and outcomes of doing (or not doing) a certain behavior will determine whether we do (or don't do) that behavior.
Perceived barriers
Perceived barriers: An individual's opinion as to what will stop him or her from adopting the new behavior
Perceived benefits
Perceived benefits: An individual's conclusion as to whether the new behavior is better than what he or she is already doing
What is the additional construct The Theory of Planned Behavior that does not exist in the Theory of Reasoned Action
Perceived control (self efficacy)
Perceived seriousness
Perceived seriousness: An individual's judgement as to the severity of the disease
What are the MAIN constructs to the Health belief Model?
Perceived susceptibility, perceived benefits, perceived barriers, and perceived seriousness,
What are the components to the Health Belief Model?
Perceived susceptibility, perceived benefits, perceived barriers, perceived seriousness, modifying variable, cues to action, and self-efficacy
Personal Susceptibility
Perceived susceptibility: An individual's assessment of his or her chances of getting a disease
perceived benefits
Person's opinion of the value or usefulness of a new behavior in decreasing the risk of developing a disease - Healthy behaviors - Secondary prevention
What are the most recent constructs added to the Health belief model?
Self efficacy and cues to action
Self-efficacy
Self-efficacy: Personal belief in one's own ability to successfully do something.
What are the practical applications of the Theory of Reasoned Action and Theory of Planned Behavior
The TRA and the TPB are not presented as behavior change theories. Their utility lie in the ability to predict and explain people's intentions and subsequently, their behavior.
How was the Theory of Reasoned Action useful and what were its shortcomings?
The Theory of Reasoned Action (TRA) was useful in explaining behaviors under a person's willful (volitional) control, but could not explain behaviors not under willful control very well. o To address this situation, in 1991 an additional construct was added to the original theory, with the revised identified as the Theory of Planned Behavior (TPB)
behavioral control
The extent of ease or difficulty we believe the performance of a behavior to be.
What is the underlying concept of the Health Belief Model?
The underlying concept of the HBM is that health behavior is determined by personal beliefs or perceptions about a disease and the strategies available to decrease its occurrence.
Theory of Reasoned Action
Theoretical model stating that effective change requires individuals to have specific intentions about their behaviors, as well as positive attitudes about a new behavior, and to perceive that their social group looks positively on the new behavior as well.
Subjective Norms
an individual's perceptions about whether significant others think he or she should (or should not) perform the behavior in question
Volitional Control
if a behavior is under volitional control, an individual has control over the behavior
Volitional Control
o Although the TRA tells us behavior is the result of a person's intention to do something, the behavior has to be under volitional control in order for this to happen o A behavior where one is under volitional control is one in which the person is able to decide, at will, to engage in or not.
Attitudes
o Attitudes are formed by a series of beliefs and result in a value being placed on the outcome of the behavior. o If the outcome or result of a behavior is seen as being positive, valuable, beneficial, desirable, advantageous, or a good thing, then a person's attitude will be favorable with a greater likelihood of the person engaging in the behavior.
Self efficacy
o In 1988, self-efficacy was added to the original four beliefs of the HBM. o The belief in one's own ability to do something. People do not try to do something new unless they think they can do it. o Self-efficacy is not only useful as a predictor of behavior but can also be the target of education to change behavior.
Subjective Norms
o In addition to attitude, intention is influenced by subjective norms. o A subjective norm is the perceived social pressure to engage or not to engage in a certain behavior. -Determined by normative beliefs. -These are the behaviors that we perceive important people in our lives expect from us. Family, friends, or peers, religious figures, healthcare providers, or others we hold in a very high regard and want to please.
Cues to actions
o In addition to the four beliefs or perceptions and modifying variables, the HBM suggest that behavior is also influenced by cues to action. o Cues to actions are events, people or things that move people to change their behavior
Behavioral Control
o In situations where there is less volitional control, even when intention is great, the TRA (Theory of Reasoned Action) is not very useful in predicting or explaining behavior. To address this, the construct of behavioral control was added to the theory. o To address this, the construct of behavioral control was added to the theory; with this, the TPB (Theory of Planned Behavior) was born o Behavior control is impacted by a set of control beliefs. These are beliefs the person has that help or hinder performance of the behavior, that is they affect the perception of how easy or difficult it is to carry out the behavior.
What intrapersonal factors that affect health behavior influence personal perception?
o Knowledge o Attitudes o Beliefs o Experiences o Skills o Culture o Religion
What is the aim of the Theory of Reasoned Action?
to explain the relationship between attitudes and behaviors within human action. • Is used to predict how individuals will behave based on their pre-existing attitudes and behavioral intentions. - An individual's decision to engage in a particular behavior is based on the outcomes the individual expects will come as a result of performing the behavior
Self-Efficacy
• Belief's in one's ability to do something. • Added to the model in 1988
What are the shortcomings of the health belief model?
• Focuses on the cognitive factors (e.g., beliefs) of a health behavior (does not consider emotion or previous experience) • Measurement of constructs has not been consistent (using different measures to examine beliefs) • Most studies have been cross-sectional or retrospective • Model does not address contextual factors • Example of a some research findings - HBM accounts for less variance in diet, exercise, and smoking behaviors, as compared to other theories - Age, gender, and race/ethnicity predict health behavior beyond HBM model components
Cues to Action
• People, events, or things that "move" a person to change their behavior
Perceived barriers
• Person's own evaluation of the obstacles in the way of adopting a new health behavior • Benefits outweigh the costs??
Perceived susceptibility
• Personal risk to get the disease or have negative consequences of a behavior (or lack of it) - Greater risk -> greater positive health behaviors - Lower risk -> lower positive health behaviors
Evaluation of the Health Belief Model
• Research supports the usefulness of the HBM • Perceived barriers is the most powerful predictor of health behaviors • Knowing how susceptible one feels to an illness is a good predictor of preventative health behavior • Knowing the perceptions of benefits is useful • HBM is useful in multicultural settings
What are the steps into making a Theory of Planned Behavior/Theory of Reasoned Action interventions?
• Step 1: Acquire salient beliefs from the target population • Step 2: Develop questionnaires to: - Assess these beliefs - Distinguish intenders from non-intenders - Determine the relative contribution of attitude, subjective norm, and perceived control to intention/behavior (some behaviors are not under control of all these) • Step 3: Design intervention to change key beliefs identified
How was the Health Belief Model developed?
• The Health Belief Model was developed at the US Public Health Service in the late 1950s. At the time, a great emphasis was placed on screening programs for disease prevention and early detection. o In the 1950s there was a great emphasis on screening programs for disease prevention and early detection for TB. There did not appear to be large numbers of people being attracted to the screening. Though it was attracting some people. Thus there was a reason to understand both why some people went for screening and why some people did not. The outcome of the study identified three sets of factors that determined participation in a voluntary screening program: • psychological readiness • situational influences • environmental conditions