Wk 6 Ch 5: Predicting health behaviour

• One way of considering factors predictive of health behaviour is to view some influences as 'distal' in their influence (eg. socioeconomic status, age, gender, ethinicity, personality) and others, proximal, such as specific beliefs and attitudes towards behaviour.
• Beliefs may mediate the effects of more distal influences. 
• Most behaviour health patterns set in childhood or early adulthood.
• Adolescents begin to seek autonomy and place more importance on peers. 
• Gender also has effect.
• Males engage in risk behaviours to project masculinity, less likely to engage in health promoting (eg wearing sunscreen). However exercise more. 

• Health behaviours serve as coping functions: problem solving, feeling better, avoidance, time out and prevention. 
• Person can have more than one reasons.
• Interventions designed to reduce unhealthy behaviour need to take into account the coping functions or goals that behaviour serves for each individual.

• Traits that are particularly enduring regardless of situation. 
• Eysenck's three factor model: individual personality is reflected in an individual's scores along three dimensions
• Extroversion: opposite to introversion
• Neuroticism: opposite to emotional stability (relaxed contented nature)
• Psychoticism: (egocentric, aggressive, antisocial nature) opposite to self control (kind, considerate, obedient nature

• 1. neuroticism
• 2. extroversion
• 3. openness (to experience)
• 4. agreeableness
• 5. conscientiousness

These traits have been validated in different cultures (with exception of conscientiousness) and at different points of the lifespan and considered relatively stable and enduring.

• More risk taking in extroversion and openness. Less on agreeable and conscientious.
• Extroversion, agreeableness and neuroticism associated with obesity. Conscientiousness inverse.
• Extroversion predicted 2 year weight gain.
• Openness range of dietary behaviour.
• Conscientiousness generally associated with positive health behaviour and neuroticism is opposite.
• Neuroticism also implicated with higher healthcare use.

• Healthy neurotics and unhealthy may exist.
• Thus personality traits may not offer sufficient explanation for health and risk behaviour. 
• What may add to predictability is how traits affect motivations.

High on agreeableness and conscientiousness, with intrinsic motivation.

Locus of control: a personality trait thought to distinguish between those who attribute responsibility for events to themselves (ie. internal LoC) or to external factors (external LoC).

• Mutidimensional scale with 3 statistically independent dimensions:
• 1. internal: consider individual as prime determinant of their health state.
• 2. External/chance: consider external forces such as luck, fate or chance determine health.
• 3. Powerful others: consider health state to be determined by actions of health and medical professionals.

mixed results

• Behaviour of people around us creates a perceived 'social norm', which suggests implicit (or explicit) approval for certain behaviour. 
• Parental approval
• Ads, school

• Commonsense representations that individuals hold in relation to objects, people and events. 
• Growing acceptance of 3 component model of attitude, whereby attitudes are considered relatively enduring and generalisable made up of 3 parts
• 1. cognitive: beliefs about the object eg. smoking relieves stress
• 2. Emotional: Feelings towards the attitude-object; eg. cigarette smoking is disgusting/pleasurable
• 3. Behavioural (or intentional(: intended action towards the object eg. I am not going to smoke.

• Direct association between attitude and behaviour have been difficult to find
• In part because, people can hold different beliefs, may be conflicting and changes in different contexts.

• Dissonance: holding contradictory thoughts
• Ambivalence: simultaneous existence of both positive and negative evaluations of an attitude-object, which could be both cognitive and emotional.

• Urealistic optimism: aka optimistic bias; whereby person considers themselves as being less likely than comparable others to develop illness or experience a negative event. 
• 4 factors associated with unrealistic optimism
• 1. A lack of personal experience with the behaviour or problem concerned
• 2. belief that their individual actions can prevent the problem
• 3. belief that id that problem has not emerged already, unlikely to do so in the future
• 4. belief that the problem is rare

• The belief in one's capabilities to organise and execute the sources of action required to manage prospective situations. 
• Highly predictive of behaviour

• Exercisers also smoke.
• Motivations also change over time. 
• Inconsistencies can perhaps be explained by the following findings:
• Different health behaviour is controlled by different external factors
• Attitudes toward health behaviour vary within and between individuals
• In the same individual, health behaviour may be motivated by different expectations eg. may smoke to relax, exercise to improve appearance, consume alcohol to socialise.
• Individuals differ in their goals and motivations eg. diet for fashion vs heart attack
• Motivating actors may change over time
• Triggers and barriers to behaviour are influenced by context eg. smoking banned in workplace

• Early theories of behaviour change based on simplistic assumption that:
• Information attitude -> change behaviour -> change
• These were found to be naive. 
• Simply providing info may or may not change attitude. 
• Even if they do change, doesn't necessarily affect behaviour.

• Models of behaviour change that consider individuals as being at 'discreet ordered stages', each one denoting a greater inclination to change outcome than the previous stage. 
• A stage theory has 4 properties:
• 1. a classification system to define stages: stage classifications are theoretical constructs, and although a prototype is defined for each stage, few people will perfectly match this ideal.
• 2. Ordering of stages: people must pass through all the stages to reach the end point of action or maintenance, but progression to end point is never inevitable nor irreversible
• 3. Common barriers to change facing people within the same stage: this idea would be helpful in encouraging progression through the stages if people at one stage have to address similar issues
• 4. Different barriers to change facing people in different stages: jk

• Developed by Prochaska and di Clemente (1984) to address intentional behavioural change. 
• Thismodel makes 2 broad assumptions: that people move through stages of change and that the process involved in each stage differ.

• 1. Pre-contemplation: a person is not currently thinking of dieting, has no intention to change dietary intake in next 6 months, and may not consider that they have a weight problem.
• 2. Contemplation: a person is aware of a need to lose weight and is considering doing so. Eg. I think i need to lose weight but not quite yet. Generally assessed as planning to change in next 6 months.
• 3. Preparation: a peron is ready to change and set goals such as planning a start date for diet (within 3 months). This stage includes thoughts, actions and people make specific plans about change.
• 4. Action: a person makes an overt behaviour change; eg. starting to eat fruit instead of biscuits.
• 5. Maintenance: a person keeps up with the dietary change and resists temptation.

• There are also:
• Termination: by this stage of behaviour change has been maintained for an adequate time for the person to feel no temptation to lapse and they believe in their total self efficacy to maintain change.
• Relapse: where a person lapses into former behaviour pattern and returns to previous stage is common and can occur at any stage.

• Precontemplation: more likely to be using denial and/or may report lower self efficacy (to change) beliefs and more barriers to change. 
• Contemplation stage: people more likely to seek info and may report reduced barriers to change and increased benefits although may still underestimate susceptibility to health threat concerned.
• Preparation stage: people start to set goals and priorities, some will make concrete plans and small changes in behaviour. Some may be setting unrealistic goals for success or underestimating ability to succeed. Motivation and self efficacy are crucial if action is to be elicited.
• Action: realistic goal setting is crucial if action is to be maintained
• Maintenance: enhanced by self monitoring and reinforcement.

• Perception of barriers and benefits also different in each stage. 
• Decisional balance: where the costs of behaviour are weighed up against the benefits of that behaviour.

• Got women to do 18 month exercise intervention.
• Found increase in activity levels almost independently of the stage of readiness that they had been in following the intervention. 
• Self efficacy increased as the stage progressed towards action.
• Decisional balance findings inconclusive.

• Changes in self efficacy etc may result from changing stages and not necessarily the catalyst for the change.
• Time frame: little empirical evidence about whether they differ in terms of attitudes or intentions.
• Past behaviour: found to be strong predictor of future behaviour, not considered in this model.
• Continuous: many people do not fit in discreet stages, may be better to have continuous.
• Does not address social aspects.
• Stage-matching may not provide better intervention than just general intervention.
• Model does not consider that the person may not have heard of the behaviour/issue.

• Stage model.
• A framework for understanding deliberate actions taken to reduce health risks.
• 7 stages, people pass through stage in sequence, no time limit.
• More info on pre-action stage compared to TTM

• Stage 1: person is 'unaware' of threat to health posed by a certain behaviour, they have no knowledge therefore not aware of risk.
• Stage 3: termed 'unengaged', aware of risks but believes the level they engage in are insufficient to pose a threat. Seen as optimistic bias
• Stage 3: 'consideration'. Akin to pre-contemplation. Deciding on whether to act on something.
• Stage 4: this stage acknowledges that perceived threat and susceptibiltiy may be high but some poeple may deicde not to act; which is different from intending to act but not doing so.
• Stage 5: 'decide to act' stage. Similar to intention/preparation. Stating intention to act doesn't mean they will. Perceived susceptibility considered necessary here to motivation progression to action. 
• Moving from 5 to 6 relates to moving from motivation to volition.
• Stage 6: action stage
• Stage 7: not always required. About maintenance, some health behaviours are not long lasting like vaccinations.

• Only 1 study using this model with Aus sample. 
• Useful in that it revealed potential target groups for health messages.
• Perceived susceptibility crucial in transition b/w stage 3 (trying to decide) to stage 5 (deciding to act).
• Not as succesful in moving 'decided to act' to action. 
• Better when shifting participants from undecided to making a decision to act (but not necessarily acting)

Proposes that the likelihood that a person will engage in a particular health behaviour depends on demographic factors ( eg. social class, gender, age) and a range of beliefs that may arise following a particular internal or external cue to action. \These beliefs encompass perceptions of threat and evaluation of the behaviour in question, with cues ti action and health motivation added at a later date.

Demogrpahic variables affect: perceived susceptibility, severity, benefits, barriers, cues to action and health motivation, which all affect likelihood of behaviour.

Different components of the HBM are more or less salient, depending on the behaviour under study.

Not significantly predictive in some cases when taking into account what we have done in the past.

• Did not specify how the different variables interact with each other  to combine and influence behaviour. Implied operate independently
• Did not specify how perceived benefits are weighted against perceived barriers.
• Static model: measures people's beliefs at one point and doesn't allow for dynamic change.
• Assumes humans are tational deicision makers.
• May overestimate role of threat.
• Takes social influences into limited consideration.
• Fails to consider whether individuals feel able to initiate the behaviour.

• Social-cognitive model.
• Arose from belief that high fear appeals can facilitate health behaviour change only when combined with specific instruction on when, where and how to perform them.
• Explains health behaviour in terms of 2 components: threat appraisal and coping appraisal. 
• Response efficacy: considering effectiveness of the recommended behaviour change. 

• Moderately successful in predicting health behaviour and intention.
• Coping appraisal components are strongest predictors.

• In addition to those in HBM
• Does not account for habitual behaviours such as hand washing.
• Does not consider social norms 

• Aim is to explore and develop psychological processes involved in making link between attitude and behaviour by incorporating social influences and the necessity of intention formation. 
• Subjective norm: a person's beliefs regarding whether important others (referents) would think that they should or should not carry out particular action. 
• Importance of the person's attitudes towards behaviour is weighted against subjective norm beliefs.

• Intention considered to be proximal determinant of behaviour. Ref;ects the individual's motivation and how hard they are prepared to carry out the behaviour.

• Focused on volitional behaviour
• Volitional behaviour: Those under the persons control

• Extended TRA to improve model's ability to address non-volitional behaviour. 
• To include concept of perceived behavioural control.

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