Health Psychology
Chapter 3:
Seeking Health Care
(Health Behavior Models)
Mansfield University
Dr. Craig, Instructor
1
Understanding/Predicting/Treating Health Behvr.
 What measurable factors affect health behavior?

Class thoughts
 Useful Theories

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generate research
organize & explain observations (research & clinical)
guide in predicting behavior
(not in book) avenues for behavior change
 All models describe processes/or variables leading to
INTENTIONAL changes toward healthy behaviors


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Health Belief Model (from Hochbaum)
Theory of Reasoned Action (Azjen)
Social-Cognitive Theory (Self-Regulation, Bandura)
Transtheoretical Model (Prochaska & DiClemente)
Well Studied Determinants
 1. Characteristics of symptoms
• painful?
• Disabling?
• Visible?
 2. Perceived Cost/Benefit of seeking help
• time, money, pain,
 3. Perceived Severity of condition
 4. Person’s Intention to Behave & Self-Efficacy
 5. Readiness To Change
 6. Social & Demographic Characteristics
Perceived
Susceptibility
of Disease
or Disability
Rosenstock & Becker’s
Health Belief Model
(health seeking behavior)
Perceived
Severity
of the Disease
or Disability
Perceived
Benefits
of Health
Improving
Behavior
HEALTH
SEEKING
BEHAVIOR
Perceived
Barriers
to Health
Improving
Behaviors
Evidence for HBM
 Mixed evidence, but some impressive results

Mammograpy
• Champion- manipulated perceived susceptibility

increased rate 4x
• others have manipulated perceived barriers and
benefits to increase attendance

Also used in safe-sex, CV screening, AIDS testing,
immunization efforts
 Large efforts will often manipulate multiple belief
systems + other important variables to increase
overall intention to behave
Theory of Planned Behavior
Attitude-thoughts, feeling, predisposition to act on a
topic. One individual beliefs about behavior/condition
Attitude
Toward
the
Behavior
RI
Subjective
Norm
Perceived
Behavioral
Control
Subjective Norm- attitude of the “social group” toward
condition (e.g., what friends think, family says)
Intention to
Behave
HEALTH
BEHAVIOR
Relative Importance- the relative influences of own
attitude vs. what subjective norms “say”
Perceived Behavior Control (self efficacy)- one belief
in their capacity to exercise behavioral control over
events that affect their lives. Event-specific
Evidence for TPB
 An extension of the theory of reasoned action

added the self-efficacy component
 Measures of intention and perceived behavioral control
have been show to be particularly powerful predictors
 Stanford 5-city project

predicted adolescent smoking
 Also predicted :
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health program attendance
breast and testicular self examination
dental flossing
Building Self-Efficacy: Socio-Cognitive Models
 Self Efficacy- people’s beliefs about the capabilities to
exercise control over events that affect their lives.
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A/K/A personal control, personal agency
Tends to be situation specific
It is continually modified by ongoing conditions
It can be changed (increased)
 How can SE be changed? [class question]
Self Efficacy: Social-Cognitive Model
Performance/
Enacting
a Behavior
vicarious
experience;
seeing someone
w/ similar skills
act successfully
+
+
+
Sense of Personal Control makes
increases likelihood of healthy
behavior.
It is affected by biological, socialcognitive & behavioral conditions
Self-Efficacy
Verbal
persuasion
or encouragement
from
trusted other
Physiological
Arousal
-
Goal
(Intention)
HEALTH
BEHAVIOR
Evidence & Info: Self-Efficacy Model
 Stanford 5 city project
• those with most difficulty changing unhealthy behavior had the
lowest efficacy
 Other studies
• efficacy directly related to smoking cessation and goal
attainment
• exercise program adherence
• stress management
• eating/dietary behavior
 Many other models have added SE to greatly improved
predictive power.
 Clear that SE is related to initiation of behavior, but not clear
whether it is related to maintenance
 SE may be more related to behrs requiring “mastery of skills”
(learned behaviors e.g condom use) than not (abstinence)
Transtheoretical Model (TTM)
 Behavior Changes in Stages:
• Precontemplation- no intention of changing bhvr, and
may not think they have a problem at all
• Contemplation- awareness of problem, some thought of
doing something about it within 6 months
• Preparation- specific behaviors and thoughts involved in
planning to change behavior
• Action- overt change in behavior made
• Maintenance- sustain behaviors and prevent relapse
 Different Stages are affected by different factors, thus requiring
different assistance to move to next stage
 Relapses part of the model-- to be expected
 Recognition of importance of decisional balance (pros and cons
of maintaining risky behavior vs. healthy behavior)
Stage Models: Transtheoretical Model
Maintenance
Behavior
Action
Preparation
No Behavior,
but varied
Readiness to
Change
Contemplation
Pre-Contemplation
Measured by Decisional Balance
survey (pros & cons)