Mr. Lema, Isaac
Clinical Psychologist (MSc)
11 th January 2016

Learning Objectives
 Understand the parameters required for health model
 Be able to apply those parameters on models
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Outline
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
Introduction
What influences health behaviors?
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Health promotion
Individual level models
Communities level models
Communication level models
 Organisational level models
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Social level models
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Introduction
 Health is a state of complete physical, psychological, and social well-being and not simply the absence of disease or infirmity
(World Health Organization, 1948)
 Behavior is a key factor in determining health
 Maternal and child underweight
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Smoking and alcohol abuse
Unsafe sex
Unsafe water and lack of adequate sanitation
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Introduction …
 Theory is a set of interrelated concepts, definitions and propositions that present a systematic view of events or situations by specifying relations among variables, in order to explain and predict the events or situations
(Kerlinger, 1986)
 Models draw on a number of theories to help understand a specific problem in a particular setting or context
(Glanz et al., 2008)
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Introduction …
 A fully developed theory explains
 Major factors that influence the phenomenon of interest
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
Relationship between these factors
Condition under which these relationships do or do not occur or the how, when and why of the hypothesized relationships
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Introduction …
 Theory can help in the planning and delivery of programs in several ways
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Better understand the nature of the problem being addressed
Used evidence informed methods and measures to monitor the problem and program
Explain or make propositions concerning how to change health status, related behaviors and their determinants
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Biological
Gene
Physiology
Age
Gender
Fitness
Weight
What influences Health
Behaviors?
© 2006 Wardsworth – Thomson
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Psychological
Personality
Reward /
Punishment
Cognitive biases
Emotion /
Motivation
Health Behaviors e.g. eating well, getting physical activity, not smoking, sleep well
Theories and Models of Behavioral Change
Social
Support
Relationship
Status
8

Health Promotion
 Health promotion means changing behavior at multiple levels
 Individual, interpersonal, institutional or organizational, community and public policy factors
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1.
2.
3.
4.
Four theories or models that have been influential in health promoting practice
Health beliefs model
Reasoned action and planned behaviors
Trans theoretical model
Social cognitive theory
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Health Promotion …
Planning Cycle
7. Outcome assessment
1. Problem definition
[Redefinition]
6. Intermediate outcome assessment
2. Solution generation
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5. Impact assessment
3. Resource mobilization
4.
Implementation
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Individual Level Models
 Most basic unit of health promotion
 Components of broader level theories and approaches
 Theories which explain health behavior change by focusing on individual characteristics
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Individual Level Models
 Explain health behavior change by focusing on individual characteristics
4.
5.
6.
7.
1.
2.
3.
Health Belief Model
Theory of Reasoned Action
Theory of Planned Behaviour
Transtheoretical Model
Social Cognitive Theory
Information Motivation Behavioural Skills*
AIDS Risk Reduction Model*
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1. Health Belief Model
 One of the most widely recognized conceptual frameworks of health behavior
 Understand individual beliefs about health
 Individuals conduct an internal assessment of the net benefits of changing their behavior, and then decide whether to act
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1. Health Belief Model …
 The likelihood of an individual taking action related to a given health problem is based on the interaction between four different types of beliefs
1.
2.
They suspect themselves to be susceptible to a condition or problem
They believe it would have potentially serious consequences
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1. Health Belief Model …
3.
They believe a course of action is available that will reduce their susceptibility or minimize the consequences and
4.
They believe that the benefits of taking action outweigh the costs or barriers
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Perceived susceptibility to problem
Perceived seriousness of consequences of problem
Perceived benefits of specified action
Perceived barriers to taking action
Perceived threat
Outcome expectations
Self efficacy
[Perceived ability to carry out recommended action
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1. Health Belief Model …
 Self efficacy is the belief in ones own ability to successfully perform a behavior
 Health promotion messages
 Mass media, peer education, and other interventions
 Act as cues to action, translating that readiness into overt behavior
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1. Health Belief Model …
 Often necessary to overcome habitual unhealthy behaviors such as not wearing seat belts, eating primarily high-fat foods, or smoking
 Factors in an individual’s sense of self-efficacy or confidence in one’s ability to make the desired change
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1. Health Belief Model …
 Limited to accounting for as much of the variance in an individual’s health behaviors as can be explained by their attitudes and beliefs
 Taking little account of social, economical and environmental influence on behavior
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2,3. Theories of Reasoned
Action and Planned
 Developed by Ajzen and Fishbein to explain human behavior that is under “voluntary” control
 People are usually rational and will make predictable decisions in well defined circumstances
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2,3. Theories of Reasoned
Action and Planned …
 Intention to act is the most immediate determinant of behavior and that all other factors influencing behavior will be mediated through behavior intention
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Behavioral beliefs
Evaluation of behavioral outcome
Attitude towards behavior
Normative beliefs
Motivational to comply
Subjective norm
Control beliefs
Perceived power
Perceived behavioral control
Behavior al intention
Behavior
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2,3. Theories of Reasoned
Action and Planned …
 Useful in identifying what information a person might need to collect from a target group before developing a program
 In depth interview
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4. Transtheoretical Model
 Developed by Prochaska and DiClemente to describe and explain the different stages of change that appear to be common to most behavior change processes
 Describe both stages of change and the process of change relevant to the different stages
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4. Transtheoretical Model …
 Behavioral change is a process rather than an event
1.
2.
Pre contemplation – not ready for change
Contemplation – thought of change
3.
4.
5.
Preparation or determination - commitment to change
Action – behavioral change initiated
Maintenance – staining change
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4. Transtheoretical Model … .)
Pre contemplation
Maintenance Contemplation
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Action Preparation
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3. Transtheoretical Model …
 Model is circular as people can enter or exit at any point
 Stage of change model
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5. Social Cognitive Model
 Interaction that occurs between an individual and their environment
 Bandura refer it as “reciprocal determinism”
 Range of personal cognitive factors form a third part of this relationship – individual and environment
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5. Social Cognitive Model …
1.
2.
3.
Capacity to learn by observing both the behavior of others and the rewards received for different behaviors
Capacity to anticipate and place value on the outcomes of different behaviors patterns – expectations
Concept of self efficacy
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Community Level Models
 Theories on change in communities for health
1.
2.
Diffusion on innovation theory
Community organisation and community building
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1. Diffusion of Innovation
Model
 Diffusion process by which an innovation is communicate through certain channel is over time among members of a social system
 Innovation an idea, practice or object perceived as a new by an individual
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1. Diffusion of Innovation
Model …
 Rogers identify five general factors that influence the success and speed with which new ideas are adopted in communities
1.
Characteristics of the potential adopters
2.
3.
4.
5.
Rate of adoption
Nature of the social system
Characteristics of the innovation
Characteristics of change agents
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1. Diffusion of Innovation
Model …
 This theory provide an excellent diagnostic tool for anal sing how and why population respond to the introduction of new ideas
 It can also be adopted in relation to organizations where the adopters may be employees or professional groups and the change agent my be managers and professional leaders
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2. Community Organizational and Building Model
 Working with local communities or community in interest has been a central strategy for health promotion workers
 Framework developed by Rothman
 Why, how and in what way local communities may be involved in health promotion
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Communication Level Models
 Modeling which guide communication to bring about behavior change
 Provide insight and guidance on the strengths and weakness of education and communication for health promotion
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Communication Level Models
1.
2.
3.
Healthy literacy
Communication behavior change model
Social marketing
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Organisational Level Models
 Model for change in organisations and creation of supportive organisational practices
1.
2.
Theories of organisational change
Models of interpectoral action
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Social Level Models of Change
1.
2.
3.
Diffusion Theory
Leadership Models
Social Movement Theory
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Conclusion
 Theory would guide research, the findings of research would inform theory and each would influence and be influenced by clinical practice
 More often than not, however the interplay among theory, empirical research and practice remains an ideal not a reality
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References
 Gross, R. (2010) Psychology the Science of Mind and
Behaviors 6 th edition; Macmillan Company
 Kerlinger, EN (1986). Foundations of Behavioral Research (3d ed.). Mew York: Holt, Rinehart and Winston.
 Glanz, KM, Rimer, BK & Viswanath, K. (Eds.),(2008). Health behavior and health education: Theory, research and practice
4th Edition, San Francisco, California: Jossey-Bass.
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