1
Q
What is the basic premise of stage models?
A
- Subset of value-expectancy theories
- Behaviour change occurs as a result of individuals passing through stages
2
Q
What is a “stage-matched” intervention? When are they deemed successful?
A
- Interventions must be “stage-matched/targeted” to individual’s stage of change
- Asking them to move 1 stage forward is easier than asking them to change
- Stage-matched interventions are deemed successful if stage progression is achieved (even without behaviour change)
3
Q
What are the types of stage models?
A
- Transtheoretical Model of Change (Prochaska)
2. Precaution Adoption Process Model (Weinstein & Sandman)
4
Q
How was the TTM developed? What makes it different from other theories?
A
- Originally developed for smoking
- Borrows concepts from many theories
- Explains how people change; more prescriptive than previous causative theories
5
Q
What are the assumptions of the TTM?
A
- No single theory can account for behaviour change
- Behaviour change is a gradual process that unfolds over time through stages
- Stages of behaviour change are both stable and open to change
- No inherent motivation to progress through stages of change
- We need an intervention to have behaviour change - Majority will not be served effectively by traditional action-oriented behaviour change programs as they are not prepared for action
- Specific processes and principles of change need to be applied at specific stages of readiness
- Stage-matched interventions have been designed mainly to enhance self-control over behaviours (self-regulation)
- Behaviour change typically consists of several attempts where individual may progress, backslide, and cycle/recycle through changes a number of times
- Stages of change are characterized as a spiral staircase
6
Q
What are the stages of change for TTM?
A
- Precontemplation (PC)
- No intention to take action within the next 6 months (“resistant”, “not ready”)
- May be uninformed about consequences of behaviour
- 3 Ds ⟶ in denial, defensive, or demoralized - Contemplation (C)
- People are ambivalent and have reasons for not adopting behaviour
- Intends to take action within the next 6 months - Preparation (PR)
- People intend to adopt a new behaviour within the next month (30 days)
- May have taken some steps in this direction (eg. trying to get informed, walking 15 minutes a day) - Action (A)
- People have made specific modifications in their lifestyles for less than 6 months
- Not all behavioural changes count as action; must be sufficient enough to reduce risk of disease (eg. 150 minutes of MVPA/week) - Maintenance (M)
- Defined as sustaining behaviour for 6+ months
- People must work to prevent relapse - Termination
- No temptation to relapse and is 100% confident (eg. brushing your teeth)
- Makes sense for cessation behaviours (eg. smoking), however there are many factors influencing PA
- *Removed from the model
7
Q
List the processes of change for TTM. Include short phrases to capture their essence.
A
- Consciousness Raising (learning)
- Dramatic Relief (emotions about unhealthy behaviour)
- Self re-evaluation (ones’ identity)
- Environmental Reevaluation (impact on others and environment)
- Self-Liberation (commitment)
- Helping Relationships (social support)
- Counter-Conditioning (healthier substitutes; problem-solving)
- Reinforcement (Contingency) Management (rewards)
- Stimulus Control (reminders or cues)
- Social Liberation (social norms changing)
8
Q
What is consciousness raising in the TTM?
A
- Increasing awareness of health-damaging effects of behaviour and ways to reduce consequences
- Finding and learning new facts, ideas, and tips that support the healthy behaviour change
- Eg. having students to count their steps, exposure to information on internet
9
Q
What is dramatic relief in the TTM?
A
- Increasing emotions/affect about unhealthy behaviours, followed by decreased affect if appropriate action is taken
- Eg. highlighting consequences of sedentariness, but alleviate that anxiety by discussing what they can do about it
10
Q
What is self re-evaluation in the TTM?
A
- Realizing that behaviour change is an important part of one’s identity/life
- Visualizing yourself as healthy and with the behaviour
11
Q
What is environmental reevaluation in the TTM?
A
- Realizing negative impact of the unhealthy behaviour or positive impact of the healthy behaviour on one’s social and/or physical environment
- Eg. how does your being sedentary affect you as a role model for the rest of the family?
12
Q
What is self-liberation in the TTM?
A
- Making a firm commitment to change
- Setting up contracts, goals, dates, and making it known to people in your life
13
Q
What is helping relationships in the TTM?
A
Seeking and using social support from relevant SOs to promote healthy behaviour change (eg. planning on going to the gym with buddy)
14
Q
What is counter-conditioning in the TTM?
A
- Learning and substituting healthier alternative behaviours and cognitions for unhealthy ones
- Eg. you like watching TV in the evening, so you exercise in the morning instead
15
Q
What is reinforcement management in the TTM?
A
Increasing rewards for positive behaviour change and decreasing rewards of the unhealthy behaviour
16
Q
What is stimulus control in the TTM?
A
- Removing reminders or cues to engage in the unhealthy behaviour and adding cues or reminders to engage in the healthy behaviour
- Eg. putting fruits and vegetables out in the front of the fridge
17
Q
What is social liberation in the TTM?
A
- Realizing that social norms are changing in direction of supporting the healthy behaviour change
- Eg. recognizing that there are more biking paths, or trend of affordable gym memberships
18
Q
Which POCs are more effective during preparation in the TTM?
A
- Self re-evaluation
- Self-liberation
- Helping relationships
- Counter-conditioning
19
Q
Which POCs are more effective during pre-contemplation in the TTM?
A
- Consciousness raising
- Dramatic relief
- Environmental re-evaluation
- Social liberation
20
Q
Which POCs are more effective during contemplation in the TTM?
A
- Consciousness raising
- Dramatic relief
- Self re-evaluation
- Environmental re-evaluation
- Social liberation
21
Q
Which POCs are more effective during action in the TTM?
A
- Self-liberation
- Helping relationships
- Counter-conditioning
- Reinforcement management
- Stimulus control
22
Q
Which POCs are more effective during maintenance in the TTM?
A
- Helping relationships
- Counter-conditioning
- Reinforcement management
- Stimulus control
23
Q
What are the 2 categories of POC effectiveness when staging?
A
- Experiential (early stages)
- Consciousness raising
- Dramatic relief
- Self re-evaluation
- Environmental re-evaluation
- Social liberation - Behaviour (later stages)
- Self-liberation
- Helping relationships
- Counter-conditioning
- Reinforcement management
- Stimulus control
24
Q
What is decisional balance in the TTM? What is the strong/weak principle? Which is the best stage?
A
- Mental weighing of importance of pros/cons associated with changing behaviour
- Similar to IMBP’s outcome evaluations
- Best for C stage
• Strong principle of progress: pros of health behaviour change must increase by 1 SD from PC to A
• Weak principle: cons of health behaviour change must decrease by ½ SD from PC to A
25
What is a T-score?
- Helps you evaluate decisional balance in the TTM
- Score of your perception of pros compared to cons
• PC ⟶ low T-score for pros, high T-score for cons
• C ⟶ higher T-score for pros, same T-score for cons
• PR ⟶ higher T-score for pros, lower T-score for cons
• A ⟶ high T-score for pros, low T-score for cons
• M ⟶ high T-score for pros, very low T-score for cons
26
What is self-efficacy in the TTM? What is resilient self-efficacy?
- Added later to TTM
- Important to move individuals from PC to M (confidence)
- Resilient self-efficacy: term used to describe people with high self-efficacy, such that behaviour can be performed despite challenging circumstances
27
What is temptation in the TTM? What is the most challenging situation?
- Dealing with temptation to engage in unhealthy behaviour
- Less likely if you have high self-efficacy
- Most challenging situation ⟶ low confidence, high temptation
28
How is the precaution adoption process model different from TTM?
- Less of an environmental focus
- Increased # of stages
- More precise definition of stages
• PC ⟶ “unengaged” or “unaware”
- Contains “Decides not to act” stage to address people who attempt and then reject change
- Do not prescribe POCs; different for each population/behaviour
29
What are the assumptions of the precaution adoption process model?
- A classification system to define stages
- An ordering of stages
- Stages that are defined such that common barriers to change are faced by people in the same stage
- Stages that are defined such that different barriers to change are faced by people in different stages
30
What are the stages in the precaution adoption process model?
1. Unaware of Health Risk
- People have never heard of a health risk
2. Unengaged by Health Risk
- Have heard of health risk and starting to form opinions
- Do not think it applied to them
- Optimism bias: people do not see themselves as being vulnerable to adverse consequences of behaviours as their peers who engage in those same behaviours
3. Deciding about Acting
- Thinking about taking action, and may have some personal experience with health risk
4. Decided Not to Act
- Considered available information and have decided not to act
- Tend to engage in actions that protect their decision (confirmation preservation, hypothesis preservation)
5. Deciding to Act
- Considered the available information and decided to take action
6. Acting
- Detailed implementation information can be given now, and influences what people choose to do
7. Maintenance
- Behaviour change has occurred
31
What is the self-determination theory?
```
- Macro-theory that integrates 6 micro-theories
• Organismic integration theory
• Basic psychological needs theory
• Cognitive evaluation theory
• Causality orientations theory
• Goal contents theory
• Relationships motivation theory
```
32
What is the organismic integration theory?
- Internalization: process of taking in values, beliefs, or behavioural regulations from external sources and transforming them into one’s own
• Continuum of high to low
- When you fully internalize a behavioural regulation, you become more autonomous (doing things of your own volition)
• Show greater behavioural persistance at activities (less likely to quit), a higher quality of behaviour, and more effective performance
• Have more positive experiences and greater psychological health and wellbeing
33
According to the organismic integration theory, what are the types of behaviour regulation?
1. Intrinsic Regulation
- Intrinsic motivation (autonomous, self-determined)
- Purpose of pleasure/enjoyment
2. Integrated Regulation
- Most autonomous extrinsic motivation
- Doing behaviours because of consistency
- Confirming sense of self (integrated with your identity)
3. Identified Regulation
- Individuals value behaviour or internalized importance of behaviour
• But rewards are still external (eg. weight loss, appearance)
• Have not examined relation of that behaviour to other aspects of their identity
4. Introjected Regulation
- Form of control that individuals enact on themselves, emphasizing internalized judgements, and evaluations
- Sense of guilt and obligation (“I should”)
5. External Regulation
- Low level of self-determined behaviour
- To get external reward (eg. praise)
• The change is not sustained
6. Non-Regulation (Amotivation)
- Not motivated to behave or no intention of doing behaviour
34
What is the basic psychological needs theory?
- 3 psychological needs:
• Autonomy ⟶ you are in control of your actions
• Competence ⟶ sense of capability, mastery, and skill
• Relatedness ⟶ sense of belonging
- Satisfying 3 needs leads to greater well-being, and not leads to greater ill-being
- Self-determined environment (autonomy support) facilitate satisfaction of 2 needs
• Controlling contexts can disrupt satisfaction of 3 needs
35
What is the cognitive evaluation theory?
- Paradox of rewards
• Praise can be detrimental depending on its delivery and reception
- Focuses on external events (eg. praise, scholarships)
• Events promoting internal perceived locus of causality increase intrinsic motivation
• Events promoting perceived competence increase intrinsic motivation
- External events have 3 aspects with a “functional significance”:
1. Informational
- Degree to which event informs you of how autonomous/good you are at something
- Increases IM by increasing internal PLOC/perceived competence
2. Controlling
- Decreases IM by external PLOC
3. Amotivating
- Decreases IM by increasing perceived incompetence
36
With regards to the cognitive evaluation theory, discuss interpersonal contexts.
- Interpersonal contexts can be characterized in degree to which motivational climate tends to be autonomy supportive, controlling, or amotivating
• Environments that most facilitate IM are those that support basic psychological needs for autonomy, competence, and relatedness
37
With regards to the cognitive evaluation theory, discuss intrapersonal contexts.
- Intrapersonal events (within yourself) can differ in their functional significance
• Internally informational events ⟶ facilitate an internal PLOC and perceived competence ⟶ increasing IM
• Internally controlling events (eg. your ego; to prove yourself to others) ⟶ experienced as pressure (self-imposed; decreased autonomy) toward specific outcomes & facilitate an external PLOC ⟶ decreasing IM
• Internally amotivating events ⟶ make salient someone’s incompetence and inability to attain desired outcomes ⟶ decreasing IM
38
What is the causality orientations theory?
- People have 3 different motivational orientations (“causality orientations”)
• Tendencies (similar to personality traits) to focus on certain aspects of environments and inner capacities (motivation & causes of their behaviours)
- Causality orientations affect psychological well-being
39
According to the causality orientations theory, what are the orientations?
1. Autonomy
- Like to seek out interesting and personally important things
- Greater integration in personality ⟶ effective performance + well-being
2. Controlled
- Like being told what to do; focus on controlling aspects of environment
- Introjection and rigidity ⟶ less positive experience/well-being
3. Impersonal
- Give up because you believe the environment is out of your control
- Incompetence and amotivation ⟶ least effective performance/well-being
40
What is the goal contents theory?
- Intrinsic life goals or aspirations and extrinsic life goals are on a continuum
• Prioritizing intrinsic goals is related to greater well-being
- The relationship between goals and wellness is mediated by the sense of autonomy
• Tendency of intrinsic goals to be autonomous (increase self-determination) and more satisfying of 3 basic psychological needs
41
What is the relationships motivation theory?
- Relatedness is an intrinsic basic psychological need and satisfying this need facilitates well-being
- Being autonomously motivated for the relationship facilitates high quality relationship and well-being
• Satisfying all 3 psychological needs within relationships
42
What were the findings for the article "Why Do They (H)it?"
- Participants started and continued HIT for mainly intrinsic reasons
• Strength/endurance
• Social affilitation (eg. spending time with friends)
• Stress management (autonomous motivation)
• Appearance
• Dissatisfaction with current exercise routine
• Challenge/competence (mastering a challenge)
• Revitalisation (how they feel after class)
• Enjoyment
• Positive health
- HIT classes should be designed to support autonomy, competence, and relatedness
1. HIT structure
- Work/rest cycle (to allow recovery; competence)
- Knowing the structure (helps participants feel they can sustain high-intensity exercise throughout the class; competence)
2. HIT exercises
- Variety (of different exercises so that there are some they can do; competence)
- Modified exercises (there are many they can do; competence)
3. Instructor
- Communication style (supported participants’ ability to choose; autonomy, competence)
- Encouraging (competence)
- Correcting technique (competence)
- Caring (instructors care about members of class; relatedness)
- “Normal people” (instructors are shown as normal people; competence)
4. Other class participants
- Friends in the class (relatedness)
- Group exercise atmosphere (relatedness, competence)
43
What were the findings for the article "Men’s Experiences of Using Pedometers to Increase PA"?
- Pedometers supported the development of autonomous motivation (intrinsic) for PA by satisfying basic needs for autonomy, competence, and relatedness
• Competence ⟶ pedometer was seen to provide tangible proof of progress
• Autonomy ⟶ ability to monitor one’s own progress and take remedial action
• Relatedness ⟶ being with other participants and coach (group-based program)
- Both groups were successful at losing weight for sustained periods of time
• No longer using devices after program (developed autonomous motivation; internalized)
• Continued using pedometer or progressed to other self-monitoring techniques (extrinsic motivation from quantification of PA)
- Some men were less successful at achieving 5% weight loss
• Felt pedometer was controlling (undermining autonomy/competence)
• Reported reliance on external factors during programme (eg. support from coach)
- Programs should identify and offer support to participants who are driven by extrinsic factors or those who have negative experiences with self-monitoring tools
44
What is the protection motivation theory?
- By Dr. R. W. Rogers (1975)
- Used to design messages for health awareness campaigns
- When faced with fear-arousing stimuli, people can adopt:
• Positive, adaptive responses to avoid threat (danger control)
• Negative, maladaptive behaviours to ignore risk (fear control)
45
What are the components of the protection motivation theory?
- Protection motivation
• Mediating variable that directs protective health behaviour
• The individual will engage in strategies to avert threat
- 2 appraisal processes:
1) Threat appraisal
- Severity/vulnerability
- Rewards of maladaptive response (engaging in health-risk behaviour or not adopting protective behaviour)
2) Coping appraisal
- Response efficacy (evaluation of how effective behaviour will be in protecting individual from harm)
- Self efficacy (perceived evaluation of capacity to perform behaviour)
- Costs of adaptive response (consequences of engaging in health behaviour)
- Other contributors:
• Past experiences
• Environmental factors
• Personality
46
What is the extended parallel process model?
- Similar to PMT (communication theory)
- If fear appear elicits perceived threat, individuals either:
• Accept fear appeal message (danger-control process; protection motivation)
• Reject fear appeal message (fear-control process; defensive motivation)
- Defensive avoidance: the individual blocks further thoughts about threat and avoid exposure to more information
- The success of a fear appeal (increase chances of danger control process) depends on:
1) Message components
- Content of message should be based on perceived threat and efficacy (same as in PMT / HMB)
2) Individual differences
47
List the fear models.
1. Protection Motivation Theory (PMT)
2. Extended Parallel Process Model (EPPM)
3. Health Belief Model
48
What is the health belief model? Discuss its origin and use.
- Originally developed to explain why individuals didn’t participate in programs to prevent diseases (TB)
• Also considered a value-expectancy theory
• Decisions are rational; based on pros/cons
- Further used to:
• Study behaviours in response to diagnosed illnesses
• Study changes in lifestyle behaviours
49
In the health belief model, what are perceptions of disease?
- Perceived susceptibility to the disease
• Belief about chances of getting adverse health condition
- Perceived severity of disease
• Belief about how serious an illness and its consequences are
- Perceived threat of disease = combo
50
In the health belief model, what are perceptions of behaviour?
```
- Perceived benefits
• Belief in efficacy of advised action to decrease risk of getting the disease or seriousness of the consequences of the disease
- Perceived barriers
• Belief about costs of advised action
• Difficulties in doing the behaviours
```
51
In the health belief model, what are cues to action?
- Events that activate readiness and push us into action to change behaviour
• Stimulate perceived threat of disease
- May be:
• Internal (eg. symptoms)
• External (eg. media, posters, having a friend with the illness)
52
In the health belief model, what is self-efficacy?
- Concept added later
| - Confidence in one’s ability to take action or do a specific behaviour
53
In the health belief model, what are modifying factors?
- Factors that influence on you in terms of how threatening the disease is
• Demographics (eg. age, sex, SES)
• Psychological (eg. personality)
• Structural (eg. knowledge of disease)
- Effectiveness of fear appeal campaigns depend on modifying factors
• Perceived threat must be specific to the target population
54
What are the limitations of the health belief model?
- Environment is not extensively covered (only in “cues to action”)
• Mainly deals with perceptions
- As it is an individual-level theory, it could blame the victim for their health problems
55
What are social ecological models? What are their basic principles?
- Focuses on people’s interactions with environment
- Multiple levels of factors influence health behaviours
• Multiple-level interventions are most effective in changing behaviour
• Levels influence each other
- Most powerful when they are behaviour-specific (tailored interventions)
56
Which strategies do the social ecological models deal with?
BOTH:
• Upstream ⟶ prevention of disease (population-level; Public Health)
• Downstream ⟶ treatment of disease (individual-level; medical model)
57
What is Sallis's SEM?
- Influences on behaviour:
• Intrapersonal factors (eg. self-eefficacy)
• Interpersonal factors (eg. social support)
• Physical environment factors
58
What is McLeroy's SEM?
LEVELS:
1. Intrapersonal
- Individual characteristics that influence behaviour (eg. knowledge, attitudes, motivation)
- Eg. professional gives individual training/counselling
2. Interpersonal
- Social relationships (family, friends, peers, people) provide social support
• Informational (by means of information; eg. providing spouse info about health behaviours)
• Instrumental (by means of tangible assistance)
• Affective (by means of caring and emotionally supporting)
- Eg. giving parents pamphlets about healthy eating for their kids, peer-led programs, role-modelling
3. Organization
- Rules, regulations, policies, and informal structures within institutions (eg. workplace, schools)
- Eg. giving employees flex-time to incorporate PA, healthy snacks in vending machines, policy about healthy foods that are offered, ergonomics (standing desk), posting point-of-decision prompts (“stimulus control”; eg. “every step counts!”)
4. Community
- Social networks and norms that exist as formal or informal AMONG individuals, groups, and organizations
- The network of relationships from one organization to another
- Eg. advocacy groups, different organizations working together to establish bike paths
5. Public Policy
- Local, provincial, and federal government policies/laws
- Eg. taxes, media campaigns from government, having transportation policies (eg. bike share), bans (eg. sledding or turbans in sports)
59
What is Bronfenbrenner's SEM?
- Model of Human Development
- People develop positive and negative behaviours through interactions with systems
1) Microsystem
- Immediate environment that affects person and in turn affects environment
- Eg. family, classroom, neighbourhood
2) Mesosystem
- Interaction of 2 microsystem environments (eg. family affecting a teen’s peer group)
3) Exosystem
- Aspects of the environment in which the individual is not directly involved, but affects them
- Eg. parents’ workplace, parents’ marriage, community
4) Macrosystem
- Larger cultural context in which the other systems function
- Eg. values, laws, resources, social norms
60
What is Cohen's SEM?
- Structural Model of Behaviour
- 4 categories of environmental factors that are critical in shaping health behaviours:
1) Availability/accessibility
2) Physical structures
- Changes in the physical environment (eg. fortification of salt with iodine)
3) Social structures and policy
- Rules and the organizations behind them mold the world we live in
- Eg. state seat belt laws, tobacco policies
4) Media and cultural influences
- Advertising may influence social norms about attractiveness in engaging in health-related behaviours
- Eg. internet, movies, music, TV, print, video games
61
What is Hovell's SEM?
- Behavioural Ecological Model
- Social norms are operant and provide reinforcement for certain types of behaviour
• Metacontingencies: social reinforcements that transcend the individual to affect large segments of a population
- Strength of metacontingency depends on probability of encountering social consequences for behaviour
• Eg. strong metacontingencies against smoking in public spaces due to social norms and anti-smoking laws
62
What is Swinburn & Egger's SEM?
- Behaviour can be understood as a product of micro- and macroenvironmental factors as well as the individual
• Microenvironments: social and physical factors that are proximal and persistent (eg. family)
• Macroenvironments: factors more distal than microenvironmental factors that affect health in an indirect way by creating metacontingencies (eg. laws)
- Asymmetric paternalism: micro- and macroenvironments are engineered to promote adoption of health-protective behaviours, especially for those less prone to adopt them
• Making the default the healthy choice
63
What is the minority stress theory?
- An SEM theory
- 3 central tenets:
• Minority status is linked to distal sources of daily stress (eg. discrimination, racism) ⟶ larger societal structures
• Minority status is linked to proximal sources of daily stress (eg. internalized racism, hopelessness) ⟶ close to the person
• Minority group members experience disproportionate health risks caused by exposure to proximal and distal stressors in social environments
64
What is the intersectionality theory?
- An SEM theory
- Social “super-structures” form the main drivers of oppression and privilege (eg. meaning society places on race)
- An individual’s membership into 1+ sociodemographic categories may lead to co-occuring forms of oppression
- Theory helps us prioritize populations experiencing co-occuring oppression
• Opportunities may arise for structural-level interventions
65
What are the strengths of social ecological models?
- Affect entire population
- Sustain behaviour changes
• Structural interventions: target any part of the environment
• “Risk environment”: environments that set the stage for people to engage in unhealthy behaviour
• Social etiology: underlying cause of the disease lies in the sociocultural environment
- Reframe behaviour from responsibility of individual (no victim-blaming)
66
What were the findings for the article "South Asian Muslim Women"?
Factors that influence South Asian muslim women’s decisions to participate in a mosque-based PA intervention:
1) Intrapersonal facilitators
- Feelings, beliefs, and motivations to continue with intervention (eg. desire to take care of bodies)
- For muslims, PA can be seen as a form of worship if within boundaries (eg. sex-segrated environment, modest clothing)
2) Interpersonal facilitators (relatedness, competence)
- The support they receive from others during the intervention (eg. supportive instructor and peers)
3) Environmental facilitators (autonomy)
- Convenience and access to PA opportunities in a local community setting (eg. within walking distance of mosque, scheduled times close to prayer times)
NUTR*3070
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