1
Q
Health Behavior Theory
A
A set of interrelated concepts, definitions, and propositions that explain or predict events or situations by specifying relations among variables
Can be:
- explanatory - explain why people engage in behaviors
- change - suggest ways to influence/change behaviors
2
Q
What are Health Behaviors?
A
- Personal attributes such as belief, expectations, motives, values, perceptions, cognitive elements.
- Personality characteristics including affective and emotional states.
- Overt behaviors patterns, actions, habits.
All relate to health maintenance, restoration, and improvement.
3
Q
Theories
A
Define and Direct:
- problems to be addressed
- solutions or interventions
- public health recommendations
4
Q
Types of Health Behaviors
A
- Preventive Health Behavior
Primary Prevention - Behaviors of healthy people who try to maintain health
-E.g., eating nutritious foods and living a healthy lifestyles to prevent diabetes onset
- Illness behavior
Secondary Prevention- Screening procedures for people at risk (illness behavior) related to incipient illness (not yet around)
-E.g., screening for diabetes
- Sick-Role Behavior
Tertiary prevention - prevention of disease progression
E.g., maintaing insulin regiment, healthy lifestyles
5
Q
Why are theories important?
A
Theories:
- Explain health behaviors
- Stimulate new ideas
- Inform interventions
- Understand mechanisms /mediators/constructs in behavior (i.e. self-efficacy) , which allows you to change factors to promote health and avoid risk
6
Q
Health Belief Model
A
People’s beliefs about whether they are at risk for a disease or health problem, and their perceptions of the benefits of taking action to avoid it, influence their readiness to take action
-Focuses on behavior drivers
and inhibitors
7
Q
Key Constructs of Health Belief Model
A
- perceived susceptibility
- perceived severity
- benefits
- barriers
- cues to action
- modifying factors (aspects you
cannot quantify) - self-efficacy
8
Q
Problems of Health Belief Model
A
o Inability to isolate any one
variable (more variables in
the equation- the more
complicated)
o COMPLICATED
o Variability in measurement
o Cues to action not well
studied
o Complexity and Law of
Parsimony (Occum’s Razor) –
simplest explanation is
usually the best
9
Q
Subjective Norm
A
Other’s beliefs will influence our behavior/intention if we find their opinion important and relevant to us
- Normative beliefs: what other people believe/norms in network
- Motivation to comply: does it matter to us what people think?
10
Q
Theory of Reasoned Action (TRA)
A
Attitudes and norms are major indicators of behavior
11
Q
Primary Assumptions of TRA
A
- Intention is most important determinant
- Individuals are rational actors
- Specific reasons underlying intentions
-Attitudes
-behavioral beliefs (quit
smoking because you
think patch will work)
-evaluation of beliefs (quit
smoking because you
want the outcome of not
smoking)
-Norms
12
Q
Critique of TRA
A
“Incomplete volitional control”
Goal attainment isn’t just intent/will → also depends on non-motivational factors like resources or obstacles
13
Q
Theory of Planned Behavior
A
Corrected the failure of TRA to address volitional control and ideas of self-efficacy
Only difference between the two is the idea of perceived control function of:
- Beliefs about level of control
over a situation - Perceived power to change the
situation
14
Q
Cue to Action
A
An internal or external motivator to engage in health-promoting behaviors
-E.g., symptoms
15
Q
Primary Appraisal
A
The process by which a person assesses whether or not an event is a stressor
Determined by cognitive appraisal
Primary → assesses if stressor
Secondary → cognitive
assessment of resources and
what can be done
16
Q
Integrated Behavior Model
A
A further development of the Theory of Planned Behavior; Created as an attempt to integrate the various constructs in previous models
Intention (formed by attitude, perceived norms, and perceived agency) remains the most salient factor
Four Other factors:
1. Knowledge and skill to perform
the behavior
2. Perceived salience (relevance)
of the behavior
3. Environmental constraints that
act as barriers
4. habit or previous experience
performing the preventive
health behavior or a similar
behavior
17
Q
Weaknesses of TRA, TPB, IBM
A
- Static models
-Lack of explicit assumptions
about cognitive processes at
initiation and maintenance
stages of behavior change - Depending on health outcome
explored, different constructs
may be more important - Explain behavior intentions and
behaviors in order to identify
intervention targets - They are NOT theories of
communication
18
Q
Transactional Model of Stress and Coping
A
DYNAMIC Model
Process-oriented and context specific
Three Stages
- Appraisal (see as stressful)→ 2. Response (what will you do about it)→
- Reappraisal (see how you feel after/reassess)
Cyclical
19
Q
Coping Strategies
A
Many in reality, but simplified in research
- Emotion-focused: regulating the
emotions associated with stress
2. Problem-focused: altering the
troubled person-environment
interaction
-can be toward self, others,
or situation
20
Q
Social Support
A
Information from others that one is loved or valued, and part of a network of people who can provide help or assistance
21
Q
True or False:
Social Support is Always Positive
A
False
E.g., marriage often used as example of social support, but if partner is abusive or neglectful, would not have a positive influence
22
Q
Concepts and Measures for Social Support
A
- Social relationships marriage often used to determine but may not be representative of a healthy relationship so be careful there
- Social network (#, frequency of contact, density)
- Perceived availability (how much do you think you can rely on)
- Received support (how often do you get it in actuality)
23
Q
Types of Social Support
A
- Emotional
- Esteem → reassurance of value
- Informational → suggestions,
feedback, tough love - Tangible or instrumental →
performance of service, tasks,
giving things that will help - Negative → minimizes prob,
criticizes, not beneficial
24
Q
Main (Direct) Effects Model of Social Support
A
The effect of social support will always be the same
E.g.,those who have high support will always be equally less depressed for any given point of stress
25
Buffering Hypothesis
Says that support buffers stress effects
E.g., you won’t see a difference in cases of low stress, but in high stress, high support people will always do better
26
Observational Learning
SCT
Four Processes
1. attention → access to models;
outcome expectations
2. retention → intellectual capacities
3. production → self-efficacy; physical and communication skills
4. motivation → outcome expectations about costs and benefits
27
Four Major Concepts of Social Cognitive Theory
1. Observational Learning
2. Reciprocal Determinism
3. Self-regulation
- Self-monitoring
- Goal-setting
- Feedback
- Self-reward
- Self-instruction
4. Self-efficacy
28
Reciprocal Determinism
Interaction of behavioral, environmental, and personal factors
Bandura’s Triangle
Person can be both agent for change and responder to change
29
Outcome Expectations
Strongly related to attitudes and beliefs
Perceived self-efficacy + outcome expectations = level of motivation
30
Types of Outcome Expectations
1. Situation-outcome expectancies
-what consequences will occur
without personal action?
2. Outcome expectancies
-what are normal consequences/
effects of a action?
3. Self-Efficacy Expectancies
-what is my perception of my ability
to perform action for desired
outcomes?
31
Self-Efficacy
Beliefs in ability to engage in behaviors that lead to desired outcomes
Confidence in ability to take action and to persist in that action despite obstacles or challenges
Beliefs about capacity to influence events that affect the individuals life
32
Self Regulation (SCT)
Systematic self control of one’s behavior
33
Forms of Self Regulation (SCT)
```
1. Self-monitoring
E.g., keep a log to see what
triggers smoking to
understand the associations in
your life with smoking
2. Goal-setting → LT ST Goals
E.g., start with one day
without smoking and build
from there
3. Feedback
E.g., provide positive feedback
and help person to act
differently by providing them
with tools
4. Self-reward
E.g., set money aside that you
save from not buying
cigarettes and buy yourself
something else
5. Self-instruction → “self-talk”
E.g., “I want to smoke. How do
I avoid it?”
6. Enlistment of social support →
E.g., ask a few people to help
you cope
```
34
True or False
SCT thinks that self-efficacy is more important to behavior than theories like TRA and TPB
True
While all three theories find the mix of self-efficacy and outcome expectations important,
SCT thinks self-efficacy is more powerful than outcome expectations
For SCT:
Outcome expectations → intentions
Self-efficacy → action/maintenance
35
Four Principles of Ecological Model
1. Multiple levels influence health behaviors→ intrapersonal, interpersonal, organizational, community, physical environment, policy
2. Influencers on behaviors interact across levels
3. Should be behavior specific; identify most relevant influencers at all levels
4. Multi-level interventions most efficient in changing behavior
36
Core Concepts of Ecological Model
1. Behavior has multiple levels of influencers
2. Health behaviors maximized when environmental and policies support healthy choices
3. Success of an intervention is not as strongly influenced by the specific form of treatment as by the number of different forms of intervention accessed
37
Influences of Behavior (Ecological Model)
1. Intrapersonal → biopsychological
2. Interpersonal → sociocultural
3. Organizational
4. Community
5. Physical environment
6. Policy
38
Macrosystem
Outer system in ecological model
| Includes broad systems of laws, economics, culture and history
39
True or False
Ecological Model does not take into account multiple levels of influence
False
```
Takes into account:
Individual
Micro-/Interpersonal
Exo/Community
Macrosystem/Institutional
```
Can be used to develop comprehensive interventions (systematically targeted)
Derived from biological science (interrelations between organisms & environments)
40
Strengths of Ecological Model
- premise is simple
- causation of behavior widely distributed
- based on the importance of interaction
41
Weaknesses of Ecological Model
- little variation in social, environmental, and
policy variables
- models lack specificity
- inconsistent support for interactions across
levels
- experimental designs conceptually at odds
with ecological approach
-requires multidisciplinary research
42
Smoking Case Study for Ecological Model
Give Interventions by Level of Influence
Individual Level
- Quit Helpline
- Intervening with nicotine addiction patches
- Mass media that targets individuals
Microsystem
-Peer pressure
Exosystem
-Work site intervention
Macrosystem/Policy Level
- Cigarette taxes
- Bans on smoking in public places
43
Ubiquitous exposure
Factors that explain differences between individuals w/in a population (cases) may not explain differences between populations (incidence rate)
44
High-Risk Prevention Strategy
Attempting to address health risk in an individual (i.e. only helping those with a genetic history of disease, etc.)
45
Population Prevention Strategy
Addresses whole population and therefore shifts data curve to the left, resulting in macro reduction of disease
46
Individual Approach
Attempting to ascertain why some individuals have poor health outcomes and others do not
47
Population Approach
Attempting to ascertain why some populations have poorer health than others
48
Fundamental causes theory (Link and Phelan, 1995)
Developed in response to trends in epidemiology that focused on attention to individual risk factors and away from social conditions as causes of disease
Theory:
1) Persistent relationship between social positions/status and health
2) Contextualizes risk factors by showing why people are exposed to individually-based risk factors (e.g., poor, smoking, diet)
3) Seeks to understand and address root causes to reduce social inequalities in health
49
Upstream Causes
Distal social factors that put people at "risk of risks" (ie; low socioeconomic status)
50
Downstream Causes
Proximate factors that affect risk directly (ie; smoking, consuming sugary soft drinks, no fruits and vegetables)
51
Fundamental Causes Approach vs. Population Perspective Approach
Priority for fundamental cause approach is to address the underlying causes of inequality that give context to health risk.
The priority for population perspective is to address the underlying causes of disease that give context to health behavior.
52
Racism/Sexism
Beliefs, attitudes, institutional arrangements, and acts that tend to denigrate individuals or groups because of phenotypic or ethnic characteristics
53
Prejudice
negative feelings about a group (affective)
54
Stereotypes
negative attitudes about a group (cognitive)
55
Discrimination
practices ranging from social distancing to aggression (behavioral)
56
Levels of Racism
Structural/institutional/systemic: Differential access to material resources and power; institutional policies and practices
Personally mediated/interpersonal:
Prejudice and discrimination: intentional and unintentional actions; lack of respect, suspicion, dehumanization, devaluation
Internalized/individual:
Acceptance/internalization and/or mere awareness of negative stereotypes about one’s group
57
Stereotype Threat
The threat that others’ judgments or their own actions will negatively stereotype them in the domain
The threat of confirming this stereotype impairs performance in achievement-related tasks for those who strongly identify with this domain, creating a self-fulfilling prophecy of poor performance.
58
Minority Stress
Chronic experience of social or economic adversity and political marginalization
Part of weathering
59
Weathering Hypothesis (Geronimus)
The stress inherent in living in a race-conscious society that disadvantages Blacks may cause disproportionate physiological deterioration, such that Blacks will show the morbidity and mortality typical of Whites who are significantly older.
60
Socioeconomic Status
Socially derived economic factors that
influence what positions individuals or
groups hold within the multiple-stratified
structure of a society
61
Stratification
Inherited or acquired characteristics
of individuals as a function of
background/upbringing and
early life opportunity structures result in people being sorted differently
62
Relationship between Socioeconomic Status (SES) and Health
– Incremental
– Evident above a level of acute material deprivation
– Not explained by traditional, proximate “risk factors”
– Modifiable (not immutable)
– Bi-directional
63
Social Gradient
Higher SES is associated with better health incrementally compared to lower SES at every level.
64
Spurious
No causal relationship, any observed relationship is coincidental
65
Social Causation of Health
Relationship where social status leads to health outcomes. Socioeconomic status is the causal factor in the relationship. Higher SES leads to higher access to resources and better health outcomes.
66
Social Drift / Reverse Causation / Selection of Health
Economic perspective: health status leads to socioeconomic outcomes. Health is the causal factor in the relationship. Health effects ability to work and move upward in SES.
67
Interactive / Reinforcing /
| bi-directional relationship of health
Relationship goes both ways, social status affects health outcomes and health outcomes affect social status. The factors of Socioeconomic Status and Health are interdependent on each other.
68
Ambivalent Sexism
Theoretical framework that sexism is a product of both openly hostile sexism and "benevolent" sexism.
69
Acculturation
Adoption of host country or "dominant cultural" norms, attitudes, "lifestyles"
Measured by language use/proficiency, time in the US, preferences, ethnic identity
Limitations: rarely defined, implicitly assumes discreet, monolithic cultural entities and unidirectional, linear processes of change, neglects socioeconomic factors and life course issues, usually approximated
70
Segmented Assimiliation
Social and economic context and subgroup heterogeneity
Variable trajectories possible, no assumption of inevitable, linear, "upward," path of integration
Key determinants of adaptation trajectories:
- Individual human capital/resources
- Receiving environment, government/native response, size and characteristics of co-ethnic population
71
Hegemonic Sexism
A system of rewards and punishments that provide
| incentive for women to remain in conventional gender roles, these sustain and legitimizes gender inequality.
72
Rejection Sensitivity
Chronic anxious expectations of rejection based on a stigmatized characteristic
Highly concerned that rejection will occur, even in ambiguous situations
Intensely react to rejection (e.g., physiological threat, impaired social relationships)
73
Structural Forms of Stigma Related to Sexual Orientation
- Social policies (e.g., employment, harassment, and marriage laws)
- Economic impact of discriminatory social policies (filing for taxes, adoption fees, estate planning)
- State laws (e.g., hate crime statute, employment non-discrimination)
74
Immigrant Paradox a.k.a. Healthy Immigrant Effect
Foreign nativity advantage in morbidity and mortality, a protective effect not sustained over time in the U.S. within and across generations.
75
Health Deterioration Hypothesis
Possible reasons why duration of residence appears to be bad for immigrant health:
- Acculturation/negative assimilation (adoption of unhealthy norms and attitudes)
- Cumulative exposure to 'toxic' US environment (stress of being racialization)
- Selective return migration (those healthy and wealthy enough to return home do so)
- Changing expectations / standards (with regards to sexual health)
- Increasing access to health care (disease diagnosis)
76
Racialization - "Othering"
Imposition, construction, perception, of racial categories and corresponding social meanings
Negotiated, with implications for discrimination and ethnic identity. Perceived discrimination increases with time in the US.
77
"Socially Assigned Race"
Social meaning of skin color varies by social context
78
Aversive Racism
Micro-aggression - unintentional bias displayed through subconscious acts towards a racial or ethnic group.
79
Age at Arrival Hypothesis
The idea that age at time of entering into the new country can affect health outcomes due to arrival during critical periods of sensitivity towards micro-aggression, smoking initiation, etc
80
Sexual orientation
a combination of:
- sexual behavior
- sexual attraction
- self-identification
81
Sex
a biological construct premised upon biological characteristics enabling sexual reproduction
82
Gender
refers to a social construct regarding culture-bound conventions, roles, and behaviors for, as well as relations between and among, women and men and boys and girls. Gender roles vary across a continuum and both gender relations and biologic expressions of gender vary within and across societies, typically in relation to social divisions premised on power and authority
83
Gender Norms
Gender differences in social embeddedness, engagement, health behaviors, and risk taking.
84
System Justification of Sexism
“generalized ideological motive to justify the existing social order”… often resulting in “internalization of inferiority by members of disadvantaged groups” and normalization and/or trivialization of the status quo
85
Gender Social-Health Paradox
- Gender social inequalities ≠ gender health inequalities
- Unlike other (major) axes of social stratification, male privilege does not translate into unambiguous health benefits for men
86
(Re)engagement of gender
Need to specify measure exposures of interest rather than subscribing to typical "masculine" and "feminine" norms and roles. (ie, measure testosterone levels, social experiences, power relations)
87
Intersectionality
Interactions between social hierarchies. The embeddedness of gender (and other axes of social stratification) in the context of health.
88
Hostile Sexism
Overtly negative evaluations and stereotypes about a gender (ie. ideas that women are incompetent and inferior to men)
89
Benevolent Sexism
Insidious, harder to identify, easier to accommodate notions of stereotypical "positive" qualities. (ie. ideas that women have more refined taste, moral sensibility, purity)
90
Patriarchy
a system of society or government in which men hold the power and women are largely excluded from it.
*BrainBuds -Core Study Time
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Decks in class (3)
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