Presentation From: Health Psychology

Topics Covered:
Unit IV: Health Behaviour Change
a) Health Behaviours
b) Approaches to health- Cognitive Behavioural etc
c) Process of health behaviour change- Trans-theoretical Model
 Sub Topic A: Health Behaviours

I. AN INTRODUCTION TO HEALTH BEHAVIOURS

A. What are Health Behaviours?

Health behaviours are behaviours undertaken by people to enhance or maintain their
health (Taylor, 2015), Which entails;
1. Health Habits: A health habit is a health behaviour that is firmly established and often
performed automatically, without awareness. These habits usually develop in childhood and
begin to stabilize around age 11 or 12 (Cohen, Brownell, & Felix, 1990). Eg., Wearing a seat
belt, brushing one’s teeth, and eating a healthy diet.
2. Primary Prevention: Instilling good health habits and changing poor ones is the task of primary
prevention. This means taking measures to combat risk factors for illness before an illness has
a chance to develop.
There are two general strategies of primary prevention.
The first and most common strategy is to get people to alter their problematic health behaviours,
such as helping people lose weight through an intervention.
 The second, more recent approach is to keep people from developing poor health habits in the
first place.
B. Practicing and Changing Health Behaviours:
‘What are the factors that lead one person to live a healthy life and another to
compromise his /her health?’
1. Demographic Factors: Younger, more affluent, better-educated people with low levels of
stress and high levels of social support typically practice better health habits than people
under higher levels of stress with fewer resources (Hanson & Chen, 2007).
2. Age: Health habits are typically good in childhood, deteriorate in adolescence and young
adulthood, but improve again among older people.
3. Values: Values affect the practice of health habits. For example, exercise for women may be
considered desirable in one culture but undesirable in another (Guilamo-Ramos, Jaccard,
Pena, & Goldberg, 2005).
4. Personal Control: People who regard their health as under their personal control practice
better health habits than people who regard their health as due to chance.
5. Social Influence: Family, friends, and workplace companions influence health-related
behaviours, sometimes in a beneficial direction, other times in an adverse direction (Broman,
1993; Turbin et al., 2006)
6. Personal Goals: Health habits are tied to personal goals. If personal fitness is an important
goal, a person is more likely to exercise.
7. Perceived Symptoms: Some health habits are controlled by perceived symptoms. For
example, a smoker who wakes up with a smoker’s cough and raspy throat may cut back in the
belief that he or she is vulnerable to health problems at that time.
8. Access to Health Care Delivery Systems: Access to the health care delivery system affects
health behaviours. For example, receiving immunizations for childhood diseases depend on
access to health care.
9. Cognitive Factors: Practice of health behaviours is tied to cognitive factors, such as
knowledge and intelligence (Jaccard, Dodge, & Guilamo-Ramos, 2005).
C. Barriers to Modifying Poor Health Behaviours:
1. Instability of Health Behaviours: Health behaviours must often be tackled one at a time. Health
habits are unstable over time. A person may stop smoking for a year but take it up again during a
period of high stress.
2. Emotional Factors: Emotions may lead to or perpetuate unhealthy behaviours. These behaviours
can be pleasurable, automatic, addictive, and resistant to change.
D. Intervening with Children and Adolescents:
1. Socialization: Health habits are strongly affected by early socialization, especially the influence of
parents as both teachers and role models (Morrongiello, Corbett, & Bellissimo, 2008). Parents instill
certain habits in their children (or not) that become automatic, such as brushing teeth regularly and
eating breakfast every day.  As children move into adolescence, they sometimes ignore the early
training they received from their parents. In addition, adolescents are exposed to alcohol
consumption, smoking, drug use, and sexual risk taking, particularly if their parents aren’t
monitoring them very closely and their peers practice these behaviours (Andrews, Tildesley, Hops, &
Li, 2002).
2. Using the teachable moment: The concept of teachable moments refers to the fact that certain times
are better than others for teaching particular health practices. Many teachable moments arise in early
childhood. Parents can teach their children basic safety behaviors, such as looking both ways before
crossing the street, and basic health habits, such as drinking milk instead of soda with dinner.
3. Closing the Window of Vulnerability: Junior School time appears to be particularly important for
the development of several health-related behaviours, which provides this window to seep into the
practices of smoking, alcohol consumption etc.
4. Adolescent Health Behaviours and Adult Health: An important reason for intervening with
adolescents is that precautions taken in adolescence may aff ect disease risk after age 45 more than
do adult health behaviors. Th e health habits a person practices as a teenager or college student may
determine which chronic diseases he or she develops and what the person ultimately dies of in
adulthood.
E. Intervening With At-Risk People:
Who? Children and Adolescents who are vulnerable , Particular groups of people such as
women who have a vulnerability of having breast cancer because her mother had suffered
from it, obesity.
1. Benefits of Focusing At-Risk People: 1. Early Identification. 2. Awareness-other risk factors.
2. Problems Of Focusing on At-Risk People: People do not always perceive their risk correctly
(Croyle et al., 2006). Most people are unrealistically optimistic and view their poor health
behaviors as widely shared but their healthy behaviors as more distinctive. For example,
smokers overestimate the number of other people who smoke.
3. Ethical Issues: At what point is it appropriate to alarm at-risk people if their personal risk is
unknown? Not everyone at risk for a particular disorder will develop the problem and, in
many cases, only many years later. For example, should adolescent daughters of breast
cancer patients be alerted to their risk and alarmed at a time when they are coming to terms
with their emerging sexuality and needs for self-esteem? Psychological distress may be
created in exchange for instilling risk reduction behaviors (Croyle, Smith, Botkin, Baty, &
Nash, 1997.
F. Health Promotion and the Elderly:
Exercise keeps older adults mobile and able to care for themselves, and it does not have to be
strenuous. Participating in social activities, running errands, and engaging in light housework
or gardening reduce the risk of mortality, perhaps by providing social support or correctly a
general sense of self-efficacy (Glass, deLeon, Marottoli, & Berkman, 1999). Among the very
old, exercise has particularly strong benefi ts (Kahana et al., 2002).
G. Ethnic and Gender Differences in Health Risks and Habits
 II. CHANGING HEALTH HABITS

A. Attitude Change and Health Behaviours

1. Educational Appeals: Educational appeals make the assumption that people will
change their health habits if they have good information about their habits. Early
and continuing efforts to change health habits have focused heavily on education
and changing attitudes.
2. Fear Appeals: Attitudinal approaches to changing health habits often make use of
fear appeals. This approach assumes that if people are afraid that a particular habit
is hurting their health, they will change their behavior to reduce their fear.
3. Message Framing: A health message can be phrased in positive or negative terms.
For example, a reminder card to get a fl u immunization can stress the benefits of
being immunized or stress the discomfort of the fl u itself (Gallagher, Updegraff ,
Rothman, & Sims, 2011).
B. The Health Belief Model:
An early influential attitude theory of why people practice health behaviors is the
health belief model (Hochbaum, 1958; Rosenstock, 1966). According to this model,
whether a person practices a health behavior depends on two factors: whether the
person perceives a personal health threat, and whether the person believes that a
particular health practice will be effective in reducing that threat.
1. Perceived Health Threat: The perception of a personal health threat is influenced
by at least three factors: general health values, which include interest in and
concern about health; specific beliefs about personal vulnerability to a particular
disorder (Dillard, Ferrer, Ubel, & Fagerlin, 2012); and beliefs about the
consequences of the disorder, such as whether they are serious. Thus, for example,
people may change their diet to include low cholesterol foods if they value health,
feel threatened by the possibility of heart disease, and perceive that the personal
threat of heart disease is severe (Brewer et al., 2007).
2. Perceived Threat Reduction: Whether a person believes a health measure will
reduce threat has two subcomponents: whether the person thinks the health practice
will be effective, and whether the cost of undertaking that measure exceeds its
benefits (Rosenstock, 1974).
3. Support for Health Belief Model: Example: It predicts preventive dental care,
breast self examination.
4. Using Health Belief Model Behaviour: Circumstances under which people’s health
behaviour might change.
5. Self-Efficacy and Health Behaviour: The belief that ne is able to continue one’s
practice of a particular behaviour.
 C. The Theory of Planned Behaviour:
A theory that attempts to link health beliefs directly to behavior is Ajzen’s theory of planned
behavior (Ajzen & Madden, 1986; Fishbein & Ajzen, 1975).
According to this theory, a health behavior is the direct result of a behavioral intention.
Behavioral intentions are themselves made up of three components: attitudes toward the
specific action, subjective norms regarding the action, and perceived behavioral control.
1. Attitudes toward the action center on the likely outcomes of the action and evaluations of
those outcomes.
2. Subjective norms are what a person believes others think that person should do (normative
beliefs) and the motivation to comply with those normative beliefs.
3. Perceived behavioral control is the perception that one can perform the action and that the
action will have the intended effect; this component of the model is similar to self-efficacy.
These factors combine to produce a behavioral intention and, ultimately, behavior change.
Example:
To take a simple example, smokers who believe that smoking causes serious health outcomes,
who believe that other people think they should stop smoking, who are motivated to comply
with those normative beliefs, who believe that they are capable of stopping smoking, and who
form a specific intention to do so will be more likely to stop smoking than people who do not
hold these beliefs.
 Benefits of Theory and Planned Behaviours: Get to know about people’s belief and intentions.
 Evidence for the Theory of Planned Behaviours: use of oral contraceptives, consumption of
soft-drinks among adolescents are some of the research based examples.
 D. Self Determination Theory

Self-determination theory (SDT), a theory that also guides health behavior modifi -
cation, builds on the idea that people are actively motivated to pursue their goals
(Deci & Ryan, 1985; Ryan & Deci, 2000).
The theory targets two important components as fundamental to behavior change,
namely autonomous motivation and perceived competence.
• People are autonomously motivated when they experience free will and choice
when making decisions.
• Competence refers to the belief that one is capable of making the health behavior
change.
 III. SPECIFIC HEALTH RELATED BEHAVIOURS

4. Developing a
1. Exercise Healthy Diet

2. Accident 5. Weight
Prevention Control and
Obesity
3. Cancer Related 6. Eating
Health Behaviours Disorders

7. Sleep

8. Rest, Renewal, and

Savouring
 IV. HEALTH COMPROMISING BEHAVIOURS

1. Alcoholism 2. Smoking

A Classical Conditioning The Health Belief

Approach to the model applied to
treatment of health behaviour of
Alcoholism stopping smoking
Sub Topic B: Approaches to Health Behaviour Change: Cognitive Behavioural
1. Cognitive-Behaviour Therapy: Cognitive-behavior approaches to health habit modification
focus on the target behavior itself, the conditions that elicit and maintain it, and the factors
that reinforce it (Dobson, 2010).
2. Self Monitoring: The rationale is that a person must understand the dimensions of the poor
health habit before change can begin. Self-monitoring assesses the frequency of a target
behavior and the antecedents and consequences of that behavior.
3. Classical Conditioning: Classical conditioning was one of the fi rst methods used for health
behavior change. For example, consider its use in the treatment of alcoholism. Antabuse
(unconditioned stimulus) is a drug that produces extreme nausea, gagging, and vomiting
(unconditioned response) when taken in conjunction with alcohol. Over time, the alcohol
becomes associated with the nausea and vomiting caused by the Antabuse and elicits the same
nausea, gagging, and vomiting response (conditioned response) without the Antabuse being
present.
4. Operant Conditioning: Operant conditioning pairs a voluntary behavior with systematic
consequences. The key to operant conditioning is reinforcement. When a person performs a
behavior and that behavior is followed by positive reinforcement, the behavior is more likely
to occur again. Similarly, if an individual performs a behavior and reinforcement is withdrawn
or the behavior is punished, the behavior is less likely to be repeated.
5. Modelling: Modeling is learning that occurs from witnessing another person perform a
behavior (Bandura, 1969). Observation and subsequent modeling can be eff ective approaches
to changing health habits. For example, in one study high school students who observed
others donating blood were more likely to do so themselves (Sarason, Sarason, Pierce,
Shearin, & Sayers, 1991).
6. Stimulus Control: The sight and smell of a pack of cigarettes may act as a discriminative
stimuli for smoking. The discriminative stimuli is important because it signals that a positive
reinforcement will subsequently occur.
Stimulus control interventions such as 1. ridding environment of discriminative stimulus
evoke the problem behaviour and 2. creating the discriminative stimuli signalling that a new
response will be reinforced.
7. The Self Control of Behaviour:
1) Self- Reinforcement
2) Contingency Contracting
3) Cognitive Restructuring
4) Behavioural Assignments
5) Social Skills Training
6) Motivational Interviewing
Here the interviewer is non judgemental
Expression of negative/positive thoughts
Clients talk as much as counsellors.
7) Relaxation Training
8. Relapse (Model on next slide)
1) Reasons for Relapse
2) Relapse Prevention
3) Lifestyle Rebalancing
 Sub Topic C: Process of Health Behaviour Change: Transtheoretical Model
1. Stages of the Transtheoretical Model:
J. O. Prochaska and his associates (Prochaska, 1994; Prochaska, DiClemente, & Norcross,
1992) developed the transtheoretical model of behavior change, a model that analyzes the
stages and processes people go through in bringing about a change in behavior and suggested
treatment goals and interventions for each stage.
1) Precontemplation: The precontemplation stage occurs when a person has no intention of
changing his or her behavior. Many people in this stage are not aware that they have a
problem, although families, friends, neighbors, or coworkers may well be. An example is the
problem drinker who is largely oblivious to the problems he creates for his family.
2) Contemplation: Contemplation is the stage in which people are aware that they have a
problem and are thinking about it but have not yet made a commitment to take action. Many
people remain in the contemplation stage for years.
3) Preparation: In the preparation stage, people intend to change their behavior but have not
yet done so successfully. In some cases, they have modified the target behavior somewhat,
such as smoking fewer cigarettes than usual, but have not yet made the commitment to
eliminate the behavior altogether.
4) Action: The action stage occurs when people modify their behavior to overcome the
problem. Action requires the commitment of time and energy to making real behavior change.
It includes stopping the behavior and modifying one’s lifestyle and environment to rid one’s
life of cues associated with the behavior.
5) Maintenance: In the stage of maintenance, people work to prevent relapse and to
consolidate the gains they have made. For example, if a person is able to remain free of an
addictive behavior for more than 6 months, he or she is assumed to be in the maintenance
stage (Wing, 2000).
2. Importance of the Stage Model of Change:
The stage model capture the processes that people actually go through while they are attempting to change
their behaviour, either on their own or with assistance.
3. Using the Stage Model of Change:
At each stage, particular types of interventions may be most appropriate. Specifically, providing people in
the precontemplation stage with information about their problem may move them to the contemplation
phase. To move people from the contemplation phase into preparation, an appropriate intervention may
induce them to assess how they feel and think about the problem and how stopping it will change them.
Interventions designed to get people to make explicit commitments as to when and how they will change
their behavior may bridge the gap between preparation and action.

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