HEALTH

PSYCHOLOGY
Unit-2
INTRODUCTION
HEALTH BEHAVIOURS AND
HEALTH HABITS
PRIMARY PREVENTION
PRACTICING AND CHANGING
HEALTH BEHAVIOURS
THEORIES OF HEALTH
BEHAVIOUR
 Researchers working in the field of health psychology
have propounded various theories to understand
health behaviours of people.
 These help to understand health behaviour and
provide an insight into what motivates some
people to follow them diligently and why some
others find it difficult to comply with good health
behaviour despite knowing the consequences of their
poor health habit. They also help to predict the type
of health related behaviour that people follow
and how they can be influenced or educated to
change and follow health behaviour.
THEORIES OF HEALTH
BEHAVIOUR
 Health behaviour theories can be basically classified
into three categories: Motivational, Behavioural
Enactment and Multi-stage theories.
 In the motivational models, intentions are
considered to be the most important determinant of
health behaviour.
 Behavioural enactment models focus on the
action control strategies individuals adopt for
translating motivation into action.
 Multi-stage theories that are the most complex of
the three theories argue that individuals progress
MOTIVATIONAL
MODELS
HEALTH BELIEF MODEL
 Health belief model (HBM) theory is one of the earliest and
the most well-known perspective that tries to explain health
behaviour of people (Sanderson 2004). A group of social
scientists were puzzled as to why people often failed to
respond to programmes that are organized to prevent
or detect diseases.
 Researchers have focused on the role of health belief in
people’s practicing or not practicing health behaviours.
 The Health belief model theory developed way back in 1950
tries to explain the reasons for the same. It states that the
probability of a person adhering to health behaviour or
taking preventive action is essentially dependent on four
factors, namely susceptibility, severity, benefits and
HEALTH BELIEF MODEL
Susceptibility:
 People are more likely to practice health behaviour, if they perceive
themselves to be susceptible to a disease or believe that they are
personally at risk. This may happen if they witness someone close to
them having the illness or have adequate knowledge about the risk
factors involved in the disease.
 Raj, for instance, is very careful with his diet and regularly engages in
physical activities like long walks and exercise to keep his weight in
check since he had seen how his mother, a diabetic, suffer from
complications arising from it and had to undergo amputation of her
toes. He is also aware that he too is genetically prone to diabetes.
 Susceptibility or perceived threat of an illness or injury to a large
extent is also dependent on factors like age, gender, socio-economic
status. Elderly individuals who find their contemporaries developing
serious illnesses like cardiovascular disorder or cancer are more likely
to perceive a personal threat and practice certain preventive health
HEALTH BELIEF MODEL
Severity:
If people know and believe that the
consequence of an illness is very fatal like
facing social embarrassment,
experiencing severe pain, disfigurement,
or even death, then they are more likely
to adhere to health behaviour.
Social embarrassment and of contacting
AIDS, may make people practice safe sex.
HEALTH BELIEF MODEL
Benefits:
 Adherence to health behaviour is also related to one’s belief
that this would be beneficial in reducing the risk of a particular
disease. People must firmly believe that reducing weight will
cut the risk of cardiovascular disease for them to work on
weight reduction.
 If reducing weight is believed to be too much of an arduous
and difficult task and a big sacrifice compared to the benefits
accrued, health habits would rarely be practiced.
 It is found that people may be aware of practicing certain
health behaviour but cannot afford to follow them. For
instance, people working across time zones or in night shifts
are aware that their health is being compromised by staying
awake and eating late, but cannot leave the job. These
HEALTH BELIEF MODEL
Benefits:
 When people believe that the benefits of practicing
certain health behaviour far outweighs the barriers or
difficulties in following them, they are more keen to
practice them.
 For instance, for some people the pleasure of partying
and drinking excessive alcohol at the behest of
friends may seem less compared to facing the sick
feeling of a hangover and the embarrassment of
missing a deadline for a project report or being late
for an important meeting.
 There may be others who may irresponsibly risk a
HEALTH BELIEF MODEL
Barriers:
 Socio-economic conditions of a person are often barriers
in health behaviour. Many find cost of medical diagnosis
and treatment prohibitive; therefore decline from visiting
a doctor, getting a medical check up or following the
prescriptive treatments.
 In remote villages, the distance between their dwellings
and Primary Health Centers (PHC) is such that
accessibility to health care is difficult.
 Lack of women medical professionals affects women’s
health in many places. These are but a few of the barriers
that exist in health behaviour in a country like India.
HEALTH BELIEF MODEL
Limitations:
 Health belief model has generated a lot of interest
among researchers who found that beliefs of
individuals influence their health behaviour. However,
it is found to be incomplete.
 For instance, it fails to take into consideration certain
routine health behaviour people perform like
brushing teeth and bathing without actually believing
in their susceptibility or benefits and cost incurred.
 Moreover, it is difficult to assess the perceived
susceptibility and severity of different people
making comparisons unfeasible.
PROTECTION MOTIVATION
THEORY
 This theory was originally proposed by R.W. Roger
(Rogers, 1975). The theory tried to understand fear
appeals and how people tried to cope with them
and are motivated to protect themselves from risks.
Roger developed protection motivation theory (PMT)
which expanded the HBM to include additional
factors.
 According to the Protection Motivation Theory, health
related behaviours of people are a product of four
components:
 1. The perceived severity of a threatening event
 2. Personal vulnerability
PROTECTION MOTIVATION
THEORY
 Whether the health behaviour change is adopted will
depend upon the individual’s level of induced
fear regarding illness and risk factors.
 For instance, several incidences of Dengue fever in
the immediate social circle like friends and
neighbours of people will induce fear of contacting
the disease. This will motivate them to practice
certain health behaviours as a preventive measure. It
has been shown that a medium level of fear brings
forth cognitive responses that lead to implementation
of behavioural change.
PROTECTION MOTIVATION
THEORY
 Protection motivation takes place both due to threat
appraisal and coping appraisal.
 People tend to evaluate the extent of health threat
and also assess their own coping responses
before intending to perform adaptive
responses.
 Perceived vulnerability to the disease and
perceived severity of the illness are expected to
inhibit the probability of maladaptive
responses. In the above mentioned instance, if the
environments in which people live are mosquito
PROTECTION MOTIVATION
THEORY
 The appraisal of coping process by people
will evaluate the nature of the coping
responses.
 Protection motivation will take place when
people believe that carrying out
recommended preventions or performing
a health habit will ensure removal of the
threat of contacting the disease
(response efficacy) and also they believe in
their own ability to perform the
PROTECTION MOTIVATION
THEORY
 Although as a predictor of health behaviour, the PMT is more accepted by
researchers in comparison to HBM, many of the criticisms laid against HBM
is also applicable to the PMT.
 For example, the PMT also assumes that people are rational in their
information processing. However, in fear appraisal there is bound to be
an element of irrationality.
 PMT also does not account for certain habitual behaviours, such as
brushing teeth, or bathing people perform that do not necessarily
include the components of threat appraise or coping appraisal. PMT
also does not include the role played by social and environmental factors in
health adaptive behaviour. Health behaviour to a large extent is dependent
on other’s behaviour and the opportunity one has to perform health
behaviour.
 The model also does not talk about tackling attitudinal change that
might take place.
PLANNED BEHAVIOUR OR
REASONED ACTION THEORY
 According to this theory, intentions are the
best predictors of people’s behaviour. In
other words, behind every voluntary
behaviour, there is decidedly a prior
intention that leads people to decide and act.
 According to this theory, intentions are
determined by three factors, namely:
 1. One’s attitude towards the behaviour
 2. Subjective norms that a person holds
 3. Perceived behavioural control one can
PLANNED BEHAVIOUR OR
REASONED ACTION THEORY
ATTITUDE TOWARDS BEHAVIOUR:
 It is basically one’s outlook towards the action, whether the
action is considered good or bad, which is in turn based on the
beliefs and the judgment of the probable consequences.
 Preeti for instance, does not give much thought to dieting, she believes
in enjoying good food, trying out new eating joints with friends and
family. Her overweight appearance she believes is an indication of her
affluent family background that she is lucky to belong. Eating less will
only give her a ‘lean mean appearance’. Joseph, a IInd year
undergraduate on the other hand holds a very different attitude
compared to many in his class towards maintaining health. He does not
smoke or consume alcohol despite a lot of pressure from friends. He
believes that once he indulges, he will slowly indulge regularly and the
probability of his getting addicted will be high. This will adversely affect
his health, his academic performance and eventually perhaps his
PLANNED BEHAVIOUR OR
REASONED ACTION THEORY
SUBJECTIVE NORM:
 This refers to what one believes are social opinion
on one’s behaviour, and what is the extent of
social rejection or social acceptance of his
behaviour.
 Going back to the case of Preeti, if she finds most of
the people she moves around with are very keen on
maintaining a slim body structure and follow proper
fitness regime through healthy diet and regular
exercise, she may start believing in this collective
opinion and change her attitude. On the other hand,
PLANNED BEHAVIOUR OR
REASONED ACTION THEORY
PERCIEVED BEHAVIOURAL CONTROL:
 This has reference to one’s belief in oneself in being able to
perform the action that is necessary to practice health
behaviour and also the belief that the action will yield positive
results.
 For instance, with changed attitude Preeti may now try to evaluate
whether she will be able to avoid fatty food, control her urge for
regular snacking, or will she be able to resist feasting on her
mother’s recipe, given that her mother is such a wonderful cook. She
should not only feel confident about her ability in self-regulation but
should be sure that her hard work and control will pay in helping her
lose weight and make her healthy. Only then Preeti will be able to
plan to practice health behaviour. Joseph will be able to plan his
health behaviour based on how he is able to control his smoking or
PLANNED BEHAVIOUR OR
REASONED ACTION THEORY
CRITICISMS:
 First, the theory seems to be incomplete, it fails to account
for people’s earlier experiences of following health
behaviour which could be crucial in either practicing or
resisting health behaviour. If Preeti or Joseph, for instance, had
experienced self-regulation in the past in overcoming their
urge for food or tobacco or alcohol, it is more likely that they
would try to do that again.
 Second, the theory lays too much emphasis on the link
between intentions and behaviour. In reality, people do
not always carry out all that they intend to do. Besides, only
some health behaviour may be determined by people’s
attitude like consuming alcohol or sexual behaviour; this may
PLANNED BEHAVIOUR OR
REASONED ACTION THEORY
CRITICISMS:
 Third, the attitudes, belief and intentions towards a particular
behaviour may be applicable to only a typical sample and cannot be
generalized on all types of groups. For example, attitude, intentions and
exercise behaviour may not be the same across rural and urban population
or men and women, or young and old.
 Finally, the theory presupposes that people’s behaviour are a result
of careful evaluation of its benefits and risks. In reality, people are
either ignorant of the risk factors, not capable of evaluation or do
not always spend so much thought behind their actions. First,
people may not often see themselves at risk of a certain health problem.
They may not believe that it can happen to them till it actually occurs.
Moreover, their behavioural change, if any, may be a result of
hearsay or imitation of someone they attach value to. For instance,
Rahul gave up drinking milk because he heard an animal activist whom he
respected advocating it. Similarly, people are known to have irrational
LEARNING THEORY
 Health behaviour and health habit of people,
just like any other behaviour, to a significant
extent, follow basic learning processes that
have been explained by Thorndike’s Trial and
Error, Pavlov’s Classical Conditioning, Skinner’s
Operant Conditioning, and Bandura’s Social
Cognitive theories.
 Health related behaviour is mainly influenced
by conditioning, essentially because of the
consequences of poor health habit.
CLASSICAL CONDITIONING
 Pavlov’s work is considered one of the most important
discoveries in the history of psychology. According to
Pavlov, the underlying principle of classical
conditioning of adaptive learning that was seen in
case of salivation to a conditioned stimulus can also
happen to other bodily process that affect diseases
and mental disorders.
 Many of us perhaps learn through classical
conditioning to avoid medical treatment and visits to
hospitals as a residue of our childhood fear of a
vaccination or an injection.
CLASSICAL CONDITIONING
 Usha who was a skinny child was force-fed during childhood
inadvertently by her mother in order to make her ‘healthy’.
Every eating time turned into a nightmare for her,
accompanied by screaming, crying, running and sometimes
even being beaten. She would often throw up and yet she
would not be spared from eating the rest of the food in the
plate.
 Today at the age of 18 she dislikes everything associated with
food, she hardly goes to any party or wedding, and gets upset
every time her mother asks her to eat. Her food habit
continues to remain poor influenced by her childhood
association with traumatic experiences.
 This might be an extreme case; however, it is evident that
CLASSICAL CONDITIONING
 Classical conditioning can teach our bodies to respond in a way
that is harmful or beneficial for our health and can often account
for the appearance of certain disease symptoms that cannot
be traced to a medical cause.
 For instance, allergic reactions have been found to be elicited by
seemingly innocuous stimulus like sight or smell of a thing
when it is consistently paired with an allergen. This is illustrated
by an example of an asthma patient who always suffered wheezing
attacks at the sight of goldfish.
 To test this, doctors brought a bowl with a gold fish in it, and
immediately she developed severe asthmatic attack and started
wheezing loudly.
 There might have been some association that had been built by this
patient over the years between an allergen and gold fish where the
CLASSICAL CONDITIONING
 Classical conditioning has been one of the first methods to be
used in behaviour modification especially for treatment of
alcoholism (Taylor, 2006).
 Antabuse is a drug that when administered makes a person
experience extreme nausea and vomiting. Antabuse acts as a
conditioned stimulus (CS) when given with alcohol (US). Over a
period of time an association is established between the two
and the person experiences nausea to alcohol (CR).
 One of the greatest drawbacks of classical conditioning in
health behaviour modification is the person’s unwillingness to
follow. Once a person for instance knows that nausea is
caused by Antabuse, he may refuse to be administered, going
back to this old habit.
OPERANT CONDITIONING
 Contrary to classical conditioning which establishes
an automatic response with a new stimulus, operant
conditioning establishes a voluntary response with a
systematic consequence. Health related behaviour of
people is greatly influenced by operant conditioning,
changing health habits due to the consequences.
Skinner identified several consequences of which the
following three types are important:
 Reinforcement
 Punishment
 Extinction
OPERANT CONDITIONING
 Reinforcement: If a person behaves in a manner
that it brings about a pleasant or a positive
outcome, the behaviour gets reinforced, increasing
its frequency of occurrence, thereby strengthening
the behaviour. Similarly, desirable health behaviour,
if rewarded, gets reinforced or established.
 Neena, for instance, loves music; she has stored her
choicest songs in her MP3 player. Now listening to
her favourite music from the MP3 while walking, she
has turned her morning walks into a pleasant and
rewarding experience bringing regularity to the
good health habit.
OPERANT CONDITIONING
 Punishment: In contrast, if a person’s
behaviour brings about an unpleasant
outcome, the behaviour gets suppressed.
Undesirable health behaviour if punished can
make a person avoid the behaviour.
 Intentions behind police levying fine, or
arresting for drunken driving or driving
without the protective gear like helmet or
seat belts is to instill fear of punishment so
that people avoid unsafe health behaviour.
OPERANT CONDITIONING
 Extinction: If a person’s behaviour stops being reinforced and
continues facing negative consequences, the behaviour
weakens and gets extinct or eliminated.
 In the instance of Neena, if she loses her MP3 or develops
hearing problem, then her good health habit of morning walk
will stop being reinforced, and she may stop the behaviour
until of course she finds some other way of reinforcing the
habit like going with a friend.
 It must also be said that if the good health behaviour stops
being rewarded, without not necessarily facing negative or
unpleasant consequences, even then, the probability of the
behaviour turning extinct remains high. Therefore, good
health behaviour needs to be reinforced periodically,
BEHAVIOUR
ENACTMENT
MODELS
AN INTRODUCTION
 Motivational models of health behaviour fallaciously
assume that intention and behaviour are almost
perfectly matched. Meta analysis of the theories have
shown that although they explain a large proportion
of the intention variance, they do not do so of
behavioural inconsistency.
 Behavioural enactment models were developed in
order to explain this gap between intentions and
behaviour. It takes a step forward from the
motivational models.
IMPLEMENTATION
INTENTION
 Taking the case of Preeti again, she might have
all the intentions of reducing her weight and
be fit but fails to turn this intention into action.
 Studies have shown that intentions explain
only 20 or 30 per cent of behaviour
variance; they are not perfect predictors
of action.
 ‘Good intentions have a bad reputation’
said Gollwitzer who introduced the concept of
Implementation Intention in 1999.
IMPLEMENTATION
INTENTION
 Implementation intention is described as a self-
regulatory strategy that helps convert
intentions into action (Gollwitzer, 1999), specifying
the ‘when’, ‘where’ and ‘how’ part of goal-
directed behaviour.
 Implementation intentions are specific plans in the
form of ‘if situation X arises, I will initiate Y
behaviour’ that has been suggested to improve goal
attainment.
 People often fail to initiate action despite having
positive intentions because achieving goals
IMPLEMENTATION
INTENTION
 There could be various reasons for this to happen. People
may face distractions or temptations to continue old
behaviour (over eating during a party); they may not
have opportunities to attain their goal (living in a place
where there are no parks or open space for jogging or
exercising) and also because it is difficult to sustain
motivation since the results of such goal-directed
behaviour are not immediate.
 According to Gollwitzer (1990, 1993), the motivational
phase that ends with the formation of a goal
intention is followed by a volitional(making a choice
or a decision) phase during which plans are made to
IMPLEMENTATION
INTENTION
 Empirical evidence has been provided that the
formation of implementation intentions increases
the likelihood that a goal will be achieved
(Gollwitzer & Brandstätter, 1997).
 A concrete plan, specifying time and place
for performing the intention becomes mentally
represented and activated, leading to better
perception, attention and memory concerning
the plan. As a result, the chosen goal-directed
behaviour will be performed automatically, with
minimal conscious effort.
MULTISTAGE
MODELS OF
HEALTH
BEHAVIOUR
THE TRANSTHEORETICAL
MODEL OF BEHAVIOUR
CHANGE

Stages of Change Model also known as Transtheoretical Model
has been proposed by Prochaska and colleagues
(Prochaska, DiClemente & Norcross, 1992), focuses mainly on
the individual’s readiness to change and explains the
various stages of gradual change in health behaviour.
 According to this theory, there are a set of five specific
categories or stages in the process of intentional change of
health behaviour
 1. Precontemplation
 2. Contemplation
 3. Preparation
 4. Action

THE TRANSTHEORETICAL
MODEL OF BEHAVIOUR
CHANGE
THE TRANSTHEORETICAL
MODEL OF BEHAVIOUR
CHANGE
 Contemplation: During this stage a person is
aware that there is a problem that needs to be
addressed but is not yet motivated enough to
change the behaviour or confident that they can
change. They may even try to change albeit
unsuccessfully.
 Sheela, for instance, knows that she is
overweight; she continues to update her
knowledge about the means of weight reduction.
She has attempted several times to stick to a lean
diet and an exercise regimen, but ultimately gave
 THE TRANSTHEORETICAL
MODEL OF BEHAVIOUR
CHANGE
Preparation: This is the phase when an individual
has an intention to change behaviour, and is
ready to make plans and set goals without
necessarily carrying it out. They may take some
small steps that will take them nearer to their
target.
 Sheela might now reduce the number of sweets she
normally takes, cut down on her partying, find out
more about proper physical work-out, and perhaps
even buy an appropriate shoe for walking. A smoker
might reduce the number of cigarettes by increasing
the time gap between each smoke. Despite all the
 THE TRANSTHEORETICAL
MODEL OF BEHAVIOUR
CHANGE
Action: This is the stage when people begin
to change their lifestyle and modify their
behaviour by committing to spend time and
effort and act positively towards their
goals.
 They make it known to family and friends
who, in turn, support them in their
endeavor. This stage may normally last for a
period of 6 months (Sarafino, 2011) when the
risk of a reversal to the old habit is high.
 THE TRANSTHEORETICAL
MODEL OF BEHAVIOUR
CHANGE
Maintenance: This is a final stage when people try
to sustain the change that they successfully
brought in their health habit and the emphasis is
more on preventing a relapse.
 If a person maintains the newly acquired health habit
for a period of 6 months, then he or she is
considered to be in this stage. This is especially true
of addictive behaviour. Social support which is still
very crucial might be withdrawn since it is believed
that the individual has already begun the action of
change.
 THE TRANSTHEORETICAL
MODEL OF BEHAVIOUR
CHANGE
People go through the stages of intentional behaviour
change in a spiral and not in a linear fashion,
moving from one stage to another.
 At each stage people often weigh the benefits of
moving upwards to the next stage. This
movement need not always be a smooth
transition from one stage to another. People may
often revert to the previous stage before moving
forward again. Such spiral movement may continue
till the process of behaviour change is finally
completed.
 THE TRANSTHEORETICAL
MODEL OF BEHAVIOUR
CHANGE
Relapse to poor health behaviour is not very
uncommon. Especially in the case of addictive
behaviour, people may go through all the
stages only to return to the first stage of
precontemplation. They may then pass
through the entire cycle of the stages all
over again.
 This might happen several times before they
totally rid themselves of the habit. That is why
researchers have called it a spiral change
THE TRANSTHEORETICAL
MODEL OF BEHAVIOUR
CHANGE
To progress through the stages of change,
people apply cognitive, affective, and
evaluative processes. Ten processes
of change have been identified with
some processes being more relevant to a
specific stage of change than other
processes.
These processes result in strategies that
help people make and maintain change.
THE TRANSTHEORETICAL
MODEL OF BEHAVIOUR
CHANGE
1. Consciousness Raising - Increasing
awareness about the healthy behavior.
2. Dramatic Relief - Emotional arousal about
the health behavior, whether positive or
negative arousal.
3. Self-Reevaluation - Self reappraisal to
realize the healthy behavior is part of who
they want to be.
4. Environmental Reevaluation - Social
reappraisal to realize how their unhealthy
THE TRANSTHEORETICAL
MODEL OF BEHAVIOUR
CHANGE
5. Social Liberation - Environmental
opportunities that exist to show society is
supportive of the healthy behavior.
6. Self-Liberation - Commitment to change
behavior based on the belief that achievement
of the healthy behavior is possible.
7. Helping Relationships - Finding
supportive relationships that encourage the
desired change.
THE TRANSTHEORETICAL
MODEL OF BEHAVIOUR
CHANGE
8. Counter-Conditioning - Substituting
healthy behaviors and thoughts for
unhealthy behaviors and thoughts.
9. Reinforcement Management - Rewarding
the positive behavior and reducing the
rewards that come from negative behavior.
10. Stimulus Control - Re-engineering the
environment to have reminders and cues that
support and encourage the healthy behavior
and remove those that encourage the
 THE TRANSTHEORETICAL
MODEL OF BEHAVIOUR
CHANGE
Despite its usefulness the transtheoretical model is not
devoid of limitations.
 First of all, according to this model, people often weigh
the cost and benefits of changing their health
behaviour. This leads them to progress from one
stage to another. As people move from first stage to
the second, the benefit of changing behaviour is
perceived to increase, and when they move from the
second stage onto the fourth stage the cost of
changing behaviour is perceived to decrease.
However, it has been found that people who weigh the
costs and benefits of change behaviour will not
necessarily move forward towards change of health
 THE TRANSTHEORETICAL
MODEL OF BEHAVIOUR
CHANGE
Second, while studying the stages of change,
researchers have found that the process of
change for stopping poor health habit like
smoking and drinking is not the same as the
process involved in starting good health
behaviour like exercising, or dieting.
 Finally, researchers have questioned the
stages of change that have been specified in
the model. They opine that there are more
stages than the ones mentioned.
PRECAUTION ADOPTION
PROCESS MODEL (PAPM)
 This theory too, like the Transtheoretical model, proposes that a
change in health behaviour goes through several stages
(Weinstein et al. 1998; Weinstein & Sandman, 2004) and people
may move back and forth from one stage to another and not
necessarily move stage by stage in a linear manner with an
exception of never returning to 1st and 2nd stage once
they have been crossed.
 However, in the PAPM, the stages of change are further broken
down consisting of seven and not five stages of change. It
also proposes different processes by which people’s progress
through the stages can be predicted.
 According to this theory, people move through a path of
absolute ignorance of the lurking health risks,
discovering their vulnerability to finally taking action and
PRECAUTION ADOPTION
PROCESS MODEL (PAPM)
 First stage: In this phase people are totally unaware of the
disease or problem. Many people for instance, are not aware
that morning breakfast is the most important meal of the day
and regularly missing it can lead to several illnesses in the
long run and also poor memory and performance.
 Second stage: People in this stage have a fair knowledge of
the risk factors involved in certain diseases. But, knowing
about health risks is one thing and changing their own
health behaviour is another. They fail to believe that
they can personally be at risk. Most people know that
wearing a helmet protects them from a potential accident, yet
many serious road accidents have occurred because the rider
failed to wear it. They have an optimistic bias about their
PRECAUTION ADOPTION
PROCESS MODEL (PAPM)
 Third Stage: In this stage people start believing that they too
are at risk of developing certain illnesses. Yet, decision to
take action in order to reduce risk factor is still lacking.
Naveen, for instance, knows that his overweight status is
putting him at risk of cardiovascular diseases, diabetes and a
host of other ailments, especially with his kind of family
history. But he remains placid and does not take any decision
yet on changing his lifestyle.
 Fourth stage: People in this stage realize that they need
to be proactive, and take necessary action but do not
do much about it. At this stage, Naveen might realize that a
decision must be taken to change his lifestyle, but he lacks
motivation and continues to practice the same poor health
PRECAUTION ADOPTION
PROCESS MODEL (PAPM)
 Fifth stage: People here finally take a decision to take
action and change their health habit and opt for a better
lifestyle. They may even plan the kind of action that they need
to take. They may enroll in a gym, buy walking shoes, or
consult nutrition experts for change of diet. There are others
who decide to give up smoking, drinking or other health
compromising behaviours. Sometimes people may directly
move from Stage 3 to Stage 5, bypassing Stage 4.
 Sixth stage: Here people start taking action and change
health habits as they had planned. They take to exercise,
take balanced diet, regulate their sleep hours, go for regular
medical check up, and give up poor health habits. One may
now see Naveen regularly in the nearby park or gym, skipping
PRECAUTION ADOPTION
PROCESS MODEL (PAPM)
 Seventh stage: In this stage, people try hard
to continue to maintain the change in
health habit adopted for a period of time.
People try to make certain changes in their
environment, give up many of the poor health
habits previously practiced, set a particular
schedule for exercise, and make some marked
changes in their lifestyle for a long-term
commitment to change.
PRECAUTION ADOPTION
PROCESS MODEL (PAPM)
 The Precaution Adoption Process Model, unlike
the Transtheoretical Model, makes a distinction
among people who are ignorant of the
health risk issue and those who have
some awareness but do not show interest
in changing health behaviour (Stages 1 and 2).
 Moreover, this theory does not consider a time
frame to each of the stages as in the previous
model.
HEALTH ACTION PROCESS
APPROACH (HAPA)
 The Health Action Process Approach model (Schwarzer,
1992) attempts to connect the motivational,
behavioural enactment models and multi-stage
models.
 According to this model, the adoption, initiation, and
maintenance of health behaviours has a clearly-
outlined process that consists of at least two stages,
namely a motivational phase and a volition phase.
 The latter is further subdivided into a planning phase and
a maintenance phase.
HEALTH ACTION PROCESS
APPROACH (HAPA)
 To sum up, the HAPA model suggests that perceived
self-efficacy plays a crucial role at all stages along
with other cognitive abilities.
 Risk perceptions, for instance, are most important
in the early motivation phase to make individual
start thinking, but do not, beyond that phase.
 Similarly, outcome expectancies are chiefly
important in the motivation phase when
individuals balance the pros and cons of certain
consequences of behaviours, but they lose their
predictive power once a person decides to act.
HEALTH ACTION PROCESS
APPROACH (HAPA)
 Coping self-efficacy (CSE) is the belief that
you can use your internal resources to deal
with challenges and threats.
 Recovery self-efficacy pertains to one's
beliefs about the ability to resume an
action after a lapse. The barriers may refer
to lack of performance for a certain period or
to a relapse.
 Risk perception is how people think about
the severity and characteristics of a risk.
PREVENTATIVE
HEALTH
BEHAVIOUR
LEVELS OF PREVENTATIVE
HEALTH BEHAVIOUR
 In order to promote health, certain preventive health habits
are adopted. Regular physical exercise, nutritious and
balanced diet, meditation and yoga, abstaining from
substance abuse like tobacco, alcohol and drugs, practising
safe sex, using safety gears are some of the behaviours
adopted by healthy people.
 People who have developed symptoms of chronic illnesses
follow certain prescribed medication, diet and exercise for
preventing further damage. These actions taken by
individuals to prevent disease from developing or to
avoid the negative outcomes of a disease condition are
called Preventive health behaviours
 Preventive health behaviour may occur at three levels:
PRIMARY PREVENTION
 The actions that are undertaken by healthy individuals
with no apparent evidence of disease or risk to
maximize their wellbeing and remain healthy are
referred to as Primary prevention.
 It is a preventive measure in medical parlance called,
prophylactic therapy, intended to prevent a medical
condition from occurring.
 Primary prevention includes both health promotion and
prevention of illness and delays the problems of
ageing.
 It is being given considerable importance since it is seen as
the best method of ensuring health enhancement and
wellbeing in people.
PRIMARY PREVENTION
 Primaryprevention cannot be resorted to if the medical
condition has already set in. In such cases, secondary and
tertiary prevention helps in maintaining health and
preventing further deterioration.
 Effective secondary and tertiary prevention strategies not only help
in prolonging life, it also adds quality to life with less
complication arising out of the disease.
 Onset of chronic disorders brings to the fore the necessity of
providing several different interventions for management of disease.
An effective intervention strategy adopts a two-pronged
approach, one dealing with the patient directly and the other
managing the environment around the patient which includes
the social and psychological atmosphere. At the individual level,
intervention involves patient education and counseling
regarding the treatment regimen, precautions and awareness about
SECONDARY PREVENTION
 When a person develops a particular disease condition,
actions are taken to identify the extent of the disease or
injury and start treatment early in order to control or
reverse the problem.
 In an illness or injury where probability of further damage
is high, secondary prevention becomes relevant. It
involves following prescribed medication, diet control,
regular health check up, physiotherapy and exercise.
 When Sam was diagnosed with hypertension during a regular
medical examination, doctors immediately put him on to
secondary prevention by prescribing medication to keep his
blood pressure in check. He was advised to be on low fat and
low salt diet, walk for at least 3–4 kms daily, quit smoking
consume alcohol if at all, in moderation, to prevent any
SECONDARY PREVENTION
 An annual medical examinations is advised by
medical practitioners to their patients after a certain
age as part of secondary prevention. Since not
all the tests have proved to be good predictors, they
have not been very useful in prevention. Therefore,
medical experts today recommend only certain
specific tests depending on the age and conditions of
the patient.
 People with a family history of disease or are exposed
to hazardous substances at workplace are more likely
to develop a chronic disease. Secondary
prevention becomes helpful for early diagnosis
TERTIARY PREVENTION
 When a person is suffering from a disease which has progressed
beyond the early stages, or the injury is serious, tertiary
prevention is planned to control its growth and prevent
further disability and help the patient to rehabilitate.
 After a surgery, for instance, a patient is put on a tertiary prevention
involving schedule of medication, special diet and physiotherapy so
that the patient recovers and further damage is prevented. Tertiary
prevention is disease-specific ranging from medication, surgery,
radiation, chemotherapy, physiotherapy etc.
 Tertiary prevention for a person suffering from cancer for instance,
will involve palliative care or supportive therapy that does not
treat or improve the underlying condition, but instead it
increases the patient’s comfort level and decreases his pain.
Because at this stage of the disease the patient is beyond any
known treatment, what can be extended is humane treatment
HEALTH
PROMOTING
BEHAVIOURS
DIET AND NUTRITION
 What we eat, how much we eat and when we eat has a direct
effect on our health. This is a well known fact. In the Indian
system of medicine, Ayurveda diet plays an important role as
medication in treatment of a disease. Over two thousand years
back Hippocrates too had stated, ‘let food be your medicine
and medicine be your food.’
 Nutrition is defined as the sum total of the processes involved
in the intake and utilization of food substances by living
organisms that includes ingestion, digestion, absorption,
transport and metabolism of nutrients in food.
 . There are six major classes of essential nutrients found in
food, namely carbohydrates, fats, protein, vitamins,
minerals and water.
EFFECTS OF MALNUTRITION
 Malnutrition including both over and under nutrition
has been found to limit development, impair
cognitive and sensory abilities and also cost
lives. Under nutrition especially during infancy,
stunts growth around 165 million children
worldwide.
 There is not only a possibility of stunted growth and
irreversible health consequences, they face a future
which will be marked by ill health, poor
academic performance and resultant poor level
of education, low income and poverty. Apart
from infant mortality, under nutrition is also
EFFECTS OF MALNUTRITION
 For instance, most people know that eating too much
sweets and processed food can contribute to physical
health problems like obesity and Type 2 diabetes, but
what is less known is that high sugar diet can
have an impact on mental health as well.
 Though numerous studies have shown the deleterious
effects a sweet tooth can have on mood, learning and
quality of life, sugar and other sweeteners, including
high fructose corn syrup, honey, molasses and maple
syrup, may contribute to a number of mental health
problems including depression, anxiety, addiction
and learning and memory (Sacks, 2013).
EXERCISE
 Our bodies are meant to walk, run, climb, bend, jump, lift and the like,
exercising all voluntary muscles. In earlier times, before the advent
of industrial–technological society, human beings were routinely
engaged in these activities which kept their bodies fit and healthy.
Gyms, fitness clinics and diet clinics were unheard of since getting
enough exercise was never an issue.
 But today, life does not entail most of these activities. We use
motored vehicles instead of walking or running, elevator for
climbing. Most of our physical activities have been taken over by
machines and gadgets rendering us inactive and thus making us
lead a sedentary life. This automated lifestyle has had a ruining
effect on our health and wellbeing. Merely resorting to low calorie
diet is perhaps insufficient in controlling weight gain because without
physical exercise it is difficult to burn calories. When people
consume more energy in the form of calories present in food compared
to what they burn through physical activity, it results in energy
surplus. If care is not taken to check it, energy surplus contributes to
BENEFITS OF EXERCISE
BENEFITS OF EXERCISE
TYPES OF EXERCISE
 Different kinds of physical exercises and activities are recommended
by different schools of thought. They fall into four basic categories –
endurance, strength, balance and flexibility.
 Although some activities fit into more than one category, most
people tend to focus on any one type of exercise or activity.
However, engaging in all of them not only enhances benefits,
but also helps to reduce boredom and cut the risk of injury.
 Endurance exercises also called aerobic exercises include brisk
walking or jogging, dancing, swimming, cycling, climbing,
games like football, basket ball or athletics and others.
Aerobic exercise is a sustained physical activity that increases
oxygen consumption over an extended period of time. It
strengthens the heart, lungs, and circulatory system and
improve overall fitness. It is marked by high intensity, long
duration and requisite high endurance.
TYPES OF EXERCISE
 Strength exercises, also called ‘strength training’ or
‘resistance training’, include activities like climbing stairs
and carrying stuff, pulling and pushing objects which
make the muscles stronger. Even small increases in
strength can make a big difference in your ability to stay
independent and carry out everyday activities.
 Balance exercises that include standingon one foot,
walking on toes and so on help in maintaining balance
and avoiding falls.
 Flexibility exercises mainly include stretching of limbs and
other body parts, and yoga. These exercises stretch the
muscles and help the body to remain supple
(bending/moving easily) and agile (move quickly and
easily). Flexibility exercises, not only helps to carry out