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·刊庆论坛·
行为医学理论
JoostDekker(原文作者) 朱荔芳 译 仇成轩 校
原文发表在 InternationalJournalofBehavioralMedicine,2008,15:13,译文发表获得国际行为医学会的许可。
DOI:10.3760/cma.j.issn.16746554.2012.04.002作者单位:DepartmentofRehabilitationMedicine,EMGOInstitute,VU
UniversityMedicalCenter,P.O.Box7057,1007MBAmsterdam,TheNetherlands(荷兰阿姆斯特丹自由大学康复医学系,现为国际行为医学会侯任主席);济宁医学院(朱荔芳);AgingResearchCenter,KarolinskaInsitutetStockholmUniversity,Stockholm,Sweden(瑞典卡罗琳斯卡医学院),济宁医学院(仇成轩)
通信作者:JoostDekker,Email:j.dekker@vumc.nl
科学研究方法是一个循环往复的过程,包括理论、
假设、观察和结论。科学家们根据理论提出一项具体
假设,接下来在实证研究中对假设进行验证,经过实证
研究中的观察对假设的真实性得出结论,并提出有无
必要对理论进行调整。在演绎推理方法中,"理论"是科学方法循环的切入点,接下来的步骤是提出假设和
设计实证研究检验假设。在归纳推理方法中,人们从
实证数据入手,通过观察形成一项理论,然后通过实证
研究对理论进行检验[1]。见图1。
图1 科学研究方法:一个循环过程
行为医学整个研究领域正见证对于理论越来越复
杂巧妙的应用,国际行为医学杂志是理论应用的积极
倡导者。传统上来讲,行为医学特别强调实证研究中
数据的搜集。近年来,对理论的需求越来越引起人们
的重视,因为理论能够促进对实证研究结果的解释和
整合。没有综合的理论框架,研究恐怕会以一堆难以
诠释的零散的数据资料而结束:理论能促进对实证研
究结果的合理解释。结合特定专业领域的知识现状,
理论有助于确定下一步的研究问题(假设和实证研
究):理论促进科学进展。
一项科学理论包含有关某一特定现实领域的一系
列概念和观点,其作为科学理论的必要条件包括:(1)概念和观点的逻辑一致性;(2)可供实证研究检验的假设;(3)精炼性,即能对一项观察结果作出简单的解释;(4)限于一个明确特定的现实领域。根据是否具备这
些必要条件就可以将科学理论和伪理论区分开来。
在行为医学领域确有几项重要的理论或理论方
法。有些能够满足科学理论所必备的条件,可以被适
当地称为理论。其它一些尚处于发展的早期阶段,有
待于进一步论证,因此最好被称为理论方法。行为医
学的主要理论和理论方法如下。
一、精神压力与情绪调节理论
这些理论描述了精神压力的反应是怎样依赖于外
部因素(精神压力源)、压力源评价、中间变量和情绪
反应调节。从历史上看,Selye[2],Lazarus和 Folkman[3]以及 Miller[4]对这一理论发表了重要的著作。近年来在国际行为医学杂志上发表的应用精神压力与
应急理论的研究包括Langelaan等[5]及Brown等[6]。
二、人格与健康理论
这些理论是关于人格在疾病发展和预后中的作
用。一个经典但过时的例子是 Friedman和 Rosenman[7]关于A型行为对心血管病影响的研究。最近的研究实例有 Denollet等[8]有关 D型行为,也是对心血管病影响的研究。
三、健康行为、健康和疾病理论
这些理论探讨的是机制问题,解释健康行为(如
吸烟、饮食和体力活动)与健康和疾病发展及预后的
关系。在体力活动或体力活动不足的研究领域,Bouchard等[9],Pate等[10]、Vuori等[11]以及 Veenhof等[12]
做出了重要的工作。
四、健康行为的社会认知理论
该理论群是关于行为的预期结果怎样决定健康行
为,涵括各种理论模式,如健康信念模式,保护 -动机理论,理性行动理论,计划行为理论,以及计划行为与
态度/社会影响/效应模式理论[1320]。最近的例子还包
括Ziegelmann和Lippke[21]以及Renner等[22]提出的理论。五、疾病理念与自我调节理论
该理论涉及病人如何看待自身的疾病,其对自身
疾病的认识又如何影响他们对疾病及其治疗作出反应
的行为(遵医嘱)。Leventhal等[23]奠定了其理论基
础,最近的例子包括Cameron等[24]的工作。
六、健康行为的环境决定因素理论
这一类理论涉及社会支持的影响、职业因素、物理
环境和健康与疾病的医疗卫生政策。Cohen与Wills[25]以及 Schwarzer与 Leppin[26]发表了有关社会支持影响方面的历史性著作。Luszczynska等[27]对该
理论有新的贡献。在职业领域,这类理论描述工作、个
人和社会环境特点是如何影响健康与疾病的。
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Karasek[28]和Siegrist[29]在该领域进行了创新性的研究,最近的成果还包括 Hintsanen等[30]以及 Shimazu等[31]的研究。最后,该类型的理论还描述物理环境和
健康政策是如何促进或阻碍健康行为的[32]。
七、行为变化的动机决定因素理论
这些理论描述个人特点、健康信息和信提供者是
如何决定行为变化的。经典的研究有Prochaska与DiClemente等[33]以及 Roter与 Hall[34],近期有 Kim等[35]的研究。
在建立假设、诠释实证研究结果的过程中审慎而
明智地运用相关理论对科学地理解研究发现很重要。
理论能够促进实证研究结果的解释与整合,而且好的
理论有助于确定符合逻辑的下一步研究工作。此外,
理论可以指导创新性成果的应用,如评价工具、治疗性
及预防性干预措施。我刊鼓励明智慎思地运用理论进
行实证研究,请不吝赐稿。
参 考 文 献
[1] deGrootAD.Methodologic.Gravenhage:Mouton,1971.[2] SelyeH.Thestressoflife.NewYork:McGrawHill,1976.[3] LazarusRS,FolkmanS.Stress,appraisalandcoping.NewYork:
Springer,1984.[4] MillerSM.Monitoringandblunting:Validationofaquestionnaireto
assessstylesofinformationseekingunderthreat.JPersSocPsychol,1987,52:345353.
[5] LangelaanS,BakkerAB,SchaufeliWB,etal.Isburnoutrelatedtoallostaticload?IntJBehavMed,2007,14:213221.
[6] BrownJP,KatzelLI,NeumannSA,etal.Silentmyocardialischemiaandcardiovascularresponsestoangerprovocationinolderadults.IntJBehavMed,2007,14,134140.
[7] FriedmanM,RosenmanRH.Associationofspecificovertbehaviorpatternwithbloodandcardiovascularfindings:Bloodcholesterollevel,bloodclottingtime,incidenceofarcussenilisandclinicalcoronaryarterydisease.JAmMedAssoc,1959,169:12861296.
[8] DenolletJ,PedersenSS,OngATL,etal.Socialinhibitionmodulatestheeffectofnegativeemotionsoncardiacprognosisfollowingpercutaneouscoronaryinterventioninthedrugelutingstentera.EurHeartJ,2006,27:171177.
[9] BouchardC,ShephardRJ,StephensT,etal.Exercise,fitnessandhealth.Champaign,IL:HumanKineticsBooks,1990.
[10]PateRR,PrattM,BlairSN,etal.Physicalactivityandpublichealth.ArecommendationfromtheCentersforDiseaseControlandPreventionandtheAmericanCollegeofSportsMedicine.JAmMedAssoc,1995,273:402407.
[11]VuoriI,FentemP,SvobodaB,etal.Thesignificanceofsportforsociety.Strasburg:CouncilofEuropePress,1995.
[12]VeenhofC,VandenEndeCHM,DekkerJ,etal.Whichpatientswithosteoarthritisofthehipand/orkneebenefitmostfrombehavioralgradedactivity?IntJBehavMed,14:8691.
[13]RogersRW.Aprotectionmotivationtheoryoffearappealsandattitudechange.JPsychol,1975,91:93114.
[14]RosenstockIM.Historicaloriginsofthehealthbeliefmodel.HealthEducMonogr,1974,2:18.
[15]FishbeinM,AjzenI.Belief,attitude,intentionandbehavior:Anintroductiontotheoryandresearch.Reading:AddisonWesley,1975.
[16] BanduraA.Selfefficacy:Towardaunifyingtheoryofbehavioralchange.PsycholRev,1977,84:191215.
[17]AjzenI.Attitudes,personalityandbehavior.Buckingham:OpenUniversityPress,1988.
[18]ArmitageCJ,ConnorM.Socialcognitionmodelsandhealthbehaviour:Astructuredreview.PsycholHealth,2000,15:173189.
[19]deWitJ,StroebeW.Socialcognitionsmodelsofhealthbehaviours//KapteinAA,WeinmanJ.HealthPsychology.Oxford:Blackwell,2004:5283.
[20]deVriesH,DijkstraM,KuhlmanP.Selfefficacy:Thethirdfactorbesidesattitudeandsubjectivenormasapredictorofbehaviouralintentions.HealthEducRes,1988,3:273282.
[21]ZiegelmannJP,LippkeS.Planningandstrategyuseinhealthbehaviorchange:Alifespanperspective.IntJBehavMed,2007,14:3039.
[22]RennerB,KwonS,YangBH,etal.SocialcognitivepredictorsofdietarybehaviorsinSouthKoreanmenandwomen.IntJBehavMed,2008,15:413.
[23]LeventhalH,NerenzDR,SteeleDJ.Illnessrepresentationsandcopingwithhealththreats//BaumA,TaylorSE,SingerJE.HandbookofPsychologyandHealth,Vol.4.Hillsdale:LawrenceErlbaum,1984:219252.
[24]CameronLD,PetrieKJ,EllisC,etal.Symptomexperiences,symptomattributions,andcausalattributionsinpatientsfollowingfirsttimemyocardialinfarction.IntJBehavMed,2005,12:3038.
[25]CohenS,WillsTA.Stress,socialsupportandthebufferinghypothesis.PsycholBull,1985,98:310357.
[26]SchwarzerR,LeppinA.Socialsupportandhealth:Ametaanalysis.PsycholHeal,1989,3:115.
[27]LuszczynskaA,BoehmerS,KnollN,etal.Emotionalsupportformenandwomenwithcancer:Dopatientsreceivewhattheirpartnersprovide?IntJBehavMed,2007,14:156163.
[28]KarasekR.Jobdemands,jobdecisionlatitude,andmentalstrain:Implicationsforjobredesign.AdministrativeScienceQuarterly,1979,24:282308.
[29]SiegristJ.Adversehealtheffectsofhigheffortlowrewardconditionsatwork.JOccupHealthPsychol,1996,1:2743.
[30]HintsanenM,ElovainioM,PuttonenS,etal.Effortrewardimbalance,heartrateandheartratevariability:ThecardiovascularriskinyoungFinssstudy.IntJBehavMed,2007,14:202212.
[31]ShimazuA,deJongeJ,IrimajiriH.LaggedeffectsofactivecopingwithintheDemandControlModel:AthreewavepanelstudyamongJapaneseemployees.IntJBehavMed,2008,15:4453.
[32]RoemmichJN,EpsteinLH,RajaS,etal.Theneighborhoodandhomeenvironments:Disparaterelationshipswithphysicalactivityandsedentarybehaviorsinyouth.AnnBehavMed,2007,33:2938.
[33]ProchaskaJO,DiClementeCC.Stagesandprocessesofselfchangeofsmoking:Towardanintegrativemodelofchange.JConsultClinPsychol,1983,51:390395.
[34]RoterDL,HallJA.Doctorstalkingwithpatients/patientstalkingwithdoctors:Improvingcommunicationinmedicalvisits.Westport:AuburnHouse,1992.
[35]KimY,CardinaBJ,LeeJ.UnderstandingexercisebehaviouramongKoreanadults:Atestofthetranstheoreticalmodel.IntJBehavMed,2006,13:295303.
(收稿日期:2012-04-15)(本文编辑:冯学泉)
【附英文原文】 EDITORIALTheoriesinBehavioralMedicine
Thescientificmethodisacyclicprocessconsistingoftheories,hypotheses,observations,andconclusions.Scientistsusetheoriestodevelopaspecifichypothesis,whichissubsequentlytestedinanempiricalstudy:theobservationsintheempiricalstudyresultina
conclusiononthetruthofthehypothesisandtheneedforadaptationofthetheory.Inthedeductiveapproach,"theory"isthepointofentryintothescientificcycle;developmentofthehypothesisanddesigninganempiricalstudyarethenextsteps.Intheinductiveapproach,onestarts
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fromempiricaldata;theseobservationsleadtoatheory,whichisthenempiricallytested(deGroot,1971).SeeFigure1.
Figure1. Thescientificmethod:Acyclicprocess.
Thefieldofbehavioralmedicineasawhole,withthisIJBMasanoutstandingexponent,iswitnessingmoresophisticateduseoftheories.Traditionally,behavioralmedicinehashadastrongfocusongatheringdatainempiricalresearch.Inrecentyears,theneedfortheoriesfacilitatingtheinterpretationandintegrationofempiricalfindingsisincreasinglyacknowledged.Withouttheintegrativeframeworkoftheory,thereisariskofendingupwithasetofloosefactswhicharedifficulttointerpret:theoryfacilitatesthecoherentinterpretationofempiricalfindings.Furthermore,theoryisconducivetoidentifyingthenextstepinresearch(hypothesisandempiricalstudy)giventhestateofknowledgeinthefield:theoryfacilitatesscientificprogress.
Ascientifictheoryconsistsofasetofconceptsandstatementsconcerningaparticulardomainofreality.Requirementsforascientifictheoryinclude(1)logicalconsistencyoftheconceptsandstatements;(2)hypotheseswhichcanbeempiricallytested;(3)parsimony,i.e.,preferencefortheleastcomplexexplanationforanobservation;and(4)beingrestrictedtoaclearlydefineddomainofreality.Theserequirementsenablethedistinctionbetweenscientifictheoriesandpseudotheories.
Inthefieldofbehavioralmedicine,severalmajortheoriesortheoreticalapproachesexist.Someofthesemeettherequirementsforascientifictheoryandcanbeproperlydesignatedasatheory.Othersareatanearlystageofdevelopmentandneedtobedevelopedfurther:thesearebestdesignatedasatheoreticalapproach.Majortheoriesandtheoreticalapproachesinbehavioralmedicinearelistedbelow.
Theoriesonstressandemotionalregulation.Thesetheoriesdescribehowthestressresponseisdependentonanexternalcue(stressor),theappraisalofthestressor,intermediatevariables,andregulationofemotionalresponses.Selye(1956/1976),LazarusandFolkman(1984),andMiller(1987)arepublicationswhichareimportantfromahistoricalperspective.RecentexamplesinthisjournalofastudyusingthestresstheoryincludeLangelaan,Bakker,Schaufeli,vanRhenen,andvanDoornen(2007)andBrown,Katzel,Neumann,Maier,andWaldstein(2007).
Theoriesonpersonalityandhealth.Thesetheoriesconcerntheroleofpersonalityinthedevelopmentandprognosisofdiseases.AclassicbutoutdatedexampleisFriedmanandRosenman(1959)onTypeAbehaviorincardiovasculardiseases.ArecentexampleisDenolletetal.(2006)onTypeDbehavior,alsoincardiovasculardisease.
Theoriesonhealthbehavior,healthanddisease.Thesetheoriesaddressthemechanismsexplainingtherelationshipbetweenhealthbehavior(suchassmoking,diet,andphysicalactivity)andthede
velopmentandprognosisofhealthanddisease.Inthefieldofphysicalactvity/inactivity,Bouchard,Shephard,Stephens,Sutton,andMcPherson(1990),Pateetal.(1995),andVuorietal.(1995)haveprovidedimportantinput.ArecentexampleisVeenhofetal.(2007).
Socialcognitivetheoriesonhealthbehavior.Thisfamilyoftheoriesaddresseshowhealthbehaviorisdeterminedbyexpectationsontheoutcomeofbehavior.ThiscategoryincludesvarioustheoreticalmodelssuchasHealthBeliefModel,ProtectionMotivationTheory,TheoryofReasonedAction,TheoryofPlannedBehavior,andTheoryofPlannedBehaviorandtheAttitudes/SocialInfluences/EfficacyModel(Rosenstock,1974;Rogers,1975;Fishbein&Ajzen,1975;Bandura,1977;Ajzen,1988;Armitage&Connor,2000;deWit&Stroebe,2004;Vries,Dijkstra,&Kuhlman,1988).RecentexamplesincludeZiegelmannandLippke(2007)andRenneretal.(2008).
Theoryonillnessperceptionandselfregulation.Thistheoryaddresseshowpatientsperceivetheirillnessandhowthisaffectstheirbehaviorinresponsetodiseaseanditstreatment(adherence).Leventhal,Nerenz,andSteele(1984)havelaidthefoundationofthistheory.ArecentexampleisCameron,Petrie,Ellis,Buick,andWeinman(2005).
Theoriesoncontextualdeterminantsofhealthbehavior.Thiscategoryconcernstheoriesontheimpactofsocialsupport,occupationalfactors,thephysicalenvironment,andhealthpolicyonhealthanddisease.CrucialhistoricalpublicationsontheimpactofsocialsupportincludeCohenandWills(1985)andSchwarzerandLeppin(1989).ArecentcontributionisLuszczynska,Boehmer,Knoll,Schulz,andSchwarzer(2007).Intheoccupationalsetting,theoriesdescribehowcharacteristicsofthejob,theperson,andthesocialenvironmentaffecthealthandillness.Karasek(1979)andSiegrist(1996)areseminalpublicationsthathaveconstitutedthisfield.RecentcontributionsincludeHintsanenetal.(2007)andShimazu,deJone,andIrimajiri(2008).Finally,theoriesinthiscategorydescribehowthephysicalenvironmentandhealthpoliciesfacilitateorimpedehealthbehavior(e.g.,Roemmich,Epstein,Raja,&andYin,2007).
Theoriesonmotivationaldeterminantsofbehavioralchange.Thesetheoriesdescribehowbehavioralchangeisdependentoncharacteristicsoftheindividual,thehealthinformation,andtheproviderofinformation.ProchaskaandDiClemente(1983)andRoterandHall(1992)areclassicalstudies.ArecentstudyisKim,Cardinal,andLee(2006).
Ajudicioususeoftheoryindevelopinghypothesesandininterpretingempiricalfindingsisinstrumentalinbringingscientificunderstanding.Theoriesfacilitatetheinterpretationandintegrationofempiricalfindings,andagoodtheoryhelpstoidentifythenextlogicalstepinresearch.Furthermore,theoryisseminalindevelopinginnovativeapplicationssuchasassessmentinstrumentsandtherapeuticandpreventiveinterventions.Thisjournalstronglyencouragessubmissionsonempiricalstudiesbasedonajudiciousandwellconsidereduseoftheory.
JoostDekkerEditorinChief
InternationalJournalofBehavioralMedicine(Refferencesomitted)
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