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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

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[21]ZiegelmannJP,LippkeS.Planningandstrategyuseinhealthbehaviorchange:Alifespanperspective.IntJBehavMed,2007,14:3039.

[22]RennerB,KwonS,YangBH,etal.SocialcognitivepredictorsofdietarybehaviorsinSouthKoreanmenandwomen.IntJBehavMed,2008,15:413.

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[28]KarasekR.Jobdemands,jobdecisionlatitude,andmentalstrain:Implicationsforjobredesign.AdministrativeScienceQuarterly,1979,24:282308.

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[30]HintsanenM,ElovainioM,PuttonenS,etal.Effortrewardimbalance,heartrateandheartratevariability:ThecardiovascularriskinyoungFinssstudy.IntJBehavMed,2007,14:202212.

[31]ShimazuA,deJongeJ,IrimajiriH.LaggedeffectsofactivecopingwithintheDemandControlModel:AthreewavepanelstudyamongJapaneseemployees.IntJBehavMed,2008,15:4453.

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(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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