Date post: | 29-Sep-2015 |
Category: |
Documents |
Upload: | sahel-uddin |
View: | 214 times |
Download: | 0 times |
(Behavioral) Theories of Health & Physical Activity
KNES 400 Session 5
Instructor: Dr. Shannon Jette
Learning Objectives Discuss the purpose of theoretical frameworks Discuss behavioral theories that provide
insight into the mechanisms underlying the relationship between intra- and inter-personal factors and health-related behaviors Discuss shortcomings of such theories !
Theoretical Frameworks
Help us to interpret or understand a situation or problem; often abstract and applicable to a broad range of situations Help us to answer why? What can be changed?
Socio-ecological model
Dahlgren!&!Whitehead,!1991!
What are factors influencing health? Determinants, correlates Where/how can we intervene?
Socio-Ecological Model Poli4cal/Macro8
economic!!
Environmental!
Organiza4onal!
Interpersonal!
Intrapersonal!
Ecological Framework multiple levels of influence
Concept Deni+on
Intrapersonal!level Individual!characteris4cs!that!inuence!behaviors!such!as!knowledge,!aFtudes,!beliefs!and!personality!traits
Interpersonal!level Interpersonal!processes!and!primary!groups,!including!family,!friends,!and!peers!that!provide!social!iden4ty,!support!and!role!deni4on
Organiza4onal!level
Rules,!regula4ons,!policies,!and!informal!structures!that!may!constrain!or!promote!recommended!behaviors
Environmental!level
Aspects!of!the!social!(networks,!norms),!built!(infrastructure!&!community!design)!and!natural!(weather,!topography)!that!inuence!behaviors
Poli4cal!(policy)!level
Local,!state,!federal!policies!and!laws!that!regulate!or!support!un/healthy!ac4ons
Adapted!from!DHHS,!2005!
Adapted ecological model of correlates of physical activity
Bauman et al., Lancet, 2012, 380: 258-71
But in addition to this broad model
Have theories that help to explain behavior (PA or health-related) at various levels of the socio-ecological model
For many years, theories focused on intra- and inter-personal levels, and aimed to Identify the influential variables that predict PA behavior
(i.e., correlates) Develop strategies to manipulate variables and bring
about changes in PA levels
Dominant theories: Cognitive-Behavioral!
1. Behavior is mediated by cognitions; that is, what people know and think affects how they act
2. Knowledge is necessary for, but not sufficient to produce, most behavior changes
3. Perceptions, motivations, skills (& the social environment) are key influences on behavior
!
Key Cognitive Behavioral Theories
Health Belief Model (HBM) Stages of Change (Transtheoretical) Model Theory of Planned Behavior Precaution Adoption Process Model Social Cognitive Theory (SCT)
Health Belief Model (HBM)
Six main constructs Perceived susceptibility Perceived severity Perceived benefits Perceived barriers Cue to action Self-efficacy (later added) !
Health Motivation is central focus why people take action to prevent, screen for or control illness conditions
Modifying Factors Individual Beliefs Action
Age Gender Personality Socioeconomics Knowledge
*Perceived susceptibility to & severity of disease
Perceived benefits
*Perceived barriers
Perceived self efficacy
Individual behaviors
Cue to action
HBM Components and Linkages
Adapted from Glanz et al., 2008
Perceived threat
Theory of Planned Behavior
Behavioral Intention is viewed as most important determinant
Behavior Behavioral Intention
Attitude toward
behavior
Subjective norm
Perceived behavioral
control
Belief about what
behavior entails
Evaluation of behavior outcome
Normative beliefs
Motivation to comply
Control beliefs
Perceived Power
Adapted from Glanz et al., 2008
Qualitative study of barriers to concussive symptom reporting in high school athletics (Chrisman et al., 2013)
young ppl knew that they should take themselves out the game
didnt want to let down teammatesor seem weak
Interventions premised upon Intrapersonal Cognitive Behavioral Theories
Some level of success but questions about effectiveness Gap between peoples intentions and behaviors; b/n
feelings of self efficacy and behaviors Premised on notion of rational What about AFFECT/EMOTIONS, including pleasure?
Reductionist tend to describe behavior in isolation of social and cultural context
Thurston,!Behavior!Change,!2014!
public health: getting ppl to deny things thatmakes them feel good
dont consider behavior in the wider context: ex: single low income mothers have higher levels of smoking; interviews showthat smoking is a huge stress relief/social norm (other factors)
At interpersonal level
Theories of health behavior assume individuals exist within and are influenced by a social environment Individual has reciprocal effect on social
environment Emphasis on human capacity for learning and
adaptation
Key Concepts in SCT Reciprocal determinism: Personal, behavioral and
environmental factors act as mutual causes of each other
Self-efficacy: situation specific self-confidence (beliefs one can execute behavior, overcome barrier)
Outcome expectances: beliefs that behavior will result in salient outcomes (esp. how person feels about him or herself)
individuals not just impacted by env. but also can shape their environment
Interaction of Self Efficacy with Environment
Responsive Environment
Unresponsive Environment
Low self efficacy
High self efficacy
Putting theory to practice?! Targeted Interventions Many work on improving self efficacy for desired
behavior Mastery experience Social modeling Self monitoring techniques Goal setting and self-reward
Group change (social support in community settings) Policies to change environment to make healthy
choice easier
: someone similar who achieved the task
: write down context as to explain behavior (ex: depressed= smoking)
:change social norms in the group
Cognitive-Behavioral Models - Critiques Constructs based on white, middle class norms Created by and tested upon
Dominant Values: Independence, choice, control in other words AGENCY, but a particular version of
agency
Stephens et al. (2009) Why did they choose to stay?
Study 1: how observers perceived survivors who evacuated (leavers) or stayed (stayers) Leavers described positively (as agentic, independent
and in control) Stayers described negatively (passive and lacking
agency) Observers perceptions reflect disjoint model of agency
prevalent in white, mc contexts = good action are those that emanate from within individual and act upon environment
Stephens et al. (2009) Why did they choose to stay?!
Study 2: interviews with survivors and found that leavers and stayers relied on divergent models of agency Leavers emphasized independence, choice and control
Predominantly white, middle class Stayers emphasized interdependence, strength and
faith Predominantly black, lower income Conjoint model of agency: good actions as those that adjust
to the environment and promote interdependence with others
Cognitive-Behavioral Models - Critiques! Insufficient attention to manner in which social structure
is internalized and normalized in an individuals unconscious? Manner in which unequal distribution of resources leads to
reproduction of unequal life chances and limitations of choice? Varying forms of CAPITAL
(more to come on this ) Might behavior change interventions lead to widening
of health inequalities as those born into privilege experience themselves as agents of their own destiny?
Socio-Ecological Model Poli4cal/Macro8
economic!!
Environmental!
Organiza4onal!
Interpersonal!
Intrapersonal!
Additional theories or frameworks
Critical race theory Structural discrimination Intersectionality Habitus (lifestyle as a reflection of social structure) Political economy Disciplinary power and Biopower