Theories in Health Education

Bandura’s Self Efficacy TheoryPender’s Health Promotion Theory Health Belief ModelGreen’s Precede-Proceed Model

Bandura's Theory Of Self-Efficacy

Self-efficacy refers to the belief that one can execute given levels of performance (a more specific notion).

Self-efficacy is the extent or strength of one's belief in one's own ability to complete tasks and reach goals.Ps ychologists have studied self-efficacy from several perspectives, noting various paths in the development of self-efficacy; the dynamics of self-efficacy, and lack thereof, in many different settings; interactions between self-efficacy and self-concept; and habits of attribution that contribute to, or detract from, self-efficacy.

Bandura's Theory Of Self-Efficacy

• This can be seen as the ability to persist and a person's ability to succeed with a task. As an example, self-efficacy directly relates to how long someone will stick to a workout regimen or a diet. High and low self-efficacy determine whether or not someone will choose to take on a challenging task or "write it off" as impossible.

• Self-efficacy affects every area of human endeavor. By determining the beliefs a person holds regarding his or her power to affect situations, it strongly influences both the power a person actually has to face challenges competently and the choices a person is most likely to make. These effects are particularly apparent, and compelling, with regard to behaviors affecting health.

• Judge et al. (2002) argued the concepts of locus of control, neuroticism, generalized self-efficacy (which differs from Bandura's theory of self-efficacy) and self-esteem measured the same, single factor and demonstrated them to be related concepts/

Bandura's Theory Of Self-Efficacy

Bandura's Theory Of Self-Efficacy

Vicarious Experience:• Bandura argues that most of our learned

behaviors are modeled. If an individual sees others doing something they may persuade themselves that they can do it to.

• What factors affect modeling and the development of self-efficacy?

• Skill level, similarity, many models, process of overcoming difficulty?

• Imagery is a form of vicarious experience.

Bandura's Theory Of Self-Efficacy

Verbal Persuasion• People can be led into believing that they can

cope successfully with what has overwhelmed them in the past (by others or themselves).

• Weaker than successful performance since individuals do not have an authentic experiential base to believe in their own self-efficacy.

• Here, it is important not only to persuade one of their efficacy, but to provide the conditions which will facilitate effective performance.

• Development of self-talk strategies.

Bandura's Theory Of Self-Efficacy

• Bandura: self-efficacy predicts actual performance provided that necessary skills and appropriate incentives are present.

• Self-efficacy is also believed to be situation and time specific.

• Bandura distinguishes between:– Knowing that a particular response will result

in a particular outcome, and (b) Believing that one has the capability of executing such a response

Bandura's Theory Of Self-Efficacy

Emotional/Physiological Arousal:• Physiological States - we judge our own self-efficacy by how we

perceive our anxiety level in different situations.• Anxiety, arousal, and avoidant behavior are largely coeffects of

perceived coping inefficacy. People avoid potentially threatening situations and activities, not because they experience anxiety arousal or anticipate they will be anxious, but because they believe they will be unable to cope successfully with situations they regard as risky.

• Suggests: need to develop effective coping strategies - stress reduction techniques (cognitive and physical), use of various kinds of imagery, biofeedback, massage) - to develop belief that one has arsenal of coping strategies.

Bandura's Theory Of Self-Efficacy

• Outcomes are independent of perceived self-efficacy when reinforcement is discriminatively awarded

• Perceived self-efficacy influences choice of behavioral settings

• Bandura's Theory Of Self-Efficacy• Goal Setting and Self-efficacy

Nola Pender’s Health Promotion Theory

Nola Pender’s Health Promotion Theory• The health promotion model notes that each person has unique

personal characteristics and experiences that affect subsequent actions. The set of variables for behavioral specific knowledge and affect have important motivational significance.

• These variables can be modified through nursing actions. Health promoting behavior is the desired behavioral outcome and is the end point in the HPM.

• Health promoting behaviors should result in improved health, enhanced functional ability and better quality of life at all stages of development.

• The final behavioral demand is also influenced by the immediate competing demand and preferences, which can derail an intended health promoting actions.

Nola Pender’s Health Promotion Theory

Major Concepts• Health promotion is defined as behavior motivated by the desire to increase well-being and

actualize human health potential. It is an approach to wellness.

On the other hand, health protection or illness prevention is described as behavior motivated desire to actively avoid illness, detect it early, or maintain functioning within the constraints of illness.

Individual characteristics and experiences (prior related behavior and personal factors).

Behavior-specific cognitions and affect (perceived benefits of action, perceived barriers to action, perceived self-efficacy, activity-related affect, interpersonal influences, and situational influences).

Behavioral outcomes (commitment to a plan of action, immediate competing demands and preferences, and health-promoting behavior).

Nola Pender’s Health Promotion Theory

Subconcepts• Personal Factors

Personal factors categorized as biological, psychological and socio-cultural. These factors are predictive of a given behavior and shaped by the nature of the target behavior being considered.a. Personal biological factors Include variable such as age gender body mass index pubertal status, aerobic capacity, strength, agility, or balance.

b. Personal psychological factorsInclude variables such as self esteem self motivation personal competence perceived health status and definition of health.

c. Personal socio-cultural factorsInclude variables such as race ethnicity, acculturation, education and socioeconomic status.

Perceived Benefits of Action Anticipated positive outcomes that will occur from health behavior.

Nola Pender’s Health Promotion TheorySubconcepts• Perceived Self Efficacy

Judgment of personal capability to organize and execute a health-promoting behavior. Perceived self efficacy influences perceived barriers to action so higher efficacy result in lowered perceptions of barriers to the performance of the behavior.

Activity Related AffectSubjective positive or negative feeling that occur before, during and following behavior based on the stimulus properties of the behavior itself. Activity-related affect influences perceived self-efficacy, which means the more positive the subjective feeling, the greater the feeling of efficacy. In turn, increased feelings of efficacy can generate further positive affect.

Interpersonal Influences Cognition concerning behaviors, beliefs, or attitudes of the others. Interpersonal influences include: norms (expectations of significant others), social support (instrumental and emotional encouragement) and modeling (vicarious learning through observing others engaged in a particular behavior). Primary sources of interpersonal influences are families, peers, and healthcare providers.

Nola Pender’s Health Promotion Theory

Subconcepts• Situational Influences

Personal perceptions and cognitions of any given situation or context that can facilitate or impede behavior. Include perceptions of options available, demand characteristics and aesthetic features of the environment in which given health promoting is proposed to take place. Situational influences may have direct or indirect influences on health behavior.

Commitment to Plan Of ActionThe concept of intention and identification of a planned strategy leads to implementation of health behavior

Immediate Competing Demands and Preferences Competing demands are those alternative behaviors over which individuals have low control because there are environmental contingencies such as work or family care responsibilities.

Competing preferences are alternative behaviors over which individuals exert relatively high control, such as choice of ice cream or apple for a snack

Health Belief Model (HBM)

Health Belief Model (HBM)

• The Health Belief Model (HBM) is one of the first theories of health behavior.

• It was developed in the 1950s by a group of U.S. Public Health Service social psychologists who wanted to explain why so few people were participating in programs to prevent and detect disease.

• HBM is a good model for addressing problem behaviors that evoke health concerns (e.g., high-risk sexual behavior and the possibility of contracting HIV) (Croyle RT, 2005)

Health Belief Model (HBM)

• The health belief model proposes that a person's health-related behavior depends on the person's perception of four critical areas: – the severity of a potential illness,– the person's susceptibility to that illness,– the benefits of taking a preventive action, and– the barriers to taking that action.

• HBM is a popular model applied in nursing, especially in issues focusing on patient compliance and preventive health care practices.

Health Belief Model (HBM)

• The model postulates that health-seeking behaviour is influenced by a person’s perception of a threat posed by a health problem and the value associated with actions aimed at reducing the threat.

• HBM addresses the relationship between a person’s beliefs and behaviors. It provides a way to understanding and predicting how clients will behave in relation to their health and how they will comply with health care therapies.

Health Belief Model (HBM)

THE MAJOR CONCEPTS AND DEFINITIONS OF THE HEALTH PROMOTION MODEL

• There are six major concepts in HBM:1. Perceived Susceptibility2. Perceived severity3. Perceived benefits 4. Perceived costs5. Motivation6. Enabling or modifying factors

Health Belief Model (HBM)

• Perceived Susceptibility: refers to a person’s perception that a health problem is personally relevant or that a diagnosis of illness is accurate.

• Perceived severity: even when one recognizes personal susceptibility, action will not occur unless the individual perceives the severity to be high enough to have serious organic or social complications.

• Perceived benefits: refers to the patient’s belief that a given treatment will cure the illness or help to prevent it.

• Perceived Costs: refers to the complexity, duration, and accessibility and accessibility of the treatment.

Health Belief Model (HBM)

• Motivation: includes the desire to comply with a treatment and the belief that people should do what.

• Modifying factors: include personality variables, patient satisfaction, and socio-demographic factors.

Green’s Precede-Proceed Model

Green’s Precede-Proceed Model

• The Precede-Proceed model is a cost-benefit evaluation framework proposed in 1974 by Dr. Lawrence W. Green, that can help health program planners, policy makers, and other evaluators analyze situations and design health programs efficiently.

• It provides a comprehensive structure for assessing health and quality of life needs, and for designing, implementing, and evaluating health promotion and other public health programs to meet those needs.[

Green’s Precede-Proceed Model

• One purpose and guiding principle of the Precede-Proceed model is to direct initial attention to outcomes, rather than inputs. It guides planners through a process that starts with desired outcomes and then works backwards in the causal chain to identify a mix of strategies for achieving those objectives.

• A fundamental assumption of the model is the active participation of its intended audience – that is, that the participants ("consumers") will take an active part in defining their own problems, establishing their goals, and developing their solutions.

Green’s Precede-Proceed Model

• In this framework, health behavior is regarded as being influenced by both individual and environmental factors, and hence has two distinct parts.

• First is an “educational diagnosis” - PRECEDE, an acronym for Predisposing, Reinforcing and Enabling Constructs in Educational Diagnosis and Evaluation. Second is an “ecological diagnosis”

• PROCEED, for Policy, Regulatory, and Organizational Constructs in Educational and Environmental Development.

Green’s Precede-Proceed Model

• The model is multidimensional and is founded in the social/behavioral sciences, epidemiology, administration, and education. The systematic utilization of the framework in a series of clinical and field trials confirmed the utility and predictive validity of the model as a planning tool (e.g. Green, Levine, & Deeds).

Green’s Precede-Proceed Model

• The PRECEDE-PROCEED model is a participatory model for creating successful community health promotion and other public health interventions.

• It is based on the premise that behavior change is by and large voluntary, and that health programs are more likely to be effective if they are planned and evaluated with the active participation of those people who will have to implement them, and those who are affected by them.

• that use the Precede-Proceed model as a guideline.

Green’s Precede-Proceed Model

• Thus health and other issues must be looked at in the context of the community. Interventions designed for behavior change to help prevent injuries and violence, improve heart-healthy behaviuors, and those to improve and increase scholarly productivity among health education faculty[8] are among the more than 1000 published applications that have been developed or evaluated

Next Week Discussion

• 2nd weekB. Perspective on Teaching and Learning1. Overview of Education on Health Care2. Concepts of teaching, learning, education process vis a vis nursing process, historical foundations for the teaching role of the nurse3. Role of the Nurse as a Health Educator4. Hallmarks of Effective Teaching in Nursing5. Principles of Good Teaching Practice in UndergraduateEducation6. Barrier to Education and Obstacles to Learning

ACTIVITY : ROLE PLAY (VIDEO)